TEESDALE VILLA RCFE

Official classification

Type A

Official code

87309(a)

Regulation authority

CCR

What the official deficiency says

(a) Except as specified in subsection (b), the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances, knives, matches, tools, sharp objects, and other similar items which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage. 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 shed, an unlocked staff bedroom, and a hallway bathroom contained unsecured items including cleaning supplies, gardening tools, and grooming supplies which poses an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 03/23/2026 Plan of Correction Administrator secured the items at the time of the visiit. POC cleared.

Official classification

Type B

Official code

1569.625(b)(1)

Regulation authority

HSC

What the official deficiency says

(1) The department shall adopt regulations to require staff members of residential care facilities for the elderly who assist residents with personal activities of daily living to receive appropriate training. This training shall consist of 40 hours of training. A staff member shall complete 20 hours, including six hours specific to dementia care, as required by subdivision (a) of Section 1569.626 and four hours specific to postural supports, restricted health conditions, and hospice care, as required by subdivision (a) of Section 1569.696, before working independently with residents. The remaining 20 hours shall include six hours specific to dementia care and shall be completed within the first four weeks of employment. The training coursework may utilize various methods of instruction, including, but not limited to, lectures, instructional videos, and interactive online courses. The additional 16 hours shall be hands-on training. 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 as one staff member did not have proof of completed initial trainings logged in their staff file which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/06/2026 Plan of Correction Administrator agreed to appropriately log the trainings that the staff member completed and to send proof of the appropriately logged trainings to CCLD no later than POC due date.

Official classification

Type B

Official code

87463(a)

Regulation authority

CCR

What the official deficiency says

(a) The pre-admission appraisal, as specified in Section 87457, Pre-Admission Appraisal, shall be updated, in writing as frequently as necessary or once every 12 months, whichever occurs first, to note significant changes in condition, as defined in Section 87101, Definitions, and to keep the appraisal accurate. For the purposes of this section, the updated pre-admission appraisal shall be referred to as the reappraisal. 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 as four resident files contained appraisals which were last updated more than 12 months prior which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/06/2026 Plan of Correction Administrator agreed to complete updated appraisals for the identified individuals and to send proof of the completed appraisals to CCLD no later than POC due date.

Official classification

Type B

Official code

1569.695(c)

Regulation authority

HSC

What the official deficiency says

(c) A facility shall conduct a drill at least quarterly for each shift. The type of emergency covered in a drill shall vary from quarter to quarter, taking into account different emergency scenarios. An actual evacuation of residents is not required during a drill. While a facility may provide an opportunity for residents to participate in a drill, it shall not require any resident participation. Documentation of the drills shall include the date, the type of emergency covered by the drill, and the names of staff participating in the drill. 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 as the last emergency disaster drill was completed more than three months prior which poses a potential safety risk to persons in care.

Official plan of correction

POC Due Date: 04/06/2026 Plan of Correction Administrator agreed to complete an emergency disaster drill and to send proof of the completed drill to CCLD no later than POC due date.

Official classification

Type A

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 aboveas the hot water temparature was measured between 136.8 and 143.4 degrees Fahrenheit which poses an immediate health risk to persons in care.

Official plan of correction

POC Due Date: 02/27/2025 Plan of Correction Licensee will submit proof of appropriate water temparature to CCLD no later than POC due date.

Official classification

Type A

Official code

87309(a)

Regulation authority

CCR

What the official deficiency says

(a) Except as specified in subsection (b), the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances, knives, matches, tools, sharp objects, and other similar items which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage. 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 a unsecured gardening tool was observed in the backyard of the facility which poses an immediate safety risk to persons in care.

Official plan of correction

POC Due Date: 02/26/2025 Plan of Correction Administrator secured the tool at the time of the visit POC cleared.

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

(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 is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above as one bathroom was observed to contain a moldy shower curtain which poses a potential health risk to persons in care.

Official plan of correction

POC Due Date: 03/12/2025 Plan of Correction Licensee will submit proof of a replaced shower curtain in the identified bathroom to CCLD no later than POC due date.

