PINNACLES AT BURTON, THE

Official classification

Type B

Official code

87469(c)(1)

Regulation authority

CCR

What the official deficiency says

87469 Advanced Directives and Requests Regarding Resuscitative Measures (c) If a resident who has an advance directive and/or request regarding resuscitative measures form on file experiences a medical emergency, facility staff shall do one of the following: (1) Immediately telephone 9-1-1, present the advance directive and/or request regarding resuscitative measures form to the responding emergency medical personnel and identify the resident as the person to whom the order refers. This requirement is not met as evidenced by: Based on interviews and record reviews, the licensee failed to provide (R1's) Advanced Directives/POLST to EMT on 10/06/25 which lead to hospitalization. This violation poses a potential health, safety, or personal rights risk to residents in care.

Official plan of correction

Licensee will ensure to review Title 22 Reg 87469 and submit in writing that it's been review and will comply. Licensee will conduct hospice staff training and submit completed sign in sheet of attendees by POC 11/30/25 to ernand.dabuet@dss.ca.gov

Deadline recorded: Nov 30, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87633(d)

Regulation authority

CCR

What the official deficiency says

87633 Hospice Care of Terminally Ill Residents (d) The licensee shall ensure that the hospice care plan is current, accurately matches the services actually being provided, and that the client’s care needs are being met at all times. This requirement is not met as evidenced by: Based on interviews and record reviews, the licensee failed to follow the hospice care plan, as required, by not contacting hospce first during an emergency on 10/06/25 and instead calling 9-1-1, resulting in R1's hospitalization. This violation poses a potential health, safety, or personal rights risk to residents in care.

Official plan of correction

Licensee will ensure to review Title 22 Reg 87633 and submit in writing that it's been review and will comply. Licensee will conduct hospice staff training and submit completed sign in sheet of attendees by POC 11/30/25 to ernand.dabuet@dss.ca.gov

Deadline recorded: Nov 30, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87465(g)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care (g) The licensee shall immediately telephone 9-1-1 if an injury or other circumstance has resulted in an imminent threat... an apparent life-threatening medical crisis... This requirement was not met as evidence by: Based on observation, interviews, and record reviews (R1) suffered head impact due to a fall and no medical attention was provided with a 911. This violaiton poses a potential health and safety risk to residents in care.

Official plan of correction

Licensee shall provide staff with training on imminent threat health conditions. Licensee will provide copies of training materials and sign in sheet to CCL by POC 03/28/25 date to ernand.dabuet@dss.ca.gov * Corrected during the visit with training conducted on 02/20/25.

Deadline recorded: Mar 28, 2025. 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 The licensee shall ensure that residents are regularly observed for changes in physical, mental..., that appropriate assistance is provided when such observation reveals unmet needs... This requirement was not met as evidence by: Based on observation, interviews, and record reviews (R1) suffered head impact and a change of conditon was not observed for decline in health condition. This violaiton poses a potential health and safety risk to residents in care.

Official plan of correction

Licensee shall provide staff with training on observation of the residents. Licensee will provide copies of training materials and sign in sheet to CCL by POC 03/28/25 date to ernand.dabuet@dss.ca.gov * Corrected during the visit with training conducted on 02/20/25.

Deadline recorded: Mar 28, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87506(c)(1)

Regulation authority

CCR

What the official deficiency says

87506 Resident Records (c) All information and records obtained from or regarding residents shall be confidential.(1) The licensee shall be responsible for storing active and inactive records and for safeguarding the confidentiality of their contents. The licensee and all employees shall reveal or make available confidential information only upon the resident's written consent or that of his designated representative. This requirement was not met as evidence by: Based on a review of records and interviews, the facility staff failed to ensure (R#1)'s designated representative did not get their records upon request. This poses a potential health and safety risk to all residents in care.

Official plan of correction

Licensee will ensure to follow Tittle 22 Regualtions at all times. As plan of correction, facility will send (R#1)'s requested records to (W#1). Proof of correction will be confirmed with (W#1) before poc due date.

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

Official classification

Type B

Official code

87555(b)(27)

Regulation authority

CCR

What the official deficiency says

(b) The following food service requirements shall apply: (27) All kitchen areas shall be kept clean and free of litter, rodents, vermin and insects. This requirement is not met as evidenced by: Based on observation and record review, the licensee did not comply with the section cited above in having evidence of vermin in the kitchen area, which poses a potential health risk to persons in care.

