MEADOW OAKS OF ROSEVILLE

Official classification

Type B

Official code

87465(a)(1)

Regulation authority

CCR

What the official deficiency says

Incidental Medical and Dental Care (a) (1) The licensee shall arrange, or assist in arranging, for medical and dental care appropriate to the conditions and needs of residents.This requirement was not met based on written report and interview. This posed a potential risk to the resident.

Official plan of correction

As this incident showed a lapse in staff following policy and occurred at a time of some management position vacancies, The licensee will do retraining with med techs and review procedures in place with incoming managers to insure policies in place are followed. POC to provide proof of training and management review of incident communication policies by the POC date of 1/12/26.

Deadline recorded: Jan 12, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87456(a)(4)

Regulation authority

CCR

What the official deficiency says

Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following: (4) The licensee shall assist residents with self-administered medications as needed. This requirement was not met based on records and statements which found R1 received a disconitnued medication. This posed a potential risk to R1.

Official plan of correction

To date, the licensee has amended the notification process for med changes to be directly emailed to ED, Nurse and GPD. Licensee agrees to increase and proceduralize MT- MT shift notes details, develop a med change alert system to compensate for lags in time from order changes to new MAR and provide retraining on newly established and existing procedures for medication communications. Documentation of procedure and or changes and date of staff training will be submitted by POC date 4/11/25. Training to be completed by 4/15/25

Deadline recorded: Apr 11, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87465(a)(4)

Regulation authority

CCR

What the official deficiency says

Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following: (4) The licensee shall assist residents with self-administered medications as needed. This requirement was not met based on records and statements. This posed a potential risk to R1.

Official plan of correction

Licensee responded and addresses to error and provided necessary monitoring and response of the resident. After review of the incident, licensee made changes to recording and highlighting of hand written MARs for new residents. This correction was noted during this visit.

Deadline recorded: Mar 28, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87705

Regulation authority

CCR

What the official deficiency says

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 ... safety ...needs as identified in his/her current appraisal and demonstrated behaviors This requirement was not met based on records and interviews that found adequate number of staff were not present to implement R1's care need. This posed an immediate risk to R1.

Official plan of correction

LPA observed that the immediate safety issues for R1 have been corrected by R1's wandering behaviors have reduced, door alarms are fully operational after battery replacement, staff pagers and walkie-talkies have been have been upgraded. Administrator agreed to discuss / review the possibilities of reducing exit possibilities during times of day. Feasibity and plan to be submitted. Administrator will review all documents pertaining to this incident and submit updated written communication forms. POC due 3/25/25

Deadline recorded: Mar 25, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87469(c)(3)

Regulation authority

CCR

What the official deficiency says

Advanced Directives and Requests Regarding Resuscitative Measures (c)(3)(c) (3) Specifically for a terminally ill For emergencies not directly related to the expected course of the resident’s terminal illness, the facility staff shall immediately telephone emergency response (9-1-1). This requirement was not met met based on records review and statements that found resident with an unwitessed fall did not receive emergency response. This posed an immediate risk to the resident.

Official plan of correction

This deficency was originally cited on 1/14/25. This deficiency is being delivered with an amended LIC809 D for 1/14/25. This deficency's POC has been cleared.

Deadline recorded: Feb 14, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87466

Regulation authority

CCR

What the official deficiency says

The licensee shall ensure that residents are regularly observed for changes in physical, mental, emotional and social functioning …When changes such as unusual weight gains or losses or deterioration of mental ability or a physical health condition are observed, the licensee shall ensure that such changes are documented and brought to the attention of the resident's physician… This requirement was not met based on records and interviews which showed a change of condition not brought to the physician’s attention. This posed an immediate risk to the resident.

Official plan of correction

Licensee will submit a plan for a review and training of accountable staff for reporting, recording and contacting medical care for changes in conditions- training to be completed within seven days.

Deadline recorded: Jan 23, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87467(a)(3)

Regulation authority

CCR

What the official deficiency says

(a) Prior to, or within two weeks of the resident's admission, the licensee shall arrange a meeting with the resident, the resident's representative, if any, appropriate facility staff, and a representative of the resident's home health agency, if any, and any other appropriate parties, to prepare a written record of the care the resident will receive in the facility, and the resident's preferences regarding the services provided at the facility. (3) The licensee shall arrange a meeting with the resident and appropriate individuals identified in Section 87467(a)(1) to review and revise the written record as specified, when there is a significant change in the resident's condition, or once every 12 months, whichever occurs first. Significant changes shall include, but not be limited to occurrences specified in Section 87463, Reappraisals. 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 3 of 6 records resident appraisals were not signed as reviewed which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/12/2025 Plan of Correction Licensee agrees to correct the deficiency for R2, R4 and R5 by the POC date and submit them to CCLD.

Official classification

Type A

Official code

87468.2(a)(4)

Regulation authority

CCR

What the official deficiency says

Additional Personal Rights of Residents in Privately Operated Facilities (a) In addition to the rights listed in Section 87468.1, ...elderly shall have all of the following personal rights: (4) To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs. This requirement was not met as evidenced by statements and records showing lack of supervision at the time of R1’s fall on 5/2/24. This posed an immediate risk to R1.

