ROYAL VISTA SAN GABRIEL

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, the licensee did not comply with the section cited above in that the 2nd floor ceiling has multiple openings exposing wiring; the ceiling is not painted; wall paper is in disrepair and 3rd floor hallway ceiling has water damage that requires repair and painting, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/07/2026 Plan of Correction Administrator agreed to submit picture proof that ceiling and wall repairs were completed.

Official classification

Type B

Official code

87555(b)(21)

Regulation authority

CCR

What the official deficiency says

(21) Freezers of adequate size shall be maintained at a temperature of 0 degree F (-17.7 degree C), and refrigerators of adequate size shall maintain a maximum temperature of 40 degree F. (4 degree C). They shall be kept clean and food stored to enable adequate air circulation to maintain the above temperatures. 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 the 3-door refrigerator had a temperature of 52 degrees, above the 40 degrees maximum temperature, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/07/2026 Plan of Correction Administrator agreed to submit proof that the refrigerator condensor and thermostat were repaired and/or that the refrigerator was replaced.

Official classification

Type B

Official code

87555(b)(29)

Regulation authority

CCR

What the official deficiency says

(29) All equipment, fixed or mobile, and dishes, shall be kept clean and maintained in good repair and free of breaks, open seams, cracks or chips. 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 the mobile kitchen food steamer ignition knobs are in disrepair and only maintains food in high temperature and staff must disconnect on/off of the steamer when it gets too hot, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/07/2026 Plan of Correction Administrator agreed to submit proof that the kitchen steamer was repaired and/or replaced.

Official classification

Type A

Official code

87608(a)(5)(B)

Regulation authority

CCR

What the official deficiency says

(B) Bed rails that extend the entire length of the bed are prohibited except for residents who are currently receiving hospice care and have a hospice care plan that specifies the need for full bed rails. 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 (R10) is not enrolled in hospice and their bed had two half rails converting it to a full bed rail, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/02/2025 Plan of Correction Staff removed one of the half bed rails during the visit. Resident (R10) has a current physician order for half bed rails. **Cleared during the visit.

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 was not met evidenced by: Based on observation, the facility has a new Administrator. Licensee failed to report changes to CCL within 30 days. Administrator Sarah Rafael was hired on 6/3/24. This poses a potential health and safety risk to persons in care.

Official plan of correction

Licensee shall submit change of Administrator documents to CCL by POC due date.

Deadline recorded: Sep 6, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.1(a)(3)

Regulation authority

CCR

What the official deficiency says

Personal Rihgts of Residents in All facilities. (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (3)To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature............... ....sleeping, or elimination. This requirement was not met evidenced by: The findings indicate that caregiver staff (S1) physically abused residents while providing assistance. S1 was suspended on 3/1/24, and is pending termination. This poses a potential health and safety risk ro persons in care.

Official plan of correction

Administrator shall ensure that residents are free of punishment, humilation, initmidation, abuse..etc. Administrator will retrain staff on personal rights. Submit plan of correction by due date.

Deadline recorded: Sep 6, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87608(a)(1)

Regulation authority

CCR

What the official deficiency says

Postural Supports. Postural supports shall be limited to appliances or devices such as braces, spring release trays, or soft ties, used to achieve proper body position and balance, to improve a resident's mobility and independent functioning, or to position rather than restrict movement including, but not limited to, preventing a resident from falling out of bed, a chair, etc. This requirement was not met as evidenced by: Based on interviews conducted, statements obtained corroborated with the allegation that S1 restrained R2 on their wheelchair by tying the reisdents hands in order to prevent the resident from putting their hands on diaper. This poses a potential health and safety risk to persons in care.

Official plan of correction

Administrator shall develop a written Plan of Correction (POC) to ensure compliance with California Code of Regulations Title 22, Section 87608. Written POC & proof of staff training must be submitted to CCL by the POC due date.