Official plan of correction

The Administrator has agreed to complete the recommendations provided by their pest control company. The Administrator will email Facility Pest Control Plan and Steps they have taken to minimize vermin in facility to Socorro.Leandro@dss.ca.gov.

Deadline recorded: Mar 4, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87405(D)(1)(1)

Regulation authority

CCR

What the official deficiency says

Knowledge of the requirements for providing care and supervision appropriate to the residents. This was not met as evidence by: Facility sent R#1 to hospital 2 weeks after initial fall. Which poses a potential health and safety risk for persons in care.

Official plan of correction

Administrator to write a plan as how to ensure residents get timely medical help. Send plan to LPA on or before POC due date,

Deadline recorded: Aug 1, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87466

Regulation authority

CCR

What the official deficiency says

The licensee shall ensure that residents are regularly observed for changes in physical,...This was not met as evident by:Facility sent R#1 to hospital 2 weeks after initial fall. Which poses a potential health and safety risk for persons in care.

Official plan of correction

Administrator to write a plan as how to ensure resdients more often when fall incident occur. Send plan to LPA on or before POC due date,

Deadline recorded: Aug 1, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87307(d)(4)

Regulation authority

CCR

What the official deficiency says

(4) Stairways, inclines, ramps and open porches and areas of potential hazard to residents with poor balance or eyesight shall be made inaccessible to residents unless equipped with sturdy hand railings and unless well-lighted. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and interview, the licensee did not comply with the section cited above.Licensing Program Analyst (LPA) David España and Administrator, Bernice Pulanco observed room 316/317 resident porch with uneven porch floor. Additionally, LPA and Administrator observed both outdoor patios (total of two) with wasps and wasps/hornet nest accessible to residents in care (i.e., exterminator may be required), which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/05/2023 Plan of Correction The administrator/licensee agreed to have all fix uneven porch and wasps/hornet nest clearned for residents ensuring resident safety. The licensee shall submit plan of correction to ensure cited deficiency do no reoccur at the facility. The administrator of records shall update the resident's/staff's needs and services plans within 30 days of today's date.

Official classification

Type B

Official code

87468(c)(2)(A)

Regulation authority

CCR

What the official deficiency says

(c) Licensees shall prominently post personal rights, nondiscrimination notice, and complaint information in areas accessible to residents, representatives, and the public. (2) Information on the appropriate reporting agency in case of a complaint or emergency, including procedures for filing confidential complaints, shall be posted as follows: (A) Licensees may use the Residential Care Facility for the Elderly (RCFE) Complaint Poster (PUB 475) or may develop their own poster as provided in this section. A poster developed by the licensee shall contain the same content as the PUB 475. The poster that is posted shall be 20” x 26” in size and be posted in the main entryway of the facility. PUB 475 may be accessed, downloaded, and printed from the www.ccld.ca.gov website. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and interview, the licensee did not comply with the section cited above.Licensing Program Analyst (LPA) David España and Administrator, Bernice Pulanco observed front entryway of the facility to not have a PUB 475 poster meeting size requirements 20”X26,” which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/05/2023 Plan of Correction The administrator/licensee agreed to have PUB 475 for residents ensuring resident safety. The licensee shall submit plan of correction to ensure cited deficiency do no reoccur at the facility. The administrator of records shall update the resident's/staff's needs and services plans within 30 days of today's date.

Official classification

Type B

Official code

1569.695(a)(1)

Regulation authority

HSC

What the official deficiency says

(a) In addition to any other requirement of this chapter, a residential care facility for the elderly shall have an emergency and disaster plan that shall include, but not be limited to, all of the following: (1) Evacuation procedures, including identification of an assembly point or points that shall be included in the facility sketch. 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. Licensing Program Analyst (LPA) David España and Administrator, Bernice Pulanco observed outdated Emergency Disaster Plan for Residential Care (LIC 610E), which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/05/2023 Plan of Correction The administrator/licensee agreed to have current Emergency Disaster Plan for Residential Care (LIC 610E) for residents ensuring resident safety. The licensee shall submit plan of correction to ensure cited deficiency do no reoccur at the facility. The administrator of records shall update the resident's/staff's needs and services plans within 30 days of today's date.