VISTA DEL MAR SENIOR LIVING

Official classification

Type B

Official code

87468.1(2)

Regulation authority

CCR

What the official deficiency says

Personal Rights of Residents in All Facilities (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This requirement is not met as evidenced by: Based on observations and interviews the licensee did not comply with the section cited above by not providing residents with comfortable accommodations by not having rooms free of malodors which included incontinent odors, cigarette smoke odors, etc. which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

Executive Director has agreed to create a plan to ensure that residents are provided with comfortable accommodations by maintaining a facility that is clear of malodors. Plan should include the following: removal of used incontinent supplies from resident rooms, the number of times staff will go into residents rooms to remove items that are/can cause malodorous and smoking prevention inside the facility. The Executive Director will train staff on said plan. Email plan & trainings to Socorro.Leandro@dss.ca.gov

Deadline recorded: Aug 3, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87307(a)(3)(C)(D)

Regulation authority

CCR

What the official deficiency says

Personal Accommodations and Services (a) Living accommodations and grounds shall be related to the facility's function. The facility shall be large enough to provide comfortable living accommodations and privacy for the residents, staff, and others who may reside in the facility. The following provisions shall apply: (3) Equipment and supplies necessary for personal care and maintenance of adequate hygiene practice shall be readily available to each resident. The resident may provide the following items; however, if the resident is unable or chooses not to provide them, the licensee shall assure provision of: (C) Clean linen, including blankets, bedspreads, top bed sheets, bottom bed sheets, pillow cases, mattress pads, bath towels, hand towels and wash cloths. The quantity shall be sufficient to permit changing at least once per week or more often when indicated to ensure that clean linen is in use by residents at all times. The linen shall be in good repair. The use of common wash cloths and towels shall be prohibited. (D) Hygiene items of general use such as soap and toilet paper. This requirement is not met as evidenced by: Based on observations and interviews the licensee did not comply with the section cited above by providing residents with a common hand towel and not ensuring that residents had hand soap and toilet paper are available to them at all times which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

Executive Director has agreed to create a plan to ensure that the use of common (hand) towels are prohibited in the facility. And residents have hand soap, toilet paper, and hand drying material (e.g. paper towels, hand dryer, individual hand towels) available to them at all times. Email plan & trainings to Socorro.Leandro@dss.ca.gov

Deadline recorded: Aug 3, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87208(a)

Regulation authority

CCR

What the official deficiency says

Plan of Operation (a) The licensee shall have and maintain a current, written definitive plan of operation for the facility. The licensee shall operate the facility in accordance with the terms specified in the plan of operation and may be cited for not doing so pursuant to Health and Safety Code section 1569.49. The plan and related materials shall be on file in the facility and shall be submitted to the licensing agency with the license application. Any significant changes in the plan of operation which would affect the services to residents shall be submitted to the licensing agency for approval. The plan and related materials shall contain the following: This requirement is not met as evidenced by: Based on observations, interviews, and record review the licensee did not comply with the section cited above by not following the facility’s Plan of Operation and not providing medication as prescribed which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

Executive Director has agreed to review the facility’s Plan of Operation regarding medication and train MedTechs & LVNs. Confirmation of reviewed Plan of Operation regarding medication and trainings shall be emailed to Socorro.Leandro@dss.ca.gov

Deadline recorded: Aug 3, 2026. 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

87303 Maintenance and Operation 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 deficiency was not met as LPA observed a live cockroach in facility hallway which poses a potential health and safety risk to residents in care.

Official plan of correction

Executive Director to submit plan to LPA by POC due date detailing what the facility is going to do regarding pest control throughout the facility. What measure will be added to cleaning procedures to ensure pests at the facility is under control to ensure residents’ health and safety. Deficiency was cleared on 04/27/26, prior to LPA Villegas superseding report.

