BLESSED HOMECARE 2 ROSEVILLE

Official classification

Type B

Official code

87412(a)

Regulation authority

CCR

What the official deficiency says

87412 Personnel Records (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 was not met by evidenced by: Licensee allowed staff S1 to work 1 shift without proper paperwork on file.

Official plan of correction

Licensee will review regulation 87412 and submit a statement of understanding to LPA by POC due date.

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

Official classification

Type A

Official code

87465(h)(2)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care(h)The following requirements shall apply to medications which are centrally stored: (2) 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 poses an immediate health and safety risk to residents in care. This was not met as evidenced by: LPA and LPM observed medications to be unlocked in kitchen drawer.

Official plan of correction

Licensee will conduct a training with staff regarding locking and storing medications. Licensee will send a copy of training to LPA by POC due date.

Deadline recorded: May 29, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87309(a)

Regulation authority

CCR

What the official deficiency says

87309 Storage Space and Access (a) Except as specified in subsection (b), the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances, knives, matches, tools, sharp objects, and other similar items which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage. This poses an immediate health and safety risk for residents in care. This was not met as evidenced by: LPA and LPM observed knives to be unlocked in kitchen, cleaning solutions unlocked outside and under sink in bathroom.

Official plan of correction

Licensee will conduct a training with staff regarding keeping knives and cleaning solutions locked and inaccessible to residents in care. Licensee will send a copy of training to LPA by POC due date.

Deadline recorded: May 29, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(4)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care (4) The licensee shall assist residents with self-administered medications as needed. This poses an immediate health and safety risk to residents in care. This was not met as evidenced by: records reviewed indicated that medications for Resident R1 were not being dispensed correctly.

Official plan of correction

Licensee will conduct a medication audit of all resident medications and ensure that Centrally Stored Medication Record is accurate to physician's orders.

Deadline recorded: May 29, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(h)(1)(C)

Regulation authority

CCR

What the official deficiency says

87465(h)(1)(C) (h)The following requirements shall apply to medications which are centrally stored: (1)Medications shall be centrally stored under the following circumstances: (C)Because of potential dangers related to the medication itself, or due to physical arrangements in the facility and the condition or the habits of other persons in the facility, the medications are determined by either a physician, the administrator, or Department to be a safety hazard to others. This poses an immediate health and safety risk to residents in care. This regulation was not met as evidenced by: LPA observed R1's prescription medications to be left in an open box on R1's side table in their room exposed to residents in care.

Official plan of correction

Licensee will submit a plan to LPA to ensure that all medications are locked and inaccessible to residents in care by POC date.

Deadline recorded: May 16, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87458(c)(1)(a)

Regulation authority

CCR

What the official deficiency says

87458 Medical Assessment (c) The medical assessment shall include...: (1) A physical examination...indicating the licensed medical professional's diagnosis... and results of an examination... (A) Communicable tuberculosis. This poses a potential health and safety risk to the residents in care. This was not met as evidenced by: Based on records reviewed and interviews conducted, R1 did not have a Tuberculosis test completed prior to moving into facility.

Official plan of correction

Licensee will ensure that R1 receives Tuberculosis test by POC due date. Licensee will ensure that all new residents have a tuberculosis test prior to move in.

Deadline recorded: Apr 1, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87456(a)(2)(4)

Regulation authority

CCR

What the official deficiency says

87456 Evaluation of Suitability for Admission (a) Prior to accepting a resident for care and in order to evaluate his/her suitability, the facility shall... (2)Perform a pre-admission appraisal. (4) Execute the admissions agreement. This poses a potential health and safety risk to residents in care. This was not met as evidenced by: Based on records reviewed and interviews conducted, R2 did not have an admission agreement or pre-admission appraisal completed prior to moving in.

Official plan of correction

Licensee will ensure that R2 has signed admission agreement and apprasal completed by POC due date. Licensee will ensure that all new residents have an admission agreement and pre- placement appraisal completed prior to move in.

