PEARL OF WEST HILLS, INC

Official classification

Type A

Official code

1569.618(a)

Regulation authority

HSC

What the official deficiency says

(a) The administrator designated by the licensee pursuant to paragraph (11) of subdivision (a) of Section 1569.15 shall be present at the facility during normal working hours. A facility manager designated by the licensee with notice to the department, shall be responsible for the operation of the facility when the administrator is temporarily absent from the facility. This requirement is not met as evidenced by: Deficient Practice Statement Based on observations and interviews, the licensee did not comply with the section cited above by not ensuring a qualified administrator or designee was responsible for facility operations today which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/28/2025 Plan of Correction The licensee will return to the facility on Sunday, 06/29/25 to ensure responsible operations of the facility.

Official classification

Type A

Official code

87355(e)(3)

Regulation authority

CCR

What the official deficiency says

(e) 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: (3) Request a transfer of a criminal record clearance as specified in Section 87355(c) or This requirement is not met as evidenced by: Deficient Practice Statement Based on interview and record review, the licensee did not comply with the section cited above in Staff #1 (S1) caring for residents without a criminal background clearance associated to the facility which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/28/2025 Plan of Correction Licensee will schedule associated staff to work in the facility until they return on 06/29/25.

Official classification

Type A

Official code

87411(d)

Regulation authority

CCR

What the official deficiency says

(d) All personnel shall be given on the job training or have related experience in the job assigned to them. This training and/or related experience shall provide knowledge of and skill in the following, as appropriate for the job assigned and as evidenced by safe and effective job performance: This requirement is not met as evidenced by: Deficient Practice Statement Based on observations and interviews, the licensee did not comply with the section cited above in allowing Staff #1 (S1) to care for residets without documented training which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/28/2025 Plan of Correction The licensee will ensure only trained staff will work in the facility after today. The licensee will also provide S1 with all required initial trainings and submit proof of trainings by 07/12/25

Official classification

Type A

Official code

87606(c)

Regulation authority

CCR

What the official deficiency says

(c) To accept or retain a person who is bedridden, other than for a temporary illness or recovery from surgery, a licensee shall obtain and maintain an appropriate fire clearance as specified in Section 87202, Fire Clearance. This requirement is not met as evidenced by: Deficient Practice Statement Based on observations and interviews, the licensee did not comply with the section cited above in exceeding the facility's fire clearance by placing two (02) bedridden residents in Bedroom #4 which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/28/2025 Plan of Correction The licensee will submit a written, measurable, and verifiable plan on the relocation of one (01) of the two (02) bedridden residents by the POC due date.

Official classification

Type A

Official code

87608(a)(3)

Regulation authority

CCR

What the official deficiency says

(a) Based on the individual's preadmission appraisal, and subsequent changes to that appraisal, the facility shall provide assistance and care for the resident in those activities of daily living which the resident is unable to do for himself/herself. Postural supports may be used under the following conditions: (3) A written order from a physician indicating the need for the postural support shall be maintained in the resident's record. The licensing agency shall be authorized to require other additional documentation if needed to verify the order. This requirement is not met as evidenced by: Deficient Practice Statement Based on interviews, the licensee did not comply with the section cited above in two (02) out of three (03) residents using full bed rails without physician orders which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/28/2025 Plan of Correction Staff #1 (S1) removed all full bed rails on bed's of residents without hospice or physician orders for full bed rails. The deficiency is cleared at this time.

Official classification

Type A

Official code

87608(a)(5)(B)

Regulation authority

CCR

What the official deficiency says

(B) Bed rails that extend the entire length of the bed are prohibited except for residents who are currently receiving hospice care and have a hospice care plan that specifies the need for full bed rails. This requirement is not met as evidenced by: Deficient Practice Statement Based on observations, the licensee did not comply with the section cited above in two (02) out of three (03) residents with full bed rails without a hospice care plan which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/28/2025 Plan of Correction Staff #1 (S1) removed all full bed rails on bed's of residents without hospice or physician orders for full bed rails. The deficiency is cleared at this time.

Official classification

Type A

Official code

87203

Regulation authority

CCR

What the official deficiency says

87203 Fire Safety All facilities shall be maintained in conformity with the regulations adopted by the State Fire Marshal for the protection of life and property against fire and panic. This requirement is not met as evidenced by: Deficient Practice Statement Based on observations, the licensee did not comply with the section cited above in one expired fire extinguisher in the kitchen which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/28/2025 Plan of Correction The licensee will replace the expired fire extinguisher by the POC due date and send a photograph of the new fire extinguisher.

