PRESERVE AT WOODLAND HILLS, THE

Official classification

Type B

Official code

1569.312(a)

Regulation authority

HSC

What the official deficiency says

1569.312 Basic services requirements Every facility required to be licensed under this chapter shall provide at least the following basic services: (a) Care and supervision as defined in Section 1569.2. This requirement is not met as evidenced by: Based on interview and record review, the licensee did not comply with the section cited above as R1 eloped from the facility while under the care of staff and was found away from the facility approximately 45 minutes later which poses a potential safety risk to clients in care.

Official plan of correction

Management stated that residents with exit-seeking behaviors will not be in rooms with windows leading outside of the facility. Management also stated that staff will get additional training to respond to the facility's Vigil signal system which notifies staff of restlessness. Proof of training and exit- seeking procedures will be sent to CCLD by due date.

Deadline recorded: Aug 19, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87411(a)

Regulation authority

CCR

What the official deficiency says

(a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. In facilities licensed for sixteen or more, sufficient support staff shall be employed to ensure provision of personal assistance and care as required in Section 87608, Postural Supports. Additional staff shall be employed as necessary to perform office work, cooking, house cleaning, laundering, and maintenance of buildings, equipment and grounds. The licensing agency may require any facility to provide additional staff whenever it determines through documentation that the needs of the particular residents, the extent of services provided, or the physical arrangements of the facility require such additional staff for the provision of adequate services. This requirement is not met as evidenced by: Deficient Practice Statement Based on interview, observation, and record review, the licensee did not comply with the section cited above as two (2) out of three (3) resident pull cords tested during the visit had staff response times ranging from 18-24 minutes, which poses a potential health and safety risk to clients in care.

Official plan of correction

POC Due Date: 08/19/2026 Plan of Correction Management stated that staff will receive training on signal response times. Proof of training will be sent to CCLD by due date.

Official classification

Type B

Official code

87412(a)

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: 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 as two (2) out of four (4) staff files were missing a health screening and TB test and one (1) was also missing first aid certification which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/19/2026 Plan of Correction Management stated health screenings, TB test, and first aid will be completed. Proof will be sent to CCLD by the due date.

Official classification

Type B

Official code

1569.686(a)(1)

Regulation authority

HSC

What the official deficiency says

1569.686 (a) A licensee shall notify the department, the State Long-Term Care Ombudsman, all residents, and, if applicable, their legal representatives, in writing, within two business days... (1) A notice of default... This requirement is not met as evidenced by: Based on interview and record review, Licensee failed to ensure The Department, LTCO, residents and their responsible parties were notified of the default received by Licensee, which caused a potential health and safety risk to residents in care.

Official plan of correction

The court appointed receiver notified The Department and residents of the default. ED will review the section cited, as well as Health and Safety Code 1569.482 and submit a statement of understanding to CCL by the due date. Civil penalty is assessed for violation of this section [Health and Safety code 1569.686(c)].

Deadline recorded: Dec 1, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87465(h)(4)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care (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... This requirement is not met as evidenced by: Based on interview and record review, the licensee did not comply with the section cited above as Resident #1 (R1) was administered Resident #2’s (R2)’s morning medications by Staff #3 (S3). This posed a potential health and safety risk to persons in care.

Official plan of correction

S3 received training on medication administration after the error and will receive additional training. Administrator stated that staff will receive vendored training by Guardian Pharmacy and will provide proof of the scheduled in-service to LPA by the due date.

Deadline recorded: Oct 2, 2025. A deadline is not proof that correction was completed.

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 5 out of 6 resident restroom sink water did not measure within the required range which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/26/2025 Plan of Correction Staff will adjust water temperature and test water temperatures for 5 days and submit CCLD the logs by POC due date.

Official classification

Type A

Official code

87303(i)

Regulation authority

CCR

What the official deficiency says

(i) Facilities shall have signal systems which shall meet the following criteria: 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 the facility did not have a call ssystem in resident rooms and bathrooms which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/26/2025 Plan of Correction Staff will inquire a third party vendor and receive a quote or service request and send CCLD proof by POC due date.

