VILLAGE AT SHERMAN OAKS, THE

Official classification

Type B

Official code

87211(a)(1)

Regulation authority

CCR

What the official deficiency says

87211 Reporting Requirements (a) Each licensee shall furnish...: (1) A written report shall be submitted to... licensing... within seven days of the occurrence of any of the events specified in (A) through (D) below… 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 two incident reports and one death report were not submitted to licensing within the required timeframe which posed a potential health, safety, or personal rights risk to clients in care.

Official plan of correction

ED agreed to submit the list of individuals from the facility who will be responsible for submitting reports to CCLD in a timely manner. Additionally, ED agreed to submit a statement of understanding which confirms that they will adhere to the 7-day reporting requirements for all future incidents. ED agreed to submit the documents to CCLD no later than POC due date.

Deadline recorded: Mar 19, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87465(a)(4)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed... (4) The licensee shall assist residents with self-administered medications as needed. 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 R1 missed administration of their prescribed Torsemide between 09/30/2025-10/03/2025 which posed a potential health risk to clients in care.

Official plan of correction

The facility had conducted in-service training with the team responsible for administering R1's medications. POC cleared at the time of the visit.

Deadline recorded: Nov 19, 2025. 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...: (1) A written report shall be submitted to... licensing...within seven days of... (D) Any incident which threatens the welfare, safety or health 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 two incident reports pertaining to incidents involving R1 were not submitted to licensing within the required timeframe which posed a potential health, safety, or personal rights risk to clients in care.

Official plan of correction

ED and DOAL agreed to submit a written statement confirming that all future reports will be submitted to CCLD within the required timeframe and will ensure someone in leadership is available to review/approve reports for submission to CCLD in the event of an absence of the ED or DOAL. ED and DOAL agreed to submit their plan on how they will ensure adequate coverage to review/submit reports along with the signed statement mentioned above to CCLD no later than POC due date.

Deadline recorded: Nov 20, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87465(a)(4)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed... (4) The licensee shall assist residents with self-administered medications as needed. 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 R1 missed administration of their prescribed Olanzapine between 08/04/2025-09/16/2025 which posed a potential health risk to clients in care.

Official plan of correction

The facility had written up the involved employees, conducted in-service training with the involved employees, and contacted hospice, the VA, and R1's family to ensure no further confusion occurs with obtaining R1's medications. POC cleared at the time of the visit.

Deadline recorded: Oct 1, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87465(h)(6)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care (h) The following requirements shall apply to medications which are centrally stored: (6) The licensee shall be responsible for assuring that a record of centrally stored prescription medications for each resident is maintained for at least one year and includes: 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 one resident's centrally stored medication and destruction record sheet contained inaccurate and out of date information which poses a potential health, risk to persons in care.

Official plan of correction

POC Due Date: 03/31/2025 Plan of Correction Licensee will submit an accurate CSMDR for the identified resident to CCLD no later than POC due date.

Official classification

Type B

Official code

87303(c)

Regulation authority

CCR

What the official deficiency says

87303 Maintenance and Operation (c) All window screens shall be clean and maintained in good repair. 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 LPAs observed three window screens/window screen frames were observed to be in disrepair which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/31/2025 Plan of Correction Licensee will complete appropriate repairs to the identified window screens/frames and will submit proof of repairs to CCLD no later than POC due date.

Official classification

Type B

Official code

87705(c)(5)

Regulation authority

CCR

What the official deficiency says

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' dementia care needs. This requirement is not met as evidenced by: Based on record review, the licensee did not comply witht he section cited above as R1 Physician's report (LIC602) is dated 12/20/2022 which poses a potential health and safety risk to residents in care.

Official plan of correction

Licensee agreed to obtain an updated LIC 602 and send to LPA via email by 10/04/2024 COB.

Deadline recorded: Oct 4, 2024. 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

(a) 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: (4) The licensee shall assist residents with self-administered medications as needed.

Official plan of correction

Facility has conducted an in service training on 6 resident rights and avoiding medication errors. S2 attended and S1 has terminated their employment at the facility. POC cleared.

Deadline recorded: Aug 13, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87464(f)(1)(c)

Regulation authority

CCR

What the official deficiency says

87464 Basic services (f)(1)(c) " Care and supervision " means the facility assumes responsibility for...ongoing assistance with activities of daily living without which the resident’s physical health, mental health, safety, or welfare would be endangered. This requirement is not met as evidenced by: Based on interviews and records review, R1 is not permitted to leave the facility unassisted, and was found outside of the facility without supervision, which poses an immediate health and safety risk to residents in care.

Official plan of correction

Licensee agreed to conduct an in-service training with staff to review section cited. In addition Licensee agreed to submit a letter of understanding to LPA via email by 04/18/2024 EOD.

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