Official plan of correction

Licensee agreed to submit a plan for assessing staffing and staff communication for residents known to have exit seeking behavior. This POC is due 1/14/25. Immediate civil penalty assesses

Deadline recorded: Jan 15, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87405(h)(5)

Regulation authority

CCR

What the official deficiency says

Administrator - Qualifications and Duties(h) (5) Provide or ensure the provision of services to the residents with appropriate regard for the residents' physical and mental well-being and needs, including those services identified… This requirement was not met based on interviews and records that found R1's supervision regularly did not receive the services of ambulation supervision, staff were unaware of when 9-1-1 was to be called and Admin was unaware of a significant event in the facility. This posed an immediate risk to the resident

Official plan of correction

Licensee agrees to submit a plan for review and communication of any incidents or concerns for resident safety issues to be brought to the ED or designee attention in a timely manor. POC by 1/15/24.

Deadline recorded: Jan 15, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87211(a)(1)

Regulation authority

CCR

What the official deficiency says

87211 Reporting Requirements(a)(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 (D) Any incident which threatens the welfare, safety or health of any resident… This requirement was not met based on interviews and records which found unreported incidents of elopements by R1. This posed a potential risk to resident.

Official plan of correction

Licensee agrees to submit the procedure of incident, to begin report, to review to submitting to CCLD for all reportable incidents by the POC date of 1/28/25.

Deadline recorded: Jan 28, 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

87303 Maintenance and Operation (a) The facility shall be … safe, … and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents. This requirement was not met based on observations which found surface from walkway to landscaping presented an uneven surface for un unsteady, unsupervised resident to fall. This poses a potential risk to residents.

Official plan of correction

Licensee agreed to to submit the procedure for safety checks of the community grounds to include check lists utilized and persons respibsible for the reviews and corrective actions by the POC 1/28/25.

Deadline recorded: Jan 28, 2025. 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

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 ... safety ...needs as identified in his/her current appraisal. This requirement was not met based on records and interviews that found adequate number of staff were not present to implement R2's identified care need. This posed an immediate risk to R2.

Official plan of correction

Licensee agrees to submit a concrete plan for how staff are to maintain eyes on R2, including contingency plans for when other resident needs may interupt the observation of R2 and will include a daily/ every shift schedule for which staff are responsible for the monitoring of R2. This POC is due by 11/7/24. Civil Penalties Applied.

Deadline recorded: Nov 7, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465

Regulation authority

CCR

What the official deficiency says

Incidental Medical and Dental Care (a) A plan for incidental medical and dental care ... The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following: (4) The licensee shall assist residents with self- administered medications as needed. This requirement was not met based on records and interviews which found care staff were not compliant with assisting R1 correctly with medications. This posed an immediate risk to R1.

Official plan of correction

Staff found to have made the error have been removed from medication duties. Licensee agrees to retrain all mediation technicians on the 7 R's of med administration, implement procedures for med techs reviewing previous shift docuentation for all meds that they pass, and procedures for reporting/ responding medication errors/ inconsistencies to managers before the medication is administered, when applicable. Licensee will submit the plan for training and procedures to be reviewed to CCL by the POC date of 11/8/24

Deadline recorded: Nov 8, 2024. 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

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 current appraisal health care needs as identified in his/her.. This requirement was not met based on reports and statements. This posed an immediate risk to R1's health and safety.

Official plan of correction

Licensee will submit a plan for supervision, staffing and training plan for restidents in memory care by the POCdate of 9/18/24.

Deadline recorded: Sep 18, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(a)(5)(D)

Regulation authority

CCR

What the official deficiency says

Incidental Medical and Dental Care (a)(5)(D) Assistance with self-administration does not include forcing a resident to take medication,... without the resident's knowledge and consent, or otherwise infringing upon a resident's right to refuse to take a medication. This requirement was not met on 6/4/24 when R1 was forced to take medications by two caregivers and a med tech. This posed an immedicate risk to the resident.

Official plan of correction

Director has discussed mandated reporting, resident right to refuse meds and no restraint policy with S1-S5. Licensee will submit the training date for all staff regarding mandated reporting, resident right to refuse meds and no restraint policy. The training date will be submitted by 6/13/24. Following completion for the training, documentation of training and participants will be submitted to CCL.

Deadline recorded: Jun 13, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87211(c)

Regulation authority

CCR

What the official deficiency says

Reporting requirements- (c) Any suspected physical abuse that does not result in serious bodily injury of an elder or dependent adult shall be reported to the local ombudsman, the corresponding licensing agency, and the local law enforcement agency within twenty-four (24) hours as required by Welfare and Institutions Code Section 15630(b)(1). This requirement was not met by S1 or S2 who witnessed the incident of 6/4/24 and failed to report to police within 24 hours. This posed an immediate risk ro residents.

