GOLDEN AGE ASSISTED LIVING

Official classification

Type A

Official code

87355(e)(3)

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: (3) Request a transfer of a criminal record clearance as specified in Section 87355(c) or 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 in one (1) out of five (5) staff members observed at the facility did not have a transfer of criminal record clearance which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/12/2026 Plan of Correction Administrator stated she will associate the staff member on guardian today or submit the Criminal Record Exemption Transfer Reequest LIC9188 to the Regional Office and submit proof to LPA by due date.

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 in two residents that were observed with full bed rail without currently receiving hospice services which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/15/2026 Plan of Correction Administrator agreed to removed the full bed rail, replace with 1/2 bed rail and submit proof to LPA by due date.

Official classification

Type A

Official code

87465(h)(5)

Regulation authority

CCR

What the official deficiency says

(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. No medications shall be transferred between containers. 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 in one out of three out of medication bottkes contained more pills than prescribed, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/09/2023 Plan of Correction Licensee agrees to contract with a credentialed entity to conduct staff training on handling of the medication, medication bottles, and will email a copy of the training materials, sign in sheet, and the name, address and phone number of the credential entity. Licensee will email proof of tratining to LPA .

Official classification

Type A

Official code

87615(a)(1)

Regulation authority

CCR

What the official deficiency says

87615(a)(1) Prohibited Health Condition: Persons who require health series 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. (1) Stage 3 and 4 pressure injuries. This requirement was not met as evidenced by: Based on interviews and record reviews, the licensee did not fail to comply with the section cited above. The Licensee retained a resident with a prohibited health condition between 9/21/21 and 9/28/21, which posed an immediate health and safety risk to residents in care.

Official plan of correction

Licensee will submit a plan on how you will ensure level of care meetings are conducted in a timely manner when there is a change in resident condition to CCLD.

Deadline recorded: Jun 1, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87466

Regulation authority

CCR

What the official deficiency says

Observation of the Resident: The licensee shall ensure that residents are regularly observed for changes… and that appropriate assistance is provided when such observation reveals unmet needs… documented and brought to the attention of the.. physician… This requirement is not met as evidenced by: Based on interviews and records review, the licensee did not comply with the section cited above. The facility failed to communicate R1’s worsening pressure injury/wound with R1’s physician which attributed to R1’s stage 4 pressure injuries while in care, which posed an immediate health and safety risk to residents in care.

Official plan of correction

Licensee will submit a plan on how you will ensure level of care meetings are conducted in a timely manner when there is a change in resident condition to CCLD. Immediate civil penalty of $500 is assessed.

Deadline recorded: Jun 1, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87463(c)

Regulation authority

CCR

What the official deficiency says

87463(c) Reappraisals(c): The licensee shall arrange a meeting with… a representative of the resident’s home health agency, if any, when there is significant change in the resident’s condition… This requirement is not met as evidenced by: Based on records review and interviews, the licensee did not comply with the section cited above as the facility failed to have a level of care meeting to discuss R1’s change of condition when R1’s pressure injury worsened, which posed a potential health and safety risk to residents in care.

Official plan of correction

Licensee will submit a plan on how you will ensure level of care meetings are conducted in a timely manner when there is a change in resident condition to CCLD.

Deadline recorded: Jun 3, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87463(a)(3)

Regulation authority

CCR

What the official deficiency says

Reappraisals (a)The pre-admission appraisal shall be updated...as frequently as necessary to note significant changes… (3) Any illness, injury…or change in the health care needs... Prohibited Health Conditions. This requirement is not met as evidenced by: Based on records review and interviews, the licensee did not comply with the section cited above as the facility failed to update R1’s appraisal with change of condition when R1’s pressure injury worsened, which posed a potential health and safety risk to residents in care.

Official plan of correction

Licensee will submit a plan on how you will ensure level of care meetings are conducted in a timely manner when there is a change in resident condition to CCLD.

Deadline recorded: Jun 3, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87506(a)(d)

Regulation authority

CCR

What the official deficiency says

87506-Residents Records a)The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility (d) All resident records shall be available to the licensing agency to inspect, audit, and copy upon demand during normal business hours. This requirement is not met as evidence by Base on the records review, the facility failed to ensure that a resident’s file for R1 was created prior to the time of admission to the facility, and while R1 resided in the facility, which poses a health and safety, personal risk to persons in care.

Official plan of correction

Licensee agrees to review Regulation 87506 (a)-(d) to ensure that no resident is admitted, and resides at the facility without a full file Resident Record. A self certification letter attesting to reviewing the regulation should be submitted to the licensing office by 03/04/2022.

Deadline recorded: Mar 4, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87705(f)(1)(2)

Regulation authority

CCR

What the official deficiency says

87705 Care of Persons with Dementia:(f)The following shall be stored inaccessible to residents with dementia:(1) Knives, matches.. (2) Over-the-counter medication.. toxic substances such as.. cleaning supplies and disinfectants. This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above, as the LPA observed one (1) lighter on the outdoor patio seating and an unlocked outdoor shed containing cleaning supplies and disinfectants, which poses an immediate health and safety rights risk to persons in care.

Official plan of correction

During today's visit, lighter and outdoor shed was locked and secured. The Licensee has agreed to do the following: 1. Provide training on section 87705(f)(1),(2) to staff, and submit proof of training to CCL by 10/11/2021. Civil penalty assessed for repeat violation on 05/27/2021.

Deadline recorded: Oct 4, 2021. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87506(d)(1)(I)

Regulation authority

CCR

What the official deficiency says

Resident Records:(d)All resident records shall..(1)Licensing representatives shall not remove..records..(I)Any other records containing.. health-related information..(e)Original records.. shall be retained for a minimum of three (3) years.. This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above, as one (1) out of six (6) resident files did not contain the resident Home Health care plan, which poses a potential health, and safety risk to persons in care.

Official plan of correction

The Licensee agreed to do the following: 1. Submit required Home Health records to CCLD by 10/07/2021.

Deadline recorded: Oct 4, 2021. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87633(b)

Regulation authority

CCR

What the official deficiency says

87633(b) Hospice Care of Terminally Ill Residents: (b) A current and complete hospice care plan shall be maintained in the facility for each hospice resident and include the following: This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above, as one (1) out of six (6) resident files did not contain the resident Hospice care plan, which poses a potential health, and safety risk to persons in care.

Official plan of correction

The Licensee agreed to do the following: 1. Submit required Hospice records to CCLD by 10/07/2021.

Deadline recorded: Oct 4, 2021. A deadline is not proof that correction was completed.