CLEARWATER AT NORTH TUSTIN

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 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. LPA observed that Staff #3 (S3) did not complete the required twenty hours of annual training, and only had twelve hours of annual training documented for the year of 2024.

Official plan of correction

POC Due Date: 12/26/2025 Plan of Correction The Executive Director stated that she will have S3 complete the required training hours. The Executive Director agreed to provide LPA proof of the comlpete training for S3 via email or fax by POC date.

Official classification

Type A

Official code

87303(e)(2)

Regulation authority

CCR

What the official deficiency says

Maintenance and Operation-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 and not more than 120 degrees F. This requirement was not met as evidenced by: On 8/31/22 hot water temperatures were measured in random resident rooms and the laundry room. Out of 9 rooms, 6 rooms did not have hot water that met regulation guidelines. This poses an immediate health and safety risk to residents in care.

Official plan of correction

Licensee agrees to immediately check water temperatures on a daily basis to ensure that it is in between regulation guidelines. Certification will be provided. Further investigation by Maintenance after initial visit on 8/31/22 concluded that there were issues with the condenser and valve. All has been repaired.

Deadline recorded: Nov 2, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87464(f)(4)

Regulation authority

CCR

What the official deficiency says

Basic Services-Basic services shall at a minimum include: Personal assistance and care as needed by the resident and as indicated in the pre-admission appraisal, with those activities of daily living such as dressing, eating, bathing and assistance with taking prescribed medications.This requirement not met as evidenced by: End of shift reports, completed by staff, were reviewed for the week of 8/24/22-8/27/22. Reports disclosed that Resident #1, #2, #3 ,#4, #5 and #6 did not receive their showers as there was no warm or hot water. This poses an immediate health and safety risk/ personal rights risk to residents in care

Official plan of correction

Licensee agrees to check hot water temperatures and end of shift reports to ensure that all residents are being showered as agreed to by the Licensee in the residents admission agreements and or care plans. Certification of understanding will be provided.

Deadline recorded: Nov 2, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87303(g)(1)

Regulation authority

CCR

What the official deficiency says

Maintenance and Operation- Facilities which have washing machines shall: Have adequate supplies available and equipment maintained in good repair. This requirement was not met as evidenced by: End of shift reports, completed by staff, were reviewed for the week of 8/24/22-8/27/22 and interviews were conducted with random staff. Laundry services were not completed due to no hot water. This poses an immediate health and safety risk to residents in care.

Official plan of correction

Licensee agrees to check all end of shift reports as well as the hot water temperatures to ensure that all residents laundry is being completed as agreed to in the residents admission agreements and or care plans. Certification will be provided.

Deadline recorded: Nov 2, 2022. 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-Basic services shall at a minimum include: (1)Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code. Care and supervision " means the facility assumes responsibility for, or provides or promises to provide in the future, ongoing assistance with activities of daily living without which the resident's physical health, mental health, safety, or welfare would be endangered. This requirement was not met as evidenced by: On 8/18/22 R1 climbed over the side gate (eloped) and staff were not aware. R1 cannot leave the facility unassisted. This poses an immediate health and safety risk to residents.

Official plan of correction

Licensee agrees to provide enough staffing to meet the care and supervision of residents in care. A statement of understanding will be provided regarding this Basic Service. Civil penalties assessed.

Deadline recorded: Aug 24, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87705(k)(8)

Regulation authority

CCR

What the official deficiency says

Care of Person's With Dementia-Delayed egress devices shall not substitute for trained staff in sufficient numbers to meet the care and supervision needs of all residents and to escort residents who leave the facility. This requirement was not met as evidenced by: On 8/4/22 R1 eloped from the Community via the delayed egress doors in the Memory Care Unit(Clearbrook). Staff were unaware that R1 had left the Community. This was not the first elopement through the doors by R1. R1 also eloped on 3/27/22 and 7/24/22.

Official plan of correction

Administrator agrees to develop an elopement plan for R1 and ensure that staff are trained on the plan. Administrator further agrees to provide more frequent checks for residents who wander and to have enough staff to escort residents who leave the facility. A copy of the plan will be provided to the Department. This deficiency was a repeat violation within a 12 month period and civil penalties are assessed.

Deadline recorded: Aug 9, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87555(b)(18)

Regulation authority

CCR

What the official deficiency says

General Food Service Requirements. The following food service requirements shall apply: Sufficient food service personnel shall be employed, trained and their working hours scheduled to meet the needs of residents. This requirement was not met as evidenced by: based on observation and interviews the licensee did not employ sufficient food service personnel which poses a potential risk to the health and safety of residents in care.

Official plan of correction

Licensee to ensure sufficient food service personnel shall be employed, trained and their working hours scheduled to meet the needs of residents at all times. Licensee to submit written proof of correction to LPA by POC due date indicating exactly how they will adhere to this regulation.

Deadline recorded: Jul 28, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87705(k)(8)

Regulation authority

CCR

What the official deficiency says

Care of Person's With Dementia-Delayed egress devices shall not substitute for trained staff in sufficient numbers to meet the care and supervision needs of all residents and to escort residents who leave the facility. This requirement was not met as evidenced by: R1 and R2 wandered from the Community without staff supervision. According to records reviewed they cannot leave the facility unassisted and have wandering behaviors. This poses an immediate health and safety risk to residents in care.

Official plan of correction

Administrator agrees to provide more frequent checks for residents who wander. Administrator states they are currently using a staffing agency and are in the process of trying to hire more staff. Staff will also be trained on elopement behaviors and procedures. Proof of correction will be provided via agenda and sign in sheet.

Deadline recorded: Apr 5, 2022. A deadline is not proof that correction was completed.