KAREN'S SENIORS CARE HOME, INC.

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 (record review)], the licensee did not comply with the section cited above in 2 out of 2 medication bottles contained more pills(9) than consistent with the start date of the medication and less pills (2) consistent with the start date of the medication, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/27/2026 Plan of Correction Administrator will provide medication training to all aregivers and will submit proof of the date, time and hours of training provided by a skilled professional, along with a sign in sheet for staff with their printed name and signatures. Proof will be emailed to LPA.

Official classification

Type B

Official code

1569.625(b)(2)

Regulation authority

HSC

What the official deficiency says

(2) In addition to paragraph (1), training requirements shall also include an additional 20 hours annually, eight hours of which shall be dementia care training, as required by subdivision (a) of Section 1569.626, and four hours of which shall be specific to postural supports, restricted health conditions, and hospice care, as required by subdivision (a) of Section 1569.696. This training shall be administered on the job, or in a classroom setting, or both, and may include online training. 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 in one three (persons)] didnot have proof of the 20 hours of annual required training on record, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/27/2026 Plan of Correction Administrator will provide proof of the training dates, time (hours), and topics provided to staff by the POC due date. Submit staff signing sheet, with printed name and the name of trainer/presenter or online training. Email to LPA by POC date.

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 one out of two bathrooms inspected the water temperature was measured above 120 degree F, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/12/2024 Plan of Correction During the inspection, the Administrator lowered the water temperature. Administrator also agreed to send LPA a temperature log for the next five (5) days and send the log to LPA via e-mail by EOD 02/14/2024.

Official classification

Type A

Official code

87615(a)(5)

Regulation authority

CCR

What the official deficiency says

(a) Persons who require health services for or have a health condition including, but not limited to, those specified below shall not be admitted or retained in a residential care facility for the elderly: (5) Residents who depend on others to perform all activities of daily living for them as set forth in Section 87459, Functional Capabilities. 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 R1 was admitted to the facility as total care and an exception is not on file which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/12/2024 Plan of Correction Licensee agreed to submit a statment of understanding of regulation 87615(a) and obtain a new LIC 602 and submit to CCLD via email by COB 02/12/2024

Official classification

Type A

Official code

87465(a)(1)

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 by each facility. The plan shall...(1) The licensee shall arrange, or assist in arranging, for medical...conditions and needs of residents. This requirement is not met as evidenced by: Based on interviews, the licensee did not comply with the section cited above as facility staff did not take action to have R1 transported to a medical facility for 10 hours after R1 fell and sustained a head injury, which posed an immediate health and safety risk to residents in care. Civil penalty issued.

Official plan of correction

Facility designee will provide LPA with the document all facility staff are trained on and have signed off on with the new facility procedure for calling 9-1-1 immediately by POC due date.

Deadline recorded: May 10, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87468.2(a)(20)

Regulation authority

CCR

What the official deficiency says

87468.2 Additional Personal Rights of Residents in Privately Operated Facilities(a)(20) To be protected from involuntary transfers, discharges, and evictions...shall comply with all eviction and relocation protections for residents...not by the resident. This requirement is not met as evidenced by: Based on interview, the licensee did not comply with the above cited section, as R1 was sent to the hospital and facility designee refused to readmit R1, which posed an immediate personal rights risk to residents in care.

Official plan of correction

Facility designee will provide to LPA by the POC due date a plan for eviction notification to implement for all future evictions.

Deadline recorded: May 17, 2023. 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)(1)(D) Any incident which threatens the welfare, safety or health of any resident, such as psychological abuse of a resident by staff or other residents, or unexplained absence of any resident. This requirement is not met as evidenced by: Based on record review, the licensee did not comply with the above cited section as an incident involving R1 that occurred at the facility around September 2020 and an incident on 02/16/2021 were not reported to CCLD, which posed a potential health and safety risk to residents in care.

Official plan of correction

Facility designee agreed to provide to LPA a copy of the facility's current plan for falls and unusual incident procedure by POC due date.

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

Official classification

Type A

Official code

87464(f)(1)

Regulation authority

CCR

What the official deficiency says

87464 Basic Services. (f) Basic services shall at a minimum include: (1) Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code Section 1569.2(c). This requirement is not met as evidenced by: Based on interview and record review, the licensee did not comply with the above cited section as proper supervision was not provided to R1, resulting in falls and R1 sustaining multiple bruises, which posed an immediate health and safety risk to residents in care. Civil penalty issued.

Official plan of correction

Facility designee will provide LPA with a copy of the documents previously provided to LPA Balisi on 10/10/2022 regarding the facility's care and supervision plan. Designee will provide to LPA by POC due date.

Deadline recorded: May 10, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87355(e)(2)

Regulation authority

CCR

What the official deficiency says

All individuals subject to a criminal record... residing or volunteering in a licensed facility: (2) Request a transfer of a criminal record clearance as specified in Section 87355 C … This requirement is not met as evidenced by: Based on record review and interview the licensee did not comply with the section cited by not transferring the criminal record clearance for S1 to this facility prior to employment which poses an immediate health, safety and personal rights risk to persons in care.

Official plan of correction

Licensee agreed to submit a transfer of a criminal record clearance for all staff not associated to the facility by 01/19/2023. Licensee will submit proof of clearance to LPA via email by eod 01/19/2023.

Deadline recorded: Jan 20, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87464(f)(1)

Regulation authority

CCR

What the official deficiency says

87464(f)(1) Basic Services. (f) Basic services shall at a minimum include: (1) Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code Section 1569.2(c). This requirement is not met as evidenced by: Based on interviews and records review, the licensee did not comply with the section cited above. (R1) was not provided the proper supervision to ensure R1’s safety. R1 had a history of falls, which led to R1 sustaining fractures to tibia, fibula, proximal fibula to left leg from a fall(s), which posed an immediate health and safety risk to residents in care.

Official plan of correction

Licensee will submit a written action plan regarding proper resident care and supervision to CCL by COB Monday 10/8/2022 via email.

Deadline recorded: Oct 10, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(a)(1)

Regulation authority

CCR

What the official deficiency says

87465(a)(1) A plan for incidental medical and dental care shall be developed by each facility. The plan shall...(1) The licensee shall arrange, or assist in arranging, for medical...conditions and needs of residents. This requirement is not met as evidenced by: Based on interviews, the licensee did not comply with the section cited above. The administrator did not take action to have R1 transported to a medical facility for 2 days after R1 fell off commode and was found on floor, which posed an immediate health and safety risk to residents in care.

Official plan of correction

Licensee will submit plan how you will ensure residents receive timely medical care. Submit to CCL by COB Monday 10/8/2022 via email.

Deadline recorded: Oct 10, 2022. A deadline is not proof that correction was completed.