FOUR SEASONS ASSISTED LIVING CENTER LLC

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 interview and record review, the licensee did not comply with the section cited above in R2's medication was not administered as prescribed which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/03/2026 Plan of Correction The Licensee will have a licensed professional conduct an in-service training with all Med-Techs and provide proof to CCLD by POC due date.

Official classification

Type B

Official code

87465(a)(6)

Regulation authority

CCR

What the official deficiency says

(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 is not met as evidenced by: Deficient Practice Statement Based on record review, the licensee did not comply with the section cited above in R1's medication record was not maintained which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/16/2026 Plan of Correction The Licensee will have a licensed professional conduct an in-service training with all Med-Techs and provide proof to CCLD by 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 above in 3 out of 5 taps delivering hot water did not measure within the required range 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 Administraor will have the Maintenance Director adjust the water tempurature and send CCLD proof of the 3 units delivering hot water within the required range of 105 degrees F and 120 degrees F by POC due date.

Official classification

Type B

Official code

87411(c)(1)

Regulation authority

CCR

What the official deficiency says

(1) Staff providing care shall receive appropriate training in first aid from persons qualified by such agencies as the American Red Cross. 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 1 out of 6 staff had a 1st aid/CPR that expired in 10/2023 which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/13/2025 Plan of Correction Administrator will have the staff send the facility their updated 1st aid/CPR training by POC due date and send the document to CCLD.

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 observation, interview, and record review, the licensee did not comply with the section cited above in 1 out of 10 residents did not have a TB test on file which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/13/2025 Plan of Correction Administrator will have the Skilled Nursing Facility complete the resident's TB test and will send CCLD proof by POC due date with the results.

Official classification

Type A

Official code

87309(a)

Regulation authority

CCR

What the official deficiency says

87309 Storage Space (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 evidence by: Based on observation the licensee did not comply with the section cited above in two carts with cleaning supplies were left unattended and the laundry room was unlocked with laundry detergent and bleach which poses an immediate health and safety risk to persons in care.

Official plan of correction

Administrator secured the carts and locked the laundry room immediately during the visit. Administrator agrees to provide training to all staff regarding the regulation and submit proof by plan of correction date 10/11/2024.

Deadline recorded: Oct 11, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

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 in four (4) out of ten (10) rooms observed as the they had disinfectants and cleaning solutions which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/26/2024 Plan of Correction Administrator agrees to do a full facility sweep and make sure any item that poses a danger to residents are removed, and will submit proof to CCL by 06/26/2024. Proof can be a self-certification letter or photos.

Official classification

Type A

Official code

87309(b)

Regulation authority

CCR

What the official deficiency says

(b) Medicines shall be stored as specified in Section 87465(c) and separately from other items specified in (a) above. 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 three (3) out of ten (10) resident bedrooms observed as they had over the counter and prescribed medications which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/26/2024 Plan of Correction Administrator agrees to do a full facility sweep and make sure that prescribed and over the counter medications are removed, and stored inaccessible to residents in care, and will submit proof to CCL by 06/26/2024. Proof can be a self-certification letter or photos.

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

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 the facility's carpet is in disrepair with stains and a 5 foot rip, there is a hole on a wall, hole on residents bathroom door, rooms need to be cleaned, and there is a broken tile inside the elevator which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/08/2024 Plan of Correction The Administrator agreed to do the following: Ensure all listed items are fixed/cleaned by 07/08/2024. If carpet is being replaced please submit proof. Proof can be invoices, photos or self-certification letter.

Official classification

Type A

Official code

87465(c)(2)

Regulation authority

CCR

What the official deficiency says

(c) If the resident's physician has stated in writing that the resident is unable to determine his/her own need for nonprescription PRN medication, but can communicate his/her symptoms clearly, facility staff designated by the licensee shall be permitted to assist the resident with self-administration, provided all of the following requirements are met: (2) Once ordered by the physician the medication is given according to the physician's directions. This requirement is not met as evidenced by: Deficient Practice Statement Based on medication audit, the licensee did not comply with the section cited above as R1, R3 and R4 did not have their medication on file which staff cannot assist with the self-administration of medication which poses/posed an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/21/2023 Plan of Correction Administrator stated they will submit a plan to conduct a medication audit. Addtionally, the facility pharmacy will be called to do their own audit. Laslty, facility will have pharmacy provide medication training. Administrator will submit documents to CCL by 06/21/23.

