ALMAVIA OF SAN RAFAEL

Official classification

Type A

Official code

87465(h)(2)

Regulation authority

CCR

What the official deficiency says

(h) The following requirements shall apply to medications which are centrally stored: (2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. This requirement is not met as evidenced by: Deficient Practice Statement Based on observations made, Licensee did not comply with the section cited above. LPA observed two residents with medications in their room that should have been centrally stored and inaccessible. This poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/17/2026 Plan of Correction Licensee to distribute a copy of medication reminder notice to all residents and responsible parties. Copy of notice to be submitted to Community Care Licensing by POC due date of 04/17/2026.

Official classification

Type B

Official code

87555(a)

Regulation authority

CCR

What the official deficiency says

(a) The total daily diet shall be of the quality and in the quantity necessary to meet the needs of the residents an shall meet the Recommended Dietary Allowances of the Food and Nutrition Board of the National Research Council. All food shall be selected, stored, prepared and served in a safe and healthful manner. This requirement is not met as evidenced by: Deficient Practice Statement Based on observations made, Licensee did not comply with the section cited above. Five instances of expired foods were observed in facility's arts and crafts refrigerator and activity cabinets, including expired milk, cheese, canned frosting, blueberries, opened boxed beef broth, and chocolate sauce. This poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/27/2026 Plan of Correction Licensee to conduct in-service training for Activity Enrichment staff on standards and expectations. Training to include: Trainer, Date of Training, Topic, Job Title, Staff Names and Signatures. Training to be submitted for review and approval by POC due date of 04/27/2026.

Official classification

Type B

Official code

87211(a)(1)

Regulation authority

CCR

What the official deficiency says

87211 Reporting Requirements: (a) Each licensee shall furnish to the licensing agency such reports as the Department may require...(1) A written report shall be submitted...within seven days of the occurrence of any of the events specified...below. This requirement was not met as evidenced by: Licensee did not comply with section cited above. Per record review, Licensee did not submit incident reports timely. This poses a potential health and safety risk to residents in care.

Official plan of correction

Licensee to submit Inservice Training for management and direct care staff. Training to include the following: Date, Topic, Name/Job Role, and Signatures. Training to be submitted tp CCL by POC due date of 12/02/2024.

Deadline recorded: Dec 2, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(a)(5)

Regulation authority

CCR

What the official deficiency says

87465(a)(5) Incidental Medical and Dental Care. A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following: The licensee shall assist residents with self administered medications as needed. This requirement was not met as evidenced by: Based on statement from facility Administrator, staff did not ensure 16 residents received their medication timely. Subsequently, 16 residents missed medication which poses an immediate health and safety risk to residents in care.

Official plan of correction

Plan of Correction already fullfilled with training with all staff that pass medication. LPA obtained copies. POC cleared.

Deadline recorded: Mar 3, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87705(b)(2)

Regulation authority

CCR

What the official deficiency says

87705(b)(2) Care of Persons with Dementia: Safety measures to address behaviors such as wandering. This requirement was not met as evidenced by: Based on record review the facility didn't comply with this section for 1of1 residents which poses an immediate Health, Safety risk to residents in care. Resident R1 isn't allowed to leave facility unassisted; left on 01/01/2022 through the egress doors after an associate left through the same door. Resident was found at the gas station by local law enforcement.

Official plan of correction

Facility agrees to address frequency of AWOL drills for staff. In addition, to conduct staff training regarding elopement, wandering and ensuring that all Memory Care Unit doors are secured. Proof of training with participants signature, trainer & date of training already submitted to CCL during Case Management.

Deadline recorded: Feb 3, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following: (2) The licensee shall provide assistance in meeting necessary medical and dental needs. This includes transportation which may be limited to the nearest available medical or dental facility which will meet the resident's need. In providing transportation the licensee shall do so directly or make arrangements for this service. This requirement was not met as evidenced by: Based on an email conversation dated for July 23, 2021, it was disclosed that facility missed a Urinalysis order for R1 in May 2021. This poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

Administrator will ensure that residents receive assistance with getting to and from scheduled medical appointments as needed. Administrator to arrange for care staff and all health care staff including med techs (in-service) training regarding adhering to Medical Appointments in addition to submitting a plan of future compliance of how they will prevent residents missing appointments moving forward. Plan of training and plan of future compliance shall be furnished to the Department of Social Services-Community Care Licensing Division to the Rohnert Park CCL office by POC date of September 30, 2021. Proof of training including sign-in sheet to be submitted to Rohnert Park CCL office by October 12, 2021.

Deadline recorded: Sep 30, 2021. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87211

Regulation authority

CCR

What the official deficiency says

87211 Reporting Requirements: (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. (A) Death of any resident from any cause regardless of where the death occurred, including but not limited to a day program, a hospital, en route to or from a hospital, or visiting away from the facility. (B) Any serious injury as determined by the attending physician and occurring while the resident is under facility supervision. (C) The use of an Automated External Defibrillator. (D) Any incident which threatens the welfare, safety or health of any resident, such as psychological abuse of a resident by staff or other residents, or unexplained absence of any resident. This requirement was not met evidenced by: Based on interviews with facility staff, and research of incident reports submitted for Almavia of San Rafael to CCL, did not properly report an incident to the CCL as required by Title 22 regulation. This poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Administrator to arrange for in-service training for staff regarding Reporting Requirements. Report and plan for training to be submitted to Rohnert Park CCL office by POC date of October 6, 2021. Proof of training along with a sign-in sheet shall be furnished to Rohnert Park CCL office by October 12, 2021.

Deadline recorded: Oct 6, 2021. A deadline is not proof that correction was completed.