Deadline recorded: Sep 6, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.2(a)(8)

Regulation authority

CCR

What the official deficiency says

Additional Personal Rights of Residents in Privately Operated Facilities. (a) In addition to the rights listed in Section 87468.1, ....:(8) To be free from neglect, financial exploitation, involuntary seclusion, punishment, humiliation, intimidation, and verbal, mental, physical, or sexual abuse. This requirement was not met evidenced by: Based on interviews conducted the findings indicate that S1 handled R1, R3, & R5 in a rough manner while providing incontinence and ADL care. This poses a potential health and safety risk to persons in care.

Official plan of correction

Administrator agreed to retrain all staff on regulation 87468.2, and submit proof of staff in-service training.

Deadline recorded: Sep 6, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.1(a)(1)(3)

Regulation authority

CCR

What the official deficiency says

Personal Rights of Residents in All Facilities. (a)Residents in all residential care facilities for the elderly shall have all of the following personal rights:(3) To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature, such as withholding residents’ money or interfering with daily living functions such as eating, sleeping, or elimination. This requirement was not met evidenced by: Based on investigation findings staff (S1 & S2) were found to be treating residents in a disrespectful manner by yelling and ignoring the residents. This poses a potential health and safety risk to persons in care.

Official plan of correction

A training regarding personal rights for residents will be provided to all staff prior to POC Due date. Executive Director Michael Forsgren will also provide training materials, agenda, and a log with staff signatures/initials proving they attened the training by POC due date. Administrator agreed to retrain staff on regulation 87468.1, submit training log with staff signatures, and provide training materials by POC due date.

Deadline recorded: Sep 6, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87303(e)(2)

Regulation authority

CCR

What the official deficiency says

(e) Water supplies and plumbing fixtures shall be maintained as follows: (2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degrees C) and not more than 120 degree F (49 degrees C). 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 on 4/23/2024 10 out 17 resident rooms inspected recorded water temperatures ranging from 83.8 DF - 125.0 Degrees Fahrenheit, which poses an immediate health, safety, or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/31/2024 Plan of Correction Administrator shall ensure that maintenance staff adjusts the water temperature to be no less than 105-degree F (41 degrees C) and not more than 120-degree F (49 degrees C). Administrator stated staff adjusted the water temperatures after the 4/23/24 visit. 1. Submit a hot water temperature log of the 10 rooms whose hot water temperature did not meet temperature requirements.

Official classification

Type B

Official code

87555(b)(29)

Regulation authority

CCR

What the official deficiency says

(b) The following food service requirements shall apply: (29) All equipment, fixed or mobile, and dishes, shall be kept clean and maintained in good repair and free of breaks, open seams, cracks or chips. 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 on 4/23/2024, LPA observed the large freezers are not in working condition. Per Dietary Supervisor, licensee was notified of non-operable freezers in January 2024, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/13/2024 Plan of Correction Administrator stated that licensee placed an order for the freezers on May 20, 2024. . Submit a copy of the purchase order and picture proof of working freezers.

Official classification

Type A

Official code

87468.2(a)(8)

Regulation authority

CCR

What the official deficiency says

Additional Personal Rights of Residents in Privately Operated Facilities: (8) To be free from neglect, financial exploitation, involuntary seclusion, punishment, humiliation, intimidation, and verbal, mental, physical, or sexual abuse. This requirement was not met evidenced by: Based on record review and interviews conducted, the findings indicate that S1 made unauthorized charges totaling approximately $800.00 by using R1's bank card/PIN for online purchases that were never received by R1, and charging concert tickets on R4's card. This poses an immediate and health and safety risk to persons in care.

Official plan of correction

Facility shall submit proof of: 1. Written POC that includes the job description of staff that are responsible for handling resident's money and accessing confidential credit card information. 2. Proof of staff retraining on facility policy against taking money, bank cards/PINs from residents and regulation 87468.2.

