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Official classification

Type B

Official code

87458(a)

Regulation authority

CCR

What the official deficiency says

(a) Prior to a person's acceptance as a resident, the licensee shall obtain and keep on file, documentation of a medical assessment, signed by a physician, made within the last year. The licensee shall be permitted to use the form LIC 602 (Rev. 9/89), Physician's Report, to obtain the 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 1 out of 1 identifiers which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/14/2024 Plan of Correction Please have physician report w/ TB test.

Official classification

Type B

Official code

87458(b)(1)

Regulation authority

CCR

What the official deficiency says

(b) The medical assessment shall include, but not be limited to: (1) A physical examination of the resident indicating the physician's primary diagnosis and secondary diagnosis, if any and results of an examination for communicable tuberculosis, other contagious/infectious or contagious diseases or other medical conditions which would preclude care of the person by the facility. 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 1 out of 1 identifiers which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/14/2024 Plan of Correction Please have physician report w/ TB test.

Official classification

Type B

Official code

87465(a)(1)

Regulation authority

CCR

What the official deficiency says

Incidental Medical and Dental Care. (a) A plan for incidental medical and dental care shall be developed by each facility. (1) The licensee shall arrange, or assist in arranging, for medical and dental care appropriate to... This requirement was not met as evidenced by: Based on the investigation, the licensee did not comply with the section cited above. Administrator admitted that R1 can't leave the facility unassisted, but on 06/25/23 R1 went missing which poses a potential health and safety risk to residents in care.

Official plan of correction

Licensee/Administrator agreed to provide in-service training to all staff to address this section of the Regulation. Copy of training will be submitted to LPA

Deadline recorded: Jul 12, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87211(a)(D)

Regulation authority

CCR

What the official deficiency says

Reporting Requirements: (a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: (D) Any incident which threatens the welfare.. This requirement was not met as evidenced by: Based on record reviews, the licensee did not comply with the section cited above. by not submitting R1's incident report to the Regional Office, which poses a potential health and safety risk to residents in care.

Official plan of correction

During the visit the Administrator provided the LPA with a copy on Incident Report that was emailed to the County on 06/29/23. No further correction is needed.

Deadline recorded: Jul 12, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

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 information obtained through records review and interviews, LPA determined Licensee abandoned resident at the hospital and did not provide care and supervision. This posed an immediate health and safety risk to the resident in care.

Official plan of correction

Licensee returned resident to facility where staff provide care and supervision.

Deadline recorded: Jan 19, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87224(a)(1)

Regulation authority

CCR

What the official deficiency says

87224 Eviction Procedures (a) The licensee may evict a resident... Thirty (30) days written notice to the resident is required ... (1) Nonpayment of the rate for basic services within ten days of the due date. This requirement is not met as evidenced by: Based on information obtained through records review and interviews, LPA determined Licensee failed to provide written notice prior to eviction. This posed a potential health and safety risk to the resident in care.

Official plan of correction

Licensee will issue a 30 day eviction to resident and LPA.

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