LILY OF THE VALLEY

Official classification

Type A

Official code

1569.695(a)(7)(E)

Regulation authority

HSC

What the official deficiency says

(a)In addition to any other requirement of this chapter, a residential care facility for the elderly shall have an emergency and disaster plan that shall include, but not be limited to, all of the following: (7) Procedures that address, but are not limited to, all of the following: (E) Storage and preservation of medications, including the storage of medications that require refrigeration. 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 1 R1 medication in the refrigerator was kept unlock and accessible, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/21/2025 Plan of Correction Medication in the refrigerator needs to be kept locked and inaccessble at all times. nnn

Official classification

Type A

Official code

87335(e)

Regulation authority

CCR

What the official deficiency says

This requirement is not met as evidenced by: (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: Deficient Practice Statement Based on observation, interview, and record review, the licensee did not comply with the section cited above in 1 out of 1 S4 is not cleared or associated with the facility to be working; which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/21/2025 Plan of Correction S4 needs finerprint clearance.

Official classification

Type B

Official code

87305(a)

Regulation authority

CCR

What the official deficiency says

87305 - Alterations to Existing Buildings or New Facilities (a)Prior to construction or alterations, all facilities shall obtain a building permit. Based on LPA's observation on 09/14/2023 and information obtained the Licensee had converted the garage to a room with a private bathroom without obtaining permits. This poses potential risk to the personal rights of the residents in care

Official plan of correction

The licensee agreed to obtain permits and proper inspections from the city. The licensee will email all necessary documents to the LPA by the POC date.

Deadline recorded: Sep 6, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87208(a)(7)(A)

Regulation authority

CCR

What the official deficiency says

This requirement is not met as evidenced by: This requirement is not met as evidenced by:Based on LPA's observation on 09/14/2023 there were an additional 2 rooms created by the Licensee which was not reflected on the facility sketch during the application process, which posed a potential health and safety issue for residents in care. Deficient Practice Statement ...Any significant changes in the plan of operation which would affect the services to residents shall be submitted to the licensing agency for approval. The plan and related materials shall contain the following:(7) Sketches, showing dimensions, of the following: Building(s) to be occupied, including a floor plan that describes the capacities of the buildings...

Official plan of correction

POC Due Date: 09/21/2023 Plan of Correction Licensee aggress to submit and LIC200 and updated facility sketch indicating a change in facility floor plan by or before POC due date

Official classification

Type A

Official code

87465(h)(5)

Regulation authority

CCR

What the official deficiency says

This requirement is not met as evidenced by: Deficient Practice Statement 87465(h)(5) Each resident's medication shall be stored in its originally received container. No medications shall be transferred between containers. LPA observed a bottle of Tramadol over the number of bills. Administrator has transfer old bills to new container of Tramadol which poses an immediate risk to residents in care.

Official plan of correction

POC Due Date: 09/21/2023 Plan of Correction Administrator will provide proof of medication training for all staff.

Official classification

Type A

Official code

87470(c)(1)(F)

Regulation authority

CCR

What the official deficiency says

87470(c) Infection Control Requirements shall be developed by the licensee... (1) The Infection Control Plan shall include: (F) Staff shall demonstrate knowledge... appropriate to the job assigned and as evidenced by safe and effective job performance. This requirement was not met as evidenced by: Deficient Practice Statement Based on observations the licensee/staff did not comply with the cited section by not screening LPA’s for symptoms of COVID 19 upon entry, which poses and immediate Health and Safety and personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/28/2022 Plan of Correction Licensee/Administrator will conduct in-house training regarding infection control. Administrator is to have a designated staff screening all visitors for Covid-19 upon arrival. Proof of training and designation of staff shall be emailed to LPA no later than 08/28/22.

Official classification

Type B

Official code

87211A(1)(a)

Regulation authority

CCR

What the official deficiency says

Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: (1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence. This report shall include the resident's name, age, sex and date of admission; date and nature of event; attending physician's name, findings, and treatment, if any; and disposition of the case. This requirement is not met as evidenced by record review and administrator admission that he never completes incident reports.

Official plan of correction

The administrator shall submit a declaration that he has reviewed the required of this section and shall submit a complete incident on the residents hospitailzations and death. Failure to submit the POC for this citation may lead to civil penalities if not corrected.

Deadline recorded: Oct 14, 2021. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87405(d)(3)

Regulation authority

CCR

What the official deficiency says

Administrator Qualifications: (d) The administrator shall have the qualifications specified in Sections 87405(d)(1) through (7). If the licensee is also the administrator, all requirements for an administrator shall apply. (3) Ability to maintain or supervise the maintenance of financial and other records. This requirement is not met as evidence by records review and administrator admission to not follow requirements of maintaining records. Such as reporting requirements. each time a resident was hospitalized.

Official plan of correction

The administrator shall submit a declaration that he has reviewed and understands the required section 87405 on administrator qualifications. The declaration shall be submitted to LPA Arambulo by the due date to clear this citation.

Deadline recorded: Oct 14, 2021. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(e)

Regulation authority

CCR

What the official deficiency says

Incidental Medical and Dental (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. This requirement has not been met as evidence by The administrator could not locate the PRN for resident #1 antibiotics. Medication was no longer available.

Official plan of correction

The administrator shall obtain a copy of the original prescription for the residents antibiotics and submit to LPA along with a declaration that he has reviewed section 87465 regarding medications. This deficiency shall only be cleared once corrections are submitted Failure to do so may be subjected to assessment of civil penalties.

Deadline recorded: Oct 14, 2021. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87508

Regulation authority

CCR

What the official deficiency says

Register of Residents (a) The licensee shall ensure that a current register of all residents in the facility is maintained and contains the following updated information: (b) Registers of residents shall be available to the licensing agency to inspect, audit, and copy upon demand during normal business hours. This requirement has not been met as evidence by a review of facility documents. The administrator did not know what the register was and did not have any updated documents.

Official plan of correction

The administrator shall review section 87508 and submit a declaration that he has read and reviewed and understands this requirement. An LIC9020 shall be submitted to LPA and each time there is a change in census the administrator shall update this form.

Deadline recorded: Oct 14, 2021. A deadline is not proof that correction was completed.