WALNUT ACRES RESIDENTIAL CARE

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 interview and medication review, the licensee did not comply with the section cited above as R1's Pantoprazole 40mg prescription label was altered by facility staff changing the time of dosage which posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/13/2025 Plan of Correction Administrator contacted the prescribing doctor and pharmacy for an order documenting the change in time of administration and updated medication label. Administrator stated that facility staff were verbally instructed by the prescribing doctor and therefore altered the label. Administrator will submit proof of the written order to CCL by 06/13/2025.

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 record review, the licensee did not comply with the section cited above in that 1 (one) staff member was not associated to facility which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/20/2024 Plan of Correction Administrator associated employee during the time of the visit. POC is cleared.

Official classification

Type B

Official code

1569.618(c)(3)

Regulation authority

HSC

What the official deficiency says

(c)The facility shall employ, and the administrator shall schedule, a sufficient number of staff members to do all of the following: (3) Ensure that at least one staff member who has cardiopulmonary resuscitation (CPR) training and first aid training is on duty and on the premises at all times. This paragraph shall not be construed to require staff to provide CPR. 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 only 1 (one) out of 5 (five) staff possesssed a valid CPR and first aid training, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/26/2024 Plan of Correction Administrator will ensure that staff get CPR and first aid training and submit proof to CCL no later than 07/26/2024.

Official classification

Type B

Official code

87412(a)(11)

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: (11) A health screening as specified in Section 87411, Personnel Requirements - General. 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 4 (four) out of 5 (five) staff did not have a health screening report, which poses a potential health and safety rights risk to persons in care.

Official plan of correction

POC Due Date: 08/02/2024 Plan of Correction Administrator will ensure that staff go to an approved physician for a health screening. Administrator will submit health screening reports to CCL no later than 08/02/2024.

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 LPA observation, the licensee did not comply with the section cited above in that 6 (six) cans of garbanzo beans, 1 (one) bag of lettuce, and 1 (one) jar of mayonnaise were expired which posed a potential health and safety rights risk to persons in care.

Official plan of correction

POC Due Date: 07/20/2024 Plan of Correction Staff discarded all expired food items during the time of the visit. POC is cleared.

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 that 2 (two) out of 5 (five) residents did not have an updated physicians report for 2024, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/26/2024 Plan of Correction Administrator will submit a statement of understanding of section 87458 to CCL by 07/26/2024. Administrator will also ensure that resident 1 goes to the physician for her appointment date of 08/05/2024. Administrator will also ensure to make appointments in a timely manner for the future.

Official classification

Type B

Official code

87465(a)(6)

Regulation authority

CCR

What the official deficiency says

When requested by the prescribing physician or the Department, a record of dosages of medication which are centrally stored shall be maintained by the facility . 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 3 out of 5 residents did not have the centrally stored medication and destruction record updated which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/11/2023 Plan of Correction Administrator will conduct medication audit. Adminstrator will write a plan to continued medication review and audit to stay in compliance by 8/11/23.

Official classification

Type A

Official code

87309(a)

Regulation authority

CCR

What the official deficiency says

(a) Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients. 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 bleach was observed under kitchen sink accessible to resident which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/07/2023 Plan of Correction Staff secured item during visit. Administrator will conduct staff training on section 87309(a) and sent to CCL by 07/07/2023.

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 record review, the licensee did not comply with the section cited above as Staff #1 had their fingerprints but was not associated to the facility which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/07/2023 Plan of Correction Administrator submitted documentations to CCL Regional Office for processing. Administrator will submit to LPA proof of staff member association to facility by 07/07/2023.

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 as all staff members did not have their initial 40 hours of training which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/14/2023 Plan of Correction Administrator will submit a plan to have all caregiver trained in 40 hours of required training. Additionally, plan will include the process of training for new caregivers hired and trained. Administrator will submit plan to CCL by 07/14/2023.

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 as 1 out of 6 residents did not have their LIC 602 on file, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/14/2023 Plan of Correction Administrator will submit signed and completed LIC 602 to CCL by 07/14/2023.

Official classification

Type B

Official code

87463(c)

Regulation authority

CCR

What the official deficiency says

(c) The licensee shall arrange a meeting with the resident, the resident's representative, if any, appropriate facility staff, and a representative of the resident's home health agency, if any, when there is significant change in the resident's condition, or once every 12 months, whichever occurs first, as specified in Section 87467, Resident Participation in Decision Making. 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 6 out of 6 residents did not have Appraisal/Need adn Service plan signed and dated by resident representative, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/21/2023 Plan of Correction Administrator will review Appraisal/Needs and Service with resident representative and submit to CCL by 07/21/2023.

Official classification

Type B

Official code

87507(c)

Regulation authority

CCR

What the official deficiency says

(c) Admission agreements shall be signed and dated, acknowledging the contents of the document, by the resident or the resident's representative, if any, and the licensee or the licensee's designated representative no later than seven days following admission. Attachments to the agreement may be utilized as long as they are also signed and dated as prescribed above. 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 1 out of 6 residents did not have a signed Admissions Agreement, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/21/2023 Plan of Correction Administrator will contact the resident's representative to signed and date the Admissions Agreement. Administrator will submit signed Admissions Agreement to CCL by 07/21/2023.

Official classification

Type A

Official code

87355(e)

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: This requirement is not met as evidenced by: Deficient Practice Statement Based on observation interview, the licensee did not comply with the section cited above as (2) staff were not associated to the facility and (1) staff did not have a cleared background check which poses an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 06/07/2022 Plan of Correction The Adminsitrator agreed to do the following: 1. Submit appropriate paperwork for the two staff and confirm that the staff are associated to the facility. Civil penalties assessed.

Official classification

Type A

Official code

87705(f)

Regulation authority

CCR

What the official deficiency says

(f) The following shall be stored inaccessible to residents with dementia: 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 knives were observed to be accesible in an unlocked cabinet in the kitchen and accessible on a dish rack on the kit hen counter. Cleaning solutions, detergent and disinfectants were observed to be unclocked and acessible in the kitchen hallway laundry closet which poses an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 06/06/2022 Plan of Correction The Administrator agreed to the following: 1. Immediatley secure all knives and cleaning solutions. Plan of correction met at the time of the visit.

Official classification

Type B

Official code

87467(f)(2)

Regulation authority

CCR

What the official deficiency says

87467 (f)(2) Basic Services. Basic services shall at a minimum include: (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 evidence obtained, the licensee did not comply with the section cited above, as all staff were observed without their masks as required, which poses a potential health and safety risk to residents in care.

Official plan of correction

The Administrator agreed to do the following: 1. Reinforce the visitation policies and procedures with staff, specifically highlighting the mask-wearing policy. Inform the LPA when this has taken place, but no later than 6/10/2022.

Deadline recorded: Jun 10, 2022. A deadline is not proof that correction was completed.