HEYDAY SENIOR LIVING OF COSTA MESA

Official classification

Type B

Official code

87457(c)(2)

Regulation authority

CCR

What the official deficiency says

This requirement is not met as evidenced by: Except as provided in Section 87638(g)(3), if an initial appraisal or any reappraisal identifies an individual resident service need which is not being met by the general program of facility services, advice shall then be obtained from a physician, social worker, or other appropriate consultant to determine if the needs can be met by the facility. If so, the licensee and the consultant shall develop a plan of action which shall include: Deficient Practice Statement Based on observation and record review, the licensee did not comply with the section cited above in which two out of three residents did not have a needs and services plans on file which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/04/2026 Plan of Correction Licensee will send proof of needs and service plans to LPA by POC due date.

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 record review, the licensee did not comply with the section cited above in which two out of two staff did not have updated training at the facility which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/04/2026 Plan of Correction Licensee will send LPA updated training records by POC due date.

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 which one out of three residents did not have a pre- admission appraisal which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/04/2026 Plan of Correction Licensee will send proof of completed pre-admission appraisal to LPA by POC due date.

Official classification

Type A

Official code

87464(f)

Regulation authority

CCR

What the official deficiency says

Basic Services 87464 (f) Basic services shall at a minimum include: (1) Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). This requirement was not met as evidence by: Per Admission records, R1 was admitted to the Hospital for multiple pressure injuries present on admission including Coccyx – unstageable. This poses an immediately an immediately health and safety risk to residents in care.

Official plan of correction

Facility licensee/administrator to submit a written statement that this regulation was understood. Proof of completion of training about Care and supervision of Administrator and all caregivers. To submit a facility plan procedure how staff will prevent residents from sustaining multiple pressure injuries while in care. To submit by 3/20/2026.

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

Official classification

Type A

Official code

87465(c)(2)

Regulation authority

CCR

What the official deficiency says

(c) If the resident's physician has stated in writing that the resident is unable to determine his/her own need for nonprescription PRN medication, but can communicate his/her symptoms clearly, facility staff designated by the licensee shall be permitted to assist the resident with self-administration, provided all of the following requirements are met: (2) Once ordered by the physician the medication is given according to the physician's directions. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA observation and record review, R2 is not being administered one medication as prescribed by physician which poses an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 08/06/2025 Plan of Correction

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

(a) 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 LPA observiation, auditory exit alarms in three out of three exits are not operational and sliding screen doors are not in good repairwhich poses a potential health and safety rights risk to persons in care.

Official plan of correction

POC Due Date: 08/26/2025 Plan of Correction AD stated auditory exit alarms and screen door will be replaced by POC due date. LPA to return to verify.

Official classification

Type B

Official code

87465(h)(2)

Regulation authority

CCR

What the official deficiency says

(h) The following requirements shall apply to medications which are centrally stored: (2) 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 observiation, 2 prescription medications were stored in an unlocked cabinet in the hallway which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 08/12/2025 Plan of Correction Facility locked the cabinet during the visit. AD stated an in-service training will be conducted by POC due date.

Official classification

Type A

Official code

87203

Regulation authority

CCR

What the official deficiency says

All facilities shall be maintained in conformity with the regulations adopted by the State Fire Marshal for the protection of life and property against fire and panic. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA observation, three smoke alarms were disarmed which poses an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 08/06/2025 Plan of Correction Facility replaced batteries in the three smoke alarms during the visit. AD stated in-service training will be conducted and email proof LPA.

Official classification

Type B

Official code

87204(a)

Regulation authority

CCR

What the official deficiency says

87204 Limitations- Capacity and Ambulatory Status (a) A licensee shall not operate a facility beyond the conditions and limitations specified on the license, including specification of the maximum number of persons who may receive services at any one time. An exception may be made in the case of catastrophic emergency when the licensing agency may make temporary exceptions to the approved capacity. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, record review, and interviews of Administrator and care staff, the facility is operating beyond the maximum number of persons who may receive hospice servies at one time. Facility has an approved hospice waiver for two but three hospice residents were noted at this time which poses a potential Health, Safety, and Personal Rights risk to persons in care. 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: 08/24/2022 Plan of Correction Licensee agrees to submit an increase of hospice waiver request and to forward proof to LPA by POC due date.