PROSPECT MANOR

Official classification

Type B

Official code

87303(e)(2)

Regulation authority

CCR

What the official deficiency says

(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. LPA tested the water temperature between 105.4 - 121.5 degrees F which is not within the required range of 105.0 -120 degrees F. which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/02/2026 Plan of Correction Licensee will adjust water and keep log for 3 days and send to LPA as proof of correction by POC due date.

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

87303(a) (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. Facility has one shelf broken in the supply room. One sliding door is broken in room 108 which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/02/2026 Plan of Correction Licensee will repair sliding door in room 108 and replace the broken shelf in the storage room by POC date and send proof to LPA.

Official classification

Type B

Official code

87211(a)(2)

Regulation authority

CCR

What the official deficiency says

87211 Reporting Requirements (a) Each licensee shall furnish to the ...g: (2) Occurrences, ...outbreaks, poisonings, catastrophes or major accidents which threaten the welfare, safety or health of residents... This requirement is not met as evidence by: Based on interviews and record review administrator failed to inform responsible party of incidents which poses a potential threat to the health, safety, or personal rights of the persons in care.

Official plan of correction

Administrator will certify in writing that will ensure responsible parties are notify of any incidents and will update phone numbers, obtain other means to contact responsible party and submit a copy of certification to the department by POC due date 9/5/25.

Deadline recorded: Sep 5, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87411(a)

Regulation authority

CCR

What the official deficiency says

87411 Personnel Requirements - General (a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. This requirement is not met as evidenced by: Based on interviews and record review, R1 who cannot leave the facility unassisted, eloped from the facility which posed an immediate health and safety risk to residents in care.

Official plan of correction

The Licensee will provide a written plan explaining how the facility will ensure that residents who cannot leave the facility unassisted are supervised as required.

Deadline recorded: Aug 16, 2025. 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 2 out of 6 bathrooms were water temperature was observed and read as follow in room #110 temperature was measured at 122.0 degrees F., and in room #224 water temperature was testd at 126.8 which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/22/2025 Plan of Correction Administrator will adjust water temperature to ensure temperature is between 105-120 degrees by POC due date 1/22/25. A daily water temperature log will be kept for 7 days and submitted to the department on 1/28/25.

Official classification

Type B

Official code

87303(e)(5)

Regulation authority

CCR

What the official deficiency says

(e) Water supplies and plumbing fixtures shall be maintained as follows: (5) Non-skid mats or strips shall be used in all bathtubs and showers. 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 2 out of 6 rooms observed, room #216 and 224 did not have skid mat/strip which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/28/2025 Plan of Correction Administrator will replace skid mat or strips in room #216 and 224 showers and submit a copy to the department by POC due date 1/28/25.

Official classification

Type A

Official code

87466

Regulation authority

CCR

What the official deficiency says

Observation of the Resident: The licensee shall ensure that residents are regularly observed for changes in physical, mental, ... such changes are documented and brought to the attention of the resident's physician and the resident's responsible person, if any. This requirement is not met as evidence by: Based on documents review and interviews conducted licensee did not ensure R1 was properly assess or reasses based on changes in condition which poses an immediate health, safety, or personal right to the persons in care.

Official plan of correction

Administrator will obtain a physician's reassessment for R1, will assist R1 based on reassement, and will provide a copy to the department by POC due date 10/30/24. **Immediate $500 Civil Penalties were assess**

Deadline recorded: Oct 30, 2024. 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(a)(1) 87211 Reporting Requirements: (a) Each licensee shall furnish..: (1)A written report shall be submitted to the licensing agency... within seven days of the occurrence...(D)Any incident which threatens the welfare, safety or health of any resident. This requirement is not met as evidence by: Facility did not report incidents when resident refused wound care during the months of July, August, and September, 2023

Official plan of correction

Licensee will provide all the incident reports for the month of July, August and September 2023 for all the days the resident refused wound care. licensee will train all staff including administrator on reporting requirements and send signed log of staff attending, topic and name of trainer to LPA by POC date which is 10/17/2024

Deadline recorded: Oct 17, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87458(a)

Regulation authority

CCR

What the official deficiency says

87458 Medical Assessment (a)(a) Prior to a person's acceptance as a resident, the licensee shall obtain and keep on file, documentation of a medical assessment, signed by a physician, made within the last year. The licensee shall be permitted to use the form LIC 602 (Rev. 9/89), Physician's Report, to obtain the medical assessment. This requirement is not met as evidenced by: R1 LIC602 when admitted was not in resident's file and the LIC602A dated on 11/22/2022 was signed by medical doctor who stated he did not have R1 as patient.

Official plan of correction

The administrator will obtain and keep on file documentation of residents Medical Assessment or LIC602A signed by a physician prior to a person’s acceptance as a resident. The administrator will send LPA the future plan about obtaining medical assessment prior to accept resident by POC due date.

Deadline recorded: Oct 17, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87207

Regulation authority

CCR

What the official deficiency says

False Claims: No licensee, officer or employee of a licensee shall make or disseminate any false or misleading statement regarding the facility or any of the services provided by the facility. This deficiency was evidenced by the following: During the course of a complaint investigation, Facility provided hand written documentation indicating that S2 had provided wound care to R1 on several occasions. Both S1 and S2 told the department that wound care was not provided.

Official plan of correction

Licensee will document a statement indicating the understanding of the regulation and will confirm that all staff have been notified about consequences regarding false claims made to licensing staff.

Deadline recorded: Oct 11, 2024. A deadline is not proof that correction was completed.

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 (a)...: To be free from neglect, financial exploitation, involuntary seclusion, punishment, humiliation, intimidation, and verbal, mental, physical, or sexual abuse. This requirement is not met as evidence by: Based on department interviews conducted and documents reviewed licensee failed to ensure R1 did not develop a wound and neglected wound care by retaining R1 with stage 4 wound which poses an immediate risk to the health, safety, or personal rights to the persons in care. *Immediate Civil Penalty for $500 is being issue*

Official plan of correction

Administrator will certify in writing that staff including administrator will follow up on any medical need(s) of residents who refuse care and upon observation, communication, or discovery of such and will provide training to staff on the above and submit training logs to the department by POC due date of 10/11/2024.

Deadline recorded: Oct 11, 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 water temperature tested in room #122 tested at 122.0 degrees F., room #118 tested at 130.6 degrees F., room #223 tested at 138.3 degrees F., which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/16/2024 Plan of Correction Maintenance will adjust water heater and administrator will certify in writing that water temperature will be maintain within the required 105-120 degrees F. in writing by POC 2/16/24, and will submit a temperature log maintain for the rooms above for the following 7 days and will submit the temperature log by 2/23/24.

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, interview, and record review, the licensee did not comply with the section cited above in R2's medication filled on 1/25/24 was out and LVN stated to have provided R2 additional pills to the dosage prescribed by the physician which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/16/2024 Plan of Correction Administrator will schedule training for LVN with a pharmacist which will cover providing medication to persons in care and the side effects of providing medication outside of the prescribed dosage, will notifiy the department of date of training by POC date 2/16/24 and will submit training certificate to the department by 2/29/24. Administrator will have R2 evaluated for correct prescription.

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

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 kitchen wall by stove was observed caved into the kitchen leaving a gap between the floor and the wall of about 3 in x 4 ft in, shower faucet in room 207 was cracked and half way gone which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/26/2024 Plan of Correction Administrator will ensure repairs are done in the kitchen wall and replace the faucet and will submit a picture of repairs to the department by POC 2/26/24.

Official classification

Type B

Official code

87411(a)

Regulation authority

CCR

What the official deficiency says

Personnel Requirements - General (a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs..... Based on interviews, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care. A staff was caught sleeping on the job.

Official plan of correction

Licensee is to comply with Title 22 Section 87411 at all times. Additionally, Licensee will conduct an in-service training with all staff and submit a training log with all staff signatures to Community Care Licensing Division (CCLD) by 01/16/2024.

Deadline recorded: Jan 16, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

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: Based on observation, resident room #108 water temperature read at 99.8 degrees F, resident room #201 water temperature read at 96.8 degrees F, resident room #209 water temperature read at 95.4 degrees F, resident room #220 water temperature read at 99.1 degrees F, the licensee did not comply with the section cited above in which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

Licensee/Administrator will adjust water heater accordingly and create a water log starting 01/29/2023 and record water temperature readings every 8 hours for the next 3 calendar days, ending on 02/01/2023. Licensee/ Administrator will send proof of water temperature log to LPA via email. First record of water log on 01/29/23 and subsequent recorded readings must measure within 105 -120 degress F.

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

Official classification

Type A

Official code

87303(e)(3)

Regulation authority

CCR

What the official deficiency says

(e) Water supplies and plumbing fixtures shall be maintained as follows: (3) Taps delivering water at 125 degree F (52 degrees C) or above shall be prominently identified by warning signs. This requirement is not met as evidenced by: Based on observation, water temperature in kitchen was measured at 184.1 degrees F, the licensee did not comply with the section cited above in which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

Licensee/Administrator will place a warning signs above kitchen sinks where water temperature will be delivering water at 125 degree F or above.

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

Official classification

Type A

Official code

87468.1(a)(1)

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: (1) To be accorded dignity in their personal relationships with staff, residents, and other persons. This standard was not met as evidenced by: S1 admitted to hugging and kissing R1 on R1’s lips on several occasions. S1 admitted being caught in R1’s closet by S2 and stated he/she hid in the closet because S1 knew the situation “looked bad”.

Official plan of correction

Administrator to provide all staff with personal rights training. Training plan will be submitted by 6/7/23. Proof of training will be submitted by 6/14/23. Immediate civil penalties assessed.

Deadline recorded: Jun 7, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87465(e)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Record: (e) For every prescription and nonprescription... there shall be a signed, ..., 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 evidence by: Based on observation licensee did not ensure medication for R2 had the proper pharmacy label which poses a potential risk to the health, personal rights, or safety of the residents in care.

Official plan of correction

Administrator will request medication with corrected label from pharmacy for medication for R2 and submit picture of the medication by 9/5/22.

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

Official classification

Type B

Official code

87465(a)(6)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care: (a) A plan... shall be developed by each facility... (6) ... a record of dosages of medications which are centrally stored shall be maintained by the facility. This requirement is not met as evidence by: Based on observation licensee did not ensure Med techs are recording medication dosages provide to the residents at each dose for R1,R2,R3,R4,R5,R6 review which poses a potential risk to the health, personal rights, or safety of the residents in care.

Official plan of correction

Administrator will ensure medication provided to the residents is on cycle and record properly by staff on medication sheet by certifying on LIC 9098 by POC due date 9/5/22.

Deadline recorded: Sep 5, 2022. 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

87303 Maintenance and Operation: (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 evidence by: Based on interviews and documents reviewed licensee did not ensure elevator was in working conditions at all times wich poses a potential health, safety, or personal rights risk for residents in care.

Official plan of correction

Licensee provided elevator repaired order dated 1/19/22 during this visit. Deficiency has been cleared as of 6/13/22.

Deadline recorded: Jun 13, 2022. A deadline is not proof that correction was completed.