SENIOR MANOR CARE

Official classification

Type B

Official code

87555(b)(26)

Regulation authority

CCR

What the official deficiency says

General Food Service Requirements (b) The following food service requirements shall apply: (26) Supplies of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days shall be maintained on the premises. Based on observation, interviews and records, the licensee did not comply with the section cited above in not having enough perishable food items for a minimum of two days for residents in care.

Official plan of correction

On 3/26/2025, facility staff brought food to the facility which consisted of over 6 grocery bags. The Licensee/Administrator agrees to create a plan to maintain perishable foods for a minimum of two days. The licensee will re-train staff on meal procedures for seconds. Email proof of correction to Socorro.Leandro@dss.ca.gov

Deadline recorded: Apr 15, 2025. 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 - General (a) Facility personnell...shall be sufficient in numbers...to provide the services...to meet resident needs. Additional staff... employed...to perform...maintenance...and grounds. This regulation has not been met as evidenced by: Based on CCLD staff's observation and record reviews, the licensee did not ensure sufficient staff were present at the facility overnight which poses a potential health, safety, or personal rights risk to residents in care.

Official plan of correction

CCLD staff and Administrator, Steven Gradney (S2), have spoken and have agreed that the administrator/licensee will hire an overnight staff in order to attend to residents' needs while in care. S2 will send an updated LIC500 to LPA Leon, via email, at MARIO.LEON@DSS.CA.GOV

Deadline recorded: Oct 2, 2024. A deadline is not proof that correction was completed.

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. This regulation has not been met as evidenced by: Based on observation, interviews, and record reviews, the licensee did not ensure the facility was clean, safe and sanitary. Licensee did not ensure the facility was serviced for vermin 6 weeks which poses a potential health, safety, or personal rights risk to residents in care.

Official plan of correction

LPA's and Administrator, Steven Gradney (S2), have spoken and have agreed that the administrator/licensee will submit updated reports on the status of the vermin control to LPA Leon, via email, at MARIO.LEON@DSS.CA.GOV

Deadline recorded: Oct 15, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87555(b)(8)(23)

Regulation authority

CCR

What the official deficiency says

87555 - General Food Service Requirements (b) ...food...requirements shall apply: (8) All food shall be of good quality...(23)...readily perishable foods or beverages...growth of micro-organisms which can cause food infections... appropriate temperature. This has not been met as evidenced by: Based on CCLD Staff observations, the licensee did not store condiments in it's appropriate temperature and cut fruit left in the refrigerator while not properly stored in a sealed compartment which poses a potential health, safety, or personal rights risk to residents in care.

Official plan of correction

CCLD and Steven Gradney, Administrator (S2), have agreed that all food items are to be handled and stored appropriately to preserve the best nutritional value. Administrator has agreed to discard the condiments and will ensure that food will follow nutritional guidelines, as suggested.

Deadline recorded: Sep 18, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87465(a)(4)

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. The plan...by obtaining such care...by compliance with the following: (4) The licensee shall assist residents with self-administered medications as needed. This has not been met as evidenced by: CCLD Staff reviewed MAR of R1 and observed no record of admission of a medication, between the dates of 09/01/24 - 09/18/24, as ordered by R1's Dr., which poses a potential health, safety, or personal rights risk to residents in care.

Official plan of correction

CCLD and Steven Gradney, Administrator (S2), have agreed that an in-staff training on medication managment will be conducted with all staff working or residing at the facility. S2 has also agreed for all staff who are assisting residents with their medication to agree, and sign, that Dr.'s orders will be consistently met moving forward.

Deadline recorded: Sep 18, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87303(f)(3)

Regulation authority

CCR

What the official deficiency says

(f) Solid waste shall be stored and disposed of as follows: (3) All containers, except movable bins, used for storage of solid wastes shall have tight-fitting covers on the containers; shall be in good repair; shall have external handles; and shall be leakproof and rodent-proof. 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 not having in good repair the waste container which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/18/2024 Plan of Correction Licensee will ensure all waste containers are in good repair. As plan of correction, Licensee will replace waste container and sent proof to LPA before POC due date.

Official classification

Type B

Official code

87506(b)(16)

Regulation authority

CCR

What the official deficiency says

(b) Each resident's record shall contain at least the following information: (16) Records of resident's cash resources as specified in Section 87217, Safeguards for Resident Cash, Personal Property, and Valuables. 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 residents R#1,R#2 and R#3 missing their SPV form on file which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/18/2024 Plan of Correction Licensee will ensure all residents have a SPV form on file. AS plan of correction, licensee will have the missing SPV forms completed and will sent a proof to LPA via email 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 [(observation) (record review)], the licensee did not comply with the section cited above in not having a medical assesssment for R#1 and R#3 which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/18/2024 Plan of Correction Licensee will ensure all residents have a medcial assessement on file. As part of POC licensee will complete missing medical assessment and send proof 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) (record review)], the licensee did not comply with the section cited above in having a TB test on file for R#2 and R#3 which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/18/2024 Plan of Correction Licensee will ensure all residents have a TB test on file. As part of POC licensee will complete missing TB test and send proof LPA via email before POC due date.

