PALOS VERDES VILLA LLC

Official classification

Type B

Official code

87411(c)

Regulation authority

CCR

What the official deficiency says

This requirement is not met as evidenced by: Deficient Practice Statement Based on observation record review, the licensee did not comply with the section cited above in having an expired CPR card for one of the direct care staff which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/03/2023 Plan of Correction Administrator will ensure all direct care staff will have current CPR cards on files. Administrator will submitt unexpired CPR to LPA via email before POC due date.

Official classification

Type B

Official code

87411(f)

Regulation authority

CCR

What the official deficiency says

(f) All personnel, including the licensee and administrator, shall be in good health, and physically and mentally capable of performing assigned tasks. Good physical health shall be verified by a 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. A report shall be made of each screening, signed by the examining physician. The report shall indicate whether the person is physically qualified to perform the duties to be assigned, and whether he/she has any health condition that would create a hazard to him/herself, other staff members or residents. A signed statement shall be obtained from each volunteer affirming that he/she is in good health. Personnel with evidence of physical illness or emotional instability that poses a significant threat to the well-being of residents shall be relieved of their duties. 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 not having a staff TB test on file which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/03/2023 Plan of Correction Administrator will ensure missing staff's TB test is perfomed and administrator will ensure all staff TB tests are on file. Administrator will submitt proof of correction to LPA via email before POC due date.

Official classification

Type B

Official code

1569.605

Regulation authority

HSC

What the official deficiency says

On and after July 1, 2015, all residential care facilities for the elderly, except those facilities that are an integral part of a continuing care retirement community, shall maintain liability insurance covering injury to residents and guests in the amount of at least one million dollars ($1,000,000) per occurrence and three million dollars ($3,000,000) in the total annual aggregate, caused by the negligent acts or omissions to act of, or neglect by, the licensee or its employees. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and records review, the licensee did not comply with the section cited above in not having a current proof of liability insurance on file which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/03/2023 Plan of Correction Administrator will ensure liability insurance is current and on file. Administrator will send proof of current liability insurance to LPA via email before POC due date.

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

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 observations the licensee did not comply with the section cited above in having the screen doors in disrepair on rooms: #3, #35 and #38 which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/03/2023 Plan of Correction Administrator will ensure facility is in good repair at all times. Administrator will send proof of repair to LPA via email before POC due date.

Official classification

Type B

Official code

1569.618(a)

Regulation authority

HSC

What the official deficiency says

(a) The administrator designated by the licensee pursuant to paragraph (11) of subdivision (a) of Section 1569.15 shall be present at the facility during normal working hours. A facility manager designated by the licensee with notice to the department, shall be responsible for the operation of the facility when the administrator is temporarily absent from the facility. This requirement is not met as evidenced by: Deficient Practice Statement Based on observations and record review the licensee did not comply with the section cited above in not having a 3rd administrator designee avalaible when the the other designees are not present, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/03/2023 Plan of Correction Administrator will ensure to choose a 3rd designee to cover when the other two administartors are off or out. Administrator will submitt a new designee to Regional Office before POC due date.

Official classification

Type B

Official code

87458(a)

Regulation authority

CCR

What the official deficiency says

(a) Prior to a person's acceptance as a resident, the licensee shall obtain and keep on file, documentation of a medical assessment, signed by a physician, made within the last year. The licensee shall be permitted to use the form LIC 602 (Rev. 9/89), Physician's Report, to obtain the medical assessment. This requirement is not met as evidenced by: Deficient Practice Statement Based on observations and records review, the licensee did not comply with the section cited above in not having a medical assesment for resident which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/03/2023 Plan of Correction Administrator will ensure missing medical assesment will be completed and filed on resident's file. Administrator will send proof of correction to LPA via email before POC due date.

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 observation and records review, the licensee did not comply with the section cited above in not having a proof of TB test on resident's file which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/03/2023 Plan of Correction Administrator will ensure missing resident TB test will be done and file. Administrator will ensure all resident's TB tests are on file and conducted. A proof of the test will be sent to LPA via email before POC due date.

Official classification

Type B

Official code

1569.695(c)

Regulation authority

HSC

What the official deficiency says

(c) A facility shall conduct a drill at least quarterly for each shift. The type of emergency covered in a drill shall vary from quarter to quarter, taking into account different emergency scenarios. An actual evacuation of residents is not required during a drill. While a facility may provide an opportunity for residents to participate in a drill, it shall not require any resident participation. Documentation of the drills shall include the date, the type of emergency covered by the drill, and the names of staff participating in the drill. This requirement is not met as evidenced by: Deficient Practice Statement Based on observations and records review, the licensee did not comply with the section cited above in not having information avaliabe to LPA regarding last fire drill conducted which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/03/2023 Plan of Correction Administrator will ensure fire drill date is avalaible when licensing is conducting annual evaluations/case managment/complaint visits. Administrator will sent proof of the last 4 fire drills conducted by the facility to LPA via email before POC due date.

Official classification

Type B

Official code

87465(c)(2)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care. (c) If the resident's physician has stated in writing that the resident. (2) Once ordered by the physician the medication is given according to the physician's directions. This requirement is not met as evidenced by: Based on observation the licensee failed to train staff in the proper way to pass out medication to residents in care, which poses a potential health and personal rights risk to residents in care.

Official plan of correction

The Administrator will conduct in-service training on Title 22 Regulations 87465 (c)(2) with all staff and submit a copy of the sign-in sheet to LPA by POC date.

Deadline recorded: Jul 14, 2023. A deadline is not proof that correction was completed.