Deadline recorded: Nov 20, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87413(a)(2)

Regulation authority

CCR

What the official deficiency says

Care and supervision of residents shall be provided without physical or verbal abuse, exploitation or prejudice. This requirement was not met by evidence of: Per reviews of staff record, staff interview and video footage (dated 8/15/23), the administrator did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Licensee agreed to review Title 22 Regulations, Section 87413 (a)(2) and submit a written plan detailing how administrator would ensure that staff provide care and supervision without physical or verbal abuse. Licensee would provide proper training to staff on physical abuse. POC due on 8/29/23.

Deadline recorded: Aug 29, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87411(a)

Regulation authority

HSC

What the official deficiency says

Personnel Requirements-General. Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. This requirement was not met by evidence of: On 8/8/23 & 8/15/2023 Dementia resident (R1) eloped out of the facility. During the 8/15/23 elopement the resident fell and sustained a facial injury resulting in hospitalization. Due to a recent fire Dementia residents are not in a locked perimeter. This poses an immediate safety risk to this residenst in care.

Official plan of correction

Administrator agreed to submit a written plan addressing staff supervision, protocols, and staff scheduling. Submit proof of staff in-service training regarding Dementia wandering behavior, methods of redirection, and resident care and supervision.

Deadline recorded: Aug 25, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.1(a)(8)

Regulation authority

CCR

What the official deficiency says

Personal Rights of Residents in All Facilities.Residents in all residential care facilities for the elderly shall have all of the following personal rights: To have their representatives regularly informed by the licensee of activities related to care or services, including ongoing evaluations, as appropriate to their needs. Based on record review and interviews conducted staff did not notify R1's responsible party of 911 incident (4/25/23) and bill received pertaining to the incident; which poses a potential health and safety risks to persons in care.

Official plan of correction

Administrator agreed to provide in-service training regarding 87468.1, and provide written statement of how the facility will document responsible party contact when incidents occur, and/or there is a change in condition.

Deadline recorded: Jul 3, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87211(a)(1)

Regulation authority

CCR

What the official deficiency says

Reporting Requirements. Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: 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..... Based on record review and interviews conducted, staff failed to notify R1's responsible party and CCL within 7 days of the incident; which poses a potential health and safety risk to persons in care.

Official plan of correction

Administrator agreed to conduct in service training with staff. Send a copy of the inservice training log sheet. Note: A copy of the incident report was provided today and faxed to CCL on 6/2/2023.

Deadline recorded: Jun 26, 2023. A deadline is not proof that correction was completed.

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 the majority of the rooms inspected had beds without mattress pads; which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/15/2023 Plan of Correction Administrator shall ensure that all resident beds have mattress pads. Submit a written plan of correction.

Official classification

Type B

Official code

87705(c)(5)

Regulation authority

CCR

What the official deficiency says

(c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following: (5) Each resident with dementia shall have an annual medical assessment as specified in Section 87458, Medical Assessment, and a reappraisal done at least annually, both of which shall include a reassessment of the resident's dementia care needs. 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 annual assessments for Dementia two (2) Dementia residents are older than 1 year; which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/15/2023 Plan of Correction Administrator shall ensure all Dementia residents have annual medical assesssments. Submit proof that R3 & R4 have current annual assessments.

Official classification

Type A

Official code

87608(a)(5)(B)

Regulation authority

CCR

What the official deficiency says

(B) Bed rails that extend the entire length of the bed are prohibited except for residents who are currently receiving hospice care and have a hospice care plan that specifies the need for full bed rails. 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 resident in room 218 had full bed rails and is not enrolled in hospice; which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/02/2023 Plan of Correction Administrator agreed to remove the full rails from the resident's bed and obtain a half rail physician order. Submit proof of correction (picture) and a copy of the physician order.