Deadline recorded: Apr 1, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87405(a)

Regulation authority

CCR

What the official deficiency says

87405 Administrator - Qualifications and Duties. All facilities shall have a qualified and currently certified administrator. The licensee and the administrator may be one and the same person... This was not met as evidenced by: Based on interview, it was learned that there is no current administrator for this facility. This poses a possible risk to the residents in care.

Official plan of correction

By 11/06/2024, the Licensee shall appoint a qualified administrator and submit a written plan on how she shall show that there will always be a qualified administrator working.

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

Official classification

Type B

Official code

87211(g)(1)

Regulation authority

CCR

What the official deficiency says

The licensee shall notify the Department, in writing, within thirty (30) days of the hiring of a new administrator. The notification shall include the following: Name and residence and mailing addresses of the new administrator. This was not met as evidenced by: Based on interview, it was learned that there is no current administrator for this facility and the Department was not notified. This poses a possible risk to the residents in care

Official plan of correction

By 11/06/2024, the Licensee shall appoint a qualified administrator and submit a written plan on how she shall show that there will always be a qualified administrator working. Licensee will also submit written notification to the Department of change in administrator.

Deadline recorded: Nov 6, 2024. 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: Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence This was not met as evidenced by: Based on interview, it was learned that facility did not report resident leaving facility unnoticed. This poses a possible risk to residents in care.

Official plan of correction

By 11/06/2024, Licensee will submit a written plan of how facility will ensure that all incidents are reported to the Department and all relavant parties.

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

Official classification

Type A

Official code

87705(j)

Regulation authority

CCR

What the official deficiency says

Care of Persons with Dementia. The licensee shall have an auditory device or other staff alert feature to monitor exits, if exiting presents a hazard to any resident. This was not met as evidenced by: LPAs observed the audio alerts were not working and Licensee stated the batteries die quickly so she put chairs to block the entrance so staff can hear the chairs move.

Official plan of correction

By 10/25/2024, Licensee shall come up with a written plan to address the audio alerts on the doors since there are two residents who attempt to leave out of the front door and one made it out the back door and side gate unnoticed by staff.

Deadline recorded: Oct 25, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87463(a)

Regulation authority

CCR

What the official deficiency says

Reappraisals. The pre-admission appraisal shall be updated, in writing as frequently as necessary to note significant changes and to keep the appraisal accurate. The reappraisals shall document changes in the resident's physical, medical, mental, and social condition... This was not met as evidenced by the appraisal has not been updated to address the resident wandering and leaving the facility unoticed by staff

Official plan of correction

By 10/25/2024, the licensee shall update the appraisals to address the current needs of the residents. Licensee shall come up with a written plan on how she shall ensure the appraisals done on each resident is complete and addresses any and all needs of the residents and submit that plan to Community Care Licensing Division.

Deadline recorded: Oct 25, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87457(a)

Regulation authority

CCR

What the official deficiency says

Pre-Admission Appraisal - General. Prior to admission, the prospective resident and his/her responsible person, if any, shall be interviewed by the licensee or the employee responsible for facility admissions This was not met as evidenced by, a review of R2's file there was not a pre-admission appraisal completed. There was one that had White-Out on it with R2's name written on top but someone else's name on the form.

Official plan of correction

By 10/31/2024, Licensee shall come up with a written plan of correction on how she shall ensure pre-admission appraisals are completed and with the correct resident name is on it.

Deadline recorded: Oct 31, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87211(a)(2)

Regulation authority

CCR

What the official deficiency says

Reporting Requirements. Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: Occurrences, such as epidemic outbreaks, poisonings, catastrophes or major accidents which threaten the welfare, safety or health of residents, personnel or visitors, shall be reported within 24 hours either by telephone or facsimile to the licensing agency. Licensee did not report the resident who left the facility unassisted to Community Care Licensing Division as of today's visit.

Official plan of correction

By 10/31/2024, the licensee shall come up with a written plan on how she shall ensure she shall meet the reporting requirements of Title 22 Regulations.

