SENIOR FAMILY HOME 1

Official classification

Type B

Official code

1569.625(b)(2)

Regulation authority

HSC

What the official deficiency says

(2) In addition to paragraph (1), training requirements shall also include an additional 20 hours annually, eight hours of which shall be dementia care training, as required by subdivision (a) of Section 1569.626, and four hours of which shall be specific to postural supports, restricted health conditions, and hospice care, as required by subdivision (a) of Section 1569.696. This training shall be administered on the job, or in a classroom setting, or both, and may include online training. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA record review and interviews, the licensee did not comply with the section cited above for two of three staff members which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/15/2026 Plan of Correction Administrator will provide staff annual training and provide documentation for in-services or trainingsto LPA by POC due date.

Official classification

Type A

Official code

87465(a)(1)

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:(1) The licensee shall arrange, or assist in arranging, for medical and dental care appropriate to the conditions and needs of residents. This requirement is not being met as evidenced by: Resident #1 showed LPA physical health issue which poses an immediate health and safety risk for the person in care.

Official plan of correction

The Plan of Correction (POC) is that Administrator shall provide LPA with scheduled appointment details for R1 by 5pm on May 7, 2025. LPA also requests follow-up after the appointment with documentation that health need was met.

Deadline recorded: May 7, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(a)(6)

Regulation authority

CCR

What the official deficiency says

(6) When requested by the prescribing physician or the Department, a record of dosages of medications which are centrally stored shall be maintained by the facility. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA observation, interview and record review, the licensee did not comply with the section cited above in six of six residents which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/09/2025 Plan of Correction Licensee (LE) shall provide LPA documentation for a current list of medications and medication administration for six of six residents to remain on file. All current medications should be listed and any discontinued medications shall be removed. LE to email LPA by plan of correction date.

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 interview and record review the licensee did not comply with the section cited above for all staff and residents which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/22/2025 Plan of Correction Licensee (LE) shall conduct a fire disaster drill by POC date. LE to email LPA documentation with the following information: The disaster drill performed, the date and time of the drill and signatures of staff who participted.

Official classification

Type B

Official code

87465(h)(5)

Regulation authority

CCR

What the official deficiency says

(h) The following requirements shall apply to medications which are centrally stored: (5) Each resident's medication shall be stored in its originally received container. No medications shall be transferred between containers. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, and staff interview, the licensee did not comply with the section cited above in five of five resident medications, which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 10/04/2024 Plan of Correction AD stated medication will stored in its originally received container, and no longer be transferred between containers. AD stated staff training will be conducted regarding proper storage of medication and proof provided to LPA via email by POC date.

Official classification

Type B

Official code

87307(a)

Regulation authority

CCR

What the official deficiency says

Living accommodations and grounds shall be related to the facility's function. The facility shall be large enough to provide comfortable living accomodations and privacy for the residents, staff, and others who may reside in the facility... This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and staff interview, the licensee did not comply with the section cited above as staff is residing in the garage, which poses a potential safety and personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/04/2024 Plan of Correction AD stated staff will no longer be residing in the garage and all furniture and personal items will be removed. AD stated picture proof will be provided to LPA via email by POC date.