Deadline recorded: Apr 9, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87411(a)

Regulation authority

CCR

What the official deficiency says

87411 Personnel Requirements – General (a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. This requirement is not met as evidenced by: Based on interviews, observations, and records review, the licensee failed to ensure sufficient staffing to meet the needs of 35 residents during overnight hours. Records review confirmed that three staff were assigned to provide care during the overnight shift. Incident reports and progress notes document a pattern of residents found with injuries during morning hours, with no documentation identifying when or how the incidents occurred. This posed a potential health and safety risk to persons in care.

Official plan of correction

Licensee agreed to submit a plan of correction to LPA Jose Anguiano at Jose.Anguiano@dss.ca.gov by due date.

Deadline recorded: Mar 26, 2026. 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

87303 Maintenance and Operation (a) 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 deficiency was not not met as as LPA observed a live coackroach in facility hallway which poses a potential health and safety risk to residents in care.

Official plan of correction

Executive Director to submit plan to LPA by POC due date detailing what the facility is going to do regarding pest control throughout the facility. What measure will be added to cleaning precedures to ensure pest at the facility is under control to ensure residents health and safety.

Deadline recorded: Apr 30, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87411(a)

Regulation authority

CCR

What the official deficiency says

87411 Personnel Requirements – General (a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. This requirement is not met as evidenced by: Based on interviews, observations, and records review, the licensee failed to ensure sufficient staffing to meet residents needs during overnight hours, resulting in an unwitnessed fall and a pattern of unwitnessed falls where staff were unaware of when or how incidents occurred, posing an potential health and safety risk to persons in care.

Official plan of correction

Licensee agreed to submit a plan of correction to LPA Jose Anguiano at Jose.Anguiano@dss.ca.gov by due date.

Deadline recorded: Mar 26, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87506(a)

Regulation authority

CCR

What the official deficiency says

87506 Resident Records 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 was not met as evidence by: based observation, records review, and interview LPA observed that MAR for R1 was not properly documented from 12/2025- 02/09/26. Medications were provided but MAR is missing several signatures which poses a potential health and safety risk to residents in care.

Official plan of correction

Licensee/Administrator to train all staff that assist with medication administration by 02/23/26, and provide LPA with a copy of all materials reviewed and the sign in sheet with signatures of all who participated. LPA to obtain copies by POC due date.

Deadline recorded: Feb 23, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87303(a)(f)

Regulation authority

CCR

What the official deficiency says

Maintenance and Operation…facility shall be clean…sanitary…at all times…for the safety…of residents...(f) All waste shall be located…and disposed of in a manner that will not…provide a breeding place or food source for insects or rodents. This requirement was not met as evidence by: Based on observations and record review, the licensee did not maintain a clean and sanitary environment. On 11/05/2025, LPA observed and photographed live and dead cockroaches in one resident room.This poses a potential health and safety risk to residents in care.

Official plan of correction

Administrator and staff will meet to develop a plan to address and eliminate the cockroach infestation. The facility agreed to submit proof of treatment and corrective actions to LPA Jose Anguiano atjose.anguiano@dss.ca.gov by due date.

Deadline recorded: Nov 20, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87355(e)(2)

Regulation authority

CCR

What the official deficiency says

87355 Criminal Record Clearance 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: Obtain a California clearance or a criminal record exemption as required by the Department or Deficient Practice Statement Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above as Staff #7 is not associated with the facility which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/25/2025 Plan of Correction Licensee/Executive Director will ensure that S7 is associated to the facility before being scheduled to work shift. LPA to obtain proof of S7's association to the facility by POC due date.

Official classification

Type A

Official code

87303(e)(2)

Regulation authority

CCR

What the official deficiency says

87303 Maintenance and Operation Water supplies and plumbing fixtures shall be maintained as follows: Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degree C) and not more than 120 degree F (49 degree C). This requirement is not met as evidenced by: Deficient Practice Statement Based on [(observation) (interview) the licensee did not comply with the section cited above as water temperatures in bedrooms 119, 135, 137, 217, and ML22 were observed to not be within range of 105 F -120 F. which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/25/2025 Plan of Correction Licensee/Executive Director to lower the water heater, and continue to check the water temparatures in bedrooms: licensee will self certify water temperatres are within requred range of 105F-120F and submit proof to LPA by POC due date.

