ANTHEM SENIOR CARE

Official classification

Type B

Official code

87465(a)(6)

Regulation authority

CCR

What the official deficiency says

(a) A plan for incidental medical and dental care shall be developed by each facility… (6) 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 was not met as evidenced by: Based on interview and record review, the Licensee did not comply with the section cited above in 5 out of 6 residents' centrally stored medication and destruction records were not maintained which poses a potential health, safety, or personal rights risk to persons in care.

Official plan of correction

The Administrator will update 5 Residents' medication records and provide them to CCLD by POC due date.

Deadline recorded: Nov 26, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87202(a)

Regulation authority

CCR

What the official deficiency says

(a) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, or the State Fire Marshal. Prior to accepting or retaining any of the following types of persons, the applicant or licensee shall notify the licensing agency and obtain an appropriate fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, or the State Fire Marshal: 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 by having bedridden resident (Resident #1 -R1) in room #2 and non-ambulatory resident (R2) in room #1 and Resident #5 (R5) in the former activity room which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/13/2025 Plan of Correction Administrator agrees to contact the fire inspector tomorrow and get a new fire clearance conducted. Also, administrator will write a statement of understanding regarding section CCR 87202(a)

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 by having the magnetic lock on the drawer where sharps are kept not functioning properly and failed to keep drawer securely locked which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/13/2025 Plan of Correction Administrator agrees to replace magnetic lock by POC due date and send proof to LPA.

Official classification

Type A

Official code

87465(a)(4)

Regulation authority

CCR

What the official deficiency says

(4) The licensee shall assist residents with self-administered medications as needed. 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 not administering prescribed medication as need it, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/13/2025 Plan of Correction Administrator agrees to contact a third-party agency to conduct medication training including how to use the centrally stored medication and destruction log. Also, administrator will write a statement of understanding regarding section CCR 87465(a)(4).

Official classification

Type A

Official code

87606(c)

Regulation authority

CCR

What the official deficiency says

(c) To accept or retain a person who is bedridden, other than for a temporary illness or recovery from surgery, a licensee shall obtain and maintain an appropriate fire clearance as specified in Section 87202, Fire Clearance. 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 by having R1 in a non approved bedridden room which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/13/2025 Plan of Correction Administrator agrees to contact the fire inspector tomorrow and get a new fire clearance conducted or movce R1 to room #3 before POC due date.

Official classification

Type A

Official code

87615(a)(5)

Regulation authority

CCR

What the official deficiency says

(a) Persons who require health services for 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: (5) Residents who depend on others to perform all activities of daily living for them as set forth in Section 87459, Functional Capabilities. 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 by having a resident unable to care for themselves which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/16/2025 Plan of Correction Administrator agrees to submit a waiver to CCL by POC due date or to have resident's physician report updated or get hospice services for R1.

Official classification

Type B

Official code

1569.618(c)(3)

Regulation authority

HSC

What the official deficiency says

(c)The facility shall employ, and the administrator shall schedule, a sufficient number of staff members to do all of the following: (3) Ensure that at least one staff member who has cardiopulmonary resuscitation (CPR) training and first aid training is on duty and on the premises at all times. This paragraph shall not be construed to require staff to provide CPR. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above by not having CPR First Aid certificate on record for all staff which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/26/2025 Plan of Correction Administrator agrees to hav all staff trained by 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 by not conducting quarterly emergency drills which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/26/2025 Plan of Correction Administrator agreed to conduct an emergency drill before POC due date and submit proof to LPA.

Official classification

Type B

Official code

87608(a)(5)(B)

Regulation authority

CCR

What the official deficiency says

(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 record review, the licensee did not comply with the section cited above by not having physician’s order showing bedrails are required which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/12/2025 Plan of Correction Administrator was able to provide proof during today's visit. POC Cleared.

