VALLEY SPRING MEMORY CARE

Official classification

Type B

Official code

87211(a)(1)

Regulation authority

CCR

What the official deficiency says

7211 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. This requirement is not met as evidenced by: Based on observation, interview, and record, the facility did not comply with the regulation listed above due to R1 had a missed medication which was not, which poses a potential health and safety risk to residents in care. reported to the Dept.

Official plan of correction

Administrator monitor progress notes and MARs regarding medication. Statement of upates will be given to the Dept by POC due.

Deadline recorded: Jul 31, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87468.1(a)(1)

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. This requirement is not met as evidenced by: Based on interviews conducted staff was overhead speaking inappropriately to resident by other staff and another resident’s family member.

Official plan of correction

Administrator agrees to provide in-staff training on personal rights and submit records of training when completed.

Deadline recorded: May 4, 2026. 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 ... compliance with the following: (4) The licensee shall assist residents with self-administered medications as needed. This requirement is not met as evidenced by: Based on interviews conducted and records reviewed Medication was incorrectly administered by being left in residents drinks and left Infront of them and found on the floor, in residents bedding and thrown in the trash.

Official plan of correction

Administrator agrees to conduct medication training with staff and submit records when completed.

Deadline recorded: May 4, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87625(b)(2)(3)

Regulation authority

CCR

What the official deficiency says

87625 Managed Incontinence (b) In addition to Section 87611, General Requirements for Allowable Health Conditions, the licensee shall be responsible for the following: (2) Ensuring that incontinent residents are checked during those periods of time when they are known to be incontinent, including during the night. (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: Based on interviews conducted and records reviewed residents were routinely soaked in urine, with saturated briefs, in soiled/ wet bedding.

Official plan of correction

Administrator agrees to provide in-staff training to all staff on incontinence regulations and develop a incontinence process/plan for NOC shift to follow to ensure residents are changed in a timely manner

Deadline recorded: May 4, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(g)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care (g)The licensee shall immediately telephone 9-1-1 if an injury or other circumstance has resulted in an imminent threat to a resident’s health including, but not limited to, an apparent life-threatening medical crisis except as specified in Sections 87469(c)(2), (c)(3), or (c)(4). This requirement is not met as evidenced by: Based on interviews conducted and records reviewed; resident had a fall that resulted in an injury and 911 was not called until next day.

Official plan of correction

Administrator agrees to conduct in-service training on Incidental Medical and Dental Care regulations regarding seeking medical treatment for residents. Administrator to submit proof of training when completed.

Deadline recorded: May 4, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87555(a)

Regulation authority

CCR

What the official deficiency says

87555 General Food Service Requirements (a) The total daily diet shall be of the quality and in the quantity necessary to meet the needs of the residents and 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: Based on observation & interview, the facility did not comply with the regulation listed above by serving the residents burnt food, which poses a potential health and safety risk to residents in care.

Official plan of correction

Licensee will have additional training conducted. Verification will be sent to the Dept by PO due date.

Deadline recorded: Apr 30, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.1(a)(2)

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: (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This requirement is not met as evidenced by: Based on observation & interview, the facility did not comply with the regulation listed above due to staff inappropriately arguing in front of residents, which poses a potential health and safety risk to residents in care.

Official plan of correction

Staff was previously terminated and staff have been informed of corrective action leading to possible termination. Licensee will provide a statement to the Dept by POC due date.

Deadline recorded: Apr 30, 2026. A deadline is not proof that correction was completed.

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 observation, interview, & record review, the licensee did not comply with the section cited above due to facility not providing a quarterly disaster drill log which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/03/2026 Plan of Correction Administrator will provide a current log for disaster drills conducted. Verifcation will be provided to the Dept by POC due date.

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, 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. This requirement is not met as evidenced by: Based on observation, interview, and record, the facility did not comply with the regulation listed above, which poses a potential health and safety risk to residents in care. R1 fell while at the facility. Licensee failed to report the fall to the Dept.