Deadline recorded: Oct 31, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

1569.312(e)

Regulation authority

HSC

What the official deficiency says

Basic services requirements. Every facility required to be licensed under this chapter shall provide at least the following basic services: Monitoring the activities of the residents while they are under the supervision of the facility to ensure their general health, safety, and well-being. Licensee failed this by a resident leaving the facility through the side gate unnoticed by staff. This is an immedate health and safety risk to residents

Official plan of correction

By 10/25/2024, the licensee shall come up with a written plan of correction that specifies how the residents shall be monitored, how staff are going to be trained to monitor the residents, and how she is going to ensure the staff are monitoring the residents. Licensee shall submit this plan to Community Care Division. $500.00 Immediate civil penalty assessed.

Deadline recorded: Oct 25, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(g)

Regulation authority

CCR

What the official deficiency says

Incidental Medical and Dental Care. 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 including, but not limited to, an apparent life-threatening medical crisis... Licensee failed this because a resident left the facility unassisted and the Licensee did not call for emergency services for at least 30 minutes. This poses an immediate risk to residents.

Official plan of correction

By 10/25/2024, Licensee shall come up with a plan addressing residents who leave the facility without assistance and unoticed. This plan shall address what steps shall be taken to find the missing resident. Licensee shall submit this plan to Community Care Licensing Division.

Deadline recorded: Oct 25, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87203

Regulation authority

CCR

What the official deficiency says

Fire Safety. All facilities shall be maintained in conformity with the regulations adopted by the State Fire Marshal for the protection of life and property against fire and panic. Licensee failed to meet this because the front door was blocked by two chairs and the sliding glass door had a wood rod placed at the bottom in the track to prevent the door from being opened. This is an immediate risk to residents.

Official plan of correction

By 10/25/2024, Licensee shall come up with a written plan for staf to address monitoring of residents who are wander risks. This plans shall also address staffing needs because if the staff on duty are assisting other residents and that leaves no staff to monitor the rest of the residents the licensee shall have another staff on duty. Licensee shall include staff training and how often she is going to train staff. $500.00 immediate civil penalty

Deadline recorded: Oct 25, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87307(d)(6)

Regulation authority

CCR

What the official deficiency says

Personal Accommodations and Services. The following space and safety provisions shall apply to all facilities: All outdoor and indoor passageways and stairways shall be kept free of obstruction. Licensee failed to meet this because the front door was blocked by two chairs and the sliding glass door had a wood rod placed at the bottom in the track to prevent the door from being opened. This is an immediate risk to residents.

Official plan of correction

By 10/25/2024, the licensee shall ensure no walkways, doorways, etc., are blocked by anything. The licensee shall submit a written statement stating she understands she cannot do this and how she shall ensure no walkways, doors, etc., are blocked.

Deadline recorded: Oct 25, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87208(a)(12)

Regulation authority

CCR

What the official deficiency says

(a) Each facility shall have and maintain a current, written definitive plan of operation. The plan and related materials shall be on file in the facility and shall be submitted to the licensing agency with the license application. Any significant changes in the plan of operation which would affect the services to residents shall be submitted to the licensing agency for approval. The plan and related materials shall contain the following: (12) The Infection Control Plan pursuant to Section 87470. 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 1 out of 1 forms which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/18/2024 Plan of Correction Administrator agrees to complete an infection control plan for the facility. Plan to be sent into CCL by 10/18/24.

Official classification

Type B

Official code

1569.69(a)(2)

Regulation authority

HSC

What the official deficiency says

(a) Each residential care facility for the elderly licensed under this chapter shall ensure that each employee of the facility who assists residents with the self-administration of medications meets all of the following training requirements: (2) In facilities licensed to provide care for 15 or fewer persons, the employee shall complete 10 hours of initial training. This training shall consist of 6 hours of hands-on shadowing training, which shall be completed prior to assisting with the self-administration of medications, and 4 hours of other training or instruction, as described in subdivision (f), which shall be completed within the first two weeks of employment. 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 2 out of 2 persons which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/18/2024 Plan of Correction Administrator agrees to complete 10 hours of initial training for all new caregivers. Administrator to send into CCL a statement of understanding of all required caregiver training. Statement to be sent into CCL by 10/18/24.

