MISSION VIEJO CARE COTTAGES 2

Official classification

Type A

Official code

87309(a)

Regulation authority

CCR

What the official deficiency says

Per CCR 87309(a), the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances, knives, matches, tools, sharp objects, and other similar items which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above as unsecured cleaning products were observed to be stored in unlocked cabinets in both bathrooms used by residents which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/13/2025 Plan of Correction Licensee moved the cleaning supplies in secured storage. In-service training will be provided to staff.

Official classification

Type A

Official code

87412(b)(3)(B)

Regulation authority

CCR

What the official deficiency says

(b) Personnel records shall be maintained for all volunteers and shall contain the following: (3) For volunteers that are required to be fingerprinted pursuant to Section 87355, Criminal Record Clearance: (B) Documentation of either a criminal record clearance or a criminal record exemption as required by Section 87355(e). 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 as staff member S1 was found to be missing an approved background clearance which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/13/2025 Plan of Correction Licensee removed the uncleared staff from the premises and from the current schedule until adequate clearance can be obtained. Civil penalty issued.

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 observation, the licensee did not comply with the section cited above as the two wall-mounted fire extinguishers observed on the premises show maintenance tags expired as of May 2025 which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/17/2025 Plan of Correction Licensee scheduled a visit with their fire safety vendor on 11/14/2025. Proof of maintenance to be provided to LPA before the plan of corrections due date.

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 record review, the licensee did not comply with the section cited above as the most recent reappraisal for resident R1 is dated 2022 which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/21/2025 Plan of Correction Licensee will update R1's reappraisal based on their most recent condition and physician report. Copy to be provided to LPA.

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 conducted during the visit, the licensee did not comply with the section cited above as one latching gate is stuck and cannot be opened easilty, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/06/2024 Plan of Correction Licensee will repair the gate and provide documentation of the repairs to LPA before the plan of corrections due date.

Official classification

Type B

Official code

87555(b)(8)

Regulation authority

CCR

What the official deficiency says

(b) The following food service requirements shall apply: (8) All food shall be of good quality. Commercial foods shall be approved by appropriate federal, state and local authorities. Food in damaged containers shall not be accepted, used or retained. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above as expired canned goods were found to be present in the garage's pantry which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/25/2024 Plan of Correction Expired food items were disposed of during the visit.

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 observation, the licensee did not comply with the section cited above as the medication closet was observed to be unlocked and the hospice comfort kit were seen to be in non-secure plastic boxes in the garage's refrigerator which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/06/2024 Plan of Correction Licensee will obtain a locking box for the comfort kit and conduct an update of the medication administration training, documentation of which will be provided to LPA before the plan of corrections due date.

Official classification

Type B

Official code

87628(a)

Regulation authority

CCR

What the official deficiency says

(a) The licensee shall be permitted to accept or retain a resident who has diabetes if the resident is able to perform his/her own glucose testing with blood or urine specimens, and is able to administer his/her own medication including medication administered orally or through injection, or has it administered by an appropriately skilled professional. This requirement is not met as evidenced by: Deficient Practice Statement Based on interviews and record reviewed, the licensee did not comply with the section cited above as one resident with insulin-dependent diabetes is stated to self-administer even though their physician report states otherwise, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/09/2024 Plan of Correction Licensee will seek to obtain an updated physician report reflecting the resident's ability to self-monitor their condition or implement measures ensuring the resident's injections are conducted by a skilled professional.

Official classification

Type B

Official code

87465(g)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care … (g) The licensee shall immediately telephone 9-1-1 if an injury or other circumstance has resulted in an imminent threat to a resident’s health… This requirement was not met as evidenced by: Based on interviews and documents, on 01/13/24 the facility did not call 9-1-1 immediately after R1’s fall and injury and only tried to take took R1 to urgent care the next day, which posed a potential health risk to persons in care.

Official plan of correction

Licensee stated they will conduct training for staff on responding to resident injuries and calling 9-1-1 and will submit proof to LPA by POC due date.]

Deadline recorded: Mar 12, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87355(e)

Regulation authority

CCR

What the official deficiency says

87355 Criminal Record Clearance (e) All individuals subject to a criminal record review (...) shall prior to working (...) in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department. This requirement is not met as evidenced by: Based on observation, record review and interviews, staff member S3 was not fingerprint cleared prior to working which poses an immediate Health, Safety, or Personal Rights risk to persons in care. CIVIL PENALTY ASSESSED.

Official plan of correction

Licensee agreed to remove staff member S3 from facility and not add them back to the schedule until fingerprint cleared and associated to the facility.

Deadline recorded: Sep 27, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87608(3)

Regulation authority

CCR

What the official deficiency says

CCR Section 87608(3) on Postural Supports indicates that (3) A written order from a physician indicating the need for the postural support shall be maintained in the resident’s record. This requirement is not met as evidenced by: Based on observation and record review, licensee was not able to provide the requested documentation during the visit which poses a potential Health, Safety, or Personal Rights risk to persons in care.

Official plan of correction

Licensee is to provide a physician order for the half rail postural supports observed during the visit before the Plan of Corrections due date.

Deadline recorded: Oct 10, 2022. A deadline is not proof that correction was completed.