Official classification

Type B

Official code

87412(f)

Regulation authority

CCR

What the official deficiency says

87412 Personnel Records (f) All personnel records shall be available to the licensing agency to inspect, audit, and copy upon demand during normal business hours. Records may be removed if necessary for copying. Removal of records shall be subject to the following requirements: This requirement is not met as evidenced by: Deficient Practice Statement Based on observations and interviews, the licensee did not comply with the section cited above in not providing the staff file of Staff #1 (S1) which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/12/2025 Plan of Correction The licensee will provide keys and training to all staff in charge of facility operations to allow for the audit of all conficential files.

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 two (02) out of three (03) water faucets which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/01/2024 Plan of Correction Licensee has agreed to lower the hot water temperature on the water heater and send proof of water temperature measured within regulations by POC due date.

Official classification

Type B

Official code

1569.618(c)(3)

Regulation authority

HSC

What the official deficiency says

(c)The facility shall employ, and the administrator shall schedule, a sufficient number of staff members to do all of the following: (3) Ensure that at least one staff member who has cardiopulmonary resuscitation (CPR) training and first aid training is on duty and on the premises at all times. This paragraph shall not be construed to require staff to provide CPR. 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 (01) out of two (02) employees which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/30/2024 Plan of Correction Licensee has agreed to provide proof of updated CPR certificate for Staff #1 (S1) and maintain in facility file by POC due date

Official classification

Type B

Official code

87412(a)(12)

Regulation authority

CCR

What the official deficiency says

(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: (12) Hazardous health conditions documents as specified in Section 87411, Personnel Requirements - General. 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 (01) out of two (02) employees which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/30/2024 Plan of Correction Licensee has agreed to provide proof of TB Test for Staff #1 (S1) and maintain in facility file by POC due date

Official classification

Type B

Official code

87456(a)(3)

Regulation authority

CCR

What the official deficiency says

(a) Prior to accepting a resident for care and in order to evaluate his/her suitability, the facility shall, as specified in this article 8: (3) Obtain and evaluate a recent medical assessment. 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 two (02) out of three (03) resident medical assessments which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/30/2024 Plan of Correction Licensee has agreed to obtain current medical assessments for Resident #1 (R1) and Resident #2 (R2) and maintain in the faiclity file by the POC due date.

Official classification

Type B

Official code

87203

Regulation authority

CCR

What the official deficiency says

87203 Fire Safety All facilities shall be maintained in conformity with the regulations adopted by the State Fire Marshal for the protection of life and property against fire and panic. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and interview, the licensee did not comply with the section cited above in one (01) out of one (01) which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/30/2024 Plan of Correction Licensee agreed to obtain a new or recently inspected fire extinguisher for the kitchen by the POC due date.

Official classification

Type A

Official code

87411(c)(3)(B)

Regulation authority

CCR

What the official deficiency says

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 & Safety Code sections 1569.625 and 1569.69 (3) The training shall include, but not be limited to, the following: Importance and techniques of personal care services, including but not limited to,..feeding...This requirement is not met as evidenced by; Based on interviews & record review, staff do not have client specific training for feeding assistance & aspiration pneumonia which poses an immediate health, safety and personal rights risk to resident in care.

Official plan of correction

Administrator will ensure that all staff get client specific training for feeding assistance and aspiration pneumonia by the POC due date.

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

Official classification

Type A

Official code

87608(5)(b)

Regulation authority

CCR

What the official deficiency says

This requirement is not met as evidenced by: Deficient Practice Statement Based on observation it was observed that resident #4 had a full bed rail and is not on hospice. This is an immediate health and safety risk to residents in care.

Official plan of correction

POC Due Date: 05/06/2022 Plan of Correction Administrator shall have bed rail removed on R4's bed. Administrator will contact R4's physician regarding bed rail

Official classification

Type A

Official code

87355(e)(2)

Regulation authority

CCR

What the official deficiency says

(e) 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: (1) Obtain a California clearance or a criminal record exemption as required by the Departmentr This requirement is not met as evidenced by: Based on record review the licensee did not comply with the section cited above by not ensuring staff 1 (S1) obtained criminal record clearance prior to employment which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

Licensee stated that S1 would not be at the facility until proper criminal record clearance is granted for S1.

Deadline recorded: Mar 4, 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

Personnel Requirements-Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. This requirement was not met as evidenced by: Based on interviews conducted facility did not have enough staff to meet all resident needs. This poses a potential health and safety risk to residents in care.

Official plan of correction

Administrator stated they have hired additional staff. A staff schedule will be sent to LPA to clear deficiency.

Deadline recorded: Mar 4, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87219(a)

Regulation authority

CCR

What the official deficiency says

Planned Activities-Residents shall be encouraged to maintain and develop their fullest potential for independent living through participation in planned activities. This requirement was not met as evidenced by: Based on interviews conducted residents did not have planned activities which posed a personal rights violation to residents in care.