Official classification

Type B

Official code

87468(c)(2)(A)

Regulation authority

CCR

What the official deficiency says

(c) Licensees shall prominently post personal rights, nondiscrimination notice, and complaint information in areas accessible to residents, representatives, and the public. (2) Information on the appropriate reporting agency in case of a complaint or emergency, including procedures for filing confidential complaints, shall be posted as follows: (A) Licensees may use the Residential Care Facility for the Elderly (RCFE) Complaint Poster (PUB 475) or may develop their own poster as provided in this section. A poster developed by the licensee shall contain the same content as the PUB 475. The poster that is posted shall be 20” x 26” in size and be posted in the main entryway of the facility. PUB 475 may be accessed, downloaded, and printed from the www.ccld.ca.gov website. 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 1 out of 1 posters which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/18/2024 Plan of Correction Administrator agrees to post the Residential Care Facility for the Elderly (RCFE) Complaint Poster (PUB 475) in a common area. Picture of the poster posted to be sent into CCL by 10/18/24.

Official classification

Type B

Official code

87457(c)

Regulation authority

CCR

What the official deficiency says

(c) Prior to admission a determination of the prospective resident's suitability for admission shall be completed and shall include an appraisal of his/her individual service needs in comparison with the admission criteria specified in Section 87455, Acceptance and Retention Limitations. 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 2 out of 3 persons which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/18/2024 Plan of Correction Administrator agrees to complete a needs and service plan for R1 and R2. Plan to be sent into CCL by 10/18/24.

Official classification

Type B

Official code

87458(a)

Regulation authority

CCR

What the official deficiency says

(a) 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. The licensee shall be permitted to use the form LIC 602 (Rev. 9/89), Physician's Report, to obtain the medical assessment. 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 1 out of 3 persons which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/25/2024 Plan of Correction Administrator agrees to obtain a medical assessment (LIC602) for R2. A copy of R2's LIC602 to be sent into CCL by 10/25/24.

Official classification

Type B

Official code

1569.695(c)

Regulation authority

HSC

What the official deficiency says

(c) A facility shall conduct a drill at least quarterly for each shift. The type of emergency covered in a drill shall vary from quarter to quarter, taking into account different emergency scenarios. An actual evacuation of residents is not required during a drill. While a facility may provide an opportunity for residents to participate in a drill, it shall not require any resident participation. Documentation of the drills shall include the date, the type of emergency covered by the drill, and the names of staff participating in the drill. 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 1 out of 1 forms which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/18/2024 Plan of Correction Administrator agrees to perform a drill quarterly for each shift. Drill to be completed and documented by 10/18/24. A copy of the drill documentation to be sent into CCL by 10/18/24.

Official classification

Type B

Official code

1569.695(d)

Regulation authority

HSC

What the official deficiency says

(d) A facility shall review the plan annually and make updates as necessary, including changes in floor plans and the population served. The licensee or administrator shall sign and date documentation to indicate that the plan has been reviewed and updated as necessary. 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 1 out of 1 forms which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/18/2024 Plan of Correction Administrator agrees to review disaster plan and make updates as necessary. A copy of the signed plan to be sent into CCL by 10/18/24.

Official classification

Type B

Official code

87506(a)

Regulation authority

CCR

What the official deficiency says

87506 Resident Records (a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff. 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 out of 3 persons which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/18/2024 Plan of Correction Administrator agrees to review regulation 87506 and ensure all residents files are up to date and current. Administrator agrees to complete a statement of understanding and send the plan to CCL by 10/18/24.

Official classification

Type B

Official code

87218(a)(1)

Regulation authority

CCR

What the official deficiency says

(a) The licensee shall ensure an adequate theft and loss program as specified in Health and Safety Code Section 1569.153. (1) The initial personal property inventory shall be completed by the licensee and the resident or the resident's representative. 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 six out of six resident files are missing the inventory list which poses a potential personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/28/2022 Plan of Correction Licensee shall submit a written plan of correction on how they shall ensure all resident inventory lists shall be completed. If a resident refuses, then the licensee shall have in writing the resident refused to have inventory done.

