INDIAN PEAK MANOR

Official classification

Type B

Official code

87303(c)

Regulation authority

CCR

What the official deficiency says

(c) All window screens shall be clean and maintained in good repair. 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 bedroom four (4). Window screen shall be replaced, as the screen does have a hole. Screens shall also be regularly maintained which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/10/2024 Plan of Correction LPA and Administrator have agreed that the screens will be replaced, and cleaned, as requested on, or prior to, the POC due date. Administrator will send photo/video evidence of the correction to LPA at MARIO.LEON@DSS.CA.GOV.

Official classification

Type B

Official code

87303(e)(6)

Regulation authority

CCR

What the official deficiency says

(e) Water supplies and plumbing fixtures shall be maintained as follows: (6) Toilet, handwashing and bathing facilities shall be maintained in operating condition. Additional equipment shall be provided in facilities accommodating physically handicapped and/or nonambulatory residents, based on the residents' needs. 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 both sinks in bathroom number two (#2) are currently clogged, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/03/2024 Plan of Correction The facility has corrected this deficiency while LPA was on-site.

Official classification

Type B

Official code

87705(c)(5)

Regulation authority

CCR

What the official deficiency says

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 for three out of five resident which poses a potential health rights risk to persons in care. LPA did not observe an annual medical assessments (LIC 602) nor reappraisals for residents #3, #4, and #5 diagnoised with dementia. LPA and staff reviewed the files together.

Official plan of correction

POC Due Date: 01/19/2024 Plan of Correction Glenda Marquez will email updated medical assessments (LIC 602) and reappraisal for residents #3, #4, and #5 to regina.cloyd@dss.ca.gov by January 19, 2024. Glenda will ensure that all dementia residents have an annual medical assessment and all clients in care will have an annual reappraisals or whenever there is a change in condition, whichever occurs first. Documents will be maintained in the resident's file.

Official classification

Type B

Official code

87412(d)

Regulation authority

CCR

What the official deficiency says

(d) The licensee shall maintain documentation that an administrator has met the certification requirements specified in Section 87406, Administrator Certification Requirements or the recertification requirements in Section 87407, Administrator Recertification Requirements. 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. LPA did not observe that the administrator recertification requirements were met which poses a potential safety and personal rights risk to persons in care. LPA had the discussion with Glenda Marquez.

Official plan of correction

POC Due Date: 01/19/2024 Plan of Correction Glenda Marquez will submit RCFE Administrator Recertification application and submit proof of correction to regina.cloyd@dss.ca.gov by the POC due date. Administrator will ensure that recertification application is postmarked before the expiration due date.

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 was not met as evidence by: Based on observations and photographs, the licensee failed to keep the facility in good repair at all times, having a broken mirror door closet in one of the resident's rooms and rusted closet railings in 3 residents' rooms. This poses a potential health and safety risk to all residents in care.

Official plan of correction

The licensee will replace the broken door and rusted railing before the POC due date. Proof of correction must be emailed to LPA before the due date.

Deadline recorded: Nov 2, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87208(a)(1)

Regulation authority

CCR

What the official deficiency says

87208 Plan of Operation (a) Each facility shall have and maintain a current, written definitive plan of operation. The plan and related materials shall be on file in the facility and shall be submitted to the licensing agency with the license application. 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: (1) Statement of purposes and program goals. This requirement was not met as evidence by: Based on observation and records review, the licensee failed to follow the original facility's Plan of Operations and Admissions Agreement in having four small dogs living inside the facility. This poses a potential health and safety risk to all residents in care.

Official plan of correction

The licensee will submit an addendum to their Admissions Agreement, Plan of Operations, a signature of all residents and their representatives stating that they are okay with the dogs being inside the facility and all dogs must be licensed and with their current shoots as POC. Proof of correction must be email to LPA before POC due date.

Deadline recorded: Nov 2, 2023. 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

87309 Storage Space (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 was not met as evidenced by: Based on observation, during a physical tour of the facility, LPA observed cleaning solutions not locked under the kitchen sink. This violation poses an immediate health and safety risk to clients in care.

Official plan of correction

Licensee will ensure all cleaning solutions are locked at all times. Licensee locked cleaning solutions while LPA was in the facility. As part of POC, licensee will re-train all staff on how to keept cleaning solutions lock at all times. Licensee will sent a copy of this training before POC due date to LPA via email.

Deadline recorded: Aug 17, 2023. A deadline is not proof that correction was completed.