GRANITE BAY COUNTRYHOUSE LLC

Official classification

Type A

Official code

87465(a)(4)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility (...) by compliance with the following: (4) The licensee shall assist residents with self-administered medications as needed. This requirement is not met as evidenced by: Based on medication count and records reviewed, the facility did not ensure that residents (R1, R2, and R3) were receiving medications as prescribed, which poses an immediate health, safety, and personal rights risk to residents in care.

Official plan of correction

Facility agrees to conduct bi-weekly audits of all medications for the next two months and submit audits to LPA. The facility will split the audits up by wing in the facility. The last week of audits will be conducted the week of 6/28/26. The facility has already provided LPA with copies of Med Tech training conducted the week of 3/23/26 as well as the medication audits concluded on 3/18/26.

Deadline recorded: Apr 30, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87211(a)(1)(D)

Regulation authority

CCR

What the official deficiency says

87211 Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: (1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below... (D) Any incident which threatens the welfare, safety or health of any resident, such as psychological abuse of a resident by staff or other residents, or unexplained absence of any resident. This requirement is not met as evidenced by: Based on records reviewed, the facility did not ensure they notified CCLD of the mismangement of R1's medications within seven days, which poses a potential health, safety, and personal rights risk to the residents in care.

Official plan of correction

Acting Executive Director indicated that they will ensure all reporting requirements are being followed. Facility will submit a statement of understanding by the POC due date of 5/13/26.

Deadline recorded: May 13, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87466

Regulation authority

CCR

What the official deficiency says

87466 Observation of the Resident The licensee shall ensure that residents are regularly observed for changes in physical, mental, emotional and social functioning and that appropriate assistance is provided... the licensee shall ensure that such changes are documented and brought to the attention of the resident's physician and the resident's responsible person, if any. This requirement is not met as evidenced by: Based on records review and interviews, facility staff did not monitor R1's feet which resulted in R1 being admitted to the hospital for septic shock and had a right lower extremity angioplasty and a right trans metatarsal amputation. This poses an immediate health and safety risk to residents in care.

Official plan of correction

Licensee agrees to conduct training with staff on ensuring staff are aware of each resident’s care needs in accordance with each individual care plans. Additionally, training shall include how staff document and communicate any changes in resident needs. Training shall be completed within 30 days of POC date. Licensee shall submit training dates and topics by POC and submit training completion ducmentation once training is completed.

Deadline recorded: Feb 16, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(c)(2)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care (c)If the resident's physician . . . nonprescription PRN medication but can communicate his/her symptoms clearly, (2) Once ordered by the physician the medication is given according to the physician's directions. This requirement was not met as evidenced by R1's PRN medication begin given routinely at 7am 8/24 - 8/28/2023. This poses a direct threat to the health and safety of residents in care.

Official plan of correction

Facility to submit plan in regards to training staff for PRN medication regulations. Additionally, Facility will add auditing measures to ensure staff are following procedures.

Deadline recorded: Dec 15, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87625(b)(3)

Regulation authority

CCR

What the official deficiency says

Managed Incontinence (3) Ensuring that incontinent residents are kept clean and dry and that the facility remains free of odors from incontinence. This requirement was not met as evidenced by R1's incontinence needs not being met as evidenced by soiled bedding and clothings. This poses a direct threat to the health and safety of residents in care.

Official plan of correction

Facility to submit date/time for training all staff in regards to incontinence needs being met.

Deadline recorded: Dec 15, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.2(a)(2)

Regulation authority

CCR

What the official deficiency says

87468.2 Additional Personal Rights of Residents in Privately Operated Facilities (2) To have their records and personal information remain confidential and to approve their release, except as authorized by law. This requirement was not met as evidenced by R1's POA receiving paperwork for other residents (5). This poses an indirect threat to the health and safety of residents in care.

Official plan of correction

Facility to submit a statement of understanding in regards to keeping residents information confidential.

Deadline recorded: Dec 28, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.2(a)(19)

Regulation authority

CCR

What the official deficiency says

87468.2 Additional Personal Rights of Residents in Privately Operated Facilities 19) To have prompt access to review all of their records and to purchase photocopies of their records. . . . (2) business days and at a cost that does not exceed the community standard for photocopies. This requirement was not met as evidenced by R1's repeated attempts to obtain R1's file while took approximately 4 weeks. This poses an indirect threat to the health and safety of residents in care.

Official plan of correction

Facility to submit a statement of understanding regarding the timeline for residents to receive their documents.

Deadline recorded: Dec 28, 2023. 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

87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. . This requirement was not met as evidenced by R1's soiled incontinence products being left throughout the room. This poses an indirect threat to the health and safety of residents in care.

Official plan of correction

Facility to submit training records for staff regarding taking used incontinence products out of residents rooms, overall cleanliness etc.

Deadline recorded: Dec 28, 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

87468.1 Personal Rights of Residents in All Facilities (8) To have their representatives regularly informed by the licensee of activities related to care or services, including ongoing evaluations, as appropriate to their needs. This requirement was not met as evidenced by R1's POA not being notified of 2 falls. This poses an indirect threat to the health and safety of residents in care.

