SUNDANCE VILLA INC.

Official classification

Type A

Official code

80019(e)(2)

Regulation authority

CCR

What the official deficiency says

80019 Criminal Record Clearance (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1522 shall prior to working, residing or volunteering in a licensed facility: (2) Obtain a California clearance or a criminal record exemption as required by the Department or.......... :This requirement is not met as evidenced by: based on observation the licensee did not comply with the section cited above as individual (I1) was not cleared in Guardian and not associated with the facility. which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

Administrator to come up with a plan as to when they need to leave the facility who will be attending to the residents. Administrator to submit plan to CCL by 04/10/2026. *$500 civil penalty is being assessed*

Deadline recorded: Apr 10, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87457(c)

Regulation authority

CCR

What the official deficiency says

(c) Prior to admission a determination of the prospective resident's suitability for admission shall be completed and shall include an appraisal of their individual service needs in comparison with the admission criteria specified in Section 87455, Acceptance and Retention Limitations. 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 two out of two residents (R1 and R2) did not have an appraisal/needs service plan which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/04/2026 Plan of Correction Administrator to complete pre appraisal/needs service plan and submit to CCL of completed documents by 02/04/2026.

Official classification

Type B

Official code

87412(f)

Regulation authority

HSC

What the official deficiency says

87412 Personnel Records (f) All personnel records shall be available to the licensing agency to inspect, audit, and copy upon demand during normal business hours. Records may be removed if necessary for copying. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPAs and Administrators observation, the licensee did not comply with the section cited above by not having S2's personnel records available for review during inspection which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/30/2026 Plan of Correction Administrator to review regulation 87412(f) and self-certify they understand personnel records must be available for review during licensing inspections.

Official classification

Type A

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 in physical, mental, emotional and social functioning and that appropriate assistance is provided when such observation reveals unmet needs. This requirement is not met as evidenced by: Based on records reviewed, Administrator did not ensure R1 received ongoing medical care for a worsening wound, resulting in R1s hospitalizion. This poses an Immediate Health, Safety or Personal Rights risk to persons in care. An immediate Civil Penalty is being issued in the amount of $500.

Official plan of correction

Administrator shall conduct retraining for all staff on the care and supervision of residents. Proof of scheduled training shall be submitted to CCLD by 04/04/2025.

Deadline recorded: Apr 4, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(a)(2)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care: (2) The licensee shall provide assistance in meeting necessary medical and dental needs. This requirement is not met as evidenced by: Based on records reviewed, Administrator allowed R1 to be soiled for an extended period of time. This poses an Immediate Health, Safety or Personal Rights risk to persons in care.

Official plan of correction

Administrator shall conduct retraining for all staff on the care and supervision of residents. Proof of scheduled training shall be submitted to CCLD by 04/04/2025.

Deadline recorded: Apr 4, 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 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. This requirement was not met as evidenced by: Based on LPA's observation, the licensee did not comply with the section cited above in that the living room and........ kitchen area was free of clutter of medical equipement and wheelchairs which poses/posed a potential health, saftey or personal rights risk to residents in care.

Official plan of correction

Facility to submit proof of pictures of living room and kitchen area to be cleared and cleaned. POC due date to CCL by 03/11/2025.

Deadline recorded: Mar 7, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

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 2 out of 2 staff, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/07/2024 Plan of Correction Administrator agrees to send a written plan addressing how facility will ensure their current (and future) staff will get required health screening documents and TB tests done before beginning working in the facility by POC due date of 03/07/2024. Administrator agrees to send proof of health screening including TB test results for 2 of 2 staff members by 03/25/2024.

Official classification

Type B

Official code

87457(c)

Regulation authority

CCR

What the official deficiency says

(c) Prior to admission a determination of the prospective resident's suitability for admission shall be completed and shall include an appraisal of his/her individual service needs in comparison with the admission criteria specified in Section 87455, Acceptance and Retention Limitations. 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 2 out of 2 residents which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/25/2024 Plan of Correction Administrator agrees to complete appraisals for 2 of 2 residents with signatures from responsible parties on form LIC625 and submit to LPA by POC due date of 03/25/2024.

Official classification

Type B

Official code

1569.695(c)

Regulation authority

HSC

What the official deficiency says

(c) A facility shall conduct a drill at least quarterly for each shift. The type of emergency covered in a drill shall vary from quarter to quarter, taking into account different emergency scenarios. An actual evacuation of residents is not required during a drill. While a facility may provide an opportunity for residents to participate in a drill, it shall not require any resident participation. Documentation of the drills shall include the date, the type of emergency covered by the drill, and the names of staff participating in the drill. This requirement is not met as evidenced by: Deficient Practice Statement Based on interview, the licensee did not comply with the section cited above by not conducting quarterly disaster drills which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/25/2024 Plan of Correction Administrator agrees to submit a disaster drill log with a sign in sheet for which staff and residents attended by POC due date of 03/25/2024.

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, the licensee did not comply with the section cited above in 1 out of 2 residents which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/25/2024 Plan of Correction Administrator agrees to submit a plan about how the facility will ensure the resident is having all incontinence needs met, including how facility plans on keeping residents room free from strong feces odor as required by regulation. Plan to be submit to LPA by POC due date of 03/25/2024.

Official classification

Type B

Official code

87705(f)(1)

Regulation authority

CCR

What the official deficiency says

(f) The following shall be stored inaccessible to residents with dementia: (1) Knives, matches, firearms, tools and other items that could constitute a danger to the resident(s). This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above by not having the knife drawer equipped with a lock which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/25/2024 Plan of Correction Licensee agrees to send photos of new lock on knife drawer, as well as a plan addressing how they will ensure residents do not have access to the knives. Plan to be submit to LPA by POC due date of 03/25/2024.