ATWATER RESIDENTIAL CARE FACILITY

Official classification

Type B

Official code

87465(6)(h)

Regulation authority

CCR

What the official deficiency says

(6) 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 record review, the licensee did not comply with the section cited above in Resident 1's centrally stored medication record is not accurate, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/25/2026 Plan of Correction Administrator and facility staff willl attend training on documenting centrally stored medications, and submit proof to LPA by POC date of 05/25/2026.

Official classification

Type B

Official code

87463(a)

Regulation authority

CCR

What the official deficiency says

87463 Reappraisals (a) The pre-admission appraisal, as specified in Section 87457, Pre-Admission Appraisal, shall be updated in writing as frequently as necessary or once every 12 months, whichever occurs first, to note significant changes in condition, as defined in Section 87101, Definitions, and to keep the appraisal accurate. For the purposes of this section, the updated pre-admission appraisal shall be referred to as the reappraisal. 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 resident 1 and residnet 3's appraisal/ needs and services plan is not updated annually, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/25/2026 Plan of Correction Administrator will submit updated needs and services plans for resident 1 and resident 3 to LPA by POC date of 05/25/2026.

Official classification

Type B

Official code

87303(e)(2)

Regulation authority

CCR

What the official deficiency says

(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 resdent 2's sink water measures to be 126 degrees, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/25/2026 Plan of Correction Administrator will ensure hot water measures to be between 105 and 120 and send proof to LPA by POC date of 05/25/2026.

Official classification

Type A

Official code

87309(a)

Regulation authority

CCR

What the official deficiency says

(a) Except as specified in subsection (b), the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances, knives, matches, tools, sharp objects, and other similar items which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage. 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 two of three facility bathrooms had cleaning supplies accessible to residents,which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/30/2025 Plan of Correction Administrator will train facility staff on safe storage of chemicals and submit to LPA by POC date of 04/30/2025.

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 record review, the licensee did not comply with the section cited above in Staff 1 does not have current CPR/First aid training on file, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/15/2025 Plan of Correction Administrator will submit proof of Staff 1's CPR/First aid training and submit to LPA by POC date of 05/15/2025.

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 Staff 2 does not have required health screening/ TB, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/14/2025 Plan of Correction Administrator will provide proof of Health screening to LPA by POC date of 05/14/2025.

Official classification

Type B

Official code

87465(h)

Regulation authority

CCR

What the official deficiency says

(h) The following requirements shall apply to medications which are centrally stored: 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 Resident 3's medications are not logged up to current date on the Centrally Stored Medication record, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/14/2025 Plan of Correction Administrator will conduct medication handling training and submit proof to LPA by POC date of 05/14/2025.

Official classification

Type B

Official code

87208(a)(7)(a)

Regulation authority

CCR

What the official deficiency says

87208 Plan of Operation (7) Sketches, showing dimensions, of the following: (A) Building(s) to be occupied, including a floor plan that describes the capacities of the buildings for the uses intended and a designation of the rooms to be used for nonambulatory residents and for bedridden residents, other than for a temporary illness or recovery from surgery as specified in Sections 87606(d) and (e) 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 the facility is using bedrooms for purposes other than listed on facility sketch (using office as bedroom) which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/07/2025 Plan of Correction Administrator will work with Licensing to ensure facility sketch is updated to reflect current bedroom use.

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. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. The following requirement has not been met as evidenced by: LPA's observed several goats along with some goat feces in the facility backyard, staff 1 stated the facility residents do not go in the backyard as there is several goats, which poses a potential, health, safety, or personal rights risk to residents in care.

Official plan of correction

Administrator will provide written plan on keeping facility patio clean, and submit to LPA by POC date of 12/26/2024

Deadline recorded: Dec 26, 2024. 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 LPA's measured hallway bathroom water temperature to be 129 degrees, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/28/2024 Plan of Correction Licensee will lower water temperature to be within required temperature of 105 to 120 and send proof to LPA by POC date of 03/28/2024.

Official classification

Type A

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 LPA's were not able to verify Staff 1 has required current first aid training, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/28/2024 Plan of Correction Licensee will send proof of Staff 1's first aid training to LPA by POC date of 03/28/2024.

