TERRACES AT VIA VERDE-A MEMORY CARE COMMUNITY, THE

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

(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: Deficient Practice Statement Based on observation during the facility walkthrough, LPA observed soiled incontinence briefs that had not been disposed of, small insects in a shared bathroom, a broken cabinet handle in a resident bathroom, and a common area restroom toilet needed cleaning and an uncovered trash can with trash to the top. LPA also observed the main living areas on both floors and the kitchen cabinets in need of cleaning, with several kitchen cabinets broken and in need of repair which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/17/2026 Plan of Correction By the POC due date, Administrator shall submit a written Plan of Correction describing how the facility will ensure the facility is maintained in a clean, safe, and sanitary condition. The licensee shall repair the identified maintenance issues and submit photographs documenting that the corrections have been completed.

Official classification

Type B

Official code

87366(h)(5)

Regulation authority

CCR

What the official deficiency says

(h) For each terminally ill resident receiving hospice services in the facility, the licensee shall maintain the following in the resident’s record: (5) A statement signed by the resident's roommate, if any, or any resident who will share a room with a person who is terminally ill to be accepted or retained as a resident, indicating his or her acknowledgment that the resident intends to receive hospice care in the facility for the remainder of the resident's life, and the roommate's voluntary agreement to grant access to the shared living space to hospice caregivers, and the resident's support network of family members, friends, clergy, and others. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review the facility did not have a written agrrement from R6 or R6 responsible party to share room with R5 who is currently on hospice, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/17/2026 Plan of Correction By the POC due date, the licensee shall obtain and maintain a written agreement from Resident 6 (R6) or R6's responsible party acknowledging and consenting to share a room with Resident 5 (R5), who is receiving hospice services. ***During exit interview LPA observed a letter provided to R6 RP however it needed additional verbage and signatures from RP and Facility Staff.***

Official classification

Type B

Official code

87506(a)

Regulation authority

CCR

What the official deficiency says

(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 readily available to facility staff and to licensing agency staff. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, record review, and interviews, facility staff did not ensure accurate medication administration documentation. LPA observed that the electronic medication administration record (ECP/eMAR) did not document the administration of medication for Resident 2 (R2). Staff reported that the medication had been administered but were unable to explain why the medication administration was not recorded in the electronic system, resulting in incomplete medication documentation.which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/17/2026 Plan of Correction By the POC due date, the licensee shall submit a written Plan of Correction describing how facility staff will ensure medications are accurately documented in the electronic medication administration record (eCP/eMAR) system. The plan shall include procedures for identifying, reporting, and following up on any system glitches or documentation errors to ensure medication administration is accurately recorded.

Official classification

Type B

Official code

87463(b)(1)

Regulation authority

CCR

What the official deficiency says

87463 Reappraisals.(b)The reappraisal shall document significant changes in the resident's physical, mental, cognitive, behavioral, or functional condition, including those required to be documented as specified in Section 87466, Observation of the Resident. (1) Significant changes in condition, as defined in Section 87101,.... This requirement is not met as evidenced by: Based on interviews and record reviews, the licensee did not comply with the section cited above in which the staff failed to address and document R1’s change in medical condition which poses a potential health, safety or personal rights risk to residents in care.

Official plan of correction

Administrator/Licensee to ensure to document and update reappraisals of residents for changes in their physical, medical, mental and social condition. Administrator will send a signed self certification that they read, reviewed and understood Title 22 Regs. 87463 and send it to LPA/CCL by POC due date.

Deadline recorded: Feb 20, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87468.2(a)(4)

Regulation authority

CCR

What the official deficiency says

87468.2 Additional Personal Rights of Residents in Privately Operated Facilities (a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly 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 is not met as evidenced by: Based on interviews, records review conducted by Investigator Hector, the licensee did not comply with the section cited above in which due to lack of care and supervision, R1 sustained a left hip fracture as a result of a fall while under the care of the facility which poses an immediate health, safety or personal rights risk to residents in care.

