CARMEL VILLAGE RETIREMENT COMMUNITY

Official classification

Type A

Official code

87705(e)

Regulation authority

CCR

What the official deficiency says

(e) Licensees that use delayed egress devices on exterior doors and perimeter fence gates shall meet the following initial and continuing requirements: This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care. LPA observed one exterior egress gate requiring a key to exit and two interior doors with non-operational alarms. Based on observation, the licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care. LPA observed one exterior egress gate requiring a key to exit and two interior doors with non-operational alarms.

Official plan of correction

POC Due Date: 04/24/2026 Plan of Correction Executive Director stated new lock and electronics for egress will be installed and functioning by POC due date. Weekly safety checks of all egress doors will be conducted on a continual basis. LPA observed technician repairing doors during the visit. All doors were tested and observed operational prior to exit. POC cleared.

Official classification

Type B

Official code

87303(f)

Regulation authority

CCR

What the official deficiency says

(f) All waste shall be located, stored, and disposed of in a manner that will not transmit communicable diseases or odors, pose a risk to health and safety, or provide a breeding place or food source for insects or rodents. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above which poses a potential health and safety risk to persons in care. During the tour of the facility, LPA observed gnats in 8 out of 20 residents apartments, the main kitchen, dining room, and other common areas. LPA also observed 6 small trash bags with soiled contents in hallways throughout building 1, building 2 and building 3.

Official plan of correction

POC Due Date: 04/30/2026 Plan of Correction Executive Director stated staff training on proper disposal of waste will be conducted and proof will provided to LPA via email by POC date. Professional vendor will be used to ensure removal of gnats and LPA will conduct an additional visit to clear POC.

Official classification

Type B

Official code

87307(a)(3)(C)

Regulation authority

CCR

What the official deficiency says

(C) Clean linen, including blankets, bedspreads, top bed sheets, bottom bed sheets, pillow cases, mattress pads, bath towels, hand towels and wash cloths. The quantity shall be sufficient to permit changing at least once per week or more often when indicated to ensure that clean linen is in use by residents at all times. The linen shall be in good repair. The use of common wash cloths and towels shall be prohibited. 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: Plan of Correction

Official classification

Type B

Official code

87555(b)(26)

Regulation authority

CCR

What the official deficiency says

(26) Supplies of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days shall be maintained on the premises. 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: Plan of Correction

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provisions of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by: Based on observation and interviews conducted, the licensee did not comply with the section cited above, which poses a potential health and safety or risk to persons in care. LPA observed water stains on ceiling panels of Building 2, third floor where leaks were resported. Interviews confirmed water damage occurred due to rain between Dec 2024 and Dec 2025 with no record that repairs had not been made.

Official plan of correction

Executive Director stated the entitre third floor roof will be inspected by a professional vendor and repaired by POC due date with proof submitted to CCLD by POC due date via email.

Deadline recorded: Mar 6, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87468.1(a)(1)

Regulation authority

CCR

What the official deficiency says

All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (1) To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement is not met as evidenced by: Based on interviews conducted, S1 admitted to ingoring R1's refusal to get out of bed and physically forcing resident to get out of bed, stand, and walk to the bathroom for a shower, which poses an immediate health, safety and personal rights risk to residents in care.

Official plan of correction

Executive Director stated S1 will be given a written notice with the possibility of termination and proof will be submitted to CCLD by POC due date.

Deadline recorded: Jan 27, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87458(a)

Regulation authority

CCR

What the official deficiency says

87458 Medical Assessment (a) Prior to a person's acceptance as a resident, the licensee shall obtain documentation of a medical assessment, signed by a licensed medical professional ... This requirement is not met as evidenced by: Based on observation, interview, and record review, the licensee did not comply with the section cited above by not maintaining a Physician’s Report that was signed and dated which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Licensee states they will provide a signed medical assessment of R1 via email to Edward.kim@dss.ca.gov by POC due date May 6, 2025.