Official classification

Type A

Official code

87303(e)(2)

Regulation authority

CCR

What the official deficiency says

Maintenance and Operation. Water supplies and plumbing fixtures shall be maintained as follows: Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degree C) and not more than 120 degree F (49 degree C). This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the hot water temperature readings today a total of 7 rooms had hot water temperatures above 120 D; which poses an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 06/02/2023 Plan of Correction Administrator shall ensure the hot water temperature in all resident rooms meets Title 22 regulation at all times of the day. Submit a written statement of how the deficiency was corrected. Staff shall check the temperature of all resident rooms. If needed contract a plumber to fix the issue.

Official classification

Type B

Official code

87303(e)(6)

Regulation authority

CCR

What the official deficiency says

Maintenance and Operation. Water supplies and plumbing fixtures shall be maintained as follows: Toilet, handwashing and bathing facilities shall be maintained in operating condition. Additional equipment shall be provided in facilities accommodating physically handicapped and/or nonambulatory residents, based on the residents' needs. This requirement was not met evidenced by: Based on observation and interviews conducted on April 23, 2023, room # 230's bathtub water fixtures could not be turned off. Security guard shut off the water supply without notifiying Administration staff and residents. Room #230's issue was repaired the same day.

Official plan of correction

Administrator shall submit written notification certifying that all resident bathrooms were inspected in order to determine the operating condition of all water fixtures in resident rooms, common bathrooms, and kitchen areas. Submit an updated LIC 610E Emergency and Disaster Plan.

Deadline recorded: May 5, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87405(a)

Regulation authority

CCR

What the official deficiency says

Administrator - Qualifications and Duties. All facilities shall have a qualified and currently certified administrator....The administrator shall have sufficient freedom from other responsibilities and shall be on the premises a sufficient number of hours to permit adequate attention to the management and administration of the facility as specified in this section. When the administrator is not in the facility, there shall be coverage by a designated substitute who shall have qualifications adequate to be responsible and accountable for management and administration of the facility as specified in this section. On 3/31/23, incomplete Administrator change documents were submitted. The Interim Administrator appointed is not at the facility sufficient number of hours.

Official plan of correction

Licensee shall submit all required Change of Administrator documents to CCL, and ensure the appointed Administrator is at the facility sufficient number of hours to permit adequate attention to the management and administration of the facility. Submit self-certification, written statement, and pending documents. *Note a civil penalty was assessed.

Deadline recorded: May 5, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

Maintenance and Operation. 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 was not met evidenced by: Based on physical plant observation, the Dementia unit's laminate flooring is in disrepair, resident rooms have stained carpets, and there are room doors that need repair on the bottom half caused by wheelchairs; which poses a potential health and safety risk to persons in care.

Official plan of correction

Licensee shall ensure the facility is in good repair at all times, and areas in need of repair are addressed in a timely manner. Submit picture proof of corrections made to the Demenia unit flooring, resident room carpets, and needed door and wall repairs. NOTE: If a POC extension is needed submi a written request prior to or by the due date.

Deadline recorded: Jun 5, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87405(a)

Regulation authority

CCR

What the official deficiency says

Administrator - Qualifications and Duties. All facilities shall have a qualified and currently certified administrator....The administrator shall have sufficient freedom from other responsibilities and shall be on the premises a sufficient number of hours to permit adequate attention to the management and administration of the facility as specified in this section. When the administrator is not in the facility, there shall be coverage by a designated substitute who shall have qualifications adequate to be responsible and accountable for management and administration of the facility as specified in this section. Administrator last worked at the facility on Feb. 17, 2023, and no designee has been appointed, nor was CCL notified.

Official plan of correction

Licensee shall find a temporary replacement and designate responsibility of facility management. Submit proof of correction by POC due date.

Deadline recorded: Mar 31, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(c)(2)

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. Based on records review, R1 had in place a physician order for Rexulti 4 mg and it got changed to 3mg on 10/11/22 by a different unathorized doctor. This poses an immediate health and safety risk to persons in care.

Official plan of correction

Licensee shall submit a plan of action to correct this repeated violation. In addition, all med-tech staff shall receive in-service training by a nurse and/or pharmacy. Submit the plan by tomorrow, and provide proof of staff training by Tuesday 3/28/23.