Official classification

Type B

Official code

87507(g)(10)(G)

Regulation authority

CCR

What the official deficiency says

(G) The rights of the resident and the responsibilities of the licensee regarding closure plans, relocation evaluations and assistance, and providing notice when a licensee evicts residents as specified in Health and Safety Code sections 1569.682 and 1569.683. 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 residents rights on file for R#3 which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/18/2024 Plan of Correction Licensee will ensure all residents have a personal rights on file. As part of POC licensee will complete missing form and send proof LPA via email before POC due date.

Official classification

Type A

Official code

87705(f)(2)

Regulation authority

CCR

What the official deficiency says

(f) The following shall be stored inaccessible to residents with dementia: (2) Over-the-counter medication, nutritional supplements or vitamins, alcohol, cigarettes, and toxic substances such as certain plants, gardening supplies, cleaning supplies and disinfectants. 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 having all cleaning agents unlocked which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/01/2024 Plan of Correction Licensee will ensure that all cleaning agents are locked at all times. As POC Licensee will retrain staff on how to properly keep cleaning agents locked at all times. Proof of training will be sent to LPA via email.

Official classification

Type A

Official code

87211(a)(D)

Regulation authority

CCR

What the official deficiency says

Any incident which threatens the welfare, safety or health of any resident, such as psychological abuse of a resident by staff or other residents, or unexplained absence of any resident. This was not met as evidence by: based on resident wandered out the facility unsupervised which poses a health and safety risk for all persons in care

Official plan of correction

Administrator to conduct a training session on how to avoid having resdient leave the facility without supervision. Send training and log with signatures to LPA.

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

Official classification

Type A

Official code

87464(f)(1)

Regulation authority

CCR

What the official deficiency says

Basic services shall at a minimum include: Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). This was not met as evidence by: Based on based on resident wandered out the facility unsupervised. Which poses a health and safety risk for all persons in care

Official plan of correction

Administrator to conduct a training session on how to avoid having resdient leave the facility without supervision. Send training and log with signatures to LPA.

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

Official classification

Type B

Official code

87468.2(a)(19)

Regulation authority

CCR

What the official deficiency says

To have prompt access to review all of their records and to purchase photocopies of their records.....This was not as evidence by: based on facility failing to provided requested records within 2 business day as per TITLE 22 regulations.

Official plan of correction

Adminsitrator to provide complete file to attorney. Send proof of delivered file to LPA.

Deadline recorded: Jul 3, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

87303(a) -The facility shall be clean, safe, sanitary and in good repair at all times...This was not met as evidence by: Based on room floor bubbling.

Official plan of correction

Administrator to repair and send copy of repair invoice to LPA on or before POC due date.

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

Official classification

Type B

Official code

87468.1(a)(2)

Regulation authority

CCR

What the official deficiency says

87468.1(a)(2) 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,... Based on observations and interviews staff were not wearing a mask. Which poses a potential health and safety risk to persons in care.

Official plan of correction

Administrator will instruct and perform training with all staff on when and how to wear mask while working at facility. Administrator will provide to LPA a sign-in sheet with staff signatures as proof that staff attended training by the POC due date: 02/07/2023

Deadline recorded: Jan 25, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

873039a

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 was not met as evidence by: Based on specific areas of facility needed paint, repair and replacement floor boards. Which poses a potential healtha dn safety risk to the persons in care.

Official plan of correction

Administrator to repair, paint, clean and/or replace any material needed to fix problems. Provide pictures of repairs and copy of invoice of repairs completed on or before POC due date.

Deadline recorded: Sep 5, 2022. A deadline is not proof that correction was completed.

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 was not met as evidence by: Based on ants in the kitchen room #2 & room #4. Which poses a potential healtha dn safety risk to the persons in care.

Official plan of correction

Administrator to treat facility for insects. Provide pictures of treament products used to treat facility on or before POC due date.

Deadline recorded: Aug 19, 2022. A deadline is not proof that correction was completed.

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: On 11/23/2021, LPA observed a cover for a kitchen drawer is missing, bathroom sink is clogged, and a ramp in the backyard is broken. This poses a potential Health, Safety and/or Personal rights risk to residents in care.

Official plan of correction

Licensee/Administrator shall repair the drawer, sink and the ramp by the POC due and email proof of corrections to Lourdes.Montoya@dss.ca.gov

Deadline recorded: Dec 3, 2021. A deadline is not proof that correction was completed.