Official classification

Type A

Official code

87412(g)

Regulation authority

CCR

What the official deficiency says

(g) All personnel records shall be maintained at the facility. 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 LPA's were not able to review Personnel records as they were not accessible, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/28/2024 Plan of Correction Licensee will provide Personnel records for all facilty Personnel to LPA by 03/28/2024 POC date.

Official classification

Type A

Official code

87465(a)(4)

Regulation authority

CCR

What the official deficiency says

(4) The licensee shall assist residents with self-administered medications as needed. 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 Resident 1 was not given Levothyroxine medication for several days due to being out of the medication, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/28/2024 Plan of Correction Licensee will send proof of medication being filled to LPA by POC date of 03/28/2024.

Official classification

Type A

Official code

87465(h)

Regulation authority

CCR

What the official deficiency says

(h) The following requirements shall apply to medications which are centrally stored: This requirement is not met as evidenced by: Deficient Practice Statement Based on records review, the licensee did not comply with the section cited above in Resident 1's medications are not currently logged on the Centrally Stored Medication Record, 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 Licensee will provide corrected Centrally Stored Medication Log for all facilty residents, and verification to prevent this error from reoccuring,

Official classification

Type A

Official code

87506(a)

Regulation authority

CCR

What the official deficiency says

(a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff. 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 LPA's were not able to review any of the 4 residents records as they were not made available, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/28/2024 Plan of Correction Licensee will provide records for all 4 facility residents by 03/28/2024 POC date.

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 LPA's observed several expired foot items in facility pantry, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/11/2024 Plan of Correction Licensee will conduct staff training or submit a plan to prevent expired food inside facility pantry and submit proof to LPA POC date 04/11/2024.

Official classification

Type B

Official code

1569.695(a)

Regulation authority

HSC

What the official deficiency says

(a)In addition to any other requirement of this chapter, a residential care facility for the elderly shall have an emergency and disaster plan that shall include, but not be limited to, all of the following: 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 LPA's requested and were not provided facilities 610E Disaster Plan, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/11/2024 Plan of Correction Licensee will provide 610D Emergency Disaster Plan to LPA by POC date of 04/11/2024.

Official classification

Type A

Official code

87202(a)

Regulation authority

CCR

What the official deficiency says

87202 Fire Clearance (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. This requirement is not met as evidenced by: 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 LPA's observed a lock on the facility front door more than 6 feet high, and not accessible to residents, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/28/2024 Plan of Correction Licensee will ensure locks if not fire cleared will be removed, and send proof to LPA by POC date of 03/28/2024.

Official classification

Type A

Official code

87355(e)(2)

Regulation authority

CCR

What the official deficiency says

87355 Criminal Record Clearance (a) The Department shall conduct a criminal record review of all individuals specified in Health and Safety Code section 1569.17 and shall have the authority to approve or deny a facility license, or employment, residence, or presence in the facility, based upon the (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) or The following requirement has not been met as evidenced by: Staff 1 is not associated to this facility in LIS or guardian, which poses an immediate health, safety, or personal rights risk to residents in care.

Official plan of correction

Licensee will submit LIC 9182 form to associate Staff 1 to the facility, and send proof to LPA by POC date of 03/14/2024.

Deadline recorded: Mar 14, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87355(b)

Regulation authority

CCR

What the official deficiency says

87355 Criminal Record Clearance (a) The Department shall conduct a criminal record review of all individuals specified in Health and Safety Code section 1569.17 and shall have the authority to approve or deny a facility license, or employment, residence, or presence in the facility, based upon the results of such review. (b) Prior to the Department issuing a license, the applicant, administrator and any adults other than a client, residing in the facility shall have a criminal record clearance or exemption. The following requirement has not been met as evidenced by: Staff 2 is not background cleared and has been providing care to residents for one month, which poses an immediate, health, safety, or personal rights risk to residents in care.

Official plan of correction

Licensee will remove staff 2 from the facility, and staff will no longer provide care to facility residents until cleared and associated to the facility.

Deadline recorded: Mar 14, 2024. 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

87411 Personnel Requirements - General (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. The following requirement has not been met as evidenced by: Facility staff frequently called local fire staff to assist with lifitng, and moving facility residents, which poses a potential, health, safety, or personal rights risk to residents in care.