Official classification

Type B

Official code

87458(a)

Regulation authority

CCR

What the official deficiency says

(a) Prior to a person's acceptance as a resident, the licensee shall obtain and keep on file, documentation of a medical assessment, signed by a physician, made within the last year. The licensee shall be permitted to use the form LIC 602 (Rev. 9/89), Physician's Report, to obtain the medical assessment. 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 R1 and R2 did not have their LIC 602 Physician's Report on file which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/30/2023 Plan of Correction Administrator will have the LIC 602 completed for R1 and R2 and submit to CCL by 06/30/23.

Official classification

Type B

Official code

87458(b)(1)

Regulation authority

CCR

What the official deficiency says

(b) The medical assessment shall include, but not be limited to: (1) A physical examination of the resident indicating the physician's primary diagnosis and secondary diagnosis, if any and results of an examination for communicable tuberculosis, other contagious/infectious or contagious diseases or other medical conditions which would preclude care of the person by the 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 as R1 did not have their Tuberculosis results on file which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/30/2023 Plan of Correction Administrator will have R1 tested for Tuberbulosis and send results to CCL by 06/30/23.

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

87303 Maintenance and Operations (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: Based on interviews and observation, the licensee did not comply with the section above as various resident stated observing cockroaches additionally the LPA observed cockroaches in a R1's room which poses an potential health, safety or personal rights risk to persons in care.

Official plan of correction

Administrator will have outside company fumigate the entire building and target specific rooms were interviews were conducted. Administrator will submit invoice of fumigation to CCL by 06/23/2023.

Deadline recorded: Jun 23, 2023. A deadline is not proof that correction was completed.

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 observation, the licensee did not comply with the section cited above as one maintence staff was identified not be to asscoiated to the facility which poses an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 05/16/2022 Plan of Correction The Adminsitrator agreed to the following: 1. Associate any staff that is wokring at the facility and submit proof to CCL.

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 staff were observed to be wearing facemasks throughout the facility which poses a potential 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: 1. Enusre that staff are reminded immediatley on the use of masks while in the facility. 2. Review masking protocols with staff and notify CCL no later than 5/20/22.

Official classification

Type A

Official code

87629(a)

Regulation authority

CCR

What the official deficiency says

87629(a) Injections. The licensee shall be permitted to accept or retain a resident who requires intramuscular, subcutaneous, or intradermal injections if the injections are administered by the resident or by an appropriately skilled professional. This requirement is not met as evidenced by: Based on interviews, the licensee did not comply with the section cited above, as staff have administered insulin injections to residents, which poses an immediate health and safety risk to residents in care.

Official plan of correction

The Administrator has agreed to do the following: 1. Review Regulation 87629 and submit a Statement of Understanding no later than 4/18/2022 2. Administrator is going to conduct an in-service with staff regarding the administration of medications. Submit confirmation that all staff have been retrained to CCL no later than 4/29/2022.

Deadline recorded: Apr 29, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.2(a)(4)

Regulation authority

CCR

What the official deficiency says

87468.2 (a)(4)... Personal Rights of Residents in All Facilities,... shall have all of the following personal rights: To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs. This requirement is not met as evidenced by: Based on interviews, the licensee did not comply with the section cited above, as it was communicated that staff lack the sufficient skills to communicate in English, which poses a potential personal rights risk to residents in care.

Official plan of correction

The Administrator has agreed to do the following: 1. Administrator is going to talk to all staff to assess personal rights protocols and develop a plan to ensure that residents and staff are able to communicate effectively and efficiently. Communicate plan to CCLD by 4/22/2022.

Deadline recorded: Apr 22, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.1(a)(1)

Regulation authority

CCR

What the official deficiency says

87468.1(a)(1) Personal Rights of Residents in All Facilities Residents in all residential care facilities for the elderly shall have all of the following personal rights: To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement is not met as evidenced by: Based on interviews, the licensee did not comply with the section cited above, as it was communicated that residents were being yelled at in the facility by staff, which poses a potential personal rights risk to residents in care.

Official plan of correction

The Administrator has agreed to do the following: 1. Administrator is going to talk to all staff to assess personal rights protocols and develop a plan to ensure that residents and staff are able to communicate effectively and efficiently. Communicate plan to CCLD by 4/22/2022.

Deadline recorded: Apr 22, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87463(a)

Regulation authority

CCR

What the official deficiency says

(a)The pre-admission appraisal shall be updated.. as frequently as necessary.. The reappraisals shall document changes in the resident's physical, medical, mental, and social condition.. This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above, as twenty (20) out of twenty (20) residents’ files did not have a reappraisal, which poses an immediate health and safety risk to residents in care.

Official plan of correction

The Licensee has agreed to do the following: 1. Submit proof of all residents’ documents LIC 603A/LIC 625 by 09/17/2021.

Deadline recorded: Sep 7, 2021. A deadline is not proof that correction was completed.