JASMIN TERRACE AT EL MOLINO

Official classification

Type B

Official code

87464(d)

Regulation authority

CCR

What the official deficiency says

Basic Services. A facility need not accept a particular resident for care. However, if a facility chooses to accept a particular resident for care, the facility shall be responsible for meeting the resident's needs as identified in the pre-admission appraisal specified in Section 87457, Pre-admission Appraisal and providing the other basic services specified below, either directly or through outside resources. Based on interviews, observation, and record review resident (R1) was not escorted to exercise class on 7/25/25 and today (7/31/25). Per home health orders R1 requires daily exercise participation. The Appraisal/Needs and Services Plan states R1 is to be escorted to activities. This poses a potentila health, safety, and personal rights risk.

Official plan of correction

Executive Director agreed to develop a plan of action on how facility will meet all resident's basic needs. Plan shall include staffing, staffing responsibilities, and facility procedures. Submit plan and proof of staff training.

Deadline recorded: Aug 14, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87608(a)(5)(B)

Regulation authority

CCR

What the official deficiency says

87608 Postural Supports (a) Based on the individual's preadmission appraisal, and subsequent changes to that appraisal, ... (5) Under no circumstances shall postural supports.... (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 3 out of 10 residents have a full bed rail on their beds and a full bed rail physician's order and are not under hospice care which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/18/2025 Plan of Correction Administrator will communicate with physician and ensure that the resident requires a full bed rail and will either change bed rail to half bed rail or will submit a postural support exception request to the department for each resident listed on LIC 811 and will submit new orders and pictures of bed rails or the exceptions by POC due date 3/18/25.

Official classification

Type A

Official code

87468.2(a)(4)

Regulation authority

CCR

What the official deficiency says

87468.2...Personal Rights...: (a)...shall have all...: (4) To care, supervision, and services that meet their individual needs ... that are sufficient..., qualifications, and competency to meet their needs. This requirement is not met as evidence by: Based on observations, interviews, and documents reviewed licensee failed to ensure R1 was injured by R2 while in care which poses an immediate health, safety, or personal rights risk to the persons in care. *Immediate $500 civil penalty is being assess*

Official plan of correction

Administrator will update needs and care plan to reflect supervision, care, needs, behaviors, and room status for R2 and will submit a copy to the department by POC due date 11/14/24. **An additional $500 civil penalty was assessed due to repeated violation noted on 4/23/24.** *Civil penalties were assess for a total of $1000.*

Deadline recorded: Nov 14, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87468.2(a)(4)

Regulation authority

CCR

What the official deficiency says

87468.2 Additional Personal Rights... (a) ...residents...shall...: (4) 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 evidence by: Based on documents review and interviews conducted facility did not ensure R1 left the facility unattended which poses an immediate risk to the health, safety, or personal rights of the persons in care.

Official plan of correction

Administrator will update needs and care plan to note the frequency of supervision provided and accomodations to assist R1 with assimilating to the environment by POC due date 4/24/24.

Deadline recorded: Apr 24, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

1569.696(a)

Regulation authority

HSC

What the official deficiency says

(a) All residential care facilities for the elderly shall provide training to direct care staff on postural supports, restricted conditions or health services, and hospice care as a component of the training requirements specified in Section 1569.625. The training shall include all of the following: 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 staff training did not include training on postural support, hospice care, restricted conditions or health services which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/10/2024 Plan of Correction Administrator will schedule training with proper training services and will provide a copy of 4 hours of in-services training on postural support, hospice care, restricted conditions or health services log (certificate) to the department by POC due date 4/10/24.

Official classification

Type B

Official code

87705(c)(5)

Regulation authority

CCR

What the official deficiency says

(c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following: (5) Each resident with dementia shall have an annual medical assessment as specified in Section 87458, Medical Assessment, and a reappraisal done at least annually, both of which shall include a reassessment of the resident's dementia care needs. 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 Appraisal Needs and Service Plan for resident #6 (R6) was last updated on 9/1/22 and #9 (R9) was last updated 1/6/23. which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/04/2024 Plan of Correction Administrator will update the appraisal needs and service plan for R6 and R9 and will submit a copy to the department by POC due date 4/4/24.