Deadline recorded: Mar 25, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.1(a)(8)

Regulation authority

CCR

What the official deficiency says

Personal Rights of Residents in All Facilities. Residents in residential care facilities for the elderly shall have personal rights which include.....8) To have their representatives regularly informed by the licensee of activities related to care or services, including ongoing evaluations, as appropriate to their needs. Based on record review, facility staff did not obtain R1's responsible party's consent to change doctor; which poses a potential health and safety risk to persons in care.

Official plan of correction

Licensee shall submit a written plan of correction, and conduct in-service training to all staff responsible with care plan responsibilities.

Deadline recorded: Mar 27, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87411(d)(4)

Regulation authority

CCR

What the official deficiency says

Personnel Requirements - General (d) All personnel shall be given on the job training or have related experience in the job assigned to them.... (4) Knowledge required to safely assist with prescribed medications which are self-administered. This requirement was not met evidenced by: Based on interviews and record review, med-tech staff and Administration staff did not do their due diligence in reviewing all medication records and physician orders. In addition, MAR documentation errors were observed during today's visit; which poses a potential health and safety risk to persons in care.

Official plan of correction

Licensee shall ensure that all staff are trained in job responsibilities,facility procedures, and all med-techs are adhering to company procedure. Submit plan of correction. ***Due to repeated medication errors it is advised the facility use an electronic Medication Administration Records system.

Deadline recorded: Mar 25, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87468.1(a)(3)

Regulation authority

CCR

What the official deficiency says

Personal Rights of Residents in All Facilities. Residents in all residential care facilities for the elderly shall have all of the following personal rights: To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature, such as withholding residents’ money or interfering with daily living functions such as eating, sleeping, or elimination. Based on interviews conducted and document review, registry staff (S1) abused resident (R1) by not dressing the resident appropriately when taking it to the dining room, and force feeding the Dementia resident without regard to choking or apiration. This poses an immediate health and safety risk to persons in care.

Official plan of correction

Administrator shall submit: 1. Staffing plan addressing insufficient staffing 2. Staff in-service training with Topic and staff signatures 3. Copy of S1's disciplinary action 4. Proof of incident report submitted to registry staffing agency

Deadline recorded: Jan 26, 2023. A deadline is not proof that correction was completed.

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. Based on records review, on Jan. 22, 2023 med-tech staff gave resident (R1) resident (R2's) Velphoro 500 mg medication in error. R1 immediately reported the error, and the medication was not taken. This poses an immediate health and safety risk to persons in care.

Official plan of correction

Administrator agreed to provide staff training to all med-tech staff by POC due date. Submit proof by POC due date. If an extension is needed submit by POC due date.

Deadline recorded: Jan 26, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

1569.269(a)(21)

Regulation authority

HSC

What the official deficiency says

Enumerated rights; severability. Residents of residential care facilities for the elderly shall have all of the following rights: To have prompt access to review all of their records and to purchase photocopies. Photocopied records shall be promptly provided, not to exceed two business days, at a cost not to exceed the community standard for photocopies. This requirement was not met evidenced by: Based on record review, the facility received a formal medical records request on 10/22/2020, and failed to provide the records within 2 business days, as required per regulation; which poses a potential health and safety risk to persons in care.

Official plan of correction

Administrator agreed submit a written plan of correction addressing resident records, enumerated rights; severability, and facility procedures regarding resident records request. Submit by POC due date.

Deadline recorded: Jan 30, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87211(a)(2)

Regulation authority

CCR

What the official deficiency says

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: (2) Occurrences, such as epidemic outbreaks, poisonings, catastrophes or major accidents which threaten the welfare, safety or health of residents, personnel or visitors, shall be reported within 24 hours..... This requirement was not met evidenced by: On 1/5/2023, the facility had 21 COVID-19 positive cases that were not reported to CCL or Dep. of Public Health (DPH) within 24 hours. They were reported to CCL until 1/10/23, and to DPH until 1/17/23; which poses an immediate health and safety risks to persons in care.

