VIP SENIOR LIVING LLC

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 4 out of 4 restroom sinks did not measure within the required range which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/04/2025 Plan of Correction The Licensee will adjust the water temperature and send CCLD proof of the water temperature measuring within the required range by the POC due date.

Official classification

Type A

Official code

87309(a)

Regulation authority

CCR

What the official deficiency says

(a) Except as specified in subsection (b), the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances, knives, matches, tools, sharp objects, and other similar items which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage. 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 the staff restroom had unsecured cleaning supplies and the kitchen drawer had an unsecured butcher knife and hammer which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/04/2025 Plan of Correction The Licensee secured the knife and hammer and will secure the cleaning supplies and send proof to CCLD by POC due date.

Official classification

Type A

Official code

87465(h)(2)

Regulation authority

CCR

What the official deficiency says

(h) The following requirements shall apply to medications which are centrally stored: (2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and interview, the licensee did not comply with the section cited above in medications were unsecured in the dining room cabinets which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/03/2025 Plan of Correction The Licensee secured or discarded of the medications during the visit. POC Cleared.

Official classification

Type A

Official code

1569.695(a)(2)

Regulation authority

HSC

What the official deficiency says

(a)In addition to any other requirement of this chapter, a residential care facility for the elderly shall have an emergency and disaster plan that shall include, but not be limited to, all of the following: (2) Plans for the facility to be self-reliant for a period of not less than 72 hours immediately following any emergency or disaster, including, but not limited to, a short-term or long-term power failure. If the facility plans to shelter in place and one or more utilities, including water, sewer, gas, or electricity, is not available, the facility shall have a plan and supplies available to provide alternative resources during an outage. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and interview, the licensee did not comply with the section cited above in the facility did not have emergency food which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/04/2025 Plan of Correction The Licensee will purchase emergency food and send CCLD proof by POC due date.

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 and interview, the licensee did not comply with the section cited above in the facility had broken drawers, door handles, closet doors, window blinds, and ceiling water damage which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/17/2025 Plan of Correction The Licensee will have their handyman make all the repairs and send CCLD proof by POC due date.

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, the licensee did not comply with the section cited above in the facility did not have a sufficient supply of 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: 09/03/2025 Plan of Correction The Licensee purchased non-perishables during the visit. POC Cleared.

Official classification

Type B

Official code

87465(a)(6)

Regulation authority

CCR

What the official deficiency says

(6) When requested by the prescribing physician or the Department, a record of dosages of medications which are centrally stored shall be maintained by the facility. This requirement is not met as evidenced by: Deficient Practice Statement Based on interview and record review, the licensee did not comply with the section cited above in 2 residents' medications were not properly documented which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/17/2025 Plan of Correction The Licensee will review all medications and update the Centrally Stored Medications and Destruction Record and send CCLD proof by POC due date.

Official classification

Type B

Official code

87465(e)

Regulation authority

CCR

What the official deficiency says

(e) For every prescription and nonprescription PRN medication for which the licensee provides assistance there shall be a signed, dated written order from a physician on a prescription blank, maintained in the resident's file, and a label on the medication. Both the physician's order and the label shall contain at least all of the following information. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview, and record review, the licensee did not comply with the section cited above in 2 residents did not have PRN Authorization Letters which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/17/2025 Plan of Correction The Licensee will obtain PRN Authorization Letters for all residents and send CCLD proof by POC due date.

Official classification

Type B

Official code

87506(c)(1)

Regulation authority

CCR

What the official deficiency says

87506 Resident Records: (c) All information and records obtained from...(1)The licensee shall be responsible for storing active and inactive records ...This requirement has not been met as evidenced by: Based on interview and records review, the licensee did not comply with the section cited above as R1’s records were not provided to R1’s Responsible Party and/or designated representative which poses a potential health and safety risk to residents in care.

Official plan of correction

Licensee stated that requested documents to R1’s responsible party will be provided. The Licensee stated that he will send LPA via email proof that documents were provided.

Deadline recorded: Nov 15, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87219(h)(2)

Regulation authority

CCR

What the official deficiency says

(h) Facilities shall provide sufficient space to accommodate both indoor and outdoor activities. Activities shall be encouraged by provision of: (2) Outdoor activity areas which are easily accessible to residents and protected from traffic. Gardens or yards shall be sufficient in size, comfortable, and appropriately equipped for outdoor use. 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 one (1) out of (1) one shaded covering which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/20/2024 Plan of Correction Get a covering for outside area.

Official classification

Type B

Official code

87555(b)(27)

Regulation authority

CCR

What the official deficiency says

(b) The following food service requirements shall apply: (27) All kitchen areas shall be kept clean and free of litter, rodents, vermin and insects. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above as vermon was visible in kitchen area which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/20/2024 Plan of Correction Pest control will come and spray facility.

Official classification

Type B

Official code

87465(h)(5)

Regulation authority

CCR

What the official deficiency says

(h) The following requirements shall apply to medications which are centrally stored: (5) Each resident's medication shall be stored in its originally received container. No medications shall be transferred between containers. 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 four (4) out of four (4) resident medications were presorted which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/10/2024 Plan of Correction Will send proof that meds are soretd on a daily basis.

