MADISON GUEST HOME

Official classification

Type B

Official code

87458(c)(1)(A)

Regulation authority

CCR

What the official deficiency says

(c) The medical assessment shall include, but not be limited to: (1) A physical examination of the resident indicating the licensed medical professional's diagnosis or diagnoses and results of an examination for all of the following: (A) Communicable tuberculosis. 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 one of three resident files which poses a potential health risk to persons in care.

Official plan of correction

POC Due Date: 06/29/2026 Plan of Correction Staff Cornejo stated results of an examination for Communicable tuberculosis will be obtained and a copy provided to LPA via email by POC date.

Official classification

Type A

Official code

87465(a)(5)(A)

Regulation authority

CCR

What the official deficiency says

(5)... Assistance with self-administered medications shall be limited to the following: (A) Medications usually prescribed for self-administration which have been authorized by the person's physician. This requirement is not met as evidenced by: Based on observation and staff interview, the licensee did not comply with the section cited above as there is no authorization from R1’s physician for one their prescribed medications and the medication remains with R1’s centrally stored medication.

Official plan of correction

Staff Cornejo stated an authorization for resident's prescribed medication will be obtained and a copy provided to LPA via email by POC date.

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

Official classification

Type B

Official code

87303(e)(2)

Regulation authority

CCR

What the official deficiency says

(2)... Hot water temperature controls shall be maintained to automatically regulate the temperature... to attain a temperature of not less than 105 degree F... and not more than 120 degree F (49 degrees C). This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above as water temperature tested at 131.0 degrees Fahrenheit which poses a potential safety risk to persons in care.

Official plan of correction

Staff Cornejo stated water temperature would be tested and a water temperature log maintained in order to ensure water temperature consists of 105 to 120 degrees Fahrenheit and proof provided to LPA via email by POC date.

Deadline recorded: Nov 21, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

1569.625(b)(2)

Regulation authority

HSC

What the official deficiency says

(2)... training requirements shall... include... 20 hours annually, eight hours of which shall be dementia care training... and four hours of which shall be specific to postural supports, restricted health conditions, and hospice care... This requirement is not met as evidenced by: Based on observation and staff interview, the licensee did not comply with the section cited above as staff files did not include 20 hours of annual training conducted, which poses a potential health, safety and personal rights risk to persons in care.

Official plan of correction

Staff Cornejo stated 20 hours of annual staff training will be completed and proof provided to LPA via email by POC date.

Deadline recorded: Nov 21, 2025. A deadline is not proof that correction was completed.

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... This requirement is not met as evidenced by: Based on observation and record review, the licensee did not comply with the section cited above as resident files reviewed did not include an updated pre-admission appraisal, which poses a potential health, safety and personal rights risk to persons in care.

Official plan of correction

Staff Cornejo stated resident files will be updated to include updated pre-admission appraisal and a copy provided to LPA via email by POC date.

Deadline recorded: Nov 21, 2025. A deadline is not proof that correction was completed.

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... 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: Based on observation and staff interview, the licensee did not comply with the section cited above as emergency drills are currently not being conducted, which poses a potential safety risk to persons in care.

Official plan of correction

Staff Cornejo stated emergency drills will be conducted and the type of emergency covered in the drill will vary from quarter to quarter and proof will be provided to LPA via email by POC date.

Deadline recorded: Nov 21, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(a)(5)(A)

Regulation authority

CCR

What the official deficiency says

(5) Facility staff, except those authorized by law, shall not administer injections, but staff designated by the licensee may assist persons with self-administration as needed. Assistance with self-administered medications shall be limited to the following: (A) Medications usually prescribed for self-administration which have been authorized by the person's physician. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and interview, the licensee did not comply with the section cited above as there is no authorization from a resident's physician for one of their prescribed medications, which poses an immediate health, safety and personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/29/2025 Plan of Correction Staff Cornejo stated an authorization for resident's prescribed medication will be obtained and a copy provided to LPA via email by POC date.

Official classification

Type A

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 medication requiring refrigeration was observed to be accessible to all facility residents in the kitchen fridge, which poses an immediate health, safety and personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/29/2025 Plan of Correction Staff Cornejo stated a medication lock box will be obtained and used to centrally store medication requiring refrigeration and proof provided to LPA via email by POC date.

Official classification

Type B

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 as water temperature tested between 138.3 and 152.6 degrees Fahrenheit, which poses a potential safety risk to persons in care.

Official plan of correction

POC Due Date: 06/27/2025 Plan of Correction Staff Cornejo stated water temperature would be tested and a water temperature log maintained in order to ensure water temperature consists of 105 to 120 degrees Fahrenheit and proof provided to LPA via email by POC 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 observation and staff interview, the licensee did not comply with the section cited above as staff files reviewed did not include 20 hours of annual training conducted, which poses a potential health, safety and personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/27/2025 Plan of Correction Staff Cornejo stated 20 hours of annual staff training will be completed and proof provided to LPA via email by POC date.

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 as medication for residents is being pre-poured into a plastic weekly medication organizer three days in advance, which poses a potential health, safety and personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/27/2025 Plan of Correction Staff Cornejo stated medication will no longer be transferred between the original prescription container and into the weekly container and staff training will be conducted on proper medication storage, and a copy of staff training will be provided to LPA via email by POC 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, the licensee did not comply with the section cited above as three of three resident files reviewed did not include a pre-admission appraisal, which poses a potential health, safety and personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/27/2025 Plan of Correction Staff Cornejo stated resident files will be updated to include a pre-admission appraisal and a copy provided to LPA via email by POC 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 observation and record review, the licensee did not comply with the section cited above as two of three resident files reviewed did not include an updated pre-admission appraisal, which poses a potential health, safety and personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/27/2025 Plan of Correction Staff Cornejo stated resident files will be updated to include updated pre-admission appraisal and a copy provided to LPA via email by POC 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 observation and staff interview, the licensee did not comply with the section cited above as emergency drills are currently not being conducted, which poses a potential safety risk to persons in care.

Official plan of correction

POC Due Date: 06/27/2025 Plan of Correction Staff Cornejo stated emergency drills will be conducted and the type of emergency covered in the drill will vary from quarter to quarter and proof will be provided to LPA via email by POC date.

Official classification

Type A

Official code

87615(a)(2)

Regulation authority

CCR

What the official deficiency says

Prohibited Health Conditions-Persons who require Gastrostomy tubes shall not be admitted or retained in a residential care facility for the elderly. This requirement was not met as evidenced by: On 7/29/21 the Department denied exceptions for R1 and R2 to have Gastrostomy tubes. The Licensee failed to relocate R1 and R2 after the Department's denial. Both residents were present at the facility on today's date.

Official plan of correction

Administrator stated that R1 will be placed on hospice services or will be relocated. R2 is receiving hospice services and will not need to be relocated. Proof of correction will be provided by 10/29/21.

Deadline recorded: Oct 28, 2021. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87633(b)

Regulation authority

CCR

What the official deficiency says

Hospice Care of Terminally Ill Residents-A current and complete hospice care plan shall be maintained in the facility for each hospice resident. Licensee failed to have a current and complete hospice care plan for R2.

Official plan of correction

Licensee agrees to update R2's hospice care plan as well as all hospice care plans for resident's in the facility. Certification shall be provided of completion. R2's care plan was faxed at the time of visit to LPAs.

Deadline recorded: Oct 29, 2021. A deadline is not proof that correction was completed.