Official plan of correction

Corrected before visit. Activity calendar was given to LPA.

Deadline recorded: Mar 2, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87406(g)

Regulation authority

CCR

What the official deficiency says

87406 Administrator Certification Requirements (g) Certificates issued under this section shall be renewed every two (2) years provided the certificate holder has complied with all renewal requirements. This requirement is not met as evidenced by: Based on review of records and interview with licensee which revealed the Licensees Administrator Certificate expired 08/08/2020 and the Administrator has not taken the required classes to renew the required Administrator Certificate which poses an immediate health, safety and personal rights risk to residents in care.

Official plan of correction

Licensee/Administrator will notify the department when they will renew their certificate and who will be the designated administrator for the facility while she completes the renewal process.

Deadline recorded: Feb 18, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87468.1(a)

Regulation authority

CCR

What the official deficiency says

(a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (14) To have reasonable access to telephones, to both make and receive confidential calls. The licensee may require reimbursement for long distance calls. This requirement was not met as evidenced by: Based on interview the licensee did not comply with the cited sections by allowing R1 to have personal/confidential phone calls with family which posed an immediate personal rightsviolation to R1.

Official plan of correction

Licensee will review the cited regulation 87468.1. Licensee will submit a written statement that they have reviewed the regulation and indicate what steps will be taken to ensure the residents personal rights are not violated.

Deadline recorded: Jan 21, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87311

Regulation authority

CCR

What the official deficiency says

All facilities shall have telephone service on the premises. Facilities with a capacity of sixteen (16) or more persons shall be listed in the telephone directory under the name of the facility. This requirement was not met as evidenced by: Based on interview and attempted telephone calls to the facility the licensee did not comply with the cited section by not ensuring that a telephone service is available on the premises at all times which poses an immediate personal rights violation to R1.

Official plan of correction

Licensee will notify the department in writing what steps have been taken to correct this deficiency, Licensee and administrator will also submit a written statement that telephone services will be made available at the facility at all times.

Deadline recorded: Jan 21, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(a)(5)

Regulation authority

CCR

What the official deficiency says

(5) The licensee shall assist residents with self-administered medications as needed. This requirement was not met as evidenced by: Based on medication count the licensee did not comply with the section cited by not assisting R1 and R2 with self administered medications as prescribed which posed/poses an immediate health and safety and personal right risk to residents in care.

Official plan of correction

Licensee and all staff attended vendorized medication training on 12/19/2021. Licensee will submit a written statement notifying the department what steps will be taken to ensure residents are assisted with medications as prescribed.

Deadline recorded: Jan 21, 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

Incidental Medical... A plan for incidental medical...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: The licensee shall arrange, or assist in arranging, for medical and dental care appropriate to the conditions and needs of residents. This requirement was not met as evidenced by: Based on interviews conducted with administrator and R1 that revealed that the administrator did not receive medical attention in a timely manner which posed an Incidental Medical...violation to resident(s) in care.

Official plan of correction

Administrator will submit a written step by step guide to ensure that facility clients medical needs are met and that residents do not experience neglect.

Deadline recorded: Dec 24, 2022. 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

(e) 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: (2) Request a transfer of a criminal record clearance as specified in Section 87355(c) or This requirement is not met as evidenced by: Based on record review the licensee did not comply with the section cited above by not transferring criminal record clearance for staff 1 (S1) to this facility prior to employment which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

Licensee Irina Karbachinskiy provided transfer of criminal record clearance and photo ID to the LPA during the visit.

Deadline recorded: Nov 5, 2021. 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

(e) 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: (1) Obtain a California clearance or a criminal record exemption as required by the Departmentr This requirement is not met as evidenced by: Based on record review the licensee did not comply with the section cited above by not ensuring staff 2 (S2) obtained criminal record clearance prior to employment which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

Licensee Irina Karbachinskiy requested for staff member to leave the facility. Licensee provided LPA a signed written statement that the staff # 2 will not return to the facility until criminal record clearance is obtained.

Deadline recorded: Nov 5, 2021. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87406(g)

Regulation authority

CCR

What the official deficiency says

87406 Administrator Certification Requirements (g) Certificates issued under this section shall be renewed every two (2) years provided the certificate holder has complied with all renewal requirements. This requirement is not met as evidenced by: Based on review of records and interview with licensee which revealed the Licensees Administrator Certificate expired 08/08/2020 and the Administrator has not taken the required classes to renew the required Administrator Certificate which poses an immediate health, safety and personal rights risk to residents in care.

Official plan of correction

This deficiency was cited on 4/20/2021. As of todays visit Licensee Irina Karbachinskiy confirmed that she has not completed all of the required classes to renew her certificate. Licensee/Administrator will notify the department when they will renew their certificate and who will be the designated administrator for the facility while she completes the renewal process.