Official classification

Type A

Official code

87309(b)

Regulation authority

CCR

What the official deficiency says

(b) Residents may have access to items specified in subsection (a) for personal use unless there is documentation, as specified in Section 87457, Pre-Admission Appraisal or Section 87463, Reappraisals, that indicates the resident's or other residents’ safety would be at risk if allowed access. 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 2 residents had access to items their Physician deemed as at risk which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/26/2025 Plan of Correction The Health and Services Director (HSD) secured R3's razors during the visit. The Executive Director and HSD will secure the cleaning supplies located under R1's restroom sink and send CCLD proof by POC due date.

Official classification

Type A

Official code

87464(f)(1)

Regulation authority

CCR

What the official deficiency says

(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: Deficient Practice Statement Based on interview, record review, and observation, the licensee did not comply with the section cited above as staff did not respond to residents calls for assistance in a timely manner, which poses a potential health, safety, and personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/26/2025 Plan of Correction The Executive Director will conduct an in service training with all Staff to address Staff's response time to resident's needs. The Executive Director will send CCLD a statement of understanding with Staff signatures by POC due date.

Official classification

Type B

Official code

87465(h)(4)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care (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... This requirement is not met as evidenced by: Based on interview, the licensee did not comply with the section cited above as Resident #1 (R1)'s Benzonatate medication was left unattended by Staff #1 (S1) which Resident #2 (R2) self-administered. This posed a potential health and safety risk to persons in care.

Official plan of correction

S1 received one-on-one training from HSD Nunez and attended a training session vendored by Guardian Pharmacy on 04/07/2025. A corrective action form was issued to S1 and HSD stated that each medication technician will be shadowed for a full day. HSD will submit a training plan for each medication technician to CCLD by 05/01/2025.

Deadline recorded: May 1, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87465(h)(4)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care (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... This requirement is not met as evidenced by: Based on medication review and interview, the licensee did not comply with the section cited above as Resident #1 (R1)'s Lorazepam medication was not administered by Staff #1 (S1) as prescribed, which posed a potential health and safety risk to persons in care.

Official plan of correction

S1 no longer works at the facility. HSD stated they will schedule a vendored training soon and will submit proof to CCL of the scheduled date by 04/01/2025.

Deadline recorded: Apr 1, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

1596.312(a)

Regulation authority

HSC

What the official deficiency says

Basic services shall at a minimum include: (a) Care and supervision as defined in Section 1569.2. This requirement is not met as evidenced by: Based on interviews conducted, evidence submitted and file review, the licensee did not comply with the section cited above. Facility staff failed to provide the necessary care and supervision to R1 and R2 which allowed the residents to elope from the facility unassisted, which poses an immediate health and safety risk to residents in care.

Official plan of correction

ED stated they will increase the delayed egress. ED will submit a written plan of action outlining the actionable changes the facility will take to prevent R2's elopement behavior by 01/08/2024 to CCL.

Deadline recorded: Jan 8, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

1569.625(b)(1)

Regulation authority

HSC

What the official deficiency says

(1) The department shall adopt regulations to require staff members of residential care facilities for the elderly who assist residents with personal activities of daily living to receive appropriate training. This training shall consist of 40 hours of training. A staff member shall complete 20 hours, including six hours specific to dementia care, as required by subdivision (a) of Section 1569.626 and four hours specific to postural supports, restricted health conditions, and hospice care, as required by subdivision (a) of Section 1569.696, before working independently with residents. The remaining 20 hours shall include six hours specific to dementia care and shall be completed within the first four weeks of employment. The training coursework may utilize various methods of instruction, including, but not limited to, lectures, instructional videos, and interactive online courses. The additional 16 hours shall be hands-on training. 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 that 3 (three) out of 5 (five) staff did not have their 40 hours of initial training which poses a potential health, safety and personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/06/2024 Plan of Correction Administrator will ensure that all staff who require 40 hours initial training will have it completed by 09/06/2024. Administrator will email training logs to CCL by due date.

