INN AT THE PARK VENTURA

Official classification

Type B

Official code

87303(c)

Regulation authority

CCR

What the official deficiency says

(c) All window screens shall be clean and maintained in good repair. 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 approximately 9 resident windows did not have screens which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/18/2026 Plan of Correction The Licensee will replace all window screens and provide proof to CCLD by POC due date.

Official classification

Type B

Official code

87303(e)(5)(A)

Regulation authority

CCR

What the official deficiency says

(e) Water supplies and plumbing fixtures shall be maintained as follows: (5) Slip-resistant mats, strips, or flooring shall be used in all bathtub and shower floors. (A) All slip-resistant mats, strips, or flooring shall be in good repair and maintain slip-resistant properties. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above. Resident shower floor strips observed peeling off in rooms 212,and 215. This poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/19/2025 Plan of Correction Administrator agreed to have maintenance apply new strips and check all resident bathroom shower floors to ensure the floor strips are in place or provide shower mats. Submit photos and self certification letter that all other bathrooms are checked to confirm showers/tub strips or shower mats are in place.

Official classification

Type B

Official code

87303(e)(6)

Regulation authority

CCR

What the official deficiency says

(e) Water supplies and plumbing fixtures shall be maintained as follows: (6) Toilet, handwashing and bathing facilities shall be maintained in operating condition. Additional equipment shall be provided in facilities accommodating physically handicapped and/or nonambulatory residents, based on the residents' needs. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above . Room 271 bathroom sink faucet is out of service (water leak); room 272 bathroom faucett does not supply sufficent hot water. This poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/19/2025 Plan of Correction Administrator agreed to have facility mainenance contact a plumber for maintenance and repair. Submit proof of invoice for repairs made to ensure plumbng issues resolved for room 272 and 271.

Official classification

Type B

Official code

87465(h)

Regulation authority

CCR

What the official deficiency says

(h) The following requirements shall apply to medications which are centrally stored: This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview and record review, the licensee did not comply with the section cited above. Four out of four resident medication records reviewed revealed record keeping issues (inaccurate expiration and fill dates recorded on the centrally stored records by facility staff and the prefilled centrally stored records provided by the pharmacy. This poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/19/2025 Plan of Correction Administrator and staff reviewed and corrected the errors during the visit; Administrator contacted the pharmacy to inform them of the errors. Administrator agreed to coordinate an in services training with staff on policy and procedures pertaining to medication record keeping.

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

87303 (a) 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. Room 110 flooring needs to be painted or repaired. Memory care resident restroom shower/bath tubs (room 259, 263, 271,272) need to be maintained clean and sanitary.

Official plan of correction

POC Due Date: 08/19/2025 Plan of Correction Administrator agreed to have maintenance and housekeeping clean and maintain memory care unit shower/bath tubs clean and sanitary. Submit photos and self certification letter that all memory care unit shower/bath tubs are checked and maintained clean and sanitary.

Official classification

Type B

Official code

87211(a)(1)

Regulation authority

CCR

What the official deficiency says

(a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: (1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of.. the events specified in (A) through (D) below. This report shall include the resident's name, age, sex and date of admission; date and nature of event; attending physician's name, findings, and treatment, if any; and disposition of the case.

Official plan of correction

Administrator stated that staff are reminded of the reporting requirements and moving forward all incidents will be reported timely. Administrator agreed to provide a self-certification letter to CCL by POC due date.

Deadline recorded: Jun 17, 2025. 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) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs... require additional staff for the provision of adequate services. This requirement is not met as evidenced by: Based on record review and interviews, the Licensee did not comply with the section cited above by not having a sufficient number of caregivers on duty during the NOC shift. This poses a potential health and safety risk for residents in care.