Official classification

Type B

Official code

87307(3)(C)

Regulation authority

CCR

What the official deficiency says

Personal Accommodations and Services (3) Equipment and supplies necessary for personal care...the licensee shall assure provision of: (C) Clean linen, including blankets, bedspreads, top bed sheets, bottom bed sheets...The quantity shall be sufficient to permit...prohibited. This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above by R1's bed not having fitted bed sheets which poses a potential health and personal rights risk to persons in care.

Official plan of correction

The licensee has agreed to place fitted sheet R1's bed. The licensee has agreed to create a plan to stay in compliance with CCR 87307(3)(C). The licensee will email proof of correction to Socorro.Leandro@dss.ca.gov.

Deadline recorded: Jul 22, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87465(a)(6)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical...care (a) A plan for incidental medical...care shall be developed by each facility. The plan...provide for assistance in obtaining such care...: (6) When requested by...a record of dosages of medications shall be maintained by the facility. This requirement has not been met as evidenced by: R1's medication admission record (MAR) in disrepair which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

LPA and licensee have agreed that med-tech staff will undergo training to reiterate how important medication (med) management, including focus on med storage, is for residents in care. Licensee has agreed that facility will send inservice conference information, including the time included & sign-in sheet, on or prior to the POC due date 05/23/2025, via email to LPA at mario.leon@dss.ca.gov

Deadline recorded: May 23, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87466

Regulation authority

CCR

What the official deficiency says

87466 Observation of the Resident. The licensee shall ensure that residents are regularly observed for changes in physical, mental, emotional, and social functioning and that appropriate assistance is provided when such observation reveals unmet needs. Based on interview and record reviews, the licensee failed to provide R1 with more assistance and supervision following discharge from the hospital on 04/19/24 due to being a high fall risk. R1 continued to experience multiple falls that resulted in a fracture of C5 and C6 vertebrae on 04/22/24, which poses an immediate health and safety risk to persons in care.

Official plan of correction

The Executive Director will provide a fall risk plan, and the facility will provide in- service training to all staff. The Executive Director will email LPA the POC. POC due date 05/19/25.

Deadline recorded: May 19, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87465(a)(6)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical...care (a) A plan for incidental medical...care shall be developed by each facility. The plan...provide for assistance in obtaining such care...: (6) When requested by...a record of dosages of medications shall be maintained by the facility. This requirement has not been met as evidenced by: R1's medication admission record (MAR) in disrepair which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

LPA and licensee have agreed that med-tech staff will undergo training to reiterate how important medication (med) management, including focus on med storage, is for residents in care. Licensee has agreed that facility will send inservice conference information, including the time included & sign-in sheet, on or prior to the POC due date 05/23/2025, via email to LPA at mario.leon@dss.ca.gov

Deadline recorded: May 23, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.1(a)(2)

Regulation authority

CCR

What the official deficiency says

Personal Rights of Residents in All Facilities Residents in all residential care facilities for the elderly shall have all of the following personal rights: To be accorded safe, healthful and comfortable accommodations... this requirement was not met as R1 who has a dementia diagnosis was able to leave the facility unassisted which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Licensee and Executive Director will submit to the department a plan detailing what measures the facility is taking to ensure this dificiency does not reoccur moving forward. Licensee and Executive Director will ensure all residents are reassessed when a change in condition is observed.

Deadline recorded: Jan 3, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87211(a)(1)(B)

Regulation authority

CCR

What the official deficiency says

Reporting Requirements.Each licensee shall furnish to the licensing agency such reports as the Department may require...a written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events...(B) Any serious injury ... occurring while the resident is under facility supervision. Based on records and interviews, the facility failed to submit a written report to ccld for R1's fall within (7) days. This violation poses a potential health, safety, or personal rights risk to persons in care.

Official plan of correction

Licensee/Administrator shall read Title 22, Section 87211 “Reporting Requirements” and send a written statement to CCLD that they have read and understand this section and will report all resident's incidents in the future. Written statement must be submitted to LPA Villegas by 12/13/24.