Official plan of correction

Licensee/Administrator shall ensure to comply with Title 22 Section 87468.2 at all times. Additionally, Licensee/Administrator shall develop a written Plan of Correction to ensure compliance with California Code of Regulations Title 22, Section 87468.2(a)(4). Written POC must be submitted to CCL/LPA by POC due date. An immediate Civil Penalty of $500.00 is being issued today, due to a resident sustaining injury while in care. Refer to LIC 421IM.

Deadline recorded: Feb 14, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87211(a)(1)(D)

Regulation authority

CCR

What the official deficiency says

87211 Reporting Requirements..(a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: (1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below. This report shall include the resident's name, age, sex and date of admission; date and nature of event; attending physician's name, findings, and treatment, if any; and disposition of the case. (D) Any incident which threatens the welfare, safety or health of any resident.. This requirement is not met as evidenced by: Based on interviews, records review conducted by Investigator Hector, the Licensee/Administrator did not comply with the section cited above in which the facility failed to report and send all incidents involving R1’s falls to CCL which poses a potential health, safety or personal rights risk to residents in care.

Official plan of correction

Licensee/administrator to ensure written reports shall be submitted to the licensing agency and to the person responsible for the residents and comply with Title 22 Regs. Section 87211. Licensee/Administrator shall develop a written Plan of Correction to ensure compliance with CCR Title 22, Section 87211. Written POC must be submitted to CCL/LPA by POC due date.

Deadline recorded: Feb 20, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(a)(4)

Regulation authority

CCR

What the official deficiency says

87465(a)(4)Incidental Medical and Dental Care A plan for incidental medical...The plan shall encourage routine medical ...care and provide for assistance in obtaining such care... (4) The licensee shall assist residents with self-administered medications as needed .This requirement is not met as evidenced by: Based on interviews and record review, the licensee did not comply with the section cited above in that R1’s morning medication were not administered on 09/01/25.

Official plan of correction

Licensee immediately demoted employee responsible for the serious error. Med techs will continuously receive quarterly med training.

Deadline recorded: Nov 7, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87407(k)(1)

Regulation authority

CCR

What the official deficiency says

Personnel Administrator Recertification Requirements. Whenever a certified administrator assumes or relinquishes responsibility for administering a residential care facility for the elderly, he or she shall provide written notice, within thirty (30) days, to: (1) The local licensing office ..... This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, the licensee did not comply with the section cited above in that Executive Director Subishsani Kumar was hired on 4/15/25 and Licensee failed to report changes to CCL within 30 days. This poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 09/19/2025 Plan of Correction Executive Director agreed to submit proof of correction, which includes all required forms to CCL by POC due date.

Official classification

Type B

Official code

87307(a)(3)(C)

Regulation authority

CCR

What the official deficiency says

(C) Clean linen, including blankets, bedspreads, top bed sheets, bottom bed sheets, pillow cases, mattress pads, bath towels, hand towels and wash cloths. The quantity shall be sufficient to permit changing at least once per week or more often when indicated to ensure that clean linen is in use by residents at all times. The linen shall be in good repair. The use of common wash cloths and towels shall be prohibited. 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 rooms 101, 106, 107, 111, 114, 202, 210, 216, 217, 219 beds did not have mattress pads, which poses a potential health, safety or personal rights risk to persons in care

Official plan of correction

POC Due Date: 09/19/2025 Plan of Correction Executive Director agreed to submit proof that the resident beds in rooms 101, 106, 107, 111, 114, 202, 210, 216, 217, 219 have mattress pads.

Official classification

Type B

Official code

87463(h)

Regulation authority

CCR

What the official deficiency says

(h) The licensee shall request that all residents receive an annual routine visit with a licensed medical professional once every twelve months, either in person or by video appointment. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, the licensee did not comply with the section cited above in that R6's last medical assessment is dated 7/28/2023, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/19/2025 Plan of Correction Executive Director agreed to submit a copy of R6's medical assessment.