Official classification

Type B

Official code

87412(a)

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: This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, the licensee did not comply with the section cited aboveas one employee did not have a file which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/12/2025 Plan of Correction Licensee will submit a completed employee file for the identified employee to CCLD o later than POC due date.

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 record review, the licensee did not comply with the section cited above as one employee's LIC 503 was ot filled out and was missing a negative TB test which poses a potential health risk to persons in care.

Official plan of correction

POC Due Date: 03/12/2025 Plan of Correction Licensee will subit a completed LIC 503 and negative TB test for the identified employee no later than POC due date.

Official classification

Type B

Official code

1569.626(a)

Regulation authority

HSC

What the official deficiency says

(a) All residential care facilities for the elderly shall meet the following training requirements, as described in Section 1569.625, for all direct care staff: This requirement is not met as evidenced by: Deficient Practice Statement Based on interview and record review, the licensee did not comply with the section cited aboveas no employee trainings were completed within the last 12 months which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/12/2025 Plan of Correction Licensee will submit either: proof of completed trainings for all employees or proof of ongoing trainings for all employees to CCLD no later than POC due date.

Official classification

Type B

Official code

87219(a)

Regulation authority

CCR

What the official deficiency says

(a) Residents shall be encouraged to maintain and develop their quality of life through participation in a variety of planned activities. The activities made available shall include: This requirement is not met as evidenced by: Deficient Practice Statement Based on interviews, the licensee did not comply with the section cited abovas resident's interviewed expressed that activities are not offered at the facility which poses personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/12/2025 Plan of Correction Licensee will submit their plan on how they intend to implement a sufficent activity plan in the facility to CCLD no later than POC due date.

Official classification

Type B

Official code

87458(c)(1)(A)

Regulation authority

CCR

What the official deficiency says

(c) The medical assessment shall include, but not be limited to: (1) A physical examination of the resident indicating the licensed medical professional's diagnosis or diagnoses and results of an examination for all of the following: (A) Communicable tuberculosis. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, the licensee did not comply with the section cited aboveas two resident's were observed to be missing negative TB tests which poses a potential health risk to persons in care.

Official plan of correction

POC Due Date: 03/12/2025 Plan of Correction Licensee will submit proof of negative TB tests for the identified residents to CCLD no later than POC due date.

Official classification

Type B

Official code

1569.695(c)

Regulation authority

HSC

What the official deficiency says

(c) A facility shall conduct a drill at least quarterly for each shift. The type of emergency covered in a drill shall vary from quarter to quarter, taking into account different emergency scenarios. An actual evacuation of residents is not required during a drill. While a facility may provide an opportunity for residents to participate in a drill, it shall not require any resident participation. Documentation of the drills shall include the date, the type of emergency covered by the drill, and the names of staff participating in the drill. This requirement is not met as evidenced by: Deficient Practice Statement Based on interview and record review, the licensee did not comply with the section cited above as disaster drills are not conducted quarterly at the facility which poses a potential safety risk to persons in care.

Official plan of correction

POC Due Date: 03/12/2025 Plan of Correction Licensee will submit proof of completed disaster drill to CCLD no later than POC due date.

Official classification

Type A

Official code

Not listed

Regulation authority

Not listed

What the official deficiency says

87705(f)(2) Toxic substances such as certain plants, gardening supplies, cleaning supplies and disinfectants are inaccessible. This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above during a physical plant tour, it was observed chemicals dispersed throughout the outdoor area, not locked at the time of the visit:chemicals, cleaners, paint... This poses an immediate health and safety risk to residents in care.

Deadline recorded: Mar 4, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87464(f)

Regulation authority

CCR

What the official deficiency says

87464(f)(1) Basic Services.(f) Basic services shall at a minimum include: (1) Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code Section 1569.2(c). The requirement was not met as evidenced by: Based on interviews and a credible witness, residents were left unsupervised on 02/14/2023, which posed an immediate health and safety risk to residents in care.

Official plan of correction

The licensee shall develop a plan to ensure that staff are always present to supervise residents, and provide training on this plan to all staff by February 24, 2023. Submit the plan to CCL by February 27, 2023.

Deadline recorded: Feb 27, 2023. A deadline is not proof that correction was completed.