SAN CLEMENTE VILLAS BY THE SEA

Official classification

Type B

Official code

1569.618(c)(3)

Regulation authority

HSC

What the official deficiency says

(c)The facility shall employ, and the administrator shall schedule, a sufficient number of staff members to do all of the following: (3) Ensure that at least one staff member who has cardiopulmonary resuscitation (CPR) training and first aid training is on duty and on the premises at all times. This paragraph shall not be construed to require staff to provide CPR. 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 six out of six staff which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/10/2026 Plan of Correction Licensee agrees to obtain CPR training for staff and forward proof 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 six out of six staff which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/10/2026 Plan of Correction Licensee agrees to provide training and forward proof to LPA by POC due date

Official classification

Type A

Official code

87307(e)(1)(A)

Regulation authority

CCR

What the official deficiency says

87307 Personal Accommodations and Services (e) The licensee shall supervise residents as needed and as determined by the resident's appraisal... when residents are in proximity to or when there is use of the following items: (1) Ranges, ovens, heaters, fireplaces, wood stoves, inserts, and other heating devices. (A) Heating devices shall have protective mechanisms or other measures to prevent access to the device, or to make it inoperable when not in use, in order to reduce the risk of burns or fire. This requirement was not met as evidenced by: It was discovered R1 did not have a cover on their thermostat in their room. R1 was sent to the hospital after being discovered on the floor of their room and with the thermostat turned all the way up. This poses a potential health and safety risk to residents in care.

Official plan of correction

Executive Director Malaspina will confirm all 22 resident rooms in the Memory Care unit have a cover placed over the thermostat. Executive Director Malaspina will email LPA Haley confirming all rooms have a cover by 1:00pm on the POC due date. LPA Haley verified R1's room does have a cover over the thermostat during the visit.

Deadline recorded: Jul 17, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87464(f)(1)

Regulation authority

CCR

What the official deficiency says

Basic services shall at a minimum include: Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). This requirement is not met as evidenced by: Based on interview conducted and record review, Licensee failed to ensure basic services was provided to R1. R1 eloped out of the facility and was found by off duty staff which poses an immediate health and safety risk to residents in care. CIVIL PENALTY ASSESSED.

Official plan of correction

Licensee conducted an in-service on 05/19/2026. CLEARED DURING VISIT.

Deadline recorded: Jul 10, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87464(f)(1)

Regulation authority

CCR

What the official deficiency says

Basic services shall at a minimum include: Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). Based on record review, Licensee failed to ensure care and supervision was provided to R1. R1 received three medications belonging to another resident and was hospitalized for observation. This poses an immediate health and safety risk to residents in care.

Official plan of correction

Licensee to conduct an in-service on administering medications and forward proof to LPA by POC due date.

Deadline recorded: Apr 10, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87464(f)(1)

Regulation authority

CCR

What the official deficiency says

Basic services shall at a minimum include: Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). This requirement is not met as evidenced by: Based on record review and interviews conducted, Licensee failed to ensure care and supervision was provided to resident. R1 eloped two times out of the facility on March 18 and 24, 2026 which poses an immediate health and safety risk to residents in care. CIVIL PENALTY ASSESSED

Official plan of correction

Licensee to conduct an in-service on resident elopements and forward proof to LPA by POC due date.

Deadline recorded: Apr 2, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87705(f)(2)

Regulation authority

CCR

What the official deficiency says

(f) Licensees that lock exterior doors or perimeter fence gates shall meet the following initial and continuing requirements: (2) The licensee shall ensure that the fire clearance includes approval of locked exterior doors or perimeter fence gates and that facility staff on all shifts have access to, and know how to use, equipment needed to unlock exterior doors or perimeter fence gates. 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.

Official plan of correction

POC Due Date: 08/22/2025 Plan of Correction Licensee to provide keys to all staff while exploring obtaining delayed egress. Licensee to forward plan 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 six out of six staff without required training which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/04/2025 Plan of Correction Licensee to conduct training and forward proof to LPA by POC 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. LPAs observed multiple items expired including yogurt, milk and cream which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/04/2025 Plan of Correction Licensee to audit food expiration dates and forward proof to LPA by POC due date.

Official classification

Type B

Official code

87411(f)

Regulation authority

CCR

What the official deficiency says

All personnel, including the licensee and administrator, shall be in good health, and physically and mentally capable of performing assigned tasks. Good physical health shall be verified by a health screening, including a chest x-ray or an intradermal test, performed by a physician not more than six (6) months prior to or seven (7) days after employment or licensure. A report shall be made of each screening, signed by the examining physician. The report shall indicate whether the person is physically qualified to perform the duties to be assigned, and whether he/she has any health condition that would create a hazard to him/herself, other staff members or residents. A signed statement shall be obtained from each volunteer affirming that he/she is in good health.... 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 out of six staff without a health screen/ TB which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/04/2025 Plan of Correction Licensee to obtain health screening/ TB and forward proof to LPA by POC due date.

Official classification

Type B

Official code

87468.2(a)(19)

Regulation authority

CCR

What the official deficiency says

Per the California Code of Regulations Section 87468.2(a)(19) listing Additional Personal Rights of Residents in Privately Operated Facilities: " residents(....) shall have all of the following personal rights: (...) (19) To have prompt access to review all of their records (...) Photocopied records shall be provided within two (2) business days (....) " . This requirement was not met as evidenced by the additional delay evidenced during the present visit. This constitutes a potential risk to the health, safety and personal rights of individuals in care.

Official plan of correction

Facility staff will inform LPA that records requested have been provided before the plan of corrections due date.

Deadline recorded: Mar 31, 2025. A deadline is not proof that correction was completed.