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 disinfectant spray was observed in room #107's bathroom cabinet accessible to the resident which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/27/2024 Plan of Correction Assistant administrator removed disinfectant spray from the room during the visit. Administrator will schedule in-service training to staff and family regarding section 87309 by 3/27/24. Administrator will submit a copy of sign-in log, agenda with description of training and duration of training by 4/2/24.

Official classification

Type B

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 water temperature in the following room tested as follow: room#114 at 103.8 F., room #119 at 89.7 F., room #134 at 100.5 F. room #259 at 100.4 F., room #240 at 104.1 F., room #204 at 90.3 F., which is not within 105-120 degrees F. which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/02/2024 Plan of Correction Administrator wil adjust water temperature and will test water temperature in the rooms above for 7 days twice a day will maintain a temperature log and will submit the log on POC due date 4/2/24.

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 in exit gate to El Molino street on the left of the building egress system is not working and was observed tied with a rope which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/05/2024 Plan of Correction Administrator will contact proper agency for repairs and will submit invoice of repairs by POC due date 4/5/24.

Official classification

Type A

Official code

87468.2(a)(4)

Regulation authority

CCR

What the official deficiency says

87468.2 Additional Personal Rights of Residents...: a)...residential care facilities ...shall ...: 4)..., supervision,... that meet... and are delivered by staff that are sufficient in..., qualifications, and competency to meet their needs.This requirement is not met as evidence by: Based on interviews and documents reviewed licensee did not ensure R1 left the faciltiy unassisted and R1 obtained a fall while unsupervised which poses an immediate risk to the health, safety, or personal rights of the persons in care.

Official plan of correction

Adminsitrator will ensure that all staff are qualify, sufficient in numbers, and competent to perform their duties and will schedule in-service training on prevention of wandering by POC due date 11/1/23. Will provide a copy of in-service with date, duration, and subject by 11/7/23.

Deadline recorded: Nov 1, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87705(k)(8)

Regulation authority

CCR

What the official deficiency says

87705 Care of Persons with Dementia (k) The following...must be met...: (8) Delayed egress devices shall not substitute for trained staff... to meet... supervision needs of all residents and to escort residents who leave the facility. This requirement is not met as evidence by: Based on interviews and documents reviewed licensee did not ensure R1 left the facility unassisted through the front door while a staff was at the front desk which poses an immediate risk to the health, safety, or personal rights of the persons in care.

Official plan of correction

Adminsitrator will ensure that all staff are qualify, sufficient in numbers, and competent to perform their duties and will schedule in-service training on ensuring egress system is working and escorting residents outside the facility by POC due date 11/1/23. Will provide a copy of in-service with date,

Deadline recorded: Nov 1, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87211(a)(1)(D)

Regulation authority

CCR

What the official deficiency says

87211 Reporting Requirements: (a) Each licensee shall furnish... (1) A written report ... within seven days of the occurrence of any of the events... (D) Any incident which threatens the welfare, safety or health of any resident, such as psychological abuse... This requirement is not met as evidence by: Based on document review licensee did not ensure a copy of incident report was provided during the visit or submitted to the department within 7 seven of incident occured on 8/27/23 which poses a potential risk to the health, safety, or personal rights of the persons in care.

Official plan of correction

Administrator will submit incident report for incident on 8/27/23 to the department by POC due date 9/8/23.

Deadline recorded: Sep 8, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87470(c)(1)(F)

Regulation authority

CCR

What the official deficiency says

(c) An Infection Control Plan...shall be included in the Plan of Operation required by Section 87208.(1)... shall includ e...:(F) Staff shall demonstrate knowledge of and skill in infection control, as appropriate to the job assigned and as evidenced by safe and effective job performance. This requirement is not met as evidence by: Based on interviews conducted Licensee did not ensure staff are following COVID 19 guidelines and supplies are replenish over night which poses a potential risk to the health, safety, or personal rights of the persons in care.

Official plan of correction

Administrator will ensure all staff are knowledge of all current guidelines regarding face mask around the facility and will ensure supplies are available at the front desk at all times. Certification in writting will be submitted to the department by POC due date 3/6/23.