Official classification

Type B

Official code

87618(b)(3)(B)

Regulation authority

CCR

What the official deficiency says

(3) Ensuring that the use of oxygen equipment meets the following requirements: (B) “No Smoking-Oxygen in Use” signs shall be posted in the appropriate areas. 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 rooms 110, 115, and 210 had oxygen tanks in the rooms but no signs of " No Smoking-Oxygen in Use " signs were observed outside the resident room door or in appropriate areas, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/19/2025 Plan of Correction Administrator shall ensure that a No Smoking-Oxygen In Use sign is posted when oxygen tanks are in the facility. Submit picture proof that the signs are posted.

Official classification

Type A

Official code

87465

Regulation authority

CCR

What the official deficiency says

Incidental Medical and Dental Care. If the resident's physician has stated in writing that the resident is unable to determine his/her own need ........ facility staff designated by the licensee shall be permitted to assist the resident with self-administration, provided all of the following requirements are met: 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 record review, the licensee did not comply with the section cited above in that R1’s Levothyroxine Sodium 75 mcg has not been filled and was last administered on 8/25/25, as well as R2’s Hyoscyamine sulf 0.125mg PRN has not been filled, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/06/2025 Plan of Correction Executive Director agreed to submit proof by tomorrow that R1 and R2's medications were filled. In addition, all med-tech staff shall receive medication administration training and documentation procedure training. Submit proof of training by 9/10/25.

Official classification

Type A

Official code

87705(f)(2)

Regulation authority

CCR

What the official deficiency says

87705 Care of Persons 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: Based on observation, the licensee did not comply with the section cited above. LPA observed R#1s medication unlocked in R3!'s room

Official plan of correction

Licensee/ Administrator remove all medications during the visit. Additionally, licensee / administrator will conduct an in-service training about this section code with all staff and submit an attendance sheet with staff signatures to CCLD by POC due date.

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

Official classification

Type A

Official code

87705(f)(1)

Regulation authority

CCR

What the official deficiency says

87705 Care of Persons with Dementia. (f) The following shall be stored inaccessible to residents with dementia: (1) Knives, matches, firearms, tools and other items that could constitute a danger to the resident(s) LPA observed scissors, shaving razors and perfumes, deodorants and other hygiene items unlocked in R#1's bathroom cabinet. Per R1's Physicians Report, R#1 is at risk at allowed direct access to personal grooming and hygiene items.

Official plan of correction

Licensee/ Administrator remove scissors, shaving razors during the visit Additionally, licensee / administrator will conduct an in-service training about this section code with all staff and submit an attendance sheet with staff signatures to CCLD by POC due date. Licensee / Administrator will contact to R#1's Pyshician to deternine that R1 not at the risk to keep parfumes in her room.

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

Official classification

Type B

Official code

87468.2(a)(4)

Regulation authority

CCR

What the official deficiency says

87468.2 Additional Personal Rights of Residents...: (a)... All Facilities...(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 is not met as evidence by: Based on records reviewed licensee did not ensure staff notified the correct physician of R1’s change in condition which poses a potential risk to the persons health, safety, or personal rights of the persons in care.

Official plan of correction

Administrator will provide in-service training to staff regarding notifying and reviewing physician appropiately by POC due date 6/18/24.

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

Official classification

Type B

Official code

1569.69

Regulation authority

HSC

What the official deficiency says

1569.69 of the Health and Safety Code. It requires direct care staff in RCFEs, excluding licensed medical professionals, to meet specified training requirements, including passing an examination, in order to be able to assist residents with the self-administration of medications. It does not authorize unlicensed personnel to directly administer medications. This requirement was not met as evidence by: Based on observation, interview and record review, the licensee did not comply with the section cited above in that two (2) Staff administered insulin to resident #1 without a license to administer medications, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

The licensee shall conduct in-service training regarding medications administration and the role of med techs. The In-service training is due to LPA by POC due date.

Deadline recorded: Apr 5, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

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) (interview) (record review)], the licensee did not comply with the section cited above. Facility did not have enough 7 day Non perishable food which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/18/2023 Plan of Correction Administrator agreed to purchase Non perishable food for 7 days and send proof to LPA by POC day.