CLARENDON SENIOR LIVING 3

Official classification

Type A

Official code

87202(a)(2)

Regulation authority

CCR

What the official deficiency says

(a) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, or the State Fire Marshal. Prior to accepting or retaining any of the following types of persons, the applicant or licensee shall notify the licensing agency and obtain an appropriate fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, or the State Fire Marshal: (2) Bedridden persons 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 in that a bedridden resident is retained in a non-bedridden room which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/04/2024 Plan of Correction Administrator stated they will move the resident from bedroom #3 to bedroom #1, as bedroom #1 has a bedridden fire clearance. Administrator will submit photographic proof to CCL by 10/04/2024.

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 that one staff member did not have a criminal record clearance transfer which posed an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/04/2024 Plan of Correction Licensee associated staff during the visit. POC is cleared.

Official classification

Type B

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 that temperatures measured between 121.1 to 122.3 degrees F which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/17/2024 Plan of Correction Administrator will record water temperature for 5 days and will submit water log to CCL by 10/17/2024.

Official classification

Type B

Official code

87555(b)(8)

Regulation authority

CCR

What the official deficiency says

(b) The following food service requirements shall apply: (8) All food shall be of good quality. Commercial foods shall be approved by appropriate federal, state and local authorities. Food in damaged containers shall not be accepted, used or retained. 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 that several perishable food items were not of good quality which posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/10/2024 Plan of Correction Staff discarded all expired items immediately. POC is cleared.

Official classification

Type A

Official code

1569.17(c)(1)(A)

Regulation authority

HSC

What the official deficiency says

(c) (1) (A) Subsequent to initial licensure, a person specified in subdivision (b) who is not exempted from fingerprinting shall obtain either a criminal record clearance or an exemption...prior to employment, residence, or initial presence in a facility...scan results This requirement is not met as evidenced by: Based on observation, record review, and interview, S1 has been employed and residing in the facility since at least November 2023 and did not obtain a criminal record clearance, which poses an immediate safety risk to residents in care.

Official plan of correction

S1 was removed from the facility during today's visit. S1 will be taken to complete their fingerprinting. Licensee and Administrator understand S1 cannot be present in the facility until criminal record clearance is obtained.

Deadline recorded: Feb 13, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87211(a)(1)

Regulation authority

CCR

What the official deficiency says

87211 Reporting Requirements (a) (1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurence of any of the events specified...disposition of the case. This requirement is not met as evidenced by: Based on interview and record review, R1 passed away on 12/23/2023 and R2 passed away on 01/14/2024 and written reports were not received nor sent to the Regional Office, which poses a potential health and safety risk to residents in care.

Official plan of correction

Administrator agreed to submit reports for both R1 and R2 to the Regional Office by POC due date. Additionally, Administrator will complete vendorized training on Reporting Requirements, including hospice notifications and submit proof of completed training by POC due date.

Deadline recorded: Feb 28, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87466

Regulation authority

CCR

What the official deficiency says

87466 Observation of the Resident The licensee shall ensure that residents are regularly observed for changes... licensee shall ensure that such changes are documented...responsible person, if any. 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 R1 had a change of condition, as they were off and on hospice and home health, and this was not documented in R1’s file which posed a potential health risk to persons in care.

Official plan of correction

Seminars and training for emaployees. Administratior will document changes among residents including need and service apraisal.

Deadline recorded: Feb 28, 2024. A deadline is not proof that correction was completed.