MONTOAK SENIOR LIVING INC.

Official classification

Type A

Official code

87465(a)(4)

Regulation authority

CCR

What the official deficiency says

A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following: When requested by the prescribing physician or the Department, a record of dosages of medications which are centrally stored shall be maintained by the facility. 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 as during medication reviews, LPA observed documentation on the MAR residents missed taking medication for days and or medication was not listed on the MAR which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/26/2024 Plan of Correction The administrator will ensure a in-service training for all staff regard medication documentation is completed by POC due date and provide proof of in-service training for all staff via email at zina.brown@dss.ca.gov

Official classification

Type B

Official code

87457(c)(1)

Regulation authority

CCR

What the official deficiency says

(1) The appraisal shall include, at a minimum, an evaluation of the prospective resident's functional capabilities, mental condition and an evaluation of social factors as specified in Sections 87459, Functional Capabilities and 87462 Social Factors. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview, and record review, the facility did not comply with the section cited above for 6 out of 12 clients which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/26/2024 Plan of Correction The facility will submit proof of needs and appraisal plan for resident #2, resident #3, resident #7, resident #8, resident# 9, and Resident #11 via email zina.brown@dss.ca.gov by POC due date.

Official classification

Type B

Official code

87705(I)(1)

Regulation authority

CCR

What the official deficiency says

(l) The following initial and continuing requirements shall be met for the licensee to lock exterior doors or perimeter fence gates: (1) Licensees shall notify the licensing agency of their intention to lock exterior doors and/or perimeter fence gates. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation the licensee did not comply with the section cited above. LPAs observed an exterior front gates had padlock in which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/06/2024 Plan of Correction The administrator will adhere to Title 22 Regulation 87705(l)(1) and remove padlocks from front gate exterior or notify licensing agency for an exemption to maintain gate locks. Proof of correction must be sent to zina.brown@dss.ca.gov within 24 hours of POC due date.

Official classification

Type A

Official code

87355(e)(1)

Regulation authority

CCR

What the official deficiency says

(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department

Official plan of correction

LPA and Administrator Najma Shaheen have agreed that S6 will obtain fingerprint clearance prior to returning to work at the above mentioned facility.

Deadline recorded: Jun 26, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by: Deficient Practice Statement Based on [(observation), the licensee did not comply with the section cited above. LPA identified missing handle for kitchen cabinet andd ceiling plaster peeling in room #6. This violation which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/28/2023 Plan of Correction Licensee will ensure is to repair the ceiling in room #6 and replace a missing cabinet kitchen handle. Proof of correction sent by fax 323-981.1781 to El Segundo Regional office by 02/28/23.

Official classification

Type B

Official code

87412(a)(11)

Regulation authority

CCR

What the official deficiency says

(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: (11) A health screening as specified in Section 87411, Personnel Requirements - General. This requirement is not met as evidenced by: Deficient Practice Statement Based on (observation and record review), the licensee did not comply with the section cited above. LPA identify staff #3 did not have health screenign for (TB). This violaiton which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/11/2023 Plan of Correction Licensee will ensure to adhere to Title 22 87412 and obtain Health Screeng and TB for staff #3. Proof of correction sent by fax 323-981.1781 to El Segundo Regional office by 02/11/23.

Official classification

Type B

Official code

87411(c)

Regulation authority

CCR

What the official deficiency says

87411 Personnel Requirements - General (c) All RCFE staff who assist residents with personal activities of daily living shall receive initial and annual training as specified in Health and Safety Code sections 1569.625 and 1569.69 (1) Staff providing care shall receive appropriate training in first aid from persons qualified by such agencies as the American Red Cross. This requirement is not met as evidenced by: Deficient Practice Statement Based on (observation) (record review), the licensee did not comply with the section cited. LPA identified staff #2,#3,#4, #5 and staff #7 did not have current CPR First Aid. This violation poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/11/2023 Plan of Correction Licensee will ensure to adhere to Title 22 87411 and obtain CPR/First Aid for all staff including the staff #2-#5 and #7. Proof of correction sent by fax 323-981.1781 to El Segundo Regional office by 02/11/23