WILLOW VIEW GARDENS MEMORY CARE & ASSISTED LIVING

Official classification

Type A

Official code

87464(f)(4)

Regulation authority

CCR

What the official deficiency says

Basic services shall at a minimum include: Personal assistance and care as needed..., with those activities of daily living such as dressing, eating, bathing and assistance with taking prescribed medications...This req is not met as evidenced by: Based on record review, Licensee failed to ensure medications were administered to R1 which poses an immediate health and safety risk to residents in care.

Official plan of correction

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

Deadline recorded: Mar 31, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87464(f)(1)

Regulation authority

CCR

What the official deficiency says

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 interviews conducted, Licensee failed to provide care and supervision. Licensee was unwilling to accept resident back to the facility which poses a potential health and safety risk to residents in care.

Official plan of correction

Resident returned to the facility in the evening on 11/03/2025. Licensee to submit a statement of understanding to LPA by POC due date.

Deadline recorded: Nov 26, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87629(b)(1)

Regulation authority

CCR

What the official deficiency says

87629(b)(1) (b)In addition to Section 87611, General Requirements for Allowable Health Conditions, the licensees who admit or retain residents who require injections shall be responsible for the following: (1)Ensuring that injections are administered by an appropriately skilled professional should the resident require assistance.

Official plan of correction

Administrator advised that they will ensure that an appropriatley skilled nurce will be in the facility seven days a week to administor injections to residents in care. Administrator wil send proof of correction to LPA via email on or before P.O.C due date.

Deadline recorded: Jul 3, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.2(a)(1)

Regulation authority

CCR

What the official deficiency says

87468.2 Additional Personal Rights of Residents in Privately Operated Facilities (a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (1) " To have a reasonable level of personal privacy... " This requirement was not met as evidenced by: Based on interviews and record review, there were four out of six private videos with views from followers ranging from 8-274 which poses a potential Personal Rights risk to persons in care.

Official plan of correction

Licensee and Administrator stated that proof of an in-service training covering the personal rights of residents will be conducted and an addendum will be created regarding a written/opt out consent to take photgraphs and video recordings will be submitted to LPA via email by POC due date.

Deadline recorded: May 27, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87411(f)

Regulation authority

CCR

What the official deficiency says

(f) 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.Personnel with evidence of physical illness or emotional instability that poses a significant threat to the well-being of residents shall be relieved of their duties. 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 three out of six personel records not consisting of a TB test result which poses a potential health and saftey risk to persons in care.

Official plan of correction

POC Due Date: 11/20/2024 Plan of Correction Licensee is to obtain copies of TB test results for each of the identified staff. Licensee is to forward proff of TB test results to LPA by POC due date.

Official classification

Type A

Official code

87465(h)(2)

Regulation authority

CCR

What the official deficiency says

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 which poses an immidiate health and saftey reisk to residence in care. LPA's observed multiple instances of unsecured medications.

Official plan of correction

POC Due Date: 11/07/2024 Plan of Correction Licensee will secure medications and forward proof to LPA by POC due date.

Official classification

Type A

Official code

87464(f)(4)

Regulation authority

CCR

What the official deficiency says

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, as specified in Section 87608, Postural Supports. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above in four out of seven resident medications not being administered per physician's order. Which poses an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 11/07/2024 Plan of Correction Licensee to provide an inservice on medication administration and provide proof to LPA by POC due date.

Official classification

Type B

Official code

87458(a)

Regulation authority

CCR

What the official deficiency says

Prior to a person's acceptance as a resident, the licensee shall obtain and keep on file, documentation of a medical assessment, signed by a physician, made within the last year...This req is not being met as evidenced by: Based on record review, Licensee failed to ensure R1 has a medical assesssment prior to admission. This poses a potential health and safety risk to residents in care.

Official plan of correction

Licensee to forward a copy of the medical assessement to LPA by POC due date.

Deadline recorded: Apr 22, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87405(d)(1)

Regulation authority

CCR

What the official deficiency says

The administrator shall have the qualifications specified in Sections 87405(d)(1) through (7).... Knowledge of the requirements for providing care and supervision appropriate to the residents. This requirement is not being met as evidenced by: Based on interviews conducted and record review, Licensee failed to ensure facility has a qualified administrator. Facility administrator is not aware of what is occurring in facility and not managing resident's private information. This poses an immediate health and safety risk to residents in care.

Official plan of correction

Licensee to submit a statement of understanding to LPA by POC due date.

Deadline recorded: Dec 14, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.1(a)(8)

Regulation authority

CCR

What the official deficiency says

Residents in all residential care facilities for the elderly shall have all of the following personal rights: To have their representatives regularly informed by the licensee of activities related to care or services..This req is not being met as evidenced by: Based on interviews conducted, Licensee failed to ensure R1's responsible party was consulted before hospice enrollment. This poses a potential health and safety risk to residents in care.

Official plan of correction

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

Deadline recorded: Dec 26, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87224(a)

Regulation authority

CCR

What the official deficiency says

The licensee may, upon thirty (30) days written notice to the resident, evict the resident for nonpayment of the rate for basic services, failure to comply with state or local law, failure to comply with the general policies of the facility...This req is not being met as evidenced by: Based on record review and interviews conducted, Licensee failed to ensure eviction notice was provided for a valid reason. Eviction reason given contradicts admission agreement. This poses a potential health and safety risk to residents in care.

Official plan of correction

Licensee to rescind eviction notice and forward proof to LPA by POC due date.

Deadline recorded: Nov 2, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87468.2(a)(4)

Regulation authority

CCR

What the official deficiency says

... residential care facilities for the elderly shall have all of the following personal rights: To care, supervision... are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs. This req is not being met as evidenced by: Based on interviews conducted, Licensee failed to ensure residents are cared for by sufficient numbers of staff. Staff are performing duties including dining room service and activity coordination. This poses an immediate health and safety risk to residents in care.

Official plan of correction

Licensee to forward a hiring plan to LPA by POC due date as well the staffing agency information.

Deadline recorded: Aug 22, 2023. 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 being met as evidenced by: Based on observation and interview, Licensee failed to ensure care is being provided to residents in care. Facility staff are not responding to resident pendant pulls. This poses a potential health and safety risk to residents in care.

Official plan of correction

Licensee has had a repair company come into facility to repair call lights. Licensee to forward proof of repair to LPA by POC due date.

Deadline recorded: Aug 22, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.2(a)(23)

Regulation authority

CCR

What the official deficiency says

.. residents in.. residential care facilities for the elderly shall have all of the following personal rights: to be encouraged to develop and maintain their fullest potential for independent living through participation in activities..This req is not being met as evidenced by:. Based on observation and interviews, Licensee failed to ensure activities are being provided to residents. Although facility has an activity calendar, all residents interviewed confirm a lack of activities. LPA observed only bingo in the afternoon. This poses a potential personal rights risk to residents in care.

Official plan of correction

Please develop and maintain a working activity schedule and forward proof to LPA by POC due date.

Deadline recorded: Sep 4, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87464(f)(4)

Regulation authority

CCR

What the official deficiency says

(f) Basic services shall at a minimum include: Personal assistance and care as needed by .. with those activities of daily living such as dressing, eating, bathing and assistance with taking prescribed medications...This req is not being met as evidenced by: Based on record review and interviews conducted, Licensee failed to ensure residents are being showered as required. Residents state not being showered and shower schedule confirms this. This poses a potential health and safety risk to residents in care.

Official plan of correction

Licensee to forward a plan to ensure residents are getting showered by POC due date.

Deadline recorded: Sep 4, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.2(a)(8)

Regulation authority

CCR

What the official deficiency says

In addition to the rights listed in Section 87468.1.. residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: To be free from.., financial exploitation, involuntary seclusion, punishment, humiliation, intimidation...This requirement is not being met as evidenced by: Based on interviews conducted, Licensee failed to ensure resident was charged properly for rent. R1 admitted into the facility on 03/09/2023 and was charged for the whole month of March. This poses a potential health and safety risk to residents in care.

Official plan of correction

Licensee provided a refund to resident in the amount of $353 and provided proof to LPA. CLEARED DURING VISIT.

Deadline recorded: May 11, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87507(g)(3)(A)

Regulation authority

CCR

What the official deficiency says

Admission agreements shall specify the following: Payment provisions, including the following: Rate for all basic services which the facility is required to provide in order to obtain and maintain a license... This requirement is not being met as evidenced by: Based on record review, Licensee failed to ensure admission agreement specified payment provisions including basic service rate. This poses a potential health and safety risk to resident's in care.

Official plan of correction

Licensee to complete admission agreement and forward completed agreement to LPA and responsible party by POC due date.

Deadline recorded: May 30, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87507(c)

Regulation authority

CCR

What the official deficiency says

Admission agreements shall be signed and dated, acknowledging the contents of the document, by the resident or the resident’s representative, if any, and the licensee or the licensee’s designated representative no later than seven days following admission...This requirement is not being met as evidenced by: Based on record review and interview conducted, Licensee failed to ensure admission agreement was signed within seven days of admission. This poses a potential health and safety risk to residents in care.

Official plan of correction

Licensee to provide a written statement of understanding of the regulation and forward proof to LPA by POC due date.

Deadline recorded: May 30, 2023. A deadline is not proof that correction was completed.