Official plan of correction

Licensee will put a plan place to be in compliance with regulation 87411(a), and copy will be sent to LPA by POC due date of 01/25/24.

Deadline recorded: Jan 25, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.1(a)

Regulation authority

CCR

What the official deficiency says

87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights:(1) To be accorded dignity in their personal relationships with staff, residents, and other persons. The following requirement has not been met as evidenced by: Facility staff engaged in a verbal altercation with facility resident which poses a potential, health, safety, or personal rights risk to residents in care.

Official plan of correction

Licensee will put a plan place to be in compliance with regulation 87468.1(a), and copy will be sent to LPA by POC due date of 01/25/24.

Deadline recorded: Jan 25, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87265(b)(3)

Regulation authority

CCR

What the official deficiency says

87265 Managed Incontinence (b) In addition to Section 87611, General Requirements for Allowable Health Conditions, the licensee shall be responsible for the following:87265 Managed Incontinence (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.. The following requirement has not been as evidenced by: Based on interviews conducted facility residents are being left in urine soaked clothing for extended periods of time, which poses an immediate, health, safety, or personal rights risk to reisdents in care.

Official plan of correction

Licensee shall provide documentation and training on how staff will evaluate residents regularly to ensure skin breakdown is not occurring and submit proof to LPA Hurt by POC date 01/11/2024.

Deadline recorded: Jan 11, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87224(a)

Regulation authority

CCR

What the official deficiency says

87224Eviction Procedures (a) The licensee may evict a resident for one or more of the reasons listed in Section 87224(a)(1) through (5). Thirty (30) days written notice to the resident is required except as otherwise specified in paragraph. The following requirement has not been met as evidenced by: Resident 1 was not accepted back into the facility after a visit to the hospital on 12/17/23, which poses an immediate, health, safety, or personal rights risk to residents in care.

Official plan of correction

Licensee will put a procedure in place to prevent future unlawful evictions, and copy will be sent to LPA by POC due date of 01/11/24.

Deadline recorded: Jan 11, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87507(a)(c)

Regulation authority

CCR

What the official deficiency says

87507 Admission Agreements (a) The licensee shall complete an individual written admission agreement, as defined in Section 87101(a), with each resident or the resident's representative, if any. (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. The following requirement has not been met as evidenced by: Resident 1's Conservator was not provided Admission Agreement within 7 days of living at the facility which poses a potential, health, safety, or personal rights risk to residents in care.

Official plan of correction

Licensee will put a procedure in place to be in compliance with regulation 87505(a)(c), and copy will be sent to LPA by POC due date of 01/24/24.

Deadline recorded: Jan 24, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87507(g)(3)(C)

Regulation authority

CCR

What the official deficiency says

Section 87507(g)(3)(C) Any fee that is charged prior to or after admission, shall be clearly specified. **This requirement was not met as evidenced by review of the admission agreement provided to RP, that did not specify a $1,355.00 holding fee.

Official plan of correction

Licensee will submit proof of refund of the $1,355.00 holding fee to the RP by 12/15/23 POC date.

Deadline recorded: Dec 15, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

1569.2

Regulation authority

HSC

What the official deficiency says

(c) “Care and supervision” means the facility assumes responsibility for, or provides or promises to provide in the future, ongoing assistance with activities of daily living without which the resident’s physical health, mental health, safety, or welfare would be endangered. Assistance includes assistance with taking medications, money management, or personal care. The following requirement has not been met as evidenced by: Resident 1 attacked several other facility residents which poses an immediate health, safety, or personal rights risk to residents in care.

Official plan of correction

Licensee will provide training to all facility staff on Care and Supervision of residents, and provide proof to LPA by POC date of 10/26/2023.

Deadline recorded: Oct 26, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(a)(4)

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: (4) The licensee shall assist residents with self-administered medications as needed. The following requirement has not been met as evidenced by: Resident 1's Centrally Stored Medication Log lists medications with no quantity which poses an immediate, health, safety, or personal rights risk to residents in care.