Official plan of correction

Administrator agrees to submit a written plan to ensure that NOC staff are supervised and accountable during working hours. This can be a new hired checking that the job is getting done and that staff are not leaving the facility during their shift leaving residents unattended and submit to LPA by 04/02/2025

Deadline recorded: Apr 2, 2025. 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

87468.1(a)(1) Personal Rights of Residents in All Facilities (a)Residents in all residential care...facilities... personal rights: (1)To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement is not met as evidenced by: Based on interviews and observations, the license did not comply with the section above when residents were not treated with dignity and respect, which posed a potential personal rights risk to residents in care.

Official plan of correction

Administrator agrees to hold personal rights from a third-party vendor for all staff including the Administrator and submit proof of completion to LPA by 04/10/2025

Deadline recorded: Apr 10, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

87303 (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... This requirement is not met as evidenced by: Based on observation and interview, the licensee did not comply with the section cited above as the main door was missing the safety spring door closer which poses a potential health, safety, and personal rights risk to persons in care.

Official plan of correction

Licensee will submit proof of completed repairs to the main door to LPA and submit proof of completion by 04/10/2025

Deadline recorded: Apr 10, 2025. 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

(a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents...(4) To care, supervision...sufficient in numbers, qualifications, and competency to meet their needs. This requirement is not met as evidenced by: Based on interviews and records review, the licensee did not comply with the section cite above as facility staff did not properly supervise R1 as per their care plan, which posed an immediate health and safety risk to residents in care.

Official plan of correction

Licensee will submit a plan on how they will ensure staff will monitor and supervise residents in a timely manner. Licensee will provide plan to LPA via email by COB 12/23/2024

Deadline recorded: Dec 23, 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

(a) A plan for incidental medical and dental care shall be developed by each facility...(4) The licensee shall assist residents with self-administered medications as needed. This requirement is not met as evidenced by: Based on records review, the licensee did not comply with section cited above as the Medication Assistance Record (MAR) revealed no indication that Vancomycin was administered as prescribed which posed an immediate health and safety risk to residents in care.

Official plan of correction

The licensee agreed to submit a plan describing how you will ensure medications are given as prescribed. Submit proof to CCL by due date.

Deadline recorded: Nov 22, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87615(a)(4)

Regulation authority

CCR

What the official deficiency says

(a) Persons who require health services... shall not be admitted or retained in a residential care facility for the elderly: (4) Staphylococcus aureus ( " staph " ) infection or other serious infection. This requirement is not met as evidenced by: Based on records review, the licensee did not comply with the section cited above. Licensee did not submit an exception request for a prohibited health condition when R1 tested positive for C. difficile colitis (C-diff), which posed an immediate health and safety risk to residents in care.

Official plan of correction

The licensee agreed to submit a plan to ensure exception requests will be submitted for residents who have Prohibited Health Conditions. Submit proof to CCL by due date.

Deadline recorded: Nov 22, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87211(a)(1)(B)

Regulation authority

CCR

What the official deficiency says

(a)Each licensee shall furnish to the licensing agency such reports...Any serious injury as determined... by the attending physician and occurring while the resident is under facility supervision. This requirement is not met as evidenced by: Based on records review, the licensee did not comply with the section cited above. Licensee did not submit an incident report when R1 tested positive for C. difficile colitis (C-diff), which posed a potential health and safety risk to residents in care.

Official plan of correction

The licensee agreed to submit a plan describing how you will ensure reporting requirements are followed. Submit proof to CCL by due date.

Deadline recorded: Nov 29, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87463(a)(3)

Regulation authority

CCR

What the official deficiency says

The pre-admission appraisal shall be updated, in writing as frequently as necessary ...(3)Any illness... that results in a circumstance or condition specified in... Prohibited Health Conditions.This requirement is not met as evidenced by: Based on records review, the licensee did not comply with the section cited above. Licensee did not update R1’s needs and services plan to reflect R1’s change in condition and develop a plan of care to meet R1’s needs, which posed a potential health and safety risk to residents in care.