Deadline recorded: Dec 13, 2024. 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

87303 Maintenance and Operation (a) The facility shall be...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 has not been met as evidenced by: Based on CCLD's observations, the licensee has failed to ensure the facility has been maintained in good repair which poses a potential risk to residents in care.

Official plan of correction

The licensee and CCLD staff have agreed that the facility will have their maintenance team inspect each room to ensure that resident's emergency pull cord are in working condition. All updates will be forwarded to CCLD staff at Mario.Leon@DSS.CA.GOV

Deadline recorded: Dec 19, 2024. 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

87303 Maintenance and Operation (a) The facility shall be...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 has not been met as evidenced by: Based on CCLD's observations, the licensee has failed to ensure the facility has been maintained in good repair which poses a potential risk to residents in care.

Official plan of correction

The licensee and CCLD staff have agreed that the facility will have their maintenance team inspect each room to ensure that resident's emergency pull cord are in working condition. All updates will be forwarded to CCLD staff at Mario.Leon@DSS.CA.GOV

Deadline recorded: Dec 19, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.1(a)(6)

Regulation authority

CCR

What the official deficiency says

Personal Rights of Residents in All Facilities Residents in all residential care facilities for the elderly shall have all of the following personal rights: (6) To leave or depart the facility at any time and to not be locked into any room, building, or on facility premises by day or night... Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above. The facility staff is following the instructions of a POA over healthcare regarding R1 right to leave the facility with visitors on outings. This poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Administrator will submit a plan on how the facility will ensure R1 Personal Rights are not violated. Facility will reach out to the ombudsman and or law enforcement if and elder abuse is suspected.

Deadline recorded: Sep 20, 2024. 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)(1)Persons who require health services for or have a health condition including, but not limited to...Stage 3 and 4 pressure injuries.This requirement is not met as evidenced by: Based on records review and interviews conducted the facility retained resident 1 despite being informed by the home health agency that the resident had pressure injury. This poses a health & Safety risk to residents in care.

Official plan of correction

Licensee/Administrator will ensure to comply and review Title 22 Regulations, Section 87615 (a)(1) Prohibited Health Condition and create a plan of correction (POC) to ensure to stay in constant communication with medical professionals and if the resident’s medical condition elevates, meaning they require a higher level of care, Licensee/Administrator will ensure the resident is relocated to a skilled- nursing facility(SNF) or hospital and the relocation will take place immediately. Licensee/Administrator agreed to submit a verification of completion to CCLD/ El Segundo ASC office no later than 5/23/24.

Deadline recorded: May 23, 2024. 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

Prohibited Health Conditions (a) Persons who require health services 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 sores (dermal ulcers). This requirement is not met as evidenced by: Facility retained Resident #1 with a Stage IV pressure injury on its coccyx (a prohibited health condition) until the resident passed away on 09/03/21. This requirement was not met as evidenced by Based on records reviewed and interviews conducted the licensee failed to care for resident with stage 3 and 4 pressure sores. This poses a Safety risk to residents in care.

Official plan of correction

Licensee/Administrator agreed to comply and review Title 22 Regulation, Section 87466 ‘Prohibited Health Condition’ and create a plan of correction (POC) to ensure to stay in constant communication with the medical professional; and, if the resident's medical condition elevates - meaning they require a higher level of /21care, Licensee/Administrator will ensure the resident is relocated to a skilled-nursing facility (SNF) or hospital; and, the relocation will take place immeLicensee/Administrator agreed to comply and review Title 22 Regulation, Section 87466 ‘Prohibited Health Condition’ and create a plan of correction (POC) to ensure to stay in constant communication with the medical professional; and, if the resident's medical condition elevates - meaning they require a higher level of /21care, Licensee/Administrator will ensure the resident is relocated to a skilled-nursing facility (SNF) or hospital; and, the relocation will take place immediately. Licensee/Administrator agreed to submit a verification of completion to CCLD/El Segundo ASC Office no later than 03/22/2024.