Official classification

Type A

Official code

87606(c)

Regulation authority

CCR

What the official deficiency says

(c) To accept or retain a bedridden person, other than for a temporary illness or recovery from surgery, a facility shall obtain and maintain an appropriate fire clearance as specified in Section 87202(a). 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 one (1) resident is not in the correct room for bedridden which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/06/2024 Plan of Correction Resident will be moved to the correct room.

Official classification

Type A

Official code

87705(h)

Regulation authority

CCR

What the official deficiency says

(h) Outdoor facility space used for resident recreation and leisure shall be completely enclosed by a fence with self-closing latches and gates, or walls, to protect the safety of residents. 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 one (1) emergency exit gate/ self latching gate does not open / close properly which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/10/2024 Plan of Correction Gate will be fixed and picture will be sent to LPA.

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 failed to ensure the hot water temperature was within the required range (tested between 125.3- 130.6 degrees) which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/27/2023 Plan of Correction Licensee agreed to adjust the water temperature by 9/27/2023 and will maintain water temperature between 105- and 120-degrees Fahrenheit. The Licensee shall submit proof of a 5 day water temperature log indicating the hot water is within the required range of 105-120 degrees F to CCLD by 10/06/2023.

Official classification

Type A

Official code

87465(a)(4)

Regulation authority

CCR

What the official deficiency says

(4) The licensee shall assist residents with self-administered medications as needed. 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 as 2 of 5 resident medications reviewed contained inconsistencies with their medication amounts remaining and amounts documented as administered on the centrally stored which poses an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 09/27/2023 Plan of Correction Within 24 hours, the Licensee will notify LPA when training will be completed. Licensee agreed to do a complete medication audit for the facility and training for all medication staff and submit documentation to CCL by 10/06/2023.

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, as 2 residents files reviewed did not contain a current medical assessment and both residents have a dementia diagnosis, which poses a potential health and personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/09/2023 Plan of Correction Licensee stated that they will obtain current medical assessments for both residents and provide proof to CCL by POC due date.

Official classification

Type B

Official code

87555(b)(27)

Regulation authority

CCR

What the official deficiency says

General Food Service Requirements (b) The following food service requirements shall apply: (27) All kitchen areas shall be kept clean and free of litter, rodents, vermin and insects. 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 cockroaches were observed in the kitchen cabinet which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/09/2023 Plan of Correction The Licensee stated that the facility does receive pest control services and the next scheduled service is for September 28, 2023. The Licensee will send proof of corrections by due date.

Official classification

Type A

Official code

87355(e)(2)

Regulation authority

CCR

What the official deficiency says

87355(e)(2) Criminal Record Clearance All individuals subject to a criminal record review pursuant to ...shall prior to working... (2) Request a transfer of a criminal record clearance...This requirement is not met as evidenced by: Based on record review and interview the licensee did not comply with the section cited by not transferring the criminal record clearance for S1 to this facility prior to employment which poses an immediate health, safety and personal rights risk to persons in care.

Official plan of correction

Licensee agreed to submit a transfer of a criminal record clearance for all staff not associated to the facility by 05/17/2023. Civil Penalties assessed in the amount of $200.

Deadline recorded: May 17, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87211(a)(1)(A)

Regulation authority

CCR

What the official deficiency says

87211 (a)(1)(A) Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports...1)A written report shall be submitted to the licensing agency...(A)Death of any resident… This requirement is not met as evidenced by: Based on record review and interview, the licensee did not comply with the section cited above as the facility is not following reporting requirements by not reporting R1’s death to CCLD which poses a potential health, safety and personal rights risk to persons in care.

Official plan of correction

The Licensee agreed to submit a statement of understanding for the above regulation to CCLD.

Deadline recorded: May 19, 2023. 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 for the elderly shall have all of the following personal rights: (2) To be accorded safe, healthful and comfortable accommodations... This requirement was not met as evidenced by: Based on observations from LPA and a credible witness, the licensee did not comply with the section cited above, as staff were not were not following COVID-19 health and safety protocols, including not wearing a mask, which poses an immediate personal rights risk to residents in care.

Official plan of correction

The Licensee agreed to do the following: Administrator agreed to hold training with all staff about proper mask-wearing and COVID-19 prevention protocol and provide training records to CCL by 08/31/2022.

Deadline recorded: Aug 31, 2022. 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 as the hot water temperature was not within the required range (tested at 132.1 degrees) which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/11/2022 Plan of Correction The Licensee agreed to send the LPA a statement that outlines how the facility will maintain hot water temperature within the required range of 105 and 120 degrees F by POC due date. The Licensee will also send the LPA a temperature log. This is a repeat violation; civil penalty assessed in the amount of $250.

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: (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 as there were disinfectants accessible, which poses an immediate health, and safety risk to persons in care.

Official plan of correction

POC Due Date: 08/11/2022 Plan of Correction During the time of the visit, the disinfectants were secured and were made inaccessible to residents in care. Plan of Correction met. This is a repeat violation; civil penalty assessed in the amount of $250.