Official classification

Type B

Official code

1569.625(b)(2)

Regulation authority

HSC

What the official deficiency says

(2) In addition to paragraph (1), training requirements shall also include an additional 20 hours annually, eight hours of which shall be dementia care training, as required by subdivision (a) of Section 1569.626, and four hours of which shall be specific to postural supports, restricted health conditions, and hospice care, as required by subdivision (a) of Section 1569.696. This training shall be administered on the job, or in a classroom setting, or both, and may include online training. This requirement is not met as evidenced by: Deficient Practice Statement Based on record, the licensee did not comply with the section cited above in that 2 (two) out of 5 (five) staff did not have their 20 hours of annual training which poses a potential health, safety and personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/06/2024 Plan of Correction Administrator will ensure that all staff who require 20 hours annual training will have it completed by 09/06/2024. Administrator will email training logs to CCL by due date.

Official classification

Type B

Official code

87465(h)(6)(A-F)

Regulation authority

CCR

What the official deficiency says

87465(h)(6)(A-F) Incidental Medical and Dental Care.The licensee shall be responsible for assuring that a record of centrally stored prescription medications for each resident is maintained for at least one year and includes: (A) The name of the resident for whom prescribed. (B) The name of the prescribing physician. (C) The drug name, strength and quantity. (D) The date filled. (E) The prescription number and the name of the issuing pharmacy. (F) Instructions, if any, regarding control and custody of the medication. This requirement is not met as evidenced by: Deficient Practice Statement Based on medication review, the licensee did not comply with the section cited above, as medications were not documented on the Centrally Stored Medications and Destruction Record for one out of two residents (R1), which poses a potential health and safety rights risk to persons in care.

Official plan of correction

POC Due Date: 08/25/2022 Plan of Correction The Administrator agreed to do the following: 1. Audit R1's medications, and ensure all medications are properly documented on the Centrally Stored Medications and Destruction Record within the next 24 hours. 2. Conduct an in-service with staff, reviewing the policies and procedures as it relates to documentation. Submit completion by 8/26/2022.

Official classification

Type A

Official code

87705(f)(2)

Regulation authority

CCR

What the official deficiency says

87705(f)(2) Care of Persons with Dementia. (f) The following shall be stored inaccessible to residents with dementia: (2) Over-the-counter medication, nutritional supplements or vitamins, alcohol, cigarettes, and toxic substances such as cleaning supplies and disinfectants. This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above, as items were accessible to residents with dementia, which poses an immediate health and safety risk to residents in care.

Official plan of correction

The Buisness Office Manager agreed to do the following: 1. Items were secured during today’s visit. Plan of Correction met. This is a repeat violation. Civil penalty of $250 assesed.

Deadline recorded: Feb 2, 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

87355(e)(2) Criminal Record Clearance. (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) This requirement is not met as evidenced by: Based on record review, the licensee did not comply with the section cited above, as S1 was not associated to the facility since 10/5/2021 and has continued to work at the facility, which poses an immediate health and safety risk to residents in care.

Official plan of correction

The Executive Director agreed to do the following: 1. Ensure that S1 is associated to the facility prior to allowing S1 to return to work. S1 will not work at the facility until proof of association is obtained.

Deadline recorded: Dec 10, 2021. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87705(f)(2)

Regulation authority

CCR

What the official deficiency says

87705(f)(2) Care of Persons with Dementia. (f) The following shall be stored inaccessible to residents with dementia: (2) Over-the-counter medication, nutritional supplements or vitamins, alcohol, cigarettes, and toxic substances such as certain plants, gardening supplies, cleaning supplies and disinfectants. This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above, as items were accessible to residents with dementia, which poses an immediate health and safety risk to residents in care.

Official plan of correction

The Executive Director agreed to do the following: 1. Items were secured during today’s visit. Plan of Correction met.

Deadline recorded: Dec 10, 2021. A deadline is not proof that correction was completed.