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Official classification

Type B

Official code

87463(b)

Regulation authority

CCR

What the official deficiency says

(b) The reappraisal shall document significant changes in the resident's physical, mental, cognitive, behavioral, or functional condition, including those required to be documented as specified in Section 87466, Observation of the Resident. 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 in 3 out of 4 resident files reviewed as the last Appraisal/Needs and Service was completed for Resident #2 on 2/28/24, Resident #3 on 2/28/24 and Resident #4 on 5/10/24 and no annual reassesment have been conducted since, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/22/2025 Plan of Correction The Licensee should ensure that an assessment is completed annually to document changes to the resident's physical, mental, cognitive, behavioral, or functional condition per observation of the resident. Licensee will schedule a meeting with each resident and their responsible party to update Resident #2, Resident #3 and Resident #4's care plan to ensure that their needs are being met. Evidence of completion will be faxed to the Department by 9/22/25.

Official classification

Type A

Official code

87555(b)(26)

Regulation authority

CCR

What the official deficiency says

87555 General Food Service Requirements (b) The following food service requirements shall apply: (26) Supplies of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days shall be maintained on the premises. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above per review of food in the pantry and refrigerator that there were insufficient perishable and non-perishables foods. There were 3 green and 1 red bell peppers, 2 plastic containers of water melon, 2-1/3 quarters of milk, yogurt in the refrigerator, 3 bananas and 3 apples in the pantry. Small cans of vegetables and soups were in the pantry, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/21/2023 Plan of Correction The Licensee will purchase the required perishable and non-perishable foods and fax over a copy of the receipt to licensing by 9/21/23

Official classification

Type B

Official code

87465(e)(1-4)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care: (e) For every prescription and nonprescription PRN medication for which the licensee provides assistance there shall be a signed, dated written order from a physician, on a prescription blank, maintained in the residents file, and a label on the medication. Both the physician's order and the label shall contain at least all of the following information.(1) The specific symptoms which indicate the need for the use of the medication. (2) The exact dosage.(3) The minimum number of hours between doses.(4)The maximum number of doses allowed in each 24-hour period. 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 no physicians orders were observed in any of the residents' files] which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/27/2023 Plan of Correction The Licensee will contact the prescribing physicians to obtain copies of the physicians orders and maintain in the residents files. The Licensee will self ceritify that the physicians orders have been obtainied by 9/2/23

Official classification

Type B

Official code

87465(a)(8)(a)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care (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 since a copy of the first aid manual was requested from the Administrator and was advised that the facility did not have one.] which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/27/2023 Plan of Correction The Licensee will purchase a copy of the first aid manual that meets Title 22 requirements and provide evidence that it was purchased and will be maintainied at the facility.

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

87303 Maintenance and Operation (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 per tour of bedroom #3, the blinds on the door leading outside were observed either missing a slate or broken as it did not close correctly to allow the resident in care privacy in the bedroom which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/27/2023 Plan of Correction The Licensee will ensure that residents are provided with well maintained window dressing to allow all residents priviacy in their rooms. Licensee will repair or replace the blinds on the side door of bedroom #3 and any other bedroom to allow resident privacy. Licensee will fax over evidence that the deficiency has been corrected by 9/27/23

Official classification

Type B

Official code

80026(h)

Regulation authority

CCR

What the official deficiency says

80026(h) Safeguards for Cash Resources, Personal Property, and Valuables of Residents (h) Each licensee shall maintain accurate records of accounts of cash resources... entrusted to his/her care, including, but not limited to the following: This requirement was not met as evidenced by: Based on interviews conducted, the licensee did not comply with the section cited above, as the facility failed to ensure clients P and I records were up to date, which poses a potential personal rights risk to residents in care.

Official plan of correction

The Licensee agreed to the following: 1.Submit a statement of understanding of section 80026(h) to CCL by 06/03/22.

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