Official plan of correction

Administrator shall submit a written plan of correction that includes: 1. Review/revise the Infection Control Plan and submit an updated ICP by tomorrow. 2. Conduct staff training and provide proof that all staff were trained in Infection Control

Deadline recorded: Jan 21, 2023. 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 was not met evidenced by: On 1/17/2023, LPA was informed by current Administrator that former Administrator stopped working at the facility. The former Administrator was discharged on Aug. 1, 2022. Licensee & Administrator failed to report to CCL of the change within 30 days. This poses a potential health and safety risk to persons in care.

Official plan of correction

On 1/17/23, Administrator submitted incomplete change of Administrator documents to CCL. Administrator agreed to submit the following pending documents: 1. Licensee letter 2. LIC 503 3. LIC 308

Deadline recorded: Jan 20, 2023. A deadline is not proof that correction was completed.

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 during medication review, the licensee did not comply with the section cited above in that six (6) out of seven (7) residents were missing 30-day supply of medications and/or physician ordered cycle medications. Resident (R1's) medications [total of 9] have not been filled since mid April 2022; which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/01/2022 Plan of Correction Licensee shall ensure all missing medications are filled by tomorrow. In addition, all staff that dispense medications shall receive in-service training. This training shall be provided by pharmacy and/or registered nurse. Submit in writting how this was corrected and attach proof of training by tomorrow.

Official classification

Type B

Official code

87468.1(a)(2)

Regulation authority

CCR

What the official deficiency says

87468.1(a)(2) Personal Rights. Each resident shall be accorded safe, healthful and comfortable accommodations, furnishings and equipment. 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 rooms 104, 107, 112, 121, 307, & 312 had sheer curtains and/or were missing curtains or blinds, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/07/2022 Plan of Correction Licensee shall ensure all residents are accorded safe, healthful and comfortable accommodations, furnishings and equipment that afford privacy. Submit proof of purchase/corrections, and a written statement indicating which rooms had new curtains installed and/or blinds repaired.

Official classification

Type B

Official code

87208(a)

Regulation authority

CCR

What the official deficiency says

Plan of Operation. Each facility shall have and maintain a current, written definitive plan of operation. The plan and related materials shall be on file in the facility..... This requirement was not met evidenced by: Based on record review during complaint control #: 28-AS-20220303150219, LPA requested a copy of the Plan of Operation and staff job descriptions, but Administrator was not able to find copies in facility record files. This poses a potential health, safety, or personal rights risk to persons in care.

Official plan of correction

Administrator shall obtain from Licensee " Royal Vista San Gabriel LLC " copies of the Plan of Operation and staff job descriptions. Submit proof of correction and a written statement by POC due date.

Deadline recorded: Mar 18, 2022. 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

Incidental Medical and Dental Care. A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following: The licensee shall assist residents with self-administered medications as needed. This requirement was not met evidenced by: Based on record review, R1's Medication Administration Record showed evidence of no medication administration beginning March 1, 2022, due to non-payment. This poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

Administrator shall obtain R1's medications immediately (no later than 24 hours) from the pharmacy. In addition, all med-tech staff shall be trained in their job responsibilities, and medication administration procedures. Submit proof of correction by tomorrow.

Deadline recorded: Mar 5, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87468.1(a)(2)

Regulation authority

CCR

What the official deficiency says

87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities...personal rights:(2)To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This requirement is not met as evidenced by: 1/11/2022 11:20 a.m. LPA was not screened for COVID-19 symptoms or temperature check by security guard or staff. This is a repeat violation from 5/12/2021. Based on observation and interview, the licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

Administrator will provide proof of visitor log for temperature check and symptom check for COVID 19 and proof of staff training of how to screen visitors and residents for COVID-19 to LPA by POC date

Deadline recorded: Jan 12, 2022. A deadline is not proof that correction was completed.