CALIFORNIA MISSION INN - ROSE MANOR

Official classification

Type A

Official code

87468.2

Regulation authority

CCR

What the official deficiency says

(a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, shall have all of the following personal rights: (4) To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs. This requirement was not met as evidenced by: Residents calls for assistance were not met in a timely due to staffing shortages.

Official plan of correction

Administrator will draft plan to address how the facility plans to deliver staff that are sufficient in numbers to provide care and supervision to residents in care. Plan must be received by 10/24/25.

Deadline recorded: Oct 24, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87507(f)

Regulation authority

CCR

What the official deficiency says

Admission Agreements. The licensee shall comply with all applicable terms and conditions set forth in the admission agreement, including all modifications and attachments. This requirement was not met evidenced by: Based on record review the findings indicate R1 was overcharged for months March 2020 and April 2020, after moving to this facility from Massey Hall. The resident continued to be billed and paid for care fees that it was no longer receiving.

Official plan of correction

Licensee shall reimburse R1 the overcharged rent amount totaling $3,306.80. Administration staff shall certify mail a check to R1 and provide proof that the money has been reimbursed.

Deadline recorded: Nov 24, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87507(d)

Regulation authority

CCR

What the official deficiency says

Admission Agreements. The licensee shall retain in the resident's file the original signed and dated admission agreement and all subsequent signed and dated modifications. This requirement was not met evidenced by: Based on observation of file/record review, the facility failed to issue a new admission agreement and/or modify the original admission agreement when R1 moved to this facility from the sister facility in the same campus. There is no record of changes in the rent fees.

Official plan of correction

Licensee shall ensure all former resident records are stored intact /complete. In addition, if a resident is moved from one facility to another, the resident and/or responsible party must be re-issued a new Admission Agreement. Submit a written statement of protocols that will be implemented, and proof of staff training.

Deadline recorded: Nov 24, 2022. 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 are not posted throughout facility to promote handwashing, cough/sneeze etiquette, and physical distancing. The public bathrooms, resident bathrooms, and common area hallways did not have COVID-19 infection control signs. 15 out of 29 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: 10/08/2021 Plan of Correction Administrator agreed to post infection control signs in all bathrooms, common area 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.

Official classification

Type A

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 and record review, the licensee did not comply with the section cited above in that medication errors were observed for residents (R1- R4). Resident (R1 & R2) had medications in the room, but per Physician's Report they are not able to administer medications. Resident (R3) was missing Melatonin tablet 10mg. Resident (R4) was observed to have medication Aquaphor ointment in the room; however per physician report cannot administer own medications. ] which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/08/2021 Plan of Correction Administrator agreed to submit a written plan of correction by tomorrow. All med-tech and direct care staff will be provided medication administration training. This training shall be provided by a pharmacy and/or registered nurse.