Official plan of correction

Facility to submit training records for med techs and Department heads are calling POAs in regards to falls and change of conditions.

Deadline recorded: Dec 28, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87705(c)(4)

Regulation authority

CCR

What the official deficiency says

87705 Care of Persons with Dementia (c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following: (4) There is an adequate number of direct care staff to support each resident’s physical, social, emotional, safety and health care needs as identified in his/her. . current appraisal. This requirement was not met as evidenced by R1's safety needs not being met which allowed them to sustain an unwitnessed falls with fractures. This poses an immediate threat to the health and safety to residents in care.

Official plan of correction

Facility to submit detailed plan of measures put into place of staff identifying unmet needs and how the facility will address it. Additonally, plan will detail meeting needs of wander risks.

Deadline recorded: Dec 7, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87466

Regulation authority

CCR

What the official deficiency says

87466 Observation of the Resident The licensee shall ensure that residents are regularly observed for changes in physical, mental, emotional and social functioning and that appropriate assistance is provided when such observation reveals unmet needs. . . . This requirement was not met as evidenced by the facility not providing R1 with appropriate safety measures as a fall risk. This poses an immediate threat to the health and safety to residents in care.

Official plan of correction

Facility will submit detailed plan on proactive measures once a fall risk is indentified.

Deadline recorded: Dec 7, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

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 in 3 out of 6 water temperatures measuring above 120 degrees which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/25/2023 Plan of Correction Licensee to submit a statement of understanding regarding water temperature by end of day 8/25/2023. Licensee to take apartment water tempatures twice a day for 7 days and submit to LPA by 9/5/2023.

Official classification

Type A

Official code

87465(g)

Regulation authority

CCR

What the official deficiency says

87465(g) - Incidental medical and dental care services - The licensee shall immediately telephone 9-1-1 if an injury or other circumstance has resulted in an imminent threat to a resident’s health... This requirement is not met as evidenced by: Based on interviews and records review it was determined that R1 fell on 3/18/2022 and EMS was not contacted. R1 was not taken to the ER until 3/22/2022. R1 sustained bruising which poses an immediate health and safety risk to residents in care.

Official plan of correction

Licensee agrees to conduct staff training on initiating emergency services and reporting requirements. Date of training shall be provided to LPA by 10/24/2022. Once training is completed, completion documentation and training topics to be provided to CCL.

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

Official classification

Type A

Official code

87705(c)(4)

Regulation authority

CCR

What the official deficiency says

87705(c)(4) - Care of Persons with Dementia (c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following: (4) There is an adequate number of direct care staff to support each resident’s physical, social, emotional, safety and health care needs as identified in his/her current appraisal. This requirement is not met as evidenced by: Based on interviews conducted and record reviewed, the Licensee did not ensure that resident (R1) was supervised according to the care plan which posed an immediate health and safety risk to residents in care.

Official plan of correction

Licensee agrees to conduct staff training on documenting and notification any residents change in conditions. Date of training shall be provided to LPA by 10/24/2022. Once training is completed, completion documentation and training topics to be provided to CCL.

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

Official classification

Type A

Official code

87465(a)(4)

Regulation authority

CCR

What the official deficiency says

The licensee shall assist residents with self-administered medications as needed. This requirement is not met as evidence by: thru review of records and observation, it was learned that the facility did not have 2 medications for a resident that were ordered as a PRN (as needed) medication. If needed, they would not have been available

Official plan of correction

The facility will ensure that all medications that have been ordered by physician will be available in the facility for when they are needed. Facility has already initiated regular medication audits. ED will submit a plan for on-going monitoring of medications by 3/24/2021.

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

Official classification

Type A

Official code

87411(a)

Regulation authority

CCR

What the official deficiency says

Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs... This requirement is not met as evidenced by: On 12/15/21 CCL staff witnessed 2 residents alone in the second floor dining area with no staff nearby. Both residents had food on the table. One resident was standing bent over the table and could potentially have fallen or choked on food with no staff nearby; the other could have potentially choked.

Official plan of correction

Facility will maintain adequate staffing to monitor residents and ensure safety. The facility has addressed this supervision issue by inviting second floor residents to spend time and eat on the first floor where there is more supervion available. ED will submit written plan of how resident monitoring will be addressed. Plan to be submitted by 3/24/22.

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

Official classification

Type A

Official code

87465(a)(5)

Regulation authority

CCR

What the official deficiency says

87465(a)(5)- Incidental Medical and Dental Care-The licensee shall assist residents with self-administered medications as needed. This requirement is not met as evidenced by: Based on observation and record review the licensee did not provide medication prescribed by physician which poses an immediate health and safety risk to residents in care.

Official plan of correction

Administrator agrees to conduct a training with all staff that handle medication. Training to include documentation, reviewing physician orders, and Extended Care Professional (ECP) for Electonic Health Records. Training provided to be sent into LPA by 9/2/2021.

Deadline recorded: Sep 1, 2021. A deadline is not proof that correction was completed.