Official plan of correction

Licensee will submit a plan documenting how she is going to ensure residents medications will be refilled, dispersed and provided to residents per physician’s orders by POC date.

Deadline recorded: Oct 26, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

1569.657(a)

Regulation authority

HSC

What the official deficiency says

§1569.657 Rate increase due to change in level of resident care; notice (a) For any rate increase due to a change in the level of care of the resident, the licensee shall provide the resident and the resident’s represent ative, if any, written notice of the rate increase within two business days after initially providing services at the new level of care. The notice shall include a detailed explanation of the additional services to be provided at the new level of care and an accompanying itemization of the charges. The following requirement has not been met as evidenced by: Licensee did not provide Resident 1's responsible party a detailed written breakdown of services provided , and it is not clear when invoice was given, which poses a potential, health, safety, or personal rights risk to residents in care.

Official plan of correction

Licensee will re submit invoice #100 to include a detailed explanation of additional services to provided at the new level of care and accompanying itemization of the charges to CCL by POC date of 10/24/2023.

Deadline recorded: Nov 9, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87265(b)(7)

Regulation authority

CCR

What the official deficiency says

87265 Managed Incontinence (b) In addition to Section 87611, General Requirements for Allowable Health Conditions, the licensee shall be responsible for the following: (7) Ensuring that the condition of the skin exposed to urine and stool is evaluated regularly to ensure that skin breakdown is not occurring. The following requirement has not been met as evidenced by: Records, and photos document Resident 1's buttocks area was extremely red and irritated over a period of weeks, which poses an immediate, health, safety or personal rights risk to resident in care.

Official plan of correction

Licensee shall provide documentation and training on how staff will evaluate residents regularly to ensure skin breakdown is not occurring and submit proof to LPA Hurt by POC date 10/26/2023.

Deadline recorded: Oct 26, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87211(1)(D)

Regulation authority

CCR

What the official deficiency says

87211Reporting Requirements e 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. The following requirement has not been met as evidenced by: LPA reviewed records of incidents on 03/09/2023 that was not reported to State Licensing which poses a potential, health, safety, or personal rights risk to residents in care.

Official plan of correction

Licensee will submit proof of regulation understanding to LPA Hurt by POC date of 11/02/2023.

Deadline recorded: Nov 2, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(h)(4)

Regulation authority

CCR

What the official deficiency says

87465Incidental 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. No persons other than the dispensing pharmacist shall alter a prescription label. (5) Each resident's medication shall be stored in its originally received container. No medications shall be transferred between containers. Based on LPA observation the facility was dispensing medications not in their orignally marked containers to Resident 1 which poses an immediate, health, safety, or personal rights risk to residents in care.

Official plan of correction

Licensee will conduct medication training with all facility staff, and submit proof to LPA Hurt by 09/22/2023 POC date.

Deadline recorded: Sep 22, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87506(a)

Regulation authority

CCR

What the official deficiency says

87506 Resident Records (a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff. The following requirement has not been met as evidenced by: Based on observation the Licensee does not have resident records in a location readily available to Licensing staff.

Official plan of correction

Licensee will provide all requested resident records to LPA by 09/22/2023 POC date.

Deadline recorded: Sep 22, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(6)(A)

Regulation authority

CCR

What the official deficiency says

(6) 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. The following requirement has not been met as evidenced by: LPA Hurt observed Resident 1 does not have a centrally stored medication log which poses an immediate, health, safety, or personal rights risk to residents in care.

Official plan of correction

Licensee will provide centrally stored medication log for Resident 1 by 09/22/2023 POC date.

Deadline recorded: Sep 22, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

1569.69(2)(f)

Regulation authority

HSC

What the official deficiency says

§1569.69 Employees assisting residents with self-administration of medication; training requirements (2) In facilities licensed to provide care for 15 or fewer persons, the employee shall complete 10 hours of initial training. This training shall consist of 6 hours of hands-on shadowing training, which shall be completed prior to assisting with the self-administration of medications, and 4 hours of other training or instruction, as described in subdivision (f), which shall be completed within the first two weeks of employment. This requirement was not met as evidenced by LPAs request for staff and resident files. Licensee was unable to provide files and proof of training at the time of visit. Interviews with staff reveal the required documented training was not conducted. If not corrected, This poses an immediate risk to the health and safety of residents in care.