Deadline recorded: May 6, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87303(e)(2)

Regulation authority

CCR

What the official deficiency says

(e) Water supplies and plumbing fixtures shall be maintained as follows: (2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degrees C) and not more than 120 degree F (49 degrees C). 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 four out of sixteen apartment units which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/23/2025 Plan of Correction Administrator stated that the hot water temperature will be readjusted and will provide provide the Acknowledgement of Understanding for the said deficiency to LPA via email by POC due date.

Official classification

Type B

Official code

87465(h)(5)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care. (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 has not been met as evidenced by: Based on LPA file review and interview, this was not followed in one of one residents, which poses a potential health and safety risk for residents in care.

Official plan of correction

Facility to provide a staff in-service on medication administration and documentation. The date, desciription of the topic covered and participant signatures are to be documented and emailed to the LPA by May 5, 2025.

Deadline recorded: May 5, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.1(a)(1)

Regulation authority

CCR

What the official deficiency says

87468.1(a)(1) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (1) To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement was not met as evidenced by facility employee yelled at resident which posed a protentional personal rights risk to residents in care. ***THIS IS AN AMENDED DEFICIENCY PAGE.***

Official plan of correction

Licensee did terminate employee as evident by paperwork provided and e mailed to LPA. POC was corrected by facility

Deadline recorded: Feb 28, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87412(a)(11)

Regulation authority

CCR

What the official deficiency says

Personnel Records 87412(a)(11): The licensee shall ensure that personel records are maintained on the Licensee, Administrator and each employee. Each personnel record shall contain the following information; (11) a health screening as specified in Section 87411, personnel requirements-general. This requirement is not met as evidenced by: Six of ten personnel files reviewed on today's date did not have health screening and tuberculosis test screening. Deficient Practice Statement Based on [(observation) (interview) (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.

Official plan of correction

POC Due Date: 04/18/2024 Plan of Correction AD Justine Ortiz agreed to have health screenings and TB tests for six identified employees by 4/18/2024 COB.

Official classification

Type B

Official code

87705(f)(1)

Regulation authority

CCR

What the official deficiency says

Care of Persons with dementia(f)(1): (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 residents. This requirement is not met as evidenced by: During inspection tour of resident's bedroom, LPAs observed knife near kitchen sink. Resident DX with MCI and history of sundowning behavior. Deficient Practice Statement Based on [(observation) (interview) (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.

Official plan of correction

POC Due Date: 04/15/2024 Plan of Correction AD Ortiz and Maintenance Director removed knife, hammer and scissors during time of inspection visit, agreed to reassess resident's physician report.

Official classification

Type B

Official code

87463(c)

Regulation authority

CCR

What the official deficiency says

87463(c) Reappraisals. The licensee shall arrange a meeting … when there is significant change in the resident’s condition, or once every 12 months, whichever occurs first. This requirement was not met as evidence by: 5 out of 8 staff interviewed reported R1 had begun engaging in unusual behavior such as sitting/crawling on the ground. No reappraisal was conducted to assess R1’s change in condition. This poses a potential risk to residents in care.

Official plan of correction

(AD) Eusey and (HWD) Sanchez will read and understand CCR 87463(c), submit proof of understanding and provide training to staff on reporting resident's change of conditions to be implemented in resident's care plans and needs and services by POC due date of 3/22/2023.

Deadline recorded: Mar 20, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87211(a)(2)

Regulation authority

CCR

What the official deficiency says

87211(a)(2)Reporting Requirements:(a)Each licensee shall furnish to the licensing agency such reports...(2)Occurrences, such as epidemic outbreaks...shall be reported within 24 hours either by telephone or facsimile to the licensing agency and to the local health officer when appropriate. CONTINUED BELOW This requirement was not met as evidenced by:3 of 3 interviewees indicated " Dropping the ball with reporting requirements " and 2 fax cover letters dated 7/26/22 reporting 8 COVID-19 positive cases past the reporting requirement. This poses a potential risk for residents in care.

Official plan of correction

Executive Director and all staff assisting with reporting requirements will read CCR 87211 Reporting Requirements and submit proof of understanding CCR 87211 by POC due date of 8/11/2022.

Deadline recorded: Aug 11, 2022. A deadline is not proof that correction was completed.