GARDENS AT PARK BALBOA, THE

Official classification

Type A

Official code

87468.1(a)(3)

Regulation authority

CCR

What the official deficiency says

Personal Rights of Residents in All Facilities: Residents in all residential care facilities for the elderly shall have all of the following personal rights: To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature, such as withholding residents’ money or interfering with daily living functions such as eating, sleeping, or elimination. This requirement was not met as evidenced by- Resident #1 was shoved by their caregiver which caused the resident to sustain a cut over the left eye. Immediate civil penalties were assessed

Official plan of correction

Licensee will provide an action plan to ensure that staff will not abuse or get physical with the residents when they have a behavior or are difficult by10/31/24. Licensee will also ensure that staff are provided with regular personal rights training by November 6, 2024

Deadline recorded: Oct 31, 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

(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 medication review and LPA observation, the licensee did not comply with the section cited above as medication for Resident #2 (R2) medication ROSUVASTATIN 20 mg, was counted and was observed to have 4 more pills than needed. However there is no record of refusal documented which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/04/2024 Plan of Correction Licensee will conduct staff training on medications and submit proof to CCL no later than POC due date.

Official classification

Type B

Official code

87465(c)(3)

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: (3) A record of each dose is maintained in the resident's record. The record shall include the date and time the PRN medication was taken, the dosage taken, and the resident's response. This requirement is not met as evidenced by: Deficient Practice Statement Based on medication review and LPA observation, the licensee did not comply with the section cited above as three (3) out of four (4) PRN medication for R1 are being administered but is not being documented which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/04/2024 Plan of Correction Licensee will submit a plan describing how you will ensure residents medications will be properly administered and documented. Submit proof to CCL no later than POC date.

Official classification

Type B

Official code

87633(a)(2)

Regulation authority

CCR

What the official deficiency says

(a) The licensee shall be permitted to accept or retain residents who have been diagnosed as terminally ill by his or her physician and surgeon and who may or may not have restrictive and/or prohibited health conditions, to reside in the facility and receive hospice services from a hospice agency in the facility, when all of the following conditions are met: (2) The licensee remains in substantial compliance with the requirements of this section, with the provisions of the Residential Care Facilities for the Elderly Act (Health and Safety Code Section 1569 et seq.), all other requirements of Chapter 8 of Title 22 of the California Code of Regulations governing Residential Care Facilities for the Elderly, and with all terms and conditions of the waiver. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review and LPA observation, the licensee did not comply with the section cited above as facility has an approved hospice waiver for four (4) residents but facility has five (5) residents on hospice which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/04/2024 Plan of Correction Licensee has agreed to submit a hospice waiver increase to CCL no later than POC due date.

Official classification

Type B

Official code

87468.2(a)(19)

Regulation authority

CCR

What the official deficiency says

Additional Personal Rights of Residents in Privately Operated Facilities: In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal 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. Facility failed to provide timely access to Resident #1's files

Official plan of correction

The Licensee will immediately contact the contact person noted on the request at the law firm to schedule a time when they may have access to Resident #1's file for copying. Licensee will provide a signed statement to Licensing stating the arrangements that have been made and agreed to by the facility and the legal representative to allow access to Resident #1's files by no later than POC date - 10/23/23,

Deadline recorded: Oct 23, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87465(f)(1)

Regulation authority

CCR

What the official deficiency says

(f) Emergency care requirements shall include the following: (1) The name, address, and telephone number of each resident's physician and dentist shall be readily available to that resident, the licensee, and facility staff. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review and observation, the licensee did not comply with the section cited above per request to verify the the names of the residents and the names of their physicians and dentist, address and contact information and the facility was not able to easily provvide the requested information which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/04/2023 Plan of Correction Licensee will ensure that the facility maintains the name, address and telephone number of each resident's physician and dentist and make it easily available to the resident, Licensee and facility staff by 10/04/23.

Official classification

Type B

Official code

87411(c)(1)

Regulation authority

CCR

What the official deficiency says

87411 Personnel Requirements General:(c) All RCFE staff who assist residents with personal activities of daily living shall receive initial and annual training as specified in Health and Safety Code sections 1569.625 and 1569.69 (1) Staff providing care shall receive appropriate training in first aid from persons qualified by such agencies as the American Red Cross. 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 per review of 10 staff files, there was no evidence of current first aid training maintained in staff files except for Grace Bulaclac. LPA was not able to establish if staff have taken current first aid training, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/11/2023 Plan of Correction Licensee will review all staff files to ensure that all staff have received first aid training and maintain evidence in the staff's files. If staff have not received first aid training, Licensee will provide a plan of aciton as to how the facility will ensure that there is a staff with first aid training, always present at the facility until all staff have received first aid and CPR training by 9/28/23.

Official classification

Type A

Official code

1569.269

Regulation authority

HSC

What the official deficiency says

1569.269 Enumerated rights; severability (a)(10) Residents of residential care facilities for the elderly shall have all of the following rights: To be free from ... verbal, mental, physical, or sexual abuse.This requirement is not met as evidenced by: Based on interviews, the licensee did not comply with the section cited above as the resident was handled roughly by staff resulting in an injury which poses an immediate health, safety and personal rights risk to persons in care.

Official plan of correction

The administrator agreed to the following: To provide a scheduled date for staff in-service regarding regulation 1569.269(a)(10) to CCL by 4/11/23. Administrator will provide documentation of staff in-service to CCL by 4/21/23.

Deadline recorded: Apr 11, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

87303(a) Maintenance and Operation. The facility shall be clean, safe, sanitary and in good repair at all times. This requirement is not met as evidenced by: Based on interview and observation, the licensee did not comply with the section cited above, as R1's call button was inoperable on 11/3/2022 and 3 out of 14 rooms did not have a call button in the resident unit, which poses an immediate health and safety risk to residents in care.

Official plan of correction

The Administrator has agreed to do the following: 1. Check all signal units in each resident room to ensure the signal unit is operational. Inform CCL when this has been completed, but no later than 11/09/2022, end of day.

Deadline recorded: Nov 9, 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

87303(e)(2) Maintenance and Operation. 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 and not more than 120 degree F. This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above, as water temperature measured above 120 degree F in four (4) out of fourteen (14) rooms, which poses an immediate health and safety risk to residents in care.

Official plan of correction

The Administrator has agreed to do the following: 1. Adjust the water boilers within the next 24 hours. 2. Conduct a 3 day water temperature log for ten rooms spread throughout the facility. Include rooms 104, 122, 126, and 212. Submit log no later than 7/16/2022.

Deadline recorded: Nov 8, 2022. 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 Reporting Requirements: (a) Each licensee shall furnish to the licensing Agency.. the following: (1)A written report.. within seven days of the occurrence of..(A) Death of any resident.. regardless of where the death occurred.. This requirement is not met as evidenced by: Based on record review and interview with the administrator, the licensee failed to comply with the section cited above as the facility failed to submit R1's Death Report as required, which poses a potential health and safety risk to residents in care.

Official plan of correction

The Licensee agreed to do the following: 1. Submit a written memo of understanding of the regulation 87211(a)(1)(A) to CCL by 5/23/2022.

Deadline recorded: May 23, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87468.2(a)(4)

Regulation authority

CCR

What the official deficiency says

87468.2(a)(4) Additional Personal Rights of Residents in Privately Operated Facilities (a)In addition.. residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (4)To care, supervision, and services.. This requirement is not met as evidenced by: Based on record review, and interviews conducted, the licensee did not comply with the section cited above as the facility did not respond to R1’s calls for assistance in a timely manner, which poses an immediate health, safety, personal rights risk to persons in care.

Official plan of correction

The Licensee has agreed to do the following: 1. Provide training on Personal Rights and Process and Procedure on the call monitoring system for time efficiency to staff. 2. Submit proof of training to CCLD.

Deadline recorded: May 23, 2022. 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(a)Personnel Requirements: Facility personnel shall at all times be sufficient in numbers..to provide the services necessary to meet resident needs..facilities licensed for sixteen or more, sufficient support staff.. to ensure..personal assistance and care.. This requirement is not met as evidenced by: Based on record review, and interviews conducted, the licensee did not comply with the section cited above as the facility did not respond to R1’s calls for assistance in a timely manner to meet R1’s needs, which poses an immediate health, safety, personal rights risk to persons in care.

Official plan of correction

The Licensee has agreed to do the following: 1. Provide training on Personal Rights and Process and Procedure on the call monitoring system for time efficiency to staff. 2. Submit proof of training to CCLD.

Deadline recorded: May 23, 2022. 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, furnishings and equipment. This requirement is not met as evidenced by: Based on record review, and interviews conducted, the licensee did not comply with the section cited above as the facility did not respond to two (2) of R1’s calls for assistance, which poses an immediate health, safety, personal rights risk to persons in care.

Official plan of correction

The Licensee has agreed to do the following: 1. Provide training on Personal Rights and Process and Procedure on the call monitoring system for time efficiency to staff. 2. Submit proof of training to CCLD.

Deadline recorded: May 23, 2022. A deadline is not proof that correction was completed.