BELMONT VILLAGE ALISO VIEJO

Official classification

Type A

Official code

87464(f)(1)

Regulation authority

CCR

What the official deficiency says

Basic services shall at a minimum include: Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). This req is not met as evidenced by: Based on interviews conducted and record review, Licensee failed to ensure care and supervision was provided to R1. R1 had 14 falls within a five month period which poses an immediate health and safety risk to residents in care. CIVIL PENALTY ASSESSED

Official plan of correction

Licensee agrees to provide an in-service on fall prevention and forward proof to LPA by POC due date.

Deadline recorded: May 9, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(h)(2)

Regulation authority

CCR

What the official deficiency says

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 LPA observation, a bottle of acetaminophen was found in a resident 1's medicine cabinet. The physician's report for this resident stated resident cannot self administer PRN medication which poses an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 02/05/2025 Plan of Correction Remove noted item and forward proof of correction to LPA by due date.

Official classification

Type B

Official code

1569.269(a)(21)

Regulation authority

HSC

What the official deficiency says

Residents of residential care facilities for the elderly shall have all of the following rights: To have prompt access to review all of their records and to purchase photocopies. Photocopied records shall be promptly provided, not to exceed two business days..This req is not being met as evidenced by: Based on records reviewed, Licensee failed to submit requested documents to resident's agent. This poses a potential health and safety risk to residents in care.

Official plan of correction

Licensee to submit requested records to resident's agent and forward proof to LPA by POC due date.

Deadline recorded: Dec 1, 2023. 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

Basic services shall at a minimum include: Personal assistance and care as needed by the resident..., with those activities of daily living such as dressing, eating, bathing and assistance with taking prescribed medications..This req is not being met as evidenced by: Based on records reviewed, Licensee failed to ensure R1 was being assisted with medication assistance. Per hospice documentation, resident was not receiving prescribed pain management at end of life. This poses an immediate health and safety risk to residents in care.

Official plan of correction

Licensee to provide an in-service inconjunction with hospice regarding medication administration and forward proof to LPA by POC due date.

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

Official classification

Type A

Official code

87464(f)(1)

Regulation authority

CCR

What the official deficiency says

Basic services shall at a minimum include: Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). This requirement is not being met as evidenced by: Based on record review, Licensee failed to ensure care was being provided to R1. Per hospice documentation, R1's oxygen was turned off on two different occasions when hospice arrived. R1 was prescribed continuous oxygen. This poses an immediate health and safety risk to residents in care.

Official plan of correction

Licensee to provide an in-service on oxygen administration and forward proof to LPA by POC due date.

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

Official classification

Type B

Official code

87468.2(a)(1)

Regulation authority

CCR

What the official deficiency says

In addition to the rights listed in Section 87468.1, residents in.. residential care facilities for the elderly shall have all of the following personal rights: To have a reasonable level of personal privacy....This requirement is not being met as evidenced by:. Based on observation, Licensee failed to ensure residents are afforded privacy. Facility is in the " Safely You " program and is not fulfilling guidelines for the program. Facility does not have video surveillance signage posted nor all consents required. LPA observed 24/27 consents. This poses a potential health and safety risk.

Official plan of correction

Facility to post video surveillance and obtain all consents for cameras and forward proof to LPA by POC due date.

Deadline recorded: Nov 2, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87464(f)(1)

Regulation authority

CCR

What the official deficiency says

Basic services shall at a minimum include: Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). This requirement is not being met as evidenced by: Based on interviews conducted, Licensee failed to ensure R1 was provided care and supervision. R1 eloped out of the facility and staff were unaware the resident was gone. This poses an immediate health and safety risk to residents in care. CIVIL PENALTY ASSESSED.

Official plan of correction

Licensee to conduct an elopement in-service and forward proof to LPA by POC due date.

Deadline recorded: Jul 16, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87464(f)(1)

Regulation authority

CCR

What the official deficiency says

Basic services shall at a minimum include: Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). This req is not being met as evidenced by: Based on observation and interview, Licensee failed to ensure care and supervision was provided to R1 and R2. R1 received no medication on June 7, 2022 and R2 received R1's medications. This poses an immediate health and safety risk to residents in care.

Official plan of correction

Licensee to provide medication re-training to all staff who administer medications and forward proof to LPA by POC due date.

Deadline recorded: Jun 22, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

1569.50(a)(3)

Regulation authority

HSC

What the official deficiency says

The department may deny an application for a license or may suspend or revoke a license...(3) Conduct that is inimical to the health, morals, welfare, or safety of either an individual in or receiving services from the facility or the people of the State of California. This poses an immediate health and safety risk to residents in care.

Official plan of correction

Licensee to provide a written statement of understanding regarding the regulation and forward proof to LPA by POC due date.

Deadline recorded: Apr 29, 2022. 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

Basic services shall at a minimum include: 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... assistance with taking prescribed medications...This req is not being met as evidenced by: Per interviews conducted, Licensee failed to ensure medication assistance was provided to R1. R1 was at the facility for four days and did not receive medication. Physician report dated 01/10/2022 indicates R1 is unable to manage medications. This poses an immediate health ansd safety risk to residents in care.

Official plan of correction

Licensee to submit a plan to ensure new residents are provided medication while re-packaging occurs at pharmacy and forward proof by POC due date.

Deadline recorded: Apr 29, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87464(f)(1)

Regulation authority

CCR

What the official deficiency says

Basic services shall at a minimum include: Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). This requirement is not being met as evidenced by: Based on interview, Licensee failed to ensure care and supervision was provided to R2. R2 took a large amount of Tramadol. Tramadol was located in the resident's room. Physician report dated 08/30/2019 indicates R2 is unable to manage meds. This poses an immediate health risk to residents in care.

Official plan of correction

Licensee to remove medications from R2's room and forward proof to LPA by POC due date.

Deadline recorded: Apr 15, 2022. A deadline is not proof that correction was completed.