WALNUT GARDEN III

Official classification

Type A

Official code

87355(e)(1)

Regulation authority

CCR

What the official deficiency says

87355: All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: This requierment is not met as evidence by: Based on records reviewed staff #1 has been working at the facility but does not have backround clearance and it is not associated to the facilit, which poses and immediate safety risk to residents in care

Official plan of correction

Administratorwill have S1 finguerprinted and associated to the facility and send prof to LPA.

Deadline recorded: Apr 12, 2024. 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

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 records review and interviews, the licensee did not comply with the section cited above. There is no staff coverage from 7:00pm to 7:00am, which poses an immediate health and safety risk to residents in care.

Official plan of correction

The licensee will submit a Personnel Report form LIC500 which reflects 24/7 adequate staff coverage. Also include the administrator’s and designated substitute’s days/hours at the facility. Submit proof to CCL by POC due date

Deadline recorded: Jan 17, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87463(b)

Regulation authority

CCR

What the official deficiency says

87463(b) Reappraisals (b) The reappraisal shall document significant changes in the resident's physical, ..., including those required to be documented as specified in Section 87466, Observation of the Resident. This requirement is not met as evidenced by: Based on records review, the licensee did not comply with the section cited above. Licensee did not update R1’s appraisal needs and services plan to document R1’s change of condition which included behavioral issues and aggression which required medication adjustment, which posed a potential health and safety risk to residents in care.

Official plan of correction

The licensee will submit a plan describing how you will ensure the resident appraisals are updated when there is a change of condition to reflect the current needs of the resident. Submit proof to CCL by POC due date

Deadline recorded: Jan 28, 2025. 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(a) Medical Assessment (a) Prior to a person's acceptance as a resident, the licensee shall obtain documentation of a medical assessment, signed by a licensed medical professional ... kept in the resident's record. This requirement is not met as evidenced by: Based on record review, the licensee did not comply with the section cited above. R1’s medical assessment was missing physician signature and date, and the section for authorization for release of medical information was blank, which posed a potential health and safety risk to residents in care.

Official plan of correction

The licensee will submit a plan how you will ensure resident documents are complete, including signatures and dates. Submit proof to CCL by POC due date

Deadline recorded: Jan 28, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87211(a)(1)(B)

Regulation authority

CCR

What the official deficiency says

87211(a)(1)(B) Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports...(1) A written report shall be submitted to the licensing agency and to the person responsible... events specified in (A) through (D) below….. (B) Any serious injury as determined by the attending physician and occurring while the resident is under facility supervision. This requirement is not met as evidenced by: Based on records review, the licensee did not comply with the section cited above. Licensee did not submit an incident report when R1 fell and fractured wrist, which posed a potential health and safety risk to residents in care.

Official plan of correction

The licensee will submit a plan describing how you will comply with reporting requirements. Submit proof to CCL by POC due date

Deadline recorded: Jan 28, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87202(a)

Regulation authority

CCR

What the official deficiency says

(a) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, or the State Fire Marshal. Prior to accepting or retaining any of the following types of persons, the applicant or licensee shall notify the licensing agency and obtain an appropriate fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, or the State Fire Marshal: 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 emergency exit gate was locked and the fire door did not self-close when smoke detectors were tested which poses an immediate health, safety and personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/11/2024 Plan of Correction Administrator contacted the fire door installer during the time of the visit and staff unlocked the emergency exit gate. Administrator agreed to ensure that the fire door will remain closed until repairs are completed. Administrator will submit proof of repairs to CCL upon completion.