Deadline recorded: Mar 6, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

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 bathroom in room #130 water temperature tested at 100.0 degrees F., and bathroom in room #239 water temperature tested at 101.6 degrees F., which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/06/2023 Plan of Correction Administrator will adjust water heater and ensure temperature is at the required temperature of 105-120 degrees F. at all times. Administrator will submit a water temperature log from 2/28/23 - 3/6/23 for room #130 and 239 water should be tested at least twice a day to the department by POC due date 3/6/23.

Official classification

Type A

Official code

87468.1(a)(1)

Regulation authority

CCR

What the official deficiency says

Personal Rights of Residents in All Facilities: (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (1) To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement is not met as evidence by: Based on documents review licensee did not ensure S2 follow residents rights by using R1's private bathroom which poses a potential health, safety, or personal rights risk to the persons in care.

Official plan of correction

Administrator will provide a plan with topics and identify consultant agency to provide proper personal rights training by 1/26/23 and will submit training agenda and sign-in by 2/8/23.

Deadline recorded: Jan 21, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87468.1(a)(2)

Regulation authority

CCR

What the official deficiency says

87468.1 Personal Rights of Residents in All Facilities: (a) Residents in all residential care facilities shall...:(2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This requirement is not met as evidence by: Based on interviews, and documents reviewed the licensee failed to ensure R1 did not sustained a hip fracture while in care which poses an immediate health, safety, or personal rights to the persons in care.

Official plan of correction

Licensee will ensure facility's plan of operation identify the number of caregivers necessary to provide assistance with transfer and will submit a copy by 1/26/23. Number of caregivers should be identified in care plan and discuss with caregivers. Administrator will provide hoyer lift training for staff and will submit copies by 2/1/23.

Deadline recorded: Jan 26, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87466

Regulation authority

CCR

What the official deficiency says

87466 Observation of the Resident: The licensee shall ensure that residents are regularly observed for changes in physical, mental, emotional and social functioning and that appropriate assistance is provided when such observation reveals unmet needs... This requirement is not met as evidence by: Based on interviews and documents review licensee failed to provide adequate direct care staff to support R1's needs identify in physician's report which poses a potential risk to the health, safety, or personal rights of persons in care.

Official plan of correction

Licensee will ensure updated plan care for R1 is review with staff in each shift to ensure that direct care is provided to meet R1's needs. A copy of updated R1's care plan and a copy of staff's sign in log of reviewed care plan is to be submitted to the department by 12/22/22.

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

Official classification

Type A

Official code

87468.2

Regulation authority

CCR

What the official deficiency says

87468.2 Additional Personal Rights of Residents in Privately Operated Facilities: (a) ... Section 87468.1, Personal Rights of Residents...(4) To care, supervision,... meet their individual needs...by staff that are sufficient in numbers, qualifications, and competency to meet their needs. This requirement is not met as evidence by: Based on documents review facility did not ensure R1 did not leave the facility unattended which is an immediate risk to the health, safety, or personal rights to the persons in care.

Official plan of correction

Licensee will create a plan to ensure that activities and proper steps are taken to prevent R1 from leaving the facility and will submit a copy of this plan to the department by POC due date 11/30/22.

Deadline recorded: Nov 30, 2022. 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

87411 Personnel Requirements - (a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs... This requirement is not met as evidence by:

Official plan of correction

Licensee will provide in-service training to staff regarding wandering behaviors and steps to take prevent and after a resident has exit the facility by POC due date 11/30/22.

Deadline recorded: Dec 6, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87211(a)(2)

Regulation authority

CCR

What the official deficiency says

Reporting Requirements: Occurrences, such as epidemic outbreaks, poisonings, catastrophes or major accidents which threaten the welfare, safety or health of residents, personnel or visitors, shall be reported within 24 hours either by telephone or facsimile to the licensing agency and to the local health officer when appropriate. This This requirement is not met as evidenced by: Dermatologist reported " suspected scabies just based on clinical presentation - did not do biopsy to confirm " ; therefore, facility did not report it to the Public Health Department.

Official plan of correction

Licensee/Administrator shall read Title 22, Section " Reporting Requirements " and send a written statement to CCL by the POC date - no later than 08/24/22.