Official plan of correction

Licensee stated they will be sending the required reports. Licensee will send a statement to the Dept by POC due date.

Deadline recorded: Mar 12, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87618(b)(3)(B)

Regulation authority

CCR

What the official deficiency says

87618 Oxygen Administration - Gas and Liquid (b) In addition to Section 87611(b), the licensee shall be responsible for the following: (3) Ensuring that the use of oxygen equipment meets the following requirements: (B) " No Smoking-Oxygen in Use " signs shall be posted in the appropriate areas. This requirement is not met as evidenced by: Based on observation, interview, and record, the facility did not comply with the regulation listed above, which poses a potential health and safety risk to residents in care. LPA conducted multiple interviews which stated there were not signs regarding oxygen in use.

Official plan of correction

Licensee will sent a statement regarding procedure for posting signs of oxygen in use. Verifications will be sent to the Dept by POC due date.

Deadline recorded: Mar 12, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87464(f)(4)

Regulation authority

CCR

What the official deficiency says

87464 Basic Services (f) Basic services shall at a minimum include: (4) Personal assistance and care as needed by the resident and as indicated in the pre-admission appraisal, with those activities of daily living such as dressing, eating, bathing and assistance with taking prescribed medications, as specified in Section 87608, Postural Supports. This requirement is not met as evidenced by: Based on observation, interview, and record, facility did not comply with the regulation listed above, which poses a potential health and safety risk to residents in care. Resident had a lapse in medication which caused the resident to go to the emergency room for high blood pressure.

Deadline recorded: Mar 6, 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

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. This requirement is not met as evidenced by: Based on observation, interview, and record, facility did not comply with the regulation listed above, which poses a potential health and safety risk to residents in care. On January 1, 2026 the facility had no Med Tech on duty from 3:00AM-7:00AM.

Deadline recorded: Mar 12, 2026. 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

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. Based on records reviewed and interviews conducted, Quetiapine Fumara 25 mg tablet. Take 1 tablet by mouth daily. Start date is 1/25/26. A total of 20 tablets should have punched out. A total of 26 tablets were punched out which is 6 over the required count. Vitamin D3 2000U 50 MCG take 1 tablet by mouth daily. Start date is 1/8/26. A total of 183 tablets should have been taken. A total of 195 tablets were counted in medication count which equals 12 pills under the required count. Metoprolol Suc ER 25 MG tabl ER 24H Take 1 tablet every day by mouth for 90 days. A total of 71 tablets should have been taken. A total of 72 were counted in medication count which equals to 1 pill under the required count, which poses an immediate Health & Safety risk to the residents.

Official plan of correction

Licensee agrees to have all medication technicians complete medication training and submit completion reports to CCLD by POC due date.

Deadline recorded: Feb 14, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87468.1(a)(1)

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. This requirement was not met as evidenced by: Licensee did not ensure residents were spoken to appropriately. After conducting interviews it was determined that S1 spoke inappropriately to residents in care which poses an immediate health safety and or personal rights risk to residents in care.

Official plan of correction

Facility has provided retraining to S1 and placed her on probation. Training included resident rights, abuse prevention, proper care of dementia, behavioral expectations and professional standards. POC to be cleared at today's visit.

Deadline recorded: Jun 17, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87464(f)(4)

Regulation authority

HSC

What the official deficiency says

Basic Services (4) Personal assistance and care as needed by the resident ... with those activities of daily living such as ... assistance with taking prescribed medications This requirement was not met as evidenced by A medical technician self reported that she had distributed the wrong medication to a resident in care. This poses an immediate risk to the care and well being of the residents in care.

Official plan of correction

The staff member will be terminated and is currently on administrative leave. The medical technician staff members have already undergone refresher training. The plan of correction will be cleared at today's visit.

Deadline recorded: May 23, 2025. A deadline is not proof that correction was completed.