A-1 BOARDING CARE

Official classification

Type B

Official code

87303(e)(5)

Regulation authority

CCR

What the official deficiency says

(e) Water supplies and plumbing fixtures shall be maintained as follows: (5) Slip-resistant mats, strips, or flooring shall be used in all bathtub and shower floors. 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 3 out of 3 bathrooms inspected, there were no slip resistant mats in the 2 private bathrooms or in the common bathrooms ons)] [identifiers] which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/27/2025 Plan of Correction The Licensee will provide or purchase a slip resistant mat for each of the bathrooms and provide evidence by 11/27/25 that the deficiency has been corrected.

Official classification

Type B

Official code

87307(a)(3)(E)

Regulation authority

CCR

What the official deficiency says

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 E) Portable or permanent closets and drawer space in the bedrooms for clothing and personal belongings. A minimum of eight (8) cubic feet (.743 cubic meters) of drawer space per resident shall be provided. This requirement is not met as evidenced by: Residents in bedroom #1 and bedroom #2 are not provided with a dresser. Built in shelves in the closet are used in lieu of dressers. Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above in 2 out of 3 rooms toured, reveal that the 2 residents in bedroom #1 and bedroom #2 are not provided with a dresser that meets Title 22 requirements for their use which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/27/2025 Plan of Correction The Licensee will provide the required dressers that meets Title 22 requiremets for residents' use in bedroom #1 and bedroom #2 snd provide evidence that the deficiency has been corrected by 11/27/25

Official classification

Type B

Official code

87465(a)(8)(A)

Regulation authority

CCR

What the official deficiency says

(a) 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: (8) If a facility has no medical unit on the grounds, a complete first aid kit shall be maintained and be readily available in a specific location in the facility. The kit shall be a general type approved by the American Red Cross, or shall contain at least the following: (A) A current edition of a first aid manual approved by the American Red Cross, the American Medical Association or a state or federal health agency. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above as no first aid manual was observed on todya's viisit, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/27/2025 Plan of Correction The Licensee will purchase a fiirst aid manual approved by the American Red Cross, the American Medical Association or a state or federal health agency and maintain at the facility. Evidence that the deficiency has been corrected will be provided to the Department by 11/27/25.

Official classification

Type B

Official code

87608(a)(3)

Regulation authority

CCR

What the official deficiency says

Postural Support - (a) Based on the individual's preadmission appraisal, and subsequent changes to that appraisal, the facility shall provide assistance and care for the resident in those activities of daily living which the resident is unable to do for himself/herself. Postural supports may be used under the following conditions. 3) A written order from a physician indicating the need for the postural support shall be maintained in the resident’s record. The licensing agency shall be authorized to require other additional documentation if needed to verify the order. 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 2 out 6 beds observed, the right bed in bedroom #2 and the right bed in bedroom #3 were observed equipped with half bedrails and there are no written orders in the residents' file from a physician to indicate the need for the postural support which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/27/2025 Plan of Correction The Licensee will remove the half bed rails observed on the beds noted above or obtain a written physician order to support the residents' need for the use of half bed rails. The written order must be maintained in the residents' file. Evidence that the bed rails were removed or a written physician's order was obtained for the need for the use of the bed rails will be provided to the Department by 11/27/25.

Official classification

Type B

Official code

87608(a)(5)(B)

Regulation authority

CCR

What the official deficiency says

Postural Supports (a) Based on the individual's preadmission appraisal, and subsequent changes to that appraisal, the facility shall provide assistance and care for the resident in those activities of daily living which the resident is unable to do for himself/herself. Postural supports may be used under the following conditions: (5) Under no circumstances shall postural supports include tying, depriving, or limiting the use of a resident's hands or feet. (B) Bed rails that extend the entire length of the bed are prohibited except for residents who are currently receiving hospice care and have a hospice care plan that specifies the need for full bed rails This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and interview with Administrator Designee, the licensee did not comply with the section cited above in 1 out of 6 resident beds observed, the left bed in bedroom #2 was observed with a full bed rail in use. The resident was formerly on hospice but has been discharged which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/27/2025 Plan of Correction The Licensee will remove the full bed rail from the Left bed in bed room #2 or submit a written request for an exception to use the full bed rail, from the Department. A Physician 's written order, medical assessment, the reason for the need of a full bed rail, support letters from physician, family, friends will be provided with the written exception request for consideration by 11/27/25.