Deadline recorded: Aug 24, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87465(a)(2)

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... for assistance in obtaining such care, by compliance with the following:(2) The licensee shall provide assistance in meeting necessary medical and dental needs. This requirement is not met as evidence by: Based on interviews and documents reviewed licensee failed to ensure R1 did not have food intake in the morning prior to surgery which poses a potential health, safety or personal rights risk to the persons in care.

Official plan of correction

Administrator conducted internal investigation and wrote warning notice form to staff responsible for not meeting R1's needs on 10/19/21. Deficiency cleared.

Deadline recorded: Aug 2, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87555(b)(21)

Regulation authority

CCR

What the official deficiency says

(b) The following food service requirements shall apply: (21) Freezers of adequate size shall be maintained at a temperature of 0 degree F (-17.7 degree C), and refrigerators of adequate size shall maintain a maximum temperature of 40 degree F. (4 degree C). They shall be kept clean and food stored to enable adequate air circulation to maintain the above temperatures. This requirement is not met as evidenced by: Deficient Practice Statement Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in [count] out of [total count] [(objects) (persons)] [identifiers] which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/12/2022 Plan of Correction Facility will ensure freezer's temperature is under 0 degrees at all times by certifying in LIC 9098 by 3/12/22 and will submit a temperature log and a professional service invoice for freezer by 3/18/22.

Official classification

Type A

Official code

87465(d)(3)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care: (d) If the resident is unable to determine his/her own need for a prescription or nonprescription PRN medication and is unable to communicate his/her symptoms... (3) The date and time... medication was taken, the dosage taken, and the residen'ts response shall be documented and maintained in the resident's facility record. 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 6 out of 11 residents did not have staff's initials in medication sheet which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/12/2022 Plan of Correction Licensee will ensure that staff are provided in-service training and submit a signing log and agenda of training to the department by 3/12/22.

Official classification

Type B

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 5 out of 11 resident's bathroom were water temperature was tested was at: room #138 tested 104.7 degrees F., #248 tested at 103.7 degrees F., #252 tested 102 degrees F., #259 tested at 99.1 degrees F., and #263 tested at 103.2 degrees F., which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/18/2022 Plan of Correction Administrator will adjust water temperature to the required water temperature and will maintain a log for the next 7 days to be submitted to the department by 3/18/22.

Official classification

Type B

Official code

87303(e)(5)

Regulation authority

CCR

What the official deficiency says

(e) Water supplies and plumbing fixtures shall be maintained as follows: (5) Non-skid mats or strips shall be used in all bathtubs and showers. 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 11 resident's bathroom observed did not have a skid mat in the shower which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/18/2022 Plan of Correction Administrator will ensure each resident is provided a skid mat will provide a picture of skid mat in each bathroom and in service training to staff sigining log and agenda to the department by 3/18/22.

Official classification

Type A

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

87303 Maintenance and Operation: (a) (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 evidence by: Based on interviews conducted Licensee did not ensure facility was free of bed bugs in 9 rooms, which poses an immediate Health, Safety, or Personal rights risk to person in care. *Immediate Civil Penalties assess for repeat violation of $250.*

Official plan of correction

Licensee will ensure pest is under control at all times and to maintain professional pest control services as necessary. Licensee provided copies of pest control service and pest control infection sheet dated 12/13/21 clearing the facility of bed bugs. Deficiency cleared on 12/14/21.

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

Official classification

Type A

Official code

87705(j)

Regulation authority

CCR

What the official deficiency says

87705 Care of Persons with Dementia: (j) The licensee shall have an auditory device or other staff alert feature to monitor exits, if exiting presents a hazard to any resident. This requirement is not met as evidence by: Based on interviews Licensee did not ensure exit door's (to courtyard) alarm batteries were working properly which poses an immediate Health, Safety, or Personal risk to the persons in care.

Official plan of correction

Licensee will ensure alarm system is in working condition. Administrator will maintain a log to track batteries live and will submit log to the department in 7 days. During the visit of 12/1/21 LPA observed alarm working.

