SUMMERFIELD OF ROSEVILLE

Official classification

Type A

Official code

87466

Regulation authority

CCR

What the official deficiency says

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. 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 and the resident's responsible person, if any. This requirement was not met based on facility failed to reassess R1 after resident sustained multiple falls. R1 sustained 9 falls between 03/12/24 and 01/14/25. This posed an immediate Health and Safety risk to residents in care.

Official plan of correction

The administrator agrees to write a plan of correction detailing how facility will address reassessments for resident’s who are documented fall risks. Additionally, the facility agrees to submit a plan on how staff will be trained and notified of resident’s who are fall risks and fall prevention protocols for each resident by 5/8/25.

Deadline recorded: May 8, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87412(a)

Regulation authority

CCR

What the official deficiency says

(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: This requirement is not met as evidenced by: Deficient Practice Statement Based on record reviewed, LPA observed that health screening and TB is missing 1 out of 5 files, and 5 out of 5 were missing a job application, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/15/2024 Plan of Correction Facility shall complete all required documents for all staff files per this regulation and will send proof to department by POC date 5/15/2024.

Official classification

Type B

Official code

87705(c)(5)

Regulation authority

CCR

What the official deficiency says

(c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following: (5) Each resident with dementia shall have an annual medical assessment as specified in Section 87458, Medical Assessment, and a reappraisal done at least annually, both of which shall include a reassessment of the resident's dementia care needs. This requirement is not met as evidenced by: Deficient Practice Statement Based on interview and records review 3 out of 5 residents did not have updated physician's report in their files which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/15/2024 Plan of Correction Facility shall submit updated physician's report by POC due date to CCL via email by 5/15/2024.

Official classification

Type A

Official code

87465(c)(2)

Regulation authority

CCR

What the official deficiency says

Incidental Medical and Dental Care (c ) If the resident's physician has stated in writing that the resident is unable to determine his/her own need for nonprescription PRN medication ... requirements are met: (2) Once ordered by the physician the medication is given according to the physician's directions. This requirement is not met as evidenced by: Based on observation, the facility did not ensure medication was given according to physician directions. During the review of medications, the LPA found that for R1’s medications were found to be full and not given to R1.

Official plan of correction

Administrator agrees to audit centrally stored medication. The facility will hold training with staff concerning medication management. The facility will send the staff sign in sheet and training syllabus. These documents will be due by the POC date of 06/01/2023.

Deadline recorded: Jun 1, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87705(c)(5)

Regulation authority

HSC

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: (5) Each resident with dementia shall have an annual medical assessment as specified in Section 87458, Medical Assessment, and a reappraisal done at least annually, both of which shall include a reassessment of the resident’s dementia care needs. This requirement is not met as evidenced by: Based on records review, the facility did not comply with he section cited. R1 did not have updated medication assessment which poses a potential health, safety, or personal rights risk to person in care

Official plan of correction

Facility agrees to schedule R1 by 6/09/2023 to get updated Medical Assessment and submit in updated Medical Assessments by 6/30/2023

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

Official classification

Type B

Official code

87705(c)(5)

Regulation authority

HSC

What the official deficiency says

87705(c)(5) Care of Persons with Dementia (c) Licensees who accep and retain residents with dementia shall be responsible for ensuring the following: Assesssment ... (5) Each resident with dementia shall have an annual medical assessment as specified in Section 87455, medical and reappraisal done at least annually. Deficient Practice Statement This requirement is not met as evidenced by: Based on interview and records review 2 out of 5 residents did not have updated physician's report in their files which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/17/2023 Plan of Correction Facility shall submit updated physician's report by POC due date to CCL via email by 5/17/2023.

Official classification

Type A

Official code

87468.1(a)(3)

Regulation authority

CCR

What the official deficiency says

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 was not met as evidenced by: Based on interviews and documentation reviewed, R1 refused medication twice and three (3) facility staff restrained R1 physicially when assisting with medication. This poses an immediate health and safety risk to resident in care.

Official plan of correction

Resident Service Director, Jasmine Juchniewicz, agrees to conduct staff training on resident's personal rights. ED is to submit proof of training and indicate what topics were discussed and staff to sign off on training, by POC due date, 02/10/2023.

Deadline recorded: Feb 10, 2023. 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

87465(a)(5)(D) Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed... include forcing a resident to take medication, hiding or camouflaging medications in other substances 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 as evidenced by: Based on interviews and documentation reviewed, R1 refused medication twice and facility staff had physically restrained R1 and insisted for R1 to take medication. This poses an immediate health and safety ricks to resident in care.

Official plan of correction

Resident Service Director, Jasmine Juchniewicz, agrees to conduct staff training on medication refusal and submit proof of training on POC due date, 2/10/2023.

Deadline recorded: Feb 10, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

1569.69(a)(1)

Regulation authority

HSC

What the official deficiency says

§1569.69 Employees assisting residents with self-administration of medication; training requirements. (a) Each residential care facility ... the employee shall complete 16 hours of initial training. This training shall consist of eight hours of hands-on shadowing training, which shall be completed prior to assisting with the self-administration of medications, and eight hours of other training or instruction, as described in subdivision (f), which shall be completed within the first two weeks of employment. Based on interviews, facility does not have records of S3's medication training or credentials. This poses an immediate health and safety ricks to resident in care.

Official plan of correction

Resident Service Director, Jasmine Juchniewicz, agrees to review Health and Safety Code 1569.69 and submit letter of understanding to CCL by POC due date, 02/10/2023.

Deadline recorded: Feb 10, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

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 the licensee did not ensure that facility kitchen is free from mold which poses an immediate health and safety risk to residents in care. LPA also observed kitchen equipment such as ice machine, mixer, and oven to be in disrepair.

Official plan of correction

Executive Director agrees to schedule an appointment for a mold remediation company to come out to facility to inspect the kitchen by POC date, 04/21/2022. Executive Director agrees to get the oven and the ice machine repaired by 04/27/2022.

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