CLEARWATER AT SOUTH BAY

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...as the Department may require, including, but not limited to, the following: (1) A written report...for the resident within seven days any..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. This has not been met as evidenced by a delay in reporting which indicates the licensee has failed to follow

Official plan of correction

LPA and S1 have confirmed that the facility will conduct an in-staff training for all supervisors and med-tech staff who reside at this facility. S1 will forward this documentation to LPA, by email, at MARIO.LEON@DSS.CA.GOV on or prior to POC due date, 10/29/25.

Deadline recorded: Oct 29, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.2(a)(19)

Regulation authority

CCR

What the official deficiency says

87468.2Additional Personal Rights of Residents in Privately Operated Facilities (a)In addition to the rights listed... the elderly shall have all of the following persoanl rights (19)To have prompt access to review all of their records and to purchase photocopies of their records. Photocopied records shall be provided within two (2) business days and at a cost that does not exceed the community standard for photocopies. This regulation was not met based on record review, Resident R1 and R2's representative was not provided copies of Resident's file within two (2) business days.

Official plan of correction

Administrator will reviewed Title 22 regulations section 87468.2 and email LPA that the section was reviewed and understood by POC due date. LPA email: wendy.gibbs@dss.ca.gov

Deadline recorded: May 10, 2025. 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 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: 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: 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 in staff not documenting when giving prescribed medications which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/01/2023 Plan of Correction Executive Director must ensure all staff who gives prescribed medications to resdients must do the proper documentation. As POC Executive Director will provide a re-training of staff and send proof to LPA via email before POC due date.

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 in keeping cleaning agents away from memory care residents which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/20/2023 Plan of Correction Executive director removed cleaning agent during LPA visit. In addition, as part of POC Executive director will ensure no other cleaning agents are in reach of memory care residents. As part of POC Executive Director will re-train care staff and family members regarding the importance of keeping cleaning solutions in a secure area. Executive director will sent proof of correction to LPA via email before POC due date.

Official classification

Type B

Official code

87303(b)

Regulation authority

CCR

What the official deficiency says

87303(b) A comfortable temperature for residents shall be maintained at all times. This was not met as evidence by; based on the observations and interviews the facility had A/C not completely operational and still remians unreapired. This poses a potential risk for persons in care.

Official plan of correction

Facility to keep providing personal electrical fan to those residents that have no A/C in their rooms. Facility provided personal fans to the residents with no A/C in their rooms. LPA verified the fans in the individuals rooms.

Deadline recorded: Sep 20, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87303(b)

Regulation authority

CCR

What the official deficiency says

87303(b) A comfortable temperature for residents shall be maintained at all times. This was not met as evidence by; based on the observations and interviews the facility had A/C cot completely operational. This poses a potential risk for persons in care.

Official plan of correction

Facility to keep providing personal electrical fan to those residents that have no A/C in their rooms. Facility provided personal fans to the residents with no A/C in their rooms. LPA verified the fans in the individuals rooms.

Deadline recorded: May 8, 2022. A deadline is not proof that correction was completed.