WALNUT VILLA

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, water temperatures in all grooming and bathing areas were not measured to be within 105 – 120 degrees F, the licensee did not comply with the section cited above in 13 out of 13 residents which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/18/2025 Plan of Correction *Water heater was lowered during visit. This clears 24hr correction.* Licensee will develop water log and record AM and PM water temperatures in resident grooming areas, for the next three business days. Water log record must record water temperatures were within 105 - 120 F degrees. Water log record must be emailed to LPA Ramirez by 11/21/2025.

Official classification

Type B

Official code

87555(b)(7)

Regulation authority

CCR

What the official deficiency says

87555 General Food Service Requirements (b) The following food service requirements shall apply: (7)Modified diets prescribed by a resident's physician as a medical necessity shall be provided. This requirement is not as evidence by: Based on observations and interviews conducted licensee did not ensure staff were providing meals to the residents based on the diets noted by the physician which poses a potential risk to the persons health, safety, and personal rights of the persons in care.

Official plan of correction

Administrator will provide training to kitchen staff that covers, special diets, servings, and preparation and will submit a copy to the department by POC due date: 2/6/25.

Deadline recorded: Feb 6, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87705(j)

Regulation authority

CCR

What the official deficiency says

87705 Care of Persons with Dementia: (j) The licensee shall have an auditory device or other staff alert feature to monitor exits, if exiting presents a hazard to any resident. This requirement is not met as evidence by: Based on observations licensee did not ensure staff maintained the auditory devices on at all times which poses a potential risk to the health, safety, or personal rights of the persons in care.

Official plan of correction

Administrator will provide training to staff on Dementia section 87705 and will provide a copy to the department by POC due date: 2/6/25.

Deadline recorded: Feb 6, 2025. 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

87465 Incidental Medical and Dental Care (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 observation (during medication review), the licensee did not comply with the section cited above as LPA obsereved 2 medications missing 8/27/24 AM medication, LPA asked Administrator why medication was off on bubble pack (as administrator previously stated that each medication on particular residents medication reviewed was punched out daily on correct date number) Administrator was unsure why medication was off and could not provide explaination, nor were there any notes in MAR, this poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/27/2024 Plan of Correction *administrator will follow up with pharmacy so that all future refills have the correct amount of medication* Licensee/Administrator to conduct an in-service training on proper medication administrator and provide LPA with training materials and training log with participants by 9/9/2024. this can be submitted via email to LPA tena.herrera@dss.ca.gov

Official classification

Type A

Official code

87303(e)(2)

Regulation authority

CCR

What the official deficiency says

87303 Maintenance and Operation (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 degree C) and not more than 120 degree F (49 degree 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 as LPA tested water temperature in Room #1 and in Resident full bath both temperatures were above 130 degress F, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/27/2024 Plan of Correction *during visit administrator lowered water temperature* Licensee/Administrator to create a water log for the next 3 days and measure water temperature, water will be tested 3x a day (morning, day, evening) and all temperatures must be within the required range. Log must be emailed to LPA by 8/31/24. (log must begin 8/27-morning and end 8/30-evening). this log may be emailed to LPA tena.herrera@dss.ca.gov

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above as during tour LPA observed a leak in the resident bathroom shower, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/09/2024 Plan of Correction Licensee/Administrator to have leak repaired and a copy of repair invoice is to be sent to LPA via email by POC due date. (tena.herrera@dss.ca.gov)

Official classification

Type B

Official code

87303(i)(1)(B)

Regulation authority

CCR

What the official deficiency says

87303 Maintenance and Operation (i) Facilities shall have signal systems which shall meet the following criteria: (1) All facilities licensed for 16 or more and all residential facilities having separate floors or buildings shall have a signal system which shall: (B) Transmit a visual and/or auditory signal to a central staffed location or produce an auditory signal at the living unit loud enough to summon staff. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited aboveas during facility tour the buzzers on doors that lead to exterior of facility (4 which are resident rooms) LPA obsereved buzzers/ringers to not be working, this is a facility that has dementia residents, this poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/09/2024 Plan of Correction **during visit Administrator purchased new signal/ring system for doors (total 8) that will be delivered to facility tomorrow 8/27/24** Licensee/Administrator to install new buzzers on all doors that exit the facility and submit a photo of new buzzers (installed) to LPA by POC due date. (tena.herrera@dss.ca.gov)