Official plan of correction

The licensee agreed to submit a plan how you will ensure the residents’ needs and services plans are updated when there is a change of condition. Submit proof to CCL by due date

Deadline recorded: Nov 29, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87405(d)(1)(2)

Regulation authority

CCR

What the official deficiency says

(d) The administrator shall have the qualifications specified in Sections 87405(d)(1) through (7)... (2) Knowledge of and ability to conform to the applicable laws, rules and regulations. This requirement is not met as evidenced by: Based on records review and interviews, the licensee did not comply with the section cited above. The administrator did not demonstrate knowledge of the requirements of Title 22 Regulations, which posed a potential health and safety risk to residents in care.

Official plan of correction

The licensee agreed to submit a plan how you will ensure the facility has a qualified administrator. Submit proof to CCL by due date.

Deadline recorded: Nov 29, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(g)

Regulation authority

CCR

What the official deficiency says

(g) The licensee shall immediately telephone 9-1-1 if an injury or other circumstance has resulted in an imminent threat to a resident’s health including, but not limited to, an apparent life-threatening medical crisis… This requirement is not met as evidenced by: Based on interviews and records review, the licensee did not comply with the section cited above. Facility staff did not seek timely medical care when R1 had C-diff and recurring symptoms, which posed an immediate health and safety risk to residents in care.

Official plan of correction

Licensee agreed to submit a plan how you will ensure residents receive timely medical care. Submit to CCL by due date.

Deadline recorded: Nov 22, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87466

Regulation authority

CCR

What the official deficiency says

The licensee shall ensure that residents are regularly observed for changes…or a physical health condition are observed, the licensee shall ensure... resident's physician and the resident's responsible person…This requirement is not met as evidenced by: Based on interviews, the licensee did not comply with the section cited above. Facility staff did not notify R1’s representative or physician when R1 had a change in physical health condition, which posed an immediate health and safety risk to residents in care.

Official plan of correction

Licensee agreed to submit a plan how you will ensure residents responsible party and physician are notified of changes in condition. Submit to CCL by due date

Deadline recorded: Nov 22, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87470(b)(2)(C)

Regulation authority

CCR

What the official deficiency says

(b) In addition to subsection (a), when one or more residents…. Are diagnosed with a contagious disease, the following shall apply:...are trained in the proper use of all required PPE... quarantine or isolation, from others.This requirement is not met as evidenced by: Based on record review, the licensee did not comply with the section cited above. The facility failed to provide the staff training regarding how to care and monitor the resident with a C-diff infection, which posed an immediate health and safety risk to residents in care.

Official plan of correction

Licensee agreed to submit a plan how you will ensure staff receive training on infection control as necessary and annually. Submit to CCL by due date

Deadline recorded: Nov 22, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87303(e)(6)

Regulation authority

CCR

What the official deficiency says

(e) Water supplies and plumbing fixtures shall be maintained as follows: (6) Toilet, handwashing and bathing facilities shall be maintained in operating condition. Additional equipment shall be provided in facilities accommodating physically handicapped and/or nonambulatory residents, based on the residents' needs. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above. Room 112 and 212 bathroom faucet water flow observed very low. This poses/posed a potential health risk to persons in care.

Official plan of correction

POC Due Date: 08/20/2024 Plan of Correction Administrator informed maintenance during visit and agreed to have the repair done by due date.

Official classification

Type B

Official code

87555(b)(23)

Regulation authority

CCR

What the official deficiency says

(b) The following food service requirements shall apply: (23) All readily perishable foods or beverages capable of supporting rapid and progressive growth of micro-organisms which can cause food infections or food intoxications shall be stored in covered containers at appropriate temperatures. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above. Food items stored in the refrigerator and freezer observed not sealed properly and not dated. This poses a potential health, and safety risk to persons in care.

Official plan of correction

POC Due Date: 08/20/2024 Plan of Correction Administrator agreed to provide in-service to kitchen staff and ensure all items stored in the refrigerator and freezer are sealed properly, labeled and dated. Provide proof of in-service training and photos as proof of correction.