Official classification

Type B

Official code

87632(a)(4)

Regulation authority

CCR

What the official deficiency says

(4) A statement by the licensee that an agreement with the hospice agency will be entered into regarding the care plan for the terminally ill resident to be accepted and/or retained in the facility. The agreement with hospice shall design and provide for the care, services, and necessary medical intervention related to the terminal illness as necessary to supplement the care and supervision provided by the licensee. 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 by not having hospice care plan for resident in care which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/19/2025 Plan of Correction Administrator submitted care plan for resident in care. POC cleared.

Official classification

Type B

Official code

87705(j)

Regulation authority

CCR

What the official deficiency says

Care of Persons with Dementia: (j) The licensee shall have an auditory device or other staff alert feature to monitor exits, if exiting presents a hazard to any resident. This requirement was not met as evidenced per tour of the facilit, it was observed that bedroom #4 an back sliding glass door did not have an auditory device installed on the door and the auditory device on bedroom #3 had a auditory device that was no operational

Official plan of correction

Licensee will ensure that all outside exiting doors have auditory devices that will monitor and alert staff when a resident leaves the facility by 8/15/24

Deadline recorded: Aug 15, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87633(a)(4)

Regulation authority

CCR

What the official deficiency says

Hospice Care of Terminally Ill Residents: The licensee shall be permitted to accept or retain residents who have been diagnosed as terminally ill...and receive hospice services from a hospice agency in the facility when all of the following conditions are met: A written hospice care plan specifies the care, services and necessary medical intervention related to the terminal illness as necessary to supplement the care and supervision provided by the facility is developed for each resident...prior to the initiation of hospice services in the facility for that resident, Resident #1 does not have a care plan

Official plan of correction

Licensee will review Title 22, Sections 87632 and 87633 and provide a signed written statement that the sections were read and understood and will be adhered to. Licensee will also contact the Hospice agency for Resident #1 and any other resident's hospice agency to obtain any and all necessary documentation needed and maintain in the residents' files. Provide evidence by 8/15/24 that the files have been updated and contain all the required documentation.

Deadline recorded: Aug 15, 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

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 requirement was not met as evidenced by: Resident #2's hospital bed was observed to be non-operational and could not to be lowered or raised to allow easy access into bed and replace the mattress as needed since it was observed propped by bedding below the mattress and the full rail needs to be removed.

Official plan of correction

Licensee will have the hospital bed repaired or replaced to allow the resident easy access into bed and a mattress in good condition is provided and the full bed rail is removed. Provide evidence that all the above corrections have been made by 8/15/24

Deadline recorded: Aug 15, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87632(d)(2)

Regulation authority

CCR

What the official deficiency says

Hospice Care Waiver: If the Department grants a hospice care waiver it shall stipulate terms and conditions of the waiver as necessary to ensure the well-being of terminally ill residents and of all other facility residents, which shall include, but not be limited to, the following requirements: The licensee shall notify the Department in writing within five working days of the initiation of hospice care.....The notice shall include the resident's name and date of admission to the facility and the name and address of the hospice. Dept not notified of R1, R4 & R's hospice initiation

Official plan of correction

Licensee will review Title 22, Section 87632 and 1. submit a statement that the section was read and understood and will be adhered to 2. Licensee will submit hospice initiation letters for Resident #1, Resident #4 and Resident #5 by 8/15/24

Deadline recorded: Aug 15, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

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 in 3 out of 3 records requested, per Licensee, the Physician's report are somewhere and could not be provided to LPA for review and which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/07/2023 Plan of Correction Licensee will ensure that all employees are in good health and physically and mentally capable of performing assigned task. Good physical health shall be verified by a health screening, including a chest x-ray or intradermal test performed by a physician not more than 6 months prior to seven days after employment or licensure. The Licensee will provide evidence that the health screening with the results of a TB test was completed by 7/7/23

Official classification

Type A

Official code

87355(e)

Regulation authority

CCR

What the official deficiency says

(e) 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: 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 in 1 out of 3 records reviewed, which poses an immediate health, safety or personal rights risk to persons in care. Susan Roberts, Backup Administrator was present at the facility on today's visit and was not able to provide evidence that a criminal record clearance was obtained and was not associated to the facility as of today's visit. Immediate civil penalties were assessed.