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

Official classification

Type A

Official code

87468.1

Regulation authority

CCR

What the official deficiency says

87468.1 Personal Rights of Residents in All Facilities: (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 evidence by: Based on documents review and interview conducted Licensee did not ensure to maintain one entrance point at the facility which poses an immediate health, safety, or personal rights risk for persons in care.

Official plan of correction

Administrator will ensure to maintain one entry point to the facility at all times. In-service training to be provided to staff and submitted to the department on 12/9/21. LPA observed door is closed and inaccessible.

Deadline recorded: Dec 9, 2021. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

1569.625(b)(2)

Regulation authority

HSC

What the official deficiency says

(2) In addition to paragraph (1), training requirements shall also include an additional 20 hours annually, eight hours of which shall be dementia care training, as required by subdivision (a) of Section 1569.626, and four hours of which shall be specific to postural supports, restricted health conditions, and hospice care, as required by subdivision (a) of Section 1569.696. This training shall be administered on the job, or in a classroom setting, or both, and may include online training. 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 9 out of 9 staff files reviewed did not have 20 hours of training in the topics above which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/10/2021 Plan of Correction Administrator will ensure that all staff complete 20 hours yearly training in the topics describe in section HSC 1569.625(b)(2) and submit a copy to the department by 11/10/21.

Official classification

Type B

Official code

87411(c)(1)

Regulation authority

CCR

What the official deficiency says

87411 Personnel Requirements: (c)All RCFE staff who assist residents with personal activities of daily living shall receive ... (1) Staff providing care shall receive appropiate training in first aid from persons qualified by such agencies as American Red Cross. 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 4 out of 9 staff files (S1,S2,S5,S9) reviewed did not have a current CPR training which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/03/2021 Plan of Correction Administrator will ensure that all staff providing care have a current CPR/First Aid training and submit a copy of the certificate by 11/3/21.

Official classification

Type B

Official code

87411(f)

Regulation authority

CCR

What the official deficiency says

87411(f) Personnel Requirements - (f) All personnel, including the licensee and the administrator shall be in good health, and physically and mentally capable of performing assigned task. Good physical health should be verify by health screening, including a chest X-ray or an intradermal test, performed by a physician not more than six (6) months prior to or seven (7) days after employment or licensure... 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 1 out of 9 staff does not have a health screening and 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: 11/03/2021 Plan of Correction Adminsitrator will ensure all staff have all require licensing documents and will provide a copy of the S6's health screening and TB test by 11/3/21 to the department.

Official classification

Type B

Official code

87465(e)

Regulation authority

CCR

What the official deficiency says

For every prescription and non prescription 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. 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 4 out of 12 resident's PRN medication reviewed did not have a label on them which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/26/2021 Plan of Correction Licensee will ensure that all PRN medication is label at all times. Licensing will submit pictures of the medication by 10/26/21.

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 2 out of 13 rooms observed nail polish under the sink in room #223 and all purpose cleaner in room #122 which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/12/2021 Plan of Correction Wellness Coordinator removed the items during the visit. Deficiency cleared during visit.

Official classification

Type B

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 as LPAs observed water temperature as follow in rooms #256 tested at 103.0; #122 tested at 102.3; #130 tested 102.4; #134 tested at 98.5; #136 tested at 102.1; and water temperature in sink area in dinning room tested at 100.4 degrees F which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/18/2021 Plan of Correction Administrator will ensure water temperature is maintain at the required temperature of 105 - 120 degrees F at all times will certify with LIC 9098 and submit a temperature log for each room for the next seven days by 10/18/21.

Official classification

Type A

Official code

87303(i)(1)(B)

Regulation authority

CCR

What the official deficiency says

Facilities shall have signal systems which shall meet the following criteria: (1) All Facilities licensed for 16 or more and all residential facilities having separate floors or buildings shall have a signal system which shall (B) transmit a visual and/or auditory signal to a central staffed location or produce an auditory signal at the living unit loud enough to summon staff. 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 LPAs tested call signal in rooms #134, 239, and 217 and staff did not respond as staff at front desk were not able to visually see light was on to let staff know to assist resident which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/12/2021 Plan of Correction Administrator is to ensure staff at the reception area have a visual or in addition an auditory signal to signal call to be able to respond to residents in a proper amount of time by 10/12/21.