GARDEN GROVE VILLA

Official classification

Type B

Official code

87211(a)(2)

Regulation authority

CCR

What the official deficiency says

87211(a) Each licensee shall furnish to the licensing agency... the following: (2) Occurrences, such as epidemic outbreaks, poisonings, catastrophes or major accidents..., shall be reported within 24 hours ... This requirement was not met as evidenced by: Based on interviews, observations, and record review, the licensee did not comply, by failing to notify the Department within 24 hours of an incident involving Resident #1 on 12/01/2025. This posed a potential health and safety risk to residents in care.

Official plan of correction

Administrator shall retrain all staff on 87211(a)(2) Reporting requirements for unusual incidents, including missing residents.Administrator shall implement a written procedure for immediate reporting of any resident absence or unusual incident. Proof of staff training and a copy of the updated reporting procedure shall be submitted to LPA by the POC due date.

Deadline recorded: Dec 16, 2025. 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

87464 Basic Services (f) Basic services shall at a minimum include: (1) Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). Based on interviews, observation and record review the licensee did not comply with the section cited by allowing residents with mild cognitive impairment and hearing loss were permitted to leave without supervision, contrary to physician precautions.

Official plan of correction

Administrator to conduct training on supervision requirements, provide documentation of staff retraining, and implement a check-out/check-in system. A proof of training to be submitted to LPA by the POC due date (12/11/2025). Two residents who were not permitted to leave unassisted were still able to leave without staff awareness.

Deadline recorded: Dec 11, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87705(5)(A)

Regulation authority

CCR

What the official deficiency says

Care of Persons with Dementia (5) Each resident with dementia shall have an annual...... as specified in Section 87458, Medical Assessment,,,,,, care needs. (A) ...., changes shall be made in the care and supervision provided......... This requirement was not met as evidenced by: Based on interviews & record review, the licensee did not ensure that the staff redirected or followed R1 when he left the facility unsupervised which poses a potential health & safety risk to residents in care.

Official plan of correction

Administrator will conduct an in service training with all staff and will submit statement of understanding regardng this seciton.

Deadline recorded: Aug 28, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87506(a)

Regulation authority

CCR

What the official deficiency says

87506 Resident Records: (a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location This requirement is not met as evidenced by: Based on record review, the licensee did not comply with the section cited above. Resident records were incomplete and or missing signatures, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Administrator agreed to complete and update all four out of four residents records by the POC date.

Deadline recorded: Aug 28, 2024. A deadline is not proof that correction was completed.

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: (f) The following shall be stored inaccessible to residents with dementia: (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 two of out two bottles of cleaning supplies and disinfectants sprays in bedroom # four (4) and six full bottles of supplements ordered by the resident in bedroom # six (6), accisseble to residents in care which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/12/2024 Plan of Correction Administrator immediately removed the cleaning supplies as well as the supplements bottles from two resident's rooms. POC cleared during the visit.

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 and interviews, the licensee failed to ensure that the facility is clean, safe, sanitary and in good repair at all times with bedrooms # one (1), four (4), and six (6) not clean and sanitary with a strong odor which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/19/2024 Plan of Correction Administrator agreed to do a deep cleaning for the bedrooms and submit a picture to LPA by the due date.