ATRIA PARK OF PACIFIC PALISADES

Official classification

Type B

Official code

87218(a)(1)

Regulation authority

CCR

What the official deficiency says

This requirement is not met as evidenced by: 87218 Theft and Loss: (a) The licensee shall ensure an adequate theft and loss program as specified in Health and Safety Code Section 1569.153. (1) The initial personal property inventory shall be completed by the licensee, and the resident, or the resident’s representative. Deficient Practice Statement Based on LPA's observation and record review, the licensee did not comply with the section cited above in not having safeguards of property and valuables present for one resident which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/12/2023 Plan of Correction The licensee has agreed to aquire and provide the signed safeguards of property and valuables for the resident to LPA, via email, at Antonine.Richard@DSS.CA.GOV OR 323.516.4092

Official classification

Type A

Official code

87303(e)(3)

Regulation authority

CCR

What the official deficiency says

(e) Water supplies and plumbing fixtures shall be maintained as follows: (3) Taps delivering water at 125 degree F (52 degrees C) or above shall be prominently identified by warning signs. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPAs observation, the licensee did not comply with the section cited above in having the water temperature above 125 degree F in the industrial kitchen which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/02/2023 Plan of Correction Corrected on-site by Administrator, Remon Pagels.

Official classification

Type B

Official code

87224(b)

Regulation authority

CCR

What the official deficiency says

87224(b) The licensee may, upon obtaining prior written approval from the licensing agency, evict the resident upon three (3) days written notice to quit. The licensing agency may grant approval for the eviction upon a finding of good cause. Good cause exists if the resident is engaging in behavior which is a threat to the mental and/or physical health or safety... mental and/or physical health or safety of others in the facility. This requirement is not met as evidenced by:Based on interviews and record reviews. The facility failed to properly inform CCLD of the 30-Day Notice to Terminate on 03/15/22. The notice is not valid unless CCLD approves. This violation posed a potential health risks to residents in care.

Official plan of correction

Executive Director is to review Title 22 Regulaiton Section 87244, and resubmit a 30-Day Notice to Terminate for RO approval by POC 05/11/22. This violation is corrected on visit 05/02/22. The facility resubmitted a new 30-Day Notice to Terminate. A hard copy was given to LPA and original was faxed on 04/29/22.

Deadline recorded: May 11, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

1569.49(c)(1)

Regulation authority

HSC

What the official deficiency says

Civil Penalty: Any violation that the department determines resulted in the injury or illness of a resident. It was observed through records review and interview that on 2/12/2021 Resident 1 was admitted to hospital with pressure injuries. This poses an immediate health and safety risk to residents in care.

Official plan of correction

Licensee will submit written plan detailing how to ensure residents are provided with required services via fax by POC due date.

Deadline recorded: Apr 21, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.1(a)(2)

Regulation authority

CCR

What the official deficiency says

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 safe, healthful and comfortable accommodation, furnishings and equipment. This requirement was not met as evidenced by: It was observed through records review and interview that on 2/12/2021 Resident 1 was admitted to hospital with pressure injuries. This poses a potential health and safety risk to residents in care.

Official plan of correction

Licensee will complete a staff training on observation, documention, reporting and seeking medical/Home Health services in a timely manner. Submit in writting plan for training and sign in sheet as verification via fax by POC due date,

Deadline recorded: May 11, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87464(f)(1)

Regulation authority

CCR

What the official deficiency says

Basic services shall at a minimum include: Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). This requirement was not met as evidenced by: Based on interviews, LPA Cifuentes found that R2 had been left unsupervised and tried to consume an inedible item. This posses a potential health and safety issue for residents in care.

Official plan of correction

Licensee will provide a plan to LPA to ensure adequate supervision and redirection as needed by POC due date. POC cleared during visit on 1/12/2022.

Deadline recorded: Jan 26, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87464(f)(4)

Regulation authority

CCR

What the official deficiency says

Basic Services Personal assistance and care as needed by the resident...such as dressing, eating, bathing and assistance with taking prescribed medications, as specified in Section 87608, Postural Supports. This requirement was not met as evidenced by: Based on records review and interviews, LPA CIfuentes confimed that on October 24, 2021 residents were not assited with taking medications as prescribed. This posses an immediate health and safety issue for residents in care.

Official plan of correction

Licensee will provide licensing with confirmation of completed medtech courses for staff via fax by 11/4/2021 POC cleared on day of visit,

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

Official classification

Type B

Official code

87411(a)

Regulation authority

CCR

What the official deficiency says

Personnel Requirements - General Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs... This requirement was not met as evidenced by Based on records review and interviews, LPA CIfuentes confimed that on October 24, 2021 facility did not have a medtech on staff. This posses a potential health and safety issue for residents in care.

Official plan of correction

Licensee will provide plan to LPA to insure sufficient staff are available for each shift to cover residents needs. Will submit to CCL via fax by POC due date. POC cleared on day of visit

Deadline recorded: Nov 17, 2021. A deadline is not proof that correction was completed.