MOON LIGHT BOARDING CARE INC

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, interview, and record review, the licensee did not comply with the section cited above in S3 does not have a fingerprint clearance which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/05/2025 Plan of Correction Administrator requested staff to leave for the day and will wait until clearance for S3 for staff to return to work. *Civil penalties were assess for $500.00.*

Official classification

Type B

Official code

87412(g)

Regulation authority

CCR

What the official deficiency says

(g) All personnel records shall be maintained at the facility. 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 administrator's file was not at the facility at the time of the visit which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/11/2025 Plan of Correction Administrator will ensure all files are kept at the facility at all times and will provide a copy of administrator's file to the department by POC due date 2/11/25.

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 in R3 does not have a TB test clearance on file which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/11/2025 Plan of Correction Administrator will obtain a TB test clearance for R3 and will submit a copy to the department by POC due date 2/11/25.

Official classification

Type B

Official code

87608(a)(5)(A)

Regulation authority

CCR

What the official deficiency says

(A) A bed rail that extends from the head half the length of the bed and used only for assistance with mobility shall be allowed. 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 2 out of 3 residents do not have physician's bed rail request on file which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/18/2025 Plan of Correction Administrator will request a physician's order/request for half bed rails for R1 and will send an exception request for R3 along with physician's bed rail request, physician's letter, and physician's report to the department by POC due date 2/18/25.

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 water temperature in bathroom #1 tested at 126.1 degrees F., #2 tested at 113.5 degrees F., #3 tested at 122.5 degrees F., and #4 tested at 124.7 degrees F., which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/02/2024 Plan of Correction Administrator will adjust water temperature and will submit in writing certifying will ensure water temperature is within the 105-120 degrees at all times by POC due date 2/2/24. A daily log will be keep for the next 7 days of temperature in each bathroom and will be submitted to the department on 2/8/24.

Official classification

Type B

Official code

87608(a)(3)

Regulation authority

CCR

What the official deficiency says

(a) Based on the individual's preadmission appraisal, and subsequent changes to that appraisal, the facility shall provide assistance and care for the resident in those activities of daily living which the resident is unable to do for himself/herself. Postural supports may be used under the following conditions: (3) A written order from a physician indicating the need for the postural support shall be maintained in the resident's record. The licensing agency shall be authorized to require other additional documentation if needed to verify the order. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation andn record review, the licensee did not comply with the section cited above in resident #2 (R2) has bed rails in bed and a physician's request is not on file which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/08/2024 Plan of Correction Administrator will submit a copy of physician request for half bed rails to the department by POC due date 2/8/24.

Official classification

Type A

Official code

87355(e)(1)

Regulation authority

CCR

What the official deficiency says

87355 Criminal Record Clearance: (e) All individuals subject to a criminal record review... shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department... This requirement is not met as evidence by: Based on observation, interviews, and documents review S1 has been working at the facility since 12/2/23 without a background clearance which poses an immediate risk to the health, safety, or personal rights of the persons in care.

Official plan of correction

Administrator asked staff to leave and staff will return once background clearance is verify. Administrator will certify in writting to the department that will ensure all staff are cleared before starting to work.

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