ANNIKA GRACE CARE HOME

Official classification

Type A

Official code

87465(d)(1-3)

Regulation authority

CCR

What the official deficiency says

(d) If the resident is unable to determine his/her own need for a prescription or nonprescription PRN medication, and is unable to communicate his/her symptoms clearly, facility staff designated by the licensee, shall be permitted to assist the resident with self-administration, provided all of the following requirements are met... This requirement is not met as evidenced by: Deficient Practice Statement Based on interview and record review, the licensee did not comply with the section cited above in three (3) out of three (3) residents who are unable to determine their own need for a prescription or nonprescription PRN medication, and are unable to communicate their symptoms clearly did not have documented records of the medication provided to them which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/24/2024 Plan of Correction The licensee shall review regulation 87465(d)(1-3) and submit a written memo of understanding to CCL by POC due date 9/24/24.

Official classification

Type B

Official code

87465(c)(3)

Regulation authority

CCR

What the official deficiency says

(c) If the resident's physician has stated in writing that the resident is unable to determine his/her own need for nonprescription PRN medication, but can communicate his/her symptoms clearly, facility staff designated by the licensee shall be permitted to assist the resident with self-administration, provided all of the following requirements are met: (3) A record of each dose is maintained in the resident's record. The record shall include the date and time the PRN medication was taken, the dosage taken, and the resident's response. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview and record review, the licensee did not comply with the section cited above in two (2) out of two (2) residents, Centrally Stored Medication Destruction Records had inaccurate dosage and missing Destruction log which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/13/2023 Plan of Correction Licensee will complete Centrally Stored Medication Destruction Record (CSMDR) for all residents to accurately match the dosage on medication bottle. Licensee will send a copy of accurate CSMDR to LPA by POC due date.

Official classification

Type B

Official code

87506(a)

Regulation authority

CCR

What the official deficiency says

87506(a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff. This requirement is not met as evidenced by: Based on interviews and record review, the licensee failed to ensure complete and required records were created and kept for two(2) out of two (2) residents in care which poses a possible health and safety risk to residents in care.

Official plan of correction

Licensee will document ID/Emergency Information, Functional Capabilities, Reappraisals, and Incident Reports for R1 and R2. Submit copies to LPA by POC due date. If R1 is transfered out of the facility the Licensee will notify LPA of such by POC due date.

Deadline recorded: Jul 7, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87615(a)(1)

Regulation authority

CCR

What the official deficiency says

87615(a) Persons who require health services for or have a health condition including, but not limited to, those specified below shall not be admitted or retained in a residential care facility for the elderly: (1) Stage 3 and 4 pressure injuries. This requirement is not met as evidenced by: Based on interviews and record review, the licensee failed to ensure above regulation by retaining R1 with a stage 3 pressure injury, which poses an immediate health and safety risk to residents in care.

Official plan of correction

Licensee will abide by state licensing regulations, and will not retain any resident with a prohibited health condition. Licensee will communicate with Home Health and R1's family about regulation cited and will certify the regulation has been understood and complied with. Licensee will submit to LPA arrangements made for R1 so that facility may be in compliance with regulation by the POC due date.

Deadline recorded: Jun 29, 2023. A deadline is not proof that correction was completed.