Official plan of correction

Licensee will provide proof of staff training to LPA Hurt by 09/05/2023 POC date.

Deadline recorded: Sep 5, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87458(b)(1)

Regulation authority

CCR

What the official deficiency says

(b) The medical assessment shall include, but not be limited to: (1) A physical examination of the resident indicating the physician's primary diagnosis and secondary diagnosis, if any...other medical conditions which would preclude care of the person by the facility. This requirement was not met as evidenced by LPAs interview with Licensee and staff stating resident file is not available at the time of visit. Staff began employment on 08/30/23 at 4:30pm and does not currently have access to residents care plan which poses a potential health, safety, or personal rights risk to residents in care.

Official plan of correction

Licensee will provide Resident 1's file to LPA Hurt by 09/08/2023 POC date.

Deadline recorded: Sep 8, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87411(a)

Regulation authority

CCR

What the official deficiency says

87411Personnel Requirements - General (a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. The following requirement has not been met as evidenced by: LPA's observed Staff 1 did not speak english, and was unable to communicate with Licensing staff, and facility residents, which poses an immediate health, safety, or personal rights risk to residents in care.

Official plan of correction

Licensee agrees to have staff present at all that can communicate with facility residents and send proof to LPA by POC date of 07/29/2023.

Deadline recorded: Jul 29, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87506(a)

Regulation authority

CCR

What the official deficiency says

87506 Resident Records (a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff. The following requirement has not been met as evidenced by: Based on interviews with Licensee, Resident 1 does not have any records and non were provided at the time of Resident 1's admission, which poses an immediate health, safety, or personal rights risk to residents in care.

Official plan of correction

Licensee agrees to provide requested records for Resident 1 and send proof to LPA by 07/29/2023 POC date.

Deadline recorded: Jul 29, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87606(c)

Regulation authority

CCR

What the official deficiency says

(c) To accept or retain a bedridden person, other than for a temporary illness or recovery from surgery, a facility shall obtain and maintain an appropriate fire clearance as specified in Section 87202(a). This requirement is not met as evidenced by: Deficient Practice Statement Based on observation,and records reviewed the licensee did not comply with the section cited above in as LPA's observed Resident 1 to be bedridden, and bedroom does not have fire clearance for bedridden residents which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/18/2023 Plan of Correction Licensee will submit proof to LPA Hurt by 05/18/2023 POC date of request for bedridden for fire clearance.

Official classification

Type A

Official code

87705(l)(1)

Regulation authority

CCR

What the official deficiency says

(l) The following initial and continuing requirements shall be met for the licensee to lock exterior doors or perimeter fence gates: (1) Licensees shall notify the licensing agency of their intention to lock exterior doors and/or perimeter fence gates. 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 LPA's observed one of three facility gates located on the south side of the backyard gate to have a lock which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/18/2023 Plan of Correction Licensee will unlock side gate, and send proof to LPA by POC dare of 05/18/2023

Official classification

Type B

Official code

87705(d)

Regulation authority

CCR

What the official deficiency says

(d) In addition to requirements specified in Section 87303, Maintenance and Operation, safety modifications shall include, but not be limited to, inaccessibility of ranges, heaters, wood stoves, inserts, and other heating devices 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 in LPA's observed backyard Barbecue grill with knobs still on accesible to residents which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/31/2023 Plan of Correction Licensee will modify BBQ grill to be inaccessible to facility dementia residents by POC date of 05/31/2023.

Official classification

Type B

Official code

87465(6)

Regulation authority

CCR

What the official deficiency says

87465 (6) 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 records reviewed, the licensee did not comply with the section cited above in LPA's observed Resident 2's Centrally Stored Medication Records does not have current information which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/31/2023 Plan of Correction Licensee will audit Centrally Stored Medication Log to ensure information is current and accurate and send proof to LPA Hurt by 05/31/2023 POC date.

