CALIFORNIA MISSION INN

Official classification

Type A

Official code

87355(e)(2)(3)

Regulation authority

CCR

What the official deficiency says

87355(e)(2)(3) (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility:(2)Obtain a California clearance or a criminal record exemption as required by the Department or (3)Request a transfer of a criminal record clearance as specified in Section 87355(c). This requirement was not met as evidenced by: Contractor #1 was present in facility without a criminal record clearance and was not associated to facility.

Official plan of correction

Administrator will obtain criminal record clearance and associate contractor #1 before being allowed in facility to assist residents .Administrator will send proof to LPA. $500 immediate civil penalty assessed. Contractor was sent home by faclity.

Deadline recorded: Mar 18, 2026. 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

Personnel Requirements -General (a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs....for sixteen or more, sufficient support staff shall be employed to ensure provision of personal assistance... This requirement is not met as evidenced by: Statements from staff and residents in care, revealed that staff are not responding to the call light assistance within a reasonable time frame which poses a potential health and safety risk to residents in care.

Official plan of correction

The Administrator will provide an in-service training to all staff on Personnel Requirements and ensure that all staff are adhering to the residents call light request. Provide the in service sign in sheet with staff signatures and topics discussed by POC due date 02/06/2025

Deadline recorded: Feb 6, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87625(a)(1)(c)

Regulation authority

CCR

What the official deficiency says

Managed Incontinence. The licensee shall be permitted to accept or retain a resident who has a manageable bowel and/or bladder incontinence condition under the following circumstances: (1) The condition can be managed with any of the following: A program of scheduled toileting at regular intervals. This requirement was not met evidenced by: Statement obtained from staff and resident stated R1 was left in soiled diaper for unreasonable time.

Official plan of correction

The Administrator will review Title 22 Regulations, Section 87625 on Managed Incontinence and conduct an in-service training with all staff and provide a copy of the sign in sheet of all attendees along with the topics covered during the in-service training. POC is due to CCL by 02/06/2025

Deadline recorded: Feb 6, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87615(a)(1)

Regulation authority

CCR

What the official deficiency says

Prohibited Health Conditions. Persons who require health services for or have a health condition including, but not limited to, those specified below shall not be admitted or retained in a residential care facility for the elderly: Stage 3 and 4 pressure injuries. This requirement was not met evidenced by: Based on record review, the licensee did not comply with the section cited above in that staff did not follow Plan of Care, were doing wound care, and retained the resident with a Stage 3 pressure injury; which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

Licensee/Administrator agrees to conduct staff training on regulation 87615, resident Care Plans, and Specialized Care Plans. Submit by tomorrow a written statement of how this deficiency will be corrected. In addition, submit proof of staff training; which includes staff signatures by 3/22/2023.

Deadline recorded: Mar 18, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87466

Regulation authority

CCR

What the official deficiency says

Observation of the Resident. The licensee shall ensure that residents are regularly observed for changes in physical, mental, emotional and social functioning and that appropriate assistance is provided when such observation reveals unmet needs.....the licensee shall ensure that such changes are documented and brought to the attention of the resident's physician and the resident's responsible person, if any. This requirement has not been met as evidenced by: Based on medical record review and investigation report, staff failed to provide routine and MD order repositioning of R1 to prevent to prevent the advancement of pressure injuries. This poses an immediate a health and safety risk to the residents in care.

Official plan of correction

Licensee/Administrator agress to conduct staff training on regulation 87466, and staff communication protocols regarding changes in residents conditions. Submit by tomorrow a written plan of how the deficiency will be corrected. Submit proof that staff were trained by 3/22/2023.

Deadline recorded: Mar 21, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87411(d)(3)

Regulation authority

CCR

What the official deficiency says

Personnel Requirements - General. All personnel shall be given on the job training or have related experience in the job assigned to them. This training and/or related experience shall provide knowledge of and skill in the following....(3) Skill and knowledge required to provide necessary resident care and supervision, including the ability to communicate with residents. This requirement was not met evidenced by: Based on investigation report, medical records, and interviews conducted staff failed to do reposition/rotation care as needed, and resident had to call front desk staff to reposition and assist with incontinence care; which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Administrator agrees to conduct staff training on incontinence care, care and supervision, and adherence to facility Plan of Operation protocol procedures; which may include hiring additional staff. Submit proof of correction to CCLD by POC due date.

Deadline recorded: Mar 22, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

1569.50(a)(3)

Regulation authority

HSC

What the official deficiency says

(a)(3) Conduct that is inimical to the health, morals, welfare, or safety of either an individual in or receiving services from the facility or the people of the State of California. 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 that signs were not observed posted in all public bathrooms and hallways that promote handwashing, cough/sneeze etiquette, and physical distancing. Four (4) out of 23 resident rooms inspected did not have either hand sanitizer or hand soap in the rooms. In addition, the latest Provider Information Notice (PIN) 21-44 was not posted where persons in care can easily access it and distribute the PIN Summary for Persons in Care which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/21/2021 Plan of Correction Administrator agreed to post infection control signs in all bathrooms, common area bathrooms & hallways, as well as ensure that hand sanitizer and soap are available for all residents in care. The latest PINs shall be posted in an easily accessible location. Submit a written statement stating how the deficiency was corrected. Attach picture proof of common area/public bathroom postings.