ARCHWAY OF CARMEL

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 and records review, the licensee did not comply with the section cited above, two out of three staff resent in the facility during the visit, not associated with the facility, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/19/2026 Plan of Correction Licensee will ensure staff leaves the facility.

Official classification

Type B

Official code

87466

Regulation authority

CCR

What the official deficiency says

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. When changes such as unusual weight gains or losses or deterioration of mental ability or a physical health condition are observed, the licensee shall ensure that such changes are documented and brought to the attention of the resident's physician and the resident's responsible person, if any. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview, and records review, the licensee did not comply with the section cited above in three out of total 4 resident files reviewed missing required observations, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/03/2026 Plan of Correction Licensee will follow regulations by ensuring residents records are updated.

Official classification

Type B

Official code

87705(c)(6)

Regulation authority

CCR

What the official deficiency says

Licensee who accept and retain residents with dementia shall be responsible for ensuring teh following: Reaprasals to be completed ..... pursuat to section 87463 This requirement is not met as evidenced by: observation, interviews, and records reviewthree out of four resident records reviewed missing updated rearaisals which poses potential health and safety risk to persons in care. Deficient Practice Statement Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in three out of four residents records reviewed missing re appraisals, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/03/2026 Plan of Correction Licensee will ensure each dementia resident files contain updated reappraisals

Official classification

Type B

Official code

1569.618(c)(4)

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: (4) Ensure that the facility is clean, safe, sanitary, and in good repair at all times. 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 in two areas accesible to residents ( indoor and outdoor ) observed whith broken apliances, boxes, and other items that restrict safe access to residents, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/03/2026 Plan of Correction Licensee will ensure facility areas that accessible to residents are clutter free and does not poses potential health and safety risk to persons in care

Official classification

Type B

Official code

87412(d)

Regulation authority

CCR

What the official deficiency says

(d) The licensee shall maintain documentation that an administrator has met the certification requirements specified in Section 87406, Administrator Certification Requirements or the recertification requirements in Section 87407, Administrator Recertification Requirements. 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 and placed facility administrator not approved by the CCL department, not associated with the facility, and does not follow licensing requirements, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/03/2026 Plan of Correction Licensee will ensure the facility has qualified administrator.

Official classification

Type B

Official code

87463(a)

Regulation authority

CCR

What the official deficiency says

(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 observation, interview, record review, the licensee did not comply with the section cited above in three out of four medical assessments reviewed missing or not updated, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/03/2026 Plan of Correction Licensee will ensure records available at the facility and updated by POC due date

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 the licensee did not comply with the section cited above and failed to provide emergency and disaster plan for review which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/03/2026 Plan of Correction Licensee will ensure emergency and disaster records available at the facility by POC due date

Official classification

Type B

Official code

87463(a)

Regulation authority

CCR

What the official deficiency says

(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 [(observation) (interview) (record review)], the licensee did not comply with the section cited above in [count] out of [total count] [(objects) (persons)] [identifiers] which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/04/2025 Plan of Correction To provide/ update re-apraisal for three out of four residents.

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 [(observation) (interview) (record review)], the licensee did not comply with the section cited above in [count] out of [total count] [(objects) (persons)] [identifiers] which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/04/2025 Plan of Correction Provide updated and signed residents records/ Admission Agreement

Official classification

Type B

Official code

87303(e)(5)

Regulation authority

CCR

What the official deficiency says

(e) Water supplies and plumbing fixtures shall be maintained as follows: (5) Non-skid mats or strips shall be used in all bathtubs and showers. 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 one out of three bathrooms, which posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/31/2024 Plan of Correction Administrator will provide proof that a non-mat or strips were placed in the bathroom nearest the facility kitchen.

Official classification

Type B

Official code

87307(d)(4)

Regulation authority

CCR

What the official deficiency says

(4) Stairways, inclines, ramps and open porches and areas of potential hazard to residents with poor balance or eyesight shall be made inaccessible to residents unless equipped with sturdy hand railings and unless well-lighted. 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 one out of three outdoor areas, which posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/31/2024 Plan of Correction

Official classification

Type B

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 in one out of three bathrooms, which posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/31/2024 Plan of Correction Administrator will provide staff with training on potential dangers and risks of cleaning soulutions and disinfectants being accessible to residents.

Official classification

Type B

Official code

87506(b)(15)

Regulation authority

CCR

What the official deficiency says

(b) Each resident's record shall contain at least the following information: (15) The admission agreement and pre-admission appraisal, specified in Sections 87507, Admission Agreements and 87457, Pre-admission Appraisal. 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 four resident files, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/31/2024 Plan of Correction Administrator agreed to update resident files with required records.

Official classification

Type B

Official code

87705(c)(6)

Regulation authority

CCR

What the official deficiency says

(c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following: (6) Appraisals are conducted on an ongoing basis pursuant to Section 87463, Reappraisals. 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 for two out of three dementia residents, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/31/2024 Plan of Correction Administrator will obtain reapraisals by a physician for the two resdents who do not have record of one within the last twelve months.

Official classification

Type B

Official code

87465(a)(5)(D)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care: (a)(5)(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 comducted and records reviewed, facility staff crushed R1's medications and placed them in food without having physician's orders to do so for 1 out of 5 residents, which presents a potential health and safety risk to residents in care.

Official plan of correction

Licensee agreed to provide staff with training regarding proper handling of medications. Licensee agreed to provide statement of understanding regarding requirements for physician orders for medications.

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