SENIOR MANOR CARE II

Official classification

Type B

Official code

1569.655(a)

Regulation authority

HSC

What the official deficiency says

1569.655(a) Increase in fee rates for elderly residents; 90 days' written notice standing amount of reasons for increase (a) If a licensee...increases the rates...the licensee shall provide no less than 90 days' prior written notice to the residents or the residents' representatives. This has not been met as evidenced by: based on record reviews and interviews conducted, the licensee did not ensure Resident #1's representative was provided a 90 days' prior written notice, which poses a potential health risk to residents in care.

Official plan of correction

Licensee and LPA have agreed that an updated notice will be provided to R1, dated 05/04/26. Notice will be emailed to LPA at MARIO.LEON@DSS.CA.GOV

Deadline recorded: May 4, 2026. 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 having cleaning agents unlocked in bathroom and under kitchen sink which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/27/2024 Plan of Correction Staff removed cleaning agents to a locked area. Licensee will ensure all cleaning agents are locked at all times. As part of plan of correction, licensee will re-train all facility staff on how to keep cleaning supplies locked at all times. Licensee will send proof of training to LPA before POC due date.

Official classification

Type A

Official code

87555(b)(26)

Regulation authority

CCR

What the official deficiency says

(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. 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 enough perishable food for 2 days for 5 residents available at the facility which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/27/2024 Plan of Correction Licensee will ensure facility has eanough perishable food for 2 days at all times. As part of plan of correction licensee will buy enough perisble food as soon as posible and send proof of correction 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) (interview) (record review)], the licensee did not comply with the section cited above in not having a TB test on file for S#1 which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/15/2024 Plan of Correction Licensee will ensure all facility staff have a TB test on file. As plan of correction, licensee will get TB test for S#1 and send proof of correction to LPA before POC due date vial email.

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 [(observation) the licensee did not comply with the section cited above in having the ceiling in living room peeling off which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/15/2024 Plan of Correction Licensee will ensure facility is in good repairs at all times. As part of plan of correction, Licensee will fix ceiling in living room and send proof of correction to LPA via email before POC due date.

Official classification

Type B

Official code

87412(a)(11)

Regulation authority

CCR

What the official deficiency says

(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: (11) A health screening as specified in Section 87411, Personnel Requirements - General. This requirement is not met as evidenced by: Deficient Practice Statement Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in not having a health screening for S#1 on file which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/15/2024 Plan of Correction Licensee will ensure all staff has a health screening on file at all times. As part of plan of correction, licensee will get S#1's health screening and send copy to LPA via email before POC due date.

Official classification

Type B

Official code

1569.319(b)

Regulation authority

HSC

What the official deficiency says

(b) A licensee shall ensure the following requirements are met in providing any internet access device for resident use: This requirement is not met as evidenced by: Deficient Practice Statement Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in not having access to internet available to residents which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/15/2024 Plan of Correction Licensee will ensure all residents have access to internet and internet devices at all times. As part of plan of correction, licensee will contract internet services for resdeint's use. Proof of contratct will be sent 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

(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 [(observation) (interview) (record review)], the licensee did not comply with the section cited above in not documenting medication given to R#1, 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: 04/15/2024 Plan of Correction Licensee will ensure staff documents medication given to all residents at all times. As part of plan of correction, licensee will re-train all facility staff on how to document medication given to residents. Proof of training will be provided to LPA via email beofre POC due date.

Official classification

Type B

Official code

87307A3

Regulation authority

CCR

What the official deficiency says

87307A(3) Equipment and supplies necessary for personal care and maintenance of adequate hygiene practice shall be readily available to each resident. The resident may provide the following items; however, if the resident is unable or chooses not to provide them, the licensee shall assure provision of.. This standard was not met as evidenced by: Based on LPA interview Resident 3 stated that they did not have a toothbrush or toothpaste, and was not provided one by the facility. This poses a potential health, safety and personal rights risk to residents in care

Official plan of correction

Facility will Provide proof of basic toothbrush and toothpaste for resident and will send an email photo to : Jade.Jordan@dss.ca.gov by POC due date of 04/04/22

Deadline recorded: Apr 4, 2022. A deadline is not proof that correction was completed.