SERENE HAVEN ASSISTED LIVING MISSION VIEJO

Official classification

Type B

Official code

1569.605

Regulation authority

HSC

What the official deficiency says

On and after July 1, 2015, all residential care facilities for the elderly, except those facilities that are an integral part of a continuing care retirement community, shall maintain liability insurance covering injury to residents and guests in the amount of at least one million dollars ($1,000,000) per occurrence and three million dollars ($3,000,000) in the total annual aggregate, caused by the negligent acts or omissions to act of, or neglect by, the licensee or its employees. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and record review, the licensee did not have a current liability insurance on file which poses a potential health, safety or personal rights risk to persons in care. The current liability insurance on file was effective 10/27/2023 to 10/27/2024.

Official plan of correction

POC Due Date: 12/21/2025 Plan of Correction Licensee will purchase liability insurance effective 2025/2026 and send proof to CCLD by POC due date via email.

Official classification

Type B

Official code

1569.625(b)(1)

Regulation authority

HSC

What the official deficiency says

(1) The department shall adopt regulations to require staff members of residential care facilities for the elderly who assist residents with personal activities of daily living to receive appropriate training. This training shall consist of 40 hours of training. A staff member shall complete 20 hours, including six hours specific to dementia care, as required by subdivision (a) of Section 1569.626 and four hours specific to postural supports, restricted health conditions, and hospice care, as required by subdivision (a) of Section 1569.696, before working independently with residents. The remaining 20 hours shall include six hours specific to dementia care and shall be completed within the first four weeks of employment. The training coursework may utilize various methods of instruction, including, but not limited to, lectures, instructional videos, and interactive online courses. The additional 16 hours shall be hands-on training. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and record review, one out of two staff (Staff #1) did not have sufficient training for the year of 2025 which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/21/2025 Plan of Correction Licensee will ensure Staff #1 conducts at minimum 20 hours of training annually and send proof to CCLD via email 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 observation and record review, Resident #5 did not have a signed, initialed, or dated Admission Agreement which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/21/2025 Plan of Correction Licensee will ensure that Resident #5's Authorized Representative will review and sign the Admission Agreement and proof will be sent to CCLD by POC due date.

Official classification

Type B

Official code

87608(a)(5)(B)

Regulation authority

CCR

What the official deficiency says

Per CCR 87608(a)(5)(B) Postural Supports " Bed rails that extend the entire length of the bed are prohibited except for residents who are currently receiving hospice care and have a hospice care plan that specifies the need for full bed rails. " This requirement is not met as evidenced by: Based on records review and observation, the bed for resident R1 is confirmed to be equipped with full rails. This constitutes a potential risk to the health, safety and personal rights of individuals in care.

Official plan of correction

Licensee will replace full rails with half rails and ensure to have adequate physician orders on file. Documentation of both to be provided to LPA before the plan of corrections due date.

Deadline recorded: Jan 24, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87606(c)

Regulation authority

CCR

What the official deficiency says

Per CCR 87606(c) Care of Bedridden Residents " To accept or retain a person who is bedridden, other than for a temporary illness or recovery from surgery, a licensee shall obtain and maintain an appropriate fire clearance as specified in Section 87202, Fire Clearance " . This requirement is not met as evidenced by: The resident in bedroom #6 has been assessed to be bedridden per their latest physician report. Bedroom #2 only is cleared for bedridden residents. This constitutes an immediate risk to the health, safety and personal rights of individuals in care.

Official plan of correction

Licensee stated they would seek to obtain an updated physician report that reflects the resident's current condition and submit documentation in support of an appeal. Immediate civil penalty assessed.

Deadline recorded: Jan 18, 2025. A deadline is not proof that correction was completed.