Deadline recorded: Mar 22, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

Not listed

Regulation authority

CCR

What the official deficiency says

Deficiency narrative not available.

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

87303(a) Maintenance and Operation(a) The facility shall be clean, safe, sanitary and in good repair always… Based on records reviewed and interviews conducted, the licensee failed to control roaches inside the facility for residents in care. This poses a Safety risk to residents in care.

Official plan of correction

The administrator will provide pest control reports for a 3-month period and log pest control reports to LPA Calderon by the due date of 03/29/2024.

Deadline recorded: Mar 29, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87612(a)(7)

Regulation authority

CCR

What the official deficiency says

87612(a)(7) Restricted Health Conditions (a) The licensee may provide care for residents who have any of the following restricted health conditions, or who require any of the following health services: (7) Incontinence of bowel and/or bladder as specified in Section 87625. This requirement was not met as evidenced by Based on records reviewed and interviews conducted the licensee failed to provide an incontinence care log to support dates and times incontinent care has been provided to R1. LPA found R1 was diagnosed with a stage 3 pressure ulcer on the coccyx on 8/23/21. This poses a Safety risk to residents in care.

Official plan of correction

The administrator will provide training to staff on how to document the incontinence log notes for residents in care by the due date of 03/29/2024.

Deadline recorded: Mar 29, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87211(a)(1)

Regulation authority

CCR

What the official deficiency says

87211 Reporting requirement Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below. This report shall include the resident's name, age, sex and date of admission; date and nature of event; attending physician's name, findings, and treatment, if any, and....

Official plan of correction

Director to submit a plan to ensure Vista Del Mar Senior Living is in compliance with 87211 (a)(1) and submit plan outlining the steps that will be taken to ensure compliance of section cited. Director will also submit incident report for scabies cases by POC due date.

Deadline recorded: Nov 24, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87465(a)(6)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care 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 and record review, the licensee did not comply with the section cited above as evening medication was not checked off on MAR and there was no documentation detailing if resident took or refused the prescribed medication which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/27/2023 Plan of Correction Licensee will conduct in-service on the importance of medication documentation and will send LPA a copy of in-service signed and dated by staff in attendance by POC due date.

Official classification

Type A

Official code

87468

Regulation authority

CCR

What the official deficiency says

87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights:(2)( To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This requirement was not met as evidence by: LPA reviewed R1 medication Mars and on 6/24/2020 and 6/25/2020 Medication Mars Quetiapine was on hold This posses an immediate health and safety issue.

Official plan of correction

Administrator with review regulation and retrain staff on medication by POC due date 5/2/23.

Deadline recorded: May 2, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

85072(b)(6)

Regulation authority

CCR

What the official deficiency says

85072 Personal Rights (b) The licensee shall insure that each client is accorded the following personal rights.(6) To possess and use his/her own personal items, including his/her own toilet articles. This requirement was not met as evidenced by Based on records reviewed and interviews conducted the licensee failed to ensure the safeguard of residents personal belongings. This poses a Safety risk to residents in care.

Official plan of correction

Administrator will provide training from front desk clerks on how to sign for and secure residents packages by the due date of 04/21/2023

Deadline recorded: Apr 21, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87468.1(a)(3)

Regulation authority

CCR

What the official deficiency says

87468.1 (a)(3) To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature, such as withholding residents’ money or interfering with daily living functions such as eating, sleeping, or elimination. This was not met as evidenced by Based on observations and interviews Staff dropping R1 and fracturing his shoulder. Which poses a potential health and safety risk to persons in care.

Official plan of correction

Executive Director implement a plan of training for all staff. What types of training will be taught, when, and who will perform the trainings? Send to LPA on or before POC due date

Deadline recorded: Apr 22, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(g)

Regulation authority

CCR

What the official deficiency says

87465(g) -The licensee shall immediately telephone 9-1-1 if an injury or other circumstance has resulted in an imminent threat to a resident’s health including, but not limited to, an apparent life-threatening medical crisis except as specified in Sections 87469(c)(2), (c)(3), or (c)(4).this was not met as evdenced by: Based on observations and interviews staff did not call or take R1 to the ER in a timely manner. Which poses a potential health and safety risk for persons in care

Official plan of correction

Executive Director implement a plan of training for all staff. What types of training will be taught, when, and who will perform the trainings? Send to LPA on or before POC due date

Deadline recorded: Apr 22, 2022. 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

87303(a) 873039a) 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 was not met as evidence by: Based on observations and interviews Facility had roaches, which poses a potential health and safety risk for the persons in care.

