BAY TOWERS AT BIXBY KNOLLS

Official classification

Type B

Official code

87211(a)(1)(D)

Regulation authority

CCR

What the official deficiency says

Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: (1) 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 disposition of the case. (D) Any incident which threatens the welfare, safety or health of any resident, such as psychological abuse of a resident by staff or other residents, or unexplained absence of any resident. This requirement was not met as evidence by: Based on observations, interviews, and records reviewed the licensee did not comply with the section cited above by not reporting water leaks in the facility, HVAC and pumps in disrepair which poses/posed an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

The Executive Director has agreed to train staff in reporting requirements. Email trainings to Socorro.Leandro@dss.ca.gov

Deadline recorded: Sep 1, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87411(f)

Regulation authority

CCR

What the official deficiency says

(f) All personnel, including the licensee and administrator, shall be in good health, and physically and mentally capable of performing assigned tasks. Good physical health shall be verified by a health screening, including a chest x-ray or an intradermal test, performed by a physician not more than six (6) months prior to or seven (7) days after employment or licensure. A report shall be made of each screening, signed by the examining physician. The report shall indicate whether the person is physically qualified to perform the duties to be assigned, and whether he/she has any health condition that would create a hazard to him/herself, other staff members or residents. A signed statement shall be obtained from each volunteer affirming that he/she is in good health.Personnel with evidence of physical illness or emotional instability that poses a significant threat to the well-being of residents shall be relieved of their duties. This requirement is not met as evidenced by: Deficient Practice Statement Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in not having Health Screening and TB test for (3) facility staff on file during annual evaluation which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/13/2025 Plan of Correction Licensee will adhere to Title 22 at all times. As Plan of Correction-POC, proof of Health Screenings and TB Tests will be sent to LPA Iniguez via email for the (3) facility employees before POC due date.

Official classification

Type B

Official code

87303(e)(2)

Regulation authority

CCR

What the official deficiency says

(e) Water supplies and plumbing fixtures shall be maintained as follows: (2) 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 degrees C) and not more than 120 degree F (49 degrees C). This requirement is not met as evidenced by: Deficient Practice Statement Based on [(observation), the licensee did not comply with the section cited above in having water temperature measured below 105F during annual survey on residents’ rooms:613,602,503,404,417 and 420. which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/13/2025 Plan of Correction Licensee will adhere to Title 22 at all times. As Plan of Correction-POC administartor stated that the order some parts of the water heater. Administrator stated that he will instructed the maintenace to bleed the water lines so the hot water. As part of POC administrator will sent LPA Iniguez an email stating the water heaters are working properly.

Official classification

Type B

Official code

87411(c)(1)

Regulation authority

CCR

What the official deficiency says

(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) (interview) (record review)], the licensee did not comply with the section cited above in not having a copy of the first aid card for Activities Director which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/13/2025 Plan of Correction Licensee will adhere to Title 22 at all times. As part of the Plan of Corrections-POC, a copy of the first aid card from the Activities Director will be sent to LPA Iniguez via emai before POC due date.

Official classification

Type B

Official code

87506(b)(15)

Regulation authority

CCR

What the official deficiency says

(b) Each resident's record shall contain at least the following information: (15) The admission agreement and pre-admission appraisal, specified in Sections 87507, Admission Agreements and 87457, Pre-admission Appraisal. This requirement is not met as evidenced by: Deficient Practice Statement Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in not having copies of Admission Agreements for (3) residents during annnual inspection which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/13/2025 Plan of Correction Licensee will adhere to Title 22 at all times. As part of Plan of Correction-POC, copies of the Admission Agreements missing from residents files, will be sent to LPA Iniguez vial email before POC due date.

Official classification

Type B

Official code

87506(b)(16)

Regulation authority

CCR

What the official deficiency says

(b) Each resident's record shall contain at least the following information: (16) Records of resident's cash resources as specified in Section 87217, Safeguards for Resident Cash, Personal Property, and Valuables. This requirement is not met as evidenced by: Deficient Practice Statement Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in not having copies of the Inventory List for (3) residents during annual evaluation which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/13/2025 Plan of Correction Licensee will adhere to Title 22 at all times. As part of Plan of Correction-POC, copies of the Invetory List missing from residents files, will be sent to LPA Iniguez vial email before POC due date.

Official classification

Type B

Official code

87507(l)

Regulation authority

CCR

What the official deficiency says

(l) The licensee shall attach a copy of applicable resident's rights specified by law or regulation to all admission agreements, and shall include information on the reporting of suspected or known elder and dependent abuse, as set forth in Health and Safety Code Section 1569.889. This requirement is not met as evidenced by: Deficient Practice Statement Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in not having copies of Personal Rights in (2) residents files during annual inspection which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/13/2025 Plan of Correction Licensee will adhere to Title 22 at all times. As part of Plan of Correction-POC, copies of the Personal Rights missing from residents files, will be sent to LPA Iniguez vial email before POC due date.

Official classification

Type B

Official code

87211(a)(1)(D)

Regulation authority

CCR

What the official deficiency says

87211 Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: (1) 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 disposition of the case. (D) Any incident which threatens the welfare, safety or health of any resident, such as psychological abuse of a resident by staff or other residents, or unexplained absence of any resident. This requirement was not met as evidence by: Based on interviews, the facility failed to report to the department one of two water heaters was in disrepair. This poses a potential health and safety risk to all residents in care.

Official plan of correction

Licensee will adhere to Title 22 at all times. As plan of correction. Executive Director stated that he will get together with his team and they will ensure that any incident that happens will be reported to the department on a timely manner. Proof of correction will be email to LPA Iniguez via email.

Deadline recorded: Jun 24, 2025. A deadline is not proof that correction was completed.