Official classification

Type A

Official code

87705(j)

Regulation authority

CCR

What the official deficiency says

(j) The licensee shall have an auditory device or other staff alert feature to monitor exits, if exiting presents a hazard to any resident. 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 LPA's observed facility alerts on doors leading to outside not functioning which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/31/2023 Plan of Correction Licensee will ensure door alerts are functioning properly and send proof to LPA Hurt by POC date of 05/31/2023.

Official classification

Type B

Official code

87464(d)

Regulation authority

CCR

What the official deficiency says

(d) A facility need not accept a particular resident for care. However, if a facility chooses to accept a particular resident for care, the facility shall be responsible for meeting the resident's needs as identified in the pre-admission appraisal specified in Section 87457, Pre-admission Appraisal and providing the other basic services specified below, either directly or through outside resources. Based on records reviewed, the Licensee did not ensure that a proper pre-admission appraisal was completed prior to admitting R1. During interview, R1 stated that their needs were not met by the facilit staff. This results in a potential health and safety risk for residents in care.

Official plan of correction

Licensee agreed to write a statement which states they will conduct a proper pre-admission appraisal and needs and services plan for any resident admitted in the future and submit to CCLD by 4/7/2023.

Deadline recorded: Apr 7, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87507(f)

Regulation authority

CCR

What the official deficiency says

87507((f)The licensee shall comply with all applicable terms and conditions set forth in the admission agreement, including all modifications and attachments. The following requirement has not been met as evidenced by: The facility Administrator did not provide written notice of rate increase within two days as stated in signed facility Admissions Agreement, which poses a potential, health, safety or personal rights risk to residents in care.

Official plan of correction

Administrator Jessica Johnson will provide written Statement of Understanding of Regualtion 87507 (f) and submit to LPA Hurt by POC date of 03/14/2023.

Deadline recorded: Mar 14, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

1569.652(a)

Regulation authority

HSC

What the official deficiency says

Health and Safety Code section 1569.652 provides in part:(a) A residential care facility for the elderly shall not require advance notice for terminating an admission agreement upon the death of a resident. No fees shall accrue once all personal property belonging to the deceased resident is removed from the living unit. The following requirement has not been met as evidenced by: Resident 1's responsible party has not been refunded after passing on 11/12/2023 which poses a potential health, safety, or personal rights risk to residents in care.

Official plan of correction

Administrator Jessica Johnson will issue refund to Resident 1's responsible party for pro rated days after his passing and submit proof to LPA by POC date of 03/14/2023.

Deadline recorded: Mar 14, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87507(g)(A)

Regulation authority

CCR

What the official deficiency says

87507 Admission Agreement (g) Admission agreements shall specify the following:(1) Basic services, as defined in Section 87101(b), (A) Rate for all basic services which the facility is required to provide in order to obtain and maintain a license. Basic services rate(s), including: 1A comprehensive description of any items and services provided under a single fee, such as monthly fee for room, board and other items and services shall be listed. The following requirement has not been met as evidenced by: Administrator did not give detailed itemized description of fees until 14 days after change of condition and rate increase, which poses a potential, health, safety, or personal rights risk to residents in care.

Official plan of correction

Administrator Jessica Johnson will provide written Statement of Understanding of Regualtion 87507 (g)(A) and submit to LPA Hurt by POC date of 03/14/2023.

Deadline recorded: Mar 14, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87507(g)(3)(C)

Regulation authority

CCR

What the official deficiency says

Section 87507(g)(3)(C) Any fee that is charged prior to or after admission, shall be clearly specified. **This requirement was not met as evidenced by review of the admission agreement provided to RP, that did not specify a $1300 holding fee.

Official plan of correction

Licensee will submit proof of refund of the holding fee to the RP within a reasonable timeframe such as 30 days and amendment of the admission agreement to include all fees and the refund provisions for each by 12/21/2022 POC date.

Deadline recorded: Dec 21, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87355(e)(1)

Regulation authority

CCR

What the official deficiency says

87355(e)(1): Obtain a California clearance or a crminal record exemption as required by the Department... This requirement was not met as evidenced by: Based on observation, Licensee did not ensure all staff obtained a California clearance or a criminal record exemption when S1 was present in the facility without a California clearance which poses an immediate health and safety risk to persons in care

Official plan of correction

Licensee agrees to submit a written statement detailing the facility's plan to ensure the requirements of section 87355(e)(1) are met to the Fresno CCL office by the POC due date.