Official plan of correction

POC Due Date: 06/17/2023 Plan of Correction The Licensee will provide a written plan as to how the Licensee will ensure that all employees and individuals who require a criminal record clearance obtain one and are associated to the facility prior to being present at the facility by 6/17/23. Licensee will also notify Licensing once the clearance for is completed. IMMEDIATE CIVIL PENALTIES ASSESSED

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) Non-skid mats or strips shall be used in all bathtubs and showers. 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 1 out of 2 bathrooms inspected, the common bathroom in the back did not have a non-skid mat, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/23/2023 Plan of Correction Licensee will purchase a non-skid mat for the common bathroom located in the back of facility. Licensee will provide evidence that a non-skid mat was purchased and placed in the bathroom.

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 above in 3 out of 3 files requested for review and was informed that the facility does not have files for the 3 staff, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/07/2023 Plan of Correction Per discussion with the Licensee/Administrator, due to the Backup Administrator being out of town, addtional time is needed to create files containing the required document for each employee, including the Administrator

Official classification

Type B

Official code

87411(c)(6)

Regulation authority

CCR

What the official deficiency says

(6) The licensee shall maintain documentation pertaining to staff training in the personnel records, as specified in Section 87412(c)(2). For on-the-job training, documentation shall consist of a statement or notation, made by the trainer, of the content covered in the training. Each item of documentation shall include a notation that indicates which of the criteria of Section 87411(c)(3) is met by the trainer. 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 in 3 out of 3 files requested for review/evidence of staff training and was advised that training logs are not kept by the facility, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/07/2023 Plan of Correction Licensee will submit a written plan indicating how the facility will ensure that all staff training are recorded and contains the following information - date of training, subject of the training, material covered, hours of training provided and the name of the trainer. Provide LPA with the written plan by 7/7/23.

Official classification

Type B

Official code

87309(a)

Regulation authority

CCR

What the official deficiency says

(a) Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients. 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 cleaning solutions were observed to be unlocked under the kitchen sink which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 05/17/2022 Plan of Correction The Administrator agreed to the folllowing: 1. To secure any and all cleaning solutions. POC cleared at time of the visit.

Official classification

Type B

Official code

87468.1(a)(2)

Regulation authority

CCR

What the official deficiency says

(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 is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above as in two staff were not wearing face masks as required which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 05/17/2022 Plan of Correction The administrator agreed to do the following: 1. Ensure that all staff continue to wear maks when in the facility. POC cleared at time of the visit.

Official classification

Type A

Official code

87203

Regulation authority

CCR

What the official deficiency says

All facilities shall be maintained in conformity with the regulations adopted by the State Fire Marshal for the protection of life and property against fire and panic. 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 fire alarm system at time of testing was inoperable which poses an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 05/20/2022 Plan of Correction The adminsitrator agreed to the following: 2. Submit proof of repairs to CCL no later than the POC date.

Official classification

Type A

Official code

87465(h)(2)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care:(h)The following requirements shall apply to medications which are centrally stored: (2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible.. This requirement is not met as evidenced by: Based on LPA's observation, the licensee did not comply with the section cited above, as medications were in a unlocked hallway closet accessible to residents in care, which poses an immediate health and safety risk to persons in care.

Official plan of correction

The administrator secured and locked all medications during visit. The Licensee agreed to do the following: 1. Provide documentation of staff training regarding regulation 87465(h)(2) to CCL by 10/22/21.

Deadline recorded: Oct 12, 2021. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(h)(5)

Regulation authority

CCR

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.

Official plan of correction

The LPA conducted a medication assessment with the Administrator. Medication was stored back to its original received container. The Licensee has agreed to do the following: 1. Provide documentation of staff training regarding regulation 87465(h)(5) to CCL by 10/22/21.

Deadline recorded: Oct 12, 2021. A deadline is not proof that correction was completed.