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 record review, the licensee did not comply with the section cited above per review of staff files, the Administrator and Staff #6's health screens do not have evidence or results that a TB test was completed, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/20/2023 Plan of Correction The Administrator and Staff #6 needs to complete a TB test or provide evidence that a TB test was conducted and the results of the test is obtained and maintained in their files by POC date - 11/20/23

Official classification

Type B

Official code

87463(a)

Regulation authority

CCR

What the official deficiency says

(a) The pre-admission appraisal shall be updated, in writing as frequently as necessary to note significant changes and to keep the appraisal accurate. The reappraisals shall document changes in the resident's physical, medical, mental, and social condition. Significant changes shall include but not be limited to: This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, the licensee did not comply with the section cited above per review of resident files, all four residents do not have completed Appraisal/Needs and Services plan in their files which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/20/2023 Plan of Correction The Licensee will ensure that all resident files contain a completed Appraisal/Needs and Services Plan to ensure that their needs are being met and addressed. Provide evidence that an Appraisal/Needs and Services Plan has been completed by 11/20/23

Official classification

Type B

Official code

1569.319(a)

Regulation authority

HSC

What the official deficiency says

(a) A licensee of a facility that has internet service shall provide at least one internet access device, such as a computer, smart phone, tablet, or other device, that can support real-time interactive applications, is equipped with videoconferencing technology, including microphone and camera functions, and is dedicated for resident use. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above as the facility has not provided the resident in care with any dedicated internet access device and does not have a plan to ensure that all residents in care have access to its use in during reasonable hours, poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/20/2023 Plan of Correction The Licensee will provide the residents with a dedicated internet device that can support real-time interactive applications, is equipped with videoconferencing technology, including a microphone and camera functions. Licensee will also pult together a plan that will allow all residents access to the use of the device within reasonable hours by 11/20/23

Official classification

Type B

Official code

87465(b)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care:(b) If the resident's physician has stated in writing that the resident is able to determine and communicate his/her need for a prescription or nonprescription PRN medication, facility staff shall be permitted to assist the resident with self-administration of his/her PRN medication. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review and interview , the licensee did not comply with the section cited above, per information provided for Resident #2 and Resident #3. They do not have PRN Authorization Letters on File for Arthritis Pain for Resident #2 and Tylenol and Benzonatate for Resident #3 which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/27/2023 Plan of Correction Licensee will contact the prescribing physician and obtain completed PRN Authorizations Letters for the PRN medications taken by all residents in care including Resident #2 and Resident #3. Submit evidence that PRN Authorization Letters are maintained in all the residents' files by 11/20/23

Official classification

Type A

Official code

Not listed

Regulation authority

Not listed

What the official deficiency says

87705 Care of Persons with Dementia: (f)The following shall be stored inaccessible to residents with dementia: (2)Over-the-counter medication.. alcohol, cigarettes, and toxic substances such as certain plants, gardening supplies, cleaning supplies and disinfectants. This requirement is not met as evidenced by: Based on LPA's observations, the licensee did not comply with the section cited above, as cleaning supplies and disinfectants were found accessible in the facility's common restroom, which poses an immediate health and safety risk to persons in care.

Deadline recorded: Oct 11, 2021. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

Not listed

Regulation authority

Not listed

What the official deficiency says

87465 Incidental Medical and Dental Care:(h)The following requirements shall apply to medications which are centrally stored: (5)Each resident's medication shall be stored in its originally received container.. This requirement is not met as evidenced by: Based on LPA's observation and medication assessment, the lincensee did not comply with the section cited above, as five (5) out of six (6) resident medications were removed from its original container and prepared for more than 24-Hours, which poses an immediate health and safety risk to persons in care.

Deadline recorded: Oct 11, 2021. A deadline is not proof that correction was completed.