Deadline recorded: Nov 8, 2021. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(C3)(D3)

Regulation authority

CCR

What the official deficiency says

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 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 & time the PRN medication was taken, the dosage taken, & the resident's response. This requirement was not met as evidenced by: Based on records review and interview the licensee did not comply with the cited sections by not documenting when PRN medications were administered to R1. Which posed an

Official plan of correction

immediate health, safety and personal rights risk to R1. Licensee/Administrator will schedule vendorized medication training for all staff. Training will need to be scheduled within 24 hours and completed by 11/19/2021

Deadline recorded: Nov 8, 2021. A deadline is not proof that correction was completed.

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 shall be permitted to assist the resident with self-administration, provided the following requirements are met: (2) Once ordered by the physician the medication is given according to the physician's directions.This requirement was not met as evidenced by: Based on medication review the licensee did not comply with the cited sections by not giving medications per the physicians directions which posed an immediate health, safety and personal rights risk to R1.

Official plan of correction

Licensee/Administrator will schedule vendorized medication training for all staff. Training will need to be scheduled within 24 hours and completed by 11/19/2021 Licensee/Administrator will also submit a written statement notifying the department what steps will be taken to prevent the reoccurrence of the cited deficiency.

Deadline recorded: Nov 8, 2021. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(e)

Regulation authority

CCR

What the official deficiency says

(e) For every prescription and nonprescription PRN medication for which the licensee provides assistance there shall be a signed, dated written order from a physician on a prescription blank, maintained in the resident's file, 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 was not met as evidenced by: Based on hospital records review the licensee did not comply with the section cited above by not having a signed written order from a physician for the medication Geodon given to resident 1 which posed an immediate health, safety and personal rights risk to R1.

Official plan of correction

Licensee/Administrator will schedule vendorized medication training for all staff. Training will need to be scheduled within 24 hours and completed by 11/19/2021 Licensee/Administrator will also submit a written statement notifying the department what steps will be taken to prevent the reoccurrence of the cited deficiency.

Deadline recorded: Nov 8, 2021. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.1(a)(1)

Regulation authority

CCR

What the official deficiency says

Personal Rights of Residents in All Facilities-To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement was not met as evidenced by: Based on interviews conducted it was revealed that R1 was yelled at by the facility administrator which posed a personal rights violation to residents in care.

Official plan of correction

Administrator shall submit written statement that no residents will be yelled at and will be talked to appropriately. Copy of written statement will be due by poc due date.

Deadline recorded: Oct 25, 2021. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.1(a)(6)

Regulation authority

CCR

What the official deficiency says

Personal Rights of Residents in All Facilities-To leave or depart the facility at any time and to not be locked into any room, building, or on facility premises by day or night. This requirement was not met as evidenced by: Based on interviews conducted residents were not able to leave the facility at anytime. This poses a potential personal rights violation to residents in care.

Official plan of correction

Administrator shall have a meeting with all residents and explain those that are able to leave the facility without supervision shall be able to without permission. Staff will have a sign in sheet to which residents will sign that meeting too place and copy will be sent to LPA by poc due date.

Deadline recorded: Oct 25, 2021. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.1(a)(12)

Regulation authority

CCR

What the official deficiency says

Personal Rights of Residents in All Facilities-To wear their own clothes; to keep and use their own personal possessions. This requirement was not met as evidenced by: Based on interviews conducted it was observed and admitted to by the administrator that R1 was not able to wear or have access to their own clothes which is a violation of residents personal rights.

Official plan of correction

Administrator will send statement that all residents will be able to wear whatever clothes they choose to and will have access to all of their clothing without interference from facility staff.

Deadline recorded: Oct 25, 2021. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87219(a)

Regulation authority

CCR

What the official deficiency says

Planned Activities-Residents shall be encouraged to maintain and develop their fullest potential for independent living through participation in planned activities. This requirement was not met as evidenced by: Based on interviews conducted facility does not have any planned activities for residents.

Official plan of correction

Administator shall come up with an activity calendar with input from the residents of various activities that residents will be offered and can participate in. Copy of activity calendar will be sent to LPA by poc due date.

Deadline recorded: Oct 25, 2021. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87468.2(a)(2)

Regulation authority

CCR

What the official deficiency says

Personal Rights of Residents in All Facilities-To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This requirement was not met as evidenced by: Based on interviews conducted staff were not checking all visitors temperatures upon entry to the facility which poses an immediate health and safety risk to residents in care.

Official plan of correction

Administrator shall have in-service with facility staff on the importance of checking all visitors temperatures. Copy of in-service sign in sheet shall be sent to LPA.

Deadline recorded: Oct 22, 2021. A deadline is not proof that correction was completed.