Deadline recorded: Sep 27, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87468.2(a)(4)

Regulation authority

CCR

What the official deficiency says

(a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (4) To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs. Based on interviews, Licensee did not ensure all residents were provided care and supervision when on 08/28/2022, R1 was able to " bypass " facility staff, exit the facility, and enter a neighboring home unsupervised, which poses an immediate health and safety risk to persons in care.

Official plan of correction

Licensee agrees to submit a written statement detailing the steps the facility will take to ensure the requirements for section 87468.2 are met to the Fresno CCL office by the POC due date. Licensee agrees to train all staff on requirements of Additional Personal Rights of Residents in Privately Operated Facilities by 10/14/2022. Evidence of training topics and attendance will be submitted to the Fresno CCL office by 10/14/2022.

Deadline recorded: Sep 27, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(a)(5)(D)

Regulation authority

CCR

What the official deficiency says

(a) A plan for incidental medical and dental care shall be developed by each facility…. (5) Assistance with self-administered medications shall be limited to the following: (D) Assistance with self-administration does not include forcing a resident to take medication, hiding or camouflaging medications in other substances without the resident's knowledge and consent, or otherwise infringing upon a resident's right to refuse to take a medication. This requirement was not met as evidenced by: Based on interviews, the Licensee did not ensure that the requirements for the section 87465(a)(5)(D) on 08/28/2022 when ADM administered PRN medications to R1 while R1 was restrained. This poses an immediate health and safety risk to residents in care

Official plan of correction

Licensee agrees to submit a written statement detailing how the facility will ensure the requirements for the above section are met to the Fresno CCL office by the POC due date.

Deadline recorded: Sep 27, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87507(g)(5)(E)

Regulation authority

CCR

What the official deficiency says

(g) Admission agreements shall specify the following...(5) Refund conditions...(E) Preadmission fees shall be refunded according to the following conditions: 1. A 100 percent refund of a preadmission fee shall be provided to an applicant or the applicant’s representative if: a. The applicant decides not to enter the facility prior to the facility completing a preadmission appraisal...b. The licensee fails to provide full written disclosure of preadmission fee charges and refund conditions. This requirement was not met as evidenced by: Based on interviews and records review, the facility did not ensure 100 percent of the $500 admission fee was refunded to R1, which poses a potential health and safety risk to persons in care.

Official plan of correction

Licensee agrees to refund $500 to R1 by the POC due date and submit proof that refund was given to the Fresno CCL office. Licensee agreed to submit a signed written statement acknowledging that the Licensee will amend the facility admission agreement to include language regarding holding fees and the terms for refund and said language must be in accordance with section 87507.

Deadline recorded: Oct 14, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

1569.69(a)(2)

Regulation authority

HSC

What the official deficiency says

(a) Each residential care facility for the elderly licensed under this chapter shall ensure that each employee of the facility who assists residents with the self-administration of medications meets all of the following training requirements: (2) In facilities licensed to provide care for 15 or fewer persons, the employee shall complete 10 hours of initial training. This training shall consist of 6 hours of hands-on shadowing training, which shall be completed prior to assisting with the self-administration of medications, and 4 hours of other training or instruction, as described in subdivision (f), which shall be completed within the first two weeks of employment. 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 when 2 out of 2 staff did not have documentation to prove staff received initial training prior to working in the faciltiy, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/17/2022 Plan of Correction Licensee agrees to submit a written statement detaling how each employee will receive training prior to working in the facility. Licensee will have 2 out of 2 employees complete the initial training submit a copy of attendance, certificates, and training topics to the Fresno CCL office by the POC due date.

Official classification

Type A

Official code

87465(a)(4)

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: (4) The licensee shall assist residents with self-administered medications as needed. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview, and record review, the licensee did not comply with the section cited above as evidenced by R1 missing 8 days of medication and R2 missing 2 PRN medications which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/20/2022 Plan of Correction Licensee agrees to submit a written statement detailing the steps the facility will take to ensure the requirements section 87465 Incidential Medical and Dental Care are met to the Fresno CCL office by the POC due date.