CARNELIAN VILLAS

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 and record review, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care. LPA observed that the Reappraisals on file for Resident #4 (R4) and Resident #5 (R5) were outdated.

Official plan of correction

POC Due Date: 10/31/2025 Plan of Correction The Administrator said that she will complete new Reappraisals for R4 and R5. The Administrator agreed to provide the Reappraisals for R4 and R5 to LPA via email or fax by POC date.

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... This requirement was not met as evidenced by: Based on observation, the licensee is not following its fire clearance by placing a latch on the very top of the front door which LPA observed S2 was unable to unlatch for almost 2 minutes while trying to open the door to allow LPA entry and which AD stated was installed to address R1’s wandering, which poses an immediate safety risk to persons in care.

Official plan of correction

CIVIL PENALTY ASSESSED. During the inspection, the licensee relocated this latch to the center of the door and LPA confirmed. Licensee stated they will retrain staff on emergency disaster exiting procedures and personal rights and will submit proof to LPA by POC due date.

Deadline recorded: Jul 25, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87208(a)(12)

Regulation authority

CCR

What the official deficiency says

87208 Plan of Operation (a) …The plan and related materials shall contain the following: … (12) The Infection Control Plan pursuant to Section 87470.. This requirement was not met as evidenced by: Based on documents and admission, the facility does not have an infection control plan, which poses a potential health risk to persons in care.

Official plan of correction

Licensee stated they will review Provider Information Notice (PIN) 22-18-ASC, as well as related PINs, and submit the Infection Control Plan to LPA by POC due date and ensure a copy is always available at the facility.

Deadline recorded: Aug 21, 2025. 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

1569.695(c) … (c) A facility shall conduct a drill at least quarterly for each shift... This requirement was not met as evidenced by: Based on documents and admission, the licensee has not been conducting quarterly emergency disaster drills as there is only one partially completed disaster drill log for 2025, which poses a potential safety risk to persons in care.

Official plan of correction

Licensee stated they will conduct an emergency disaster drill and submit proof to LPA by POC due date and will conduct emergency disaster drills quarterly moving forward.

Deadline recorded: Aug 21, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87465(a)(1)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care (a) … (1) The licensee shall arrange, or assist in arranging, for medical and dental care appropriate to the conditions and needs of residents. This requirement was not met as evidenced by: Based on documents and observations, the licensee did not ensure R3 received assistance with medications when they did not receive their evening Donepezil 10MG once this month, which poses a potential health risk to persons in care.

Official plan of correction

During the inspection, the licensee notified R3’s doctor who stated the missed dose is not a major concern. Licensee stated they will conduct medication refresher training and submit proof to LPA by POC due date.

Deadline recorded: Aug 21, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87412(g)

Regulation authority

CCR

What the official deficiency says

87412 Personnel Records … (g) All personnel records shall be maintained at the facility and shall be available to the licensing agency for review. This requirement was not met as evidenced by: Based on documents and admission, the licensee does not have S4’s personnel file present at the facility or otherwise accessible during the inspection, which poses a potential safety risk to persons in care.

Official plan of correction

Licensee stated they will ensure S4 has a complete personnel file at the facility and submit proof to LPA by POC due date.

Deadline recorded: Aug 21, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

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 leavining chemeclas under sink unsecured and unlocked which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/24/2024 Plan of Correction AD wil provide proof and E mail LPA a copy by due date

Official classification

Type A

Official code

87705(f)(1)

Regulation authority

CCR

What the official deficiency says

(f) The following shall be stored inaccessible to residents with dementia: (1) Knives, matches, firearms, tools and other items that could constitute a danger to the resident(s). 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 sharpes unlocked and screw drivers in kitchn un secured which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/24/2024 Plan of Correction AD wil provide proof and E mail LPA a copy by due date

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

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. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above by not maintaining the three cloged restroom sinks which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/23/2025 Plan of Correction AD wil provide proof and E mail LPA a copy by due date

Official classification

Type B

Official code

87705(f)(2)

Regulation authority

CCR

What the official deficiency says

(f) The following shall be stored inaccessible to residents with dementia: (2) Over-the-counter medication, nutritional supplements or vitamins, alcohol, cigarettes, and toxic substances such as certain plants, gardening supplies, cleaning supplies and disinfectants. 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 leaving medication in resident's room which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/23/2025 Plan of Correction AD wil provide proof and E mail LPA a copy by due date

Official classification

Type A

Official code

87465(h)(2)

Regulation authority

CCR

What the official deficiency says

This requirement is not met as evidenced by: The following requirements shall apply to medications which are centrally stored: 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. Deficient Practice Statement Based on observation the licensee did not comply with the section cited above in 2 out of 2 counts which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/14/2022 Plan of Correction Administrator will purchase a refrigerator for medication and will purchase a lock for centrally stored medications.