Official plan of correction

Executive Director will implement a plan on best practices to ensure the facility will not have a pest problem in the future. Send to LPA on or before POC due date.

Deadline recorded: Apr 22, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87405(h)(5)

Regulation authority

CCR

What the official deficiency says

87405(h)(5) Provide or ensure the provision of services to the residents with appropriate regard for the residents' physical and mental well-being and needs, including those services identified in the residents' Pre-Admission Appraisals, specified in Section 87457, Pre-admission Appraisal, and Reappraisal, as specified in Section 87463. This was not met as evidence by: Based on observations and interviews Administrator failed to get immediate help for R#1. Which poses a potential health and safety risk for persons in care.

Official plan of correction

Administrator will create a plan and how to report and seek immediate help for residents by POC due date.

Deadline recorded: Apr 22, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87631(3)(A)

Regulation authority

CCR

What the official deficiency says

87631 Healing Wounds (3) Residents with a stage one or two pressure injury must have the condition diagnosed by a physician or an appropriately skilled professional. (A) The resident shall receive care for the pressure injury from a physician or an appropriately skilled professional. This requirement was not met as evidenced by: Based on LPA observations, interviews conducted and record reviews, the Licensee failed to ensure to address R1's diagnosed by skilled professional for the Stage 1 & 2 wounds. No wound care plan in place. This violation poses an immediate health and safety risk to residents in care.

Official plan of correction

Licensee agrees that a Plan of Correction in place by 12/15/21. The licensee will adhere to Title 22 Section 87631 and develop a written plan. POC must be sent to licensing office by POC date 12/15/21.

Deadline recorded: Dec 15, 2021. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87466

Regulation authority

CCR

What the official deficiency says

87466 Observation of the Resident State regulations require the licensee to ensure that residents are regularly observed for changes in physical, mental, emotional and social functioning and that appropriate assistance is provided when such observation reveals unmet needs. This requirement was not met as evidenced by: Based on LPA observations, interviews conducted, and record reviews, the Licensee was aware of R1's wounds condition and incorrectly diagnosed the wound condition. This violation poses a potential health and safety risk to residents in care.

Official plan of correction

Licensee shall have a written plan to ensure that in addition to the resident's needs and services plan a specific plan is drafted for each resident's change in physical, mental, emotional, and social functioning and that appropriate assistance is provided when such observation reveals unmet needs. The plan must be submitted by POC date 12/15/21 to the licensing office.

Deadline recorded: Dec 15, 2021. 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

87303 Maintenance and Operation (a) 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 was not met as evidenced by Based on records reviewed and interviews conducted the licensee failed to ensure Residents #1 was afforded a safe and comfortable accommodations. R1 was infected with bed bugs while in placement at facility. This poses a health & Safety risk to residents in care.

Official plan of correction

Administrator will follow protocols of Department of Public Health. Administrator will provide copy of actions taken by' facility based on Department of Public Health's instructions. Due date 10/01/2021.

Deadline recorded: Oct 1, 2021. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87211(A)(2)

Regulation authority

CCR

What the official deficiency says

87211 Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports...(2) Occurrences, such as epidemic outbreaks... This requirement was not met as evidenced by: Based on records reviewed and interviews conducted the licensee failed to report the bed bug outbreak to VA social services or Department of Social Services. This poses a health & Safety risk to residents in care.

Official plan of correction

Administrator will ensure additional training regarding proper reporting from staff to upper management to reporting parties. Administrator shall submit to LPA by POC

Deadline recorded: Oct 1, 2021. A deadline is not proof that correction was completed.