Official classification

Type B

Official code

87412(f)

Regulation authority

CCR

What the official deficiency says

(f) All personnel records shall be available to the licensing agency to inspect, audit, and copy upon demand during normal business hours. Records may be removed if necessary for copying. Removal of records shall be subject to the following requirements: This requirement is not met as evidenced by: Deficient Practice Statement This was cited in error. NO deficiency

Official plan of correction

POC Due Date: 12/28/2022 Plan of Correction This was cited in error. No deficiency

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 review, the licensee did not comply with the section cited above in the staff records are incomplete. They are missing training logs, and criminal record statements, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/28/2022 Plan of Correction Licensee shall submit in writing how they shall ensure all staff files are complete.

Official classification

Type B

Official code

87412(a)(6)(A)

Regulation authority

CCR

What the official deficiency says

(A) For administrators this shall include verification that he/she meets the educational requirements in Section 87405(d) through (g). 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 there are no staff training logs which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/28/2022 Plan of Correction Licensee shall submit in writing how they shall ensure there are complete staff training logs. LPA did observed staff worked at a previous residential care facility for the elderly prior to this facility.

Official classification

Type B

Official code

87412(a)(13)(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: (13) For employees that are required to be fingerprinted pursuant to Section 87355, Criminal Record Clearance: (A) A signed statement regarding their criminal record history as required by Section 87355(d). This requirement is not met as evidenced by: Deficient Practice Statement cited in error. All staff have criminal record clearance

Official plan of correction

POC Due Date: 11/28/2022 Plan of Correction cited in error. NO deficiency cited.

Official classification

Type B

Official code

87411(d)

Regulation authority

CCR

What the official deficiency says

(d) All personnel shall be given on the job training or have related experience in the job assigned to them. This training and/or related experience shall provide knowledge of and skill in the following, as appropriate for the job assigned and as evidenced by safe and effective job performance: 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 because there is no proof of staff training which poses/posed a potential health, safety or personal rights risk to persons in care. LPA did observed staff worked at a previous residential care facility for the elderly prior to this facility.

Official plan of correction

POC Due Date: 12/28/2022 Plan of Correction Licensee shall submit in writing how they shall ensure all staff are full trained per the regulations and how they are going to have a staff training log.

Official classification

Type B

Official code

87412(c)(2)

Regulation authority

CCR

What the official deficiency says

(c) Licensees shall maintain in the personnel records verification of required staff training and orientation. (2) Documentation of staff training shall include: This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, the license did not comply with the section cited above because the personnel records lack verification which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/28/2022 Plan of Correction Licensee shall submit in writing how they are going to ensure there is verification. LPA did observed staff worked at a previous residential care facility for the elderly prior to this facility.

Official classification

Type B

Official code

87613(a)(2)(B)

Regulation authority

CCR

What the official deficiency says

(2) Ensure that facility staff who will participate in meeting the resident's specialized care needs complete training provided by a licensed professional sufficient to meet those needs. (B) Training shall be completed prior to the staff providing services to the resident. 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 because there is no proof staff received the training and by whom which poses/posed a potential health, safety or personal rights risk to persons in care. LPA did observed staff worked at a previous residential care facility for the elderly prior to this facility.

Official plan of correction

POC Due Date: 12/28/2022 Plan of Correction Licensee shall submit in writing how they shall ensure the person giving the staff training is quailified and how they shall ensure the trainer is qualified. LPA did observed staff worked at a previous residential care facility for the elderly prior to this facility.

Official classification

Type B

Official code

1569.625(b)(1)

Regulation authority

HSC

What the official deficiency says

(1) The department shall adopt regulations to require staff members of residential care facilities for the elderly who assist residents with personal activities of daily living to receive appropriate training. This training shall consist of 40 hours of training. A staff member shall complete 20 hours, including six hours specific to dementