GRANT SERENITY OF DEL MAR INC.

Official classification

Type A

Official code

87608(a)(5)(B)

Regulation authority

CCR

What the official deficiency says

Postural Supports. 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: Based on observation, R1's bed has full bed rails, and residents (R2 & R3's) beds had three-quarter length and none of the residents are enrolled in hospice care, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

Staff removed the bed rails during the visit. Resident files were reviewed. LPA confirmed that all three residents have current half rail bed physician orders. **Citation cleared during the visit.

Deadline recorded: May 22, 2026. 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

(a) residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (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 was not met as evidenced by: staff did not following instructions pertaining to pressure injury care which resulted in R6's worsening pressure injuries. This poses an immediate risk to the health, safety, or personal rights of persons in care.

Official plan of correction

Licensee will develop and submit a plan outlining the procedures and protocols for ensuring that staff adhere to specific care instructions for residents. Plan must be received by 12/08/25 via email to LPA Ramirez. Kimberly.ramirez@dss.ca.gov

Deadline recorded: Dec 8, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

(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 facility carbon monoxide detector did not work at time of inspection which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/21/2025 Plan of Correction Licensee had batteries changed at time of visit POC cleared.

Official classification

Type A

Official code

87411(a)

Regulation authority

CCR

What the official deficiency says

(a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. In facilities licensed for sixteen or more, sufficient support staff shall be employed to ensure provision of personal assistance and care as required in Section 87608, Postural Supports. Additional staff shall be employed as necessary to perform office work, cooking, house cleaning, laundering, and maintenance of buildings, equipment and grounds. The licensing agency may require any facility to provide additional staff whenever it determines through documentation that the needs of the particular residents, the extent of services provided, or the physical arrangements of the facility require such additional staff for the provision of adequate services. 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 staff was falsifying medication administration record stating medication was given to residents and medication was in fact missing from facility which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/21/2025 Plan of Correction Licensee will provide detailed training on medication and how to properly complete MAR log when being used and send to LPA by POC due date. Staff will also be trained on the importance of not falsifying documents.

Official classification

Type A

Official code

87465(a)(5)(D)

Regulation authority

CCR

What the official deficiency says

(5) Facility staff, except those authorized by law, shall not administer injections, but staff designated by the licensee may assist persons with self-administration as needed. Assistance with self-administered medications shall be limited to the following: (D) Assistance with self-administration does not include forcing a resident to take medications, hiding or camouflaging medications in other substances without the resident's knowledge and consent, or otherwise infringing upon a resident's right to refuse to take a medication. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above LPA observed S3 putting a crushed pill in R6's cottage cheese with no orders on file which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/22/2025 Plan of Correction Licensee will obtain orders from physicians stating crushed pills in food is permited for R2 and send to LPA by POC due date.

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 record review, the licensee did not comply with the section cited above in four (4) out of six (6) residents were missing medication which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/15/2025 Plan of Correction Licensee order all medication and send LPA pictures as proof by POC due date. R5- Carvedil 3.125 MG. R2 Melatonin,Sorbitol 30 MG PRN, Folic Acid, Bisacodyl PRN, and Haldol PRN. R4 Vitamin D2. R3 Melatonin, and Quetiapine 25 MG.

Official classification

Type B

Official code

87458(c)(1)

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: 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 R6 was missing completed physicians report (602) and R4 was missing appraisal needs and service plan, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/04/2025 Plan of Correction Licensee will email documents by POC due date.

Official classification

Type B

Official code

87505

Regulation authority

CCR

What the official deficiency says

87505 Documentation and Support: Each facility shall document ...any reappraisal or assessment which was necessary...If supporting documentation from a physician is required, this input shall also be obtained and may be the same assessment... This requirement is not met as evidence by: Based on record review and interviews licensee did not ensure R1 was evaluated by a medical professional to determine level of care which poses a potential risk to the health, safety, or personal rights of the persons in care.

Official plan of correction

Licensee will certify in writing that will ensure that a medical professional determines the need of level of care and will ensure that administrator obtains training on prohibited health conditions, higher level of care determination of care and submit a copy to the department by POC due date 4/24/25.

Deadline recorded: Apr 24, 2025. 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 of Residents...: (a)... shall have all of the following personal rights: (4) To care, supervision, and services that meet their individual needs and are delivered by staff... to meet their needs. This requirement is not met as evidence by: Based on interviews and document review conducted licensee failed to prevent R1 developed stage 3 and 4 wounds within 7 days of admission which poses an immediate health, safety, or personal rights risk to the persons in care.

Official plan of correction

Administrator will provide staff with hospice, repositioning, wound prevention, observation, and care and submit a copy of training log with duration, topic, and sign-in log to the department by POC due date 11/6/24.

Deadline recorded: Nov 6, 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 cleaning supplies were observed accessible to the residents next to the dryer, and cabinet under sink was unlock which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/06/2023 Plan of Correction Administrator removed all cleaning supplies next to dryer and staff lock cabinet during the visit. Deficiency cleared during the visit.

Official classification

Type A

Official code

1569.17(b)(1)(C)

Regulation authority

HSC

What the official deficiency says

(C) Any person who provides client assistance in dressing, grooming, bathing, or personal hygiene. Any nurse assistant or home health aide meeting the requirements of Section 1338.5 or 1736.6, respectively, who is not employed, retained, or contracted by the licensee, and who has been certified or recertified on or after July 1, 1998, shall be deemed to meet the criminal record clearance requirements of this section. A certified nurse assistant and certified home health aide who will be providing client assistance and who falls under this exemption shall provide one copy of their current certification, prior to providing care, to the residential care facility for the elderly. The facility shall maintain the copy of the certification on file as long as the care is being provided by the certified nurse assistant or certified home health aide at the facility. Nothing in this paragraph restricts the right of the department to exclude a certified nurse assistant or certified home health aide from a licensed residential care facility for the elderly pursuant to Section 1569.58. 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 Licensee did not ensure Staff #4 (S4) background clearance was cleared before working which poses an immediate health, safety or personal rights risk to persons in care. *Immediate Civil Penalties Assess*

Official plan of correction

POC Due Date: 10/06/2023 Plan of Correction Administrator asked S4 to leave during the visit. Administrator will certify in writing that before any staff begins working will ensure they are eligible for work before start date to the department by POC due date 10/6/23.

Official classification

Type A

Official code

87355(e)(3)

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: (3) Request a transfer of a criminal record clearance as specified in Section 87355(c) or 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 S2 and S3 were not transfer/ associated to the facility which poses an immediate health, safety or personal rights risk to persons in care. *Immediate Civil Penalites Assess*

Official plan of correction

POC Due Date: 10/06/2023 Plan of Correction Administrator will obtain access to Guardian and associate S2 and S3 to the facility and provide a copy of Guardian facility's list by POC due date 10/6/23

Official classification

Type B

Official code

87412(f)

Regulation authority

CCR

What the official deficiency says

(f) All personnel records shall be available to the licensing agency to inspect, audit, and copy upon demand during normal business hours. Records may be removed if necessary for copying. Removal of records shall be subject to the following requirements: 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 S5's file was not available for review 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: 10/12/2023 Plan of Correction Administrator will provide a copy of S5's file to the department by POC due date 10/12/23.

Official classification

Type B

Official code

1569.625(b)(1)

Regulation authority

HSC

What the official deficiency says

(1) The department shall adopt regulations to require staff members of residential care facilities for the elderly who assist residents with personal activities of daily living to receive appropriate training. This training shall consist of 40 hours of training. A staff member shall complete 20 hours, including six hours specific to dementia care, as required by subdivision (a) of Section 1569.626 and four hours specific to postural supports, restricted health conditions, and hospice care, as required by subdivision (a) of Section 1569.696, before working independently with residents. The remaining 20 hours shall include six hours specific to dementia care and shall be completed within the first four weeks of employment. The training coursework may utilize various methods of instruction, including, but not limited to, lectures, instructional videos, and interactive online courses. The additional 16 hours shall be hands-on training. 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 4 staff files reviewed did not have sufficient hours of training on file, LPA observed 4 training logs without duration of training which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/19/2023 Plan of Correction Administrator will provided 40 hours of initial training in all the required areas and submit a copy of training to the department by POC due date 10/19/23.