LOLA SENIOR GUEST HOME

Official classification

Type A

Official code

87615(a)

Regulation authority

CCR

What the official deficiency says

(a) Persons who require health services for or have a health condition including, but not limited to, those specified below shall not be admitted or retained in a residential care facility for the elderly: This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and interview confirmation, the licensee did not comply with the section cited above for resident 1 (R1) which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/01/2025 Plan of Correction Administrator Dinh will email a request for an exemption for Resident 1. Including all required hospice information.

Official classification

Type A

Official code

87633(f)(1)

Regulation authority

CCR

What the official deficiency says

(1) The record of each training session shall specify the names and credentials of the trainer, the persons in attendance, the subject matter covered, and the date and duration of the training session. 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 for Resident 1 (R1) which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/01/2025 Plan of Correction Administrator Dinh will email LPA proof of training provided to facility staff by the Hospice provider caring for R1's G Tube. Including the relevant information on the skilled professional who provided the training for facility staff.

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 medications 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 and interview confirmation, the licensee did not comply with the section cited above, as unsecured noon time and pm medications were observed sitting on top of the medication storage area accessible to residents in care which poses an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 10/01/2025 Plan of Correction Administrator Dinh will conduct an in service training on medication administration and storage for all staff listed on the personnel report. Administrator Dinh will email LPA a training certificate for each staff who competed the training.

Official classification

Type B

Official code

87211(a)(1)

Regulation authority

CCR

What the official deficiency says

87211 Reporting Requirements (a) Each licensee shall furnish...reports as the Department may require, including, but not limited to... (1) A written report shall be submitted to the licensing agency... within seven days of the occurrence of any of the events specified... below. This report shall include the resident’s name, age...disposition of the case. This requirement is not being met as evidenced by: Administrator Dinh confirmed no incident was sent to the Regional Office regarding R1’s elopement.

Official plan of correction

Administrator Dinh will read and review the regulation section on reporting requirements and email LPA Haley a signed statement of acknowledgement and understanding by 4:00pm on the POC due date.

Deadline recorded: Aug 5, 2025. 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

87464 Basic Services (f) Basic services shall at a minimum include: (1) Care and supervision as defined in section 87101(c)(3) and Health and Safety Code Section 1569.2(c). This requirement was not met as evidenced by: Based on interview confirmation and document review, R1 was able to leave the facility unassisted in the middle of the night without staff being aware of the residents’ whereabouts, which poses an immediate threat to the residents health and safety.

Official plan of correction

Administrator Dinh stated he will provide an in-service training for all staff on elopement procedures, caregivers responsibilities, and provide a seven-day schedule for the caregiver who will be assigned to be on duty at night. Administrator Dinh will send a summary of the completed in-service training with a sign-in sheet. The summary breakdown will include the duration of the training and the topics covered during the in-service training. All documents will be emailed to LPA Haley by 4:00pm on the POC due date.

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

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

The facility shall be safe, celan, sanitary, and in good repair at all times. Maintenance shall include provisions of maintenance services and procedures for the safety and well-being or residents, employees and visitors. This requirement is not met as evidenced by: during the tour of the physical plant LPA Haley observed clutter, debris, old furniture, and a backyard fence that was leaning into the neighboring property. Deficient Practice Statement Based on observation, of the clutter behind the garage, on the side of the garage, and the backyard fence that was in disrepair, the licensee did not comply with the section cited above, which posed a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 06/06/2024 Plan of Correction POC has already been completed. All the miscellaneous items have been removed from behind and the side of the garage. All old furniture has been removed form the pool area. The fence that was leaning into the neighboring property was removed. No further action is needed.