Official plan of correction

Director has discussed mandated reporting, resident right to refuse meds and no restraint policy with S1-S5. Licensee will submit the training date for all staff regarding mandated reporting, resident right to refuse meds and no restraint policy. The training date will be submitted by 6/13/24. Following completion for the training, documentation of training and participants will be submitted to CCL.

Deadline recorded: Jun 13, 2024. 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

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 current appraisal health care needs as identified in his/her.. This requirement was not met based on reports and statements. This posed an immediate risk to R1's health and safety.

Official plan of correction

Licensee has repaired doors to insure they fully close when exited. Licensee will submit records of staff training having been conducted as a result of this incident by the POC date of 5/6/24.

Deadline recorded: May 6, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87507(f)

Regulation authority

CCR

What the official deficiency says

87507(f) Admission Agreement The licensee shall comply with all applicable terms and conditions set forth in the admission agreement, including all modifications and attachments. This requirement was not met as evidenced by: Based on documentation review, Licensee did not adhere to admission agreement and did not provide refund to R1’s RP. This poses a potential potential health and safety risk to resident in care.

Official plan of correction

Assistant Executive Director agrees to provide RP refund and submit proof to CCL by POC due date, 1/04/2023.

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

Official classification

Type B

Official code

87625(b)(3)

Regulation authority

CCR

What the official deficiency says

87625 Managed Incontinence (b) In addition to Section 87611, General Requirements for Allowable Health Conditions, the licensee shall be responsible for the following: (3) Ensuring that incontinent residents are kept clean and dry, and that the facility remains free of odors from incontinence. This requirement is not met as evidenced by: Based on interviews and observation the licensee did not ensure R1’s room is free of odor which poses a potential health and safety risk to resident in care.

Official plan of correction

Resident Care Director agrees to maintain all incontinence resident bedrooms to be free of odor. RCD agrees to review section 87625 and submit letter of understanding to CCL by POC due date. On 12/14/2022, LPA amended LIC 90999-D.

Deadline recorded: Dec 15, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87468.1(a)(3)

Regulation authority

CCR

What the official deficiency says

87468.1 Personal Rights of Residents in All Facilities. (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (3) To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature, such as withholding residents’ money or interfering with daily living functions such as eating, sleeping, or elimination. This requirement is not met as evidenced by: Based on interview the licensee did not ensure that resident was afforded their personal rights which poses an immediate health and safety risk to residents in care.

Official plan of correction

Administrator agrees to conduct a training for all staff on abuse, neglect, and mandate reporting. Facility to submit scheduled training by end of day 1/21/22. In addition staff no longer works at the facility.

Deadline recorded: Jan 21, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87468.1(a)(1)

Regulation authority

CCR

What the official deficiency says

87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (1) To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement is not met as evidenced by: Based on interviews conducted facility did not ensure staff were trained on how to treat resident with dignity and respect. Resulting in S1 grabbing/twisting R1's arm.

Official plan of correction

Administrator agrees to conduct a training for all staff on abuse, neglect, and mandate reporting. Facility to submit scheduled training by end of day 02/16/22. In addition staff no longer works at the facility.

Deadline recorded: Feb 16, 2022. 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 ... 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, R1 left the facility and was driven to wife's residence by a good samaritan. This poses an immediate threat to the health and safety of the resident in care.

Official plan of correction

Executive Director agrees to conduct staff training regarding elopment. Facility to submit scheduled training by end of day 12/3/2021. Training to be completed by all care staff by 12/31/2021.

Deadline recorded: Dec 3, 2021. 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. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by: Based on observation, LPA observed hallway light bulbs and bathroom light bulbs located in the Memory Care unit were out and not working. This poses a potential health and safety risk to residents in care.

Official plan of correction

Administrator agrees to change the light bulbs and send a photo of working lights to LPA on due date, 5/14/2021.

Deadline recorded: May 14, 2021. 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 Services (a) A plan for incidental medical and dental care shall be developed by each facility. (5) the licensee shall assist residents with self-administered medications as needed. This requirement is not met as evidenced by: Based on records review and interviews, medication was not given to R1 and not documented on the Medication Administration Records per facility policy.

Official plan of correction

Administrator agrees to schedule an audit from an outside agency to audit medication rooms. Administrator to inform LPA of what agency and date the audit will take place by 4/27/2021. Administrator agrees to conduct a training with all staff on proper medication documentation and medication management. Subject of training and staff sign in sheet to be sent into CCL by 4/27/2021.

Deadline recorded: Apr 27, 2021. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87468.1(a)(8)

Regulation authority

CCR

What the official deficiency says

87468.1 (a)(8) Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (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 is not met as evidenced by: Based on records review and interviews, facility did not notify the change in physician’s order.

Official plan of correction

Administrator agrees to conduct training with all staff on reporting requirements. Subject of training and staff sign in sheet to be sent into CCL by 4/27/2021.

Deadline recorded: Apr 27, 2021. A deadline is not proof that correction was completed.