Official classification

Type B

Official code

87465(h)(4)

Regulation authority

CCR

What the official deficiency says

(h) The following requirements shall apply to medications which are centrally stored: (4) All centrally stored medications shall be labeled and maintained in compliance with state and federal laws. No persons other than the dispensing pharmacist shall alter a prescription label. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, interview and observation, the licensee did not comply with the section cited above. Random resident medication and medication records reviewed revealed facility staff are not ensuring that residents centrally stored medications are logged/recorded as required by regulation. Centrally stored records were missing expiration, fill and start dates. This poses a potential health, and safety risk to persons in care.

Official plan of correction

POC Due Date: 08/23/2024 Plan of Correction Administrator agreed to provide in-service to medtech staff and develop and maintain a centrally stored log/record for each resident. Administrator will begin with the five residents identified during todays visit

Official classification

Type B

Official code

87625(b)(3)

Regulation authority

CCR

What the official deficiency says

(b) In addition to Section 87611, General Requirements for Allowable Health Conditions, the licensee shall be responsible for the following: (3) Ensuring that incontinent residents are kept clean and dry and that the facility remains free of odors from incontinence. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and record review, the licensee did not comply with the section cited above. During the tour Resident #5's bathroom was observed with feces all around the toilet. Resident #5 records reviewed revealed that R5 requires assistance with incontinent care.

Official plan of correction

POC Due Date: 08/20/2024 Plan of Correction Administrator agreed to develop an incontinent care plan for resident #5 and provide in-service to staff. Submit plan of correction by due date.

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

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. Room 259 window shades and bathroom drawer observed missing; floor tiles missing in room 259 and 267; Memory Care Hallway floor strips observed peeling off. This poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 08/20/2024 Plan of Correction Administrator agreed to complete all repairs and submit photo as proof of correction.

Official classification

Type A

Official code

87464(f)(2)

Regulation authority

CCR

What the official deficiency says

87464(f)(2)- Safe and healthful living accommodations and services, as specified in Section 87307, Personal Accommodations and Services. This requirement is not met as evidenced by: Based on interviews and record review, the licensee did not comply with the above section by failing to protect a resident from an unwanted intruder entering a private room, which posed an immediate health , safety and personal rights risk to residents in care.

Official plan of correction

Licensee agreed to review section cited and provide a statement of understanding as well as a written plan to monitor building during NOC shift to CCL via email by COB 7/31/2024

Deadline recorded: Jul 31, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.2(25)

Regulation authority

CCR

What the official deficiency says

87468.2 (25) - To protection of their property from theft or loss according to Health and Safety Code sections 1569.152, 1569.153, and 1569.154. This requirement is not met as evidenced by: Based on interviews and records review, the licensee did not comply with the section cited above as multiple personal items of R1 were in possession of a houseless person who entered R1’s room while in care, which posed a potential health, safety and personal rights risk to residents in care.

Official plan of correction

Licensee agreed to review section cited and provide a statement of understanding to CCL via email by COB 08/09/2024.

Deadline recorded: Aug 9, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

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...safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by Based on interviews and records review, the licensee failed to comply with the section cited above as bed bugs were observed by multiple residents in multiple bedrooms, which poses a potential health and personal rights risk to persons in care.

Official plan of correction

The Administrator agreed to review section cited and provide a statement of understanding to LPA via email by 01/19/2024 COB. In addition Admin agreed to speak with pest control company regarding options for possible additional preventative measures to limit bed bug infestations.

Deadline recorded: Jan 19, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

97507(g)(10)

Regulation authority

CCR

What the official deficiency says

The requirements pertaining to the involuntary transfer or eviction of residents, including: The justification, worded exactly as shown in the applicable state law or regulation, that permits an eviction. This requirement is not met as evidenced by: Based on record review and interviews, the licensee did not comply with the section cited above as R1 was refused entry to the facility after being brought back to the facility, which poses a potential health, safety, and personal rights violation to residents in care.

Official plan of correction

The Licensee has agreed to review Regulation 87224 Eviction Process and submit statement of understanding to CCL by 08/31/2023.

Deadline recorded: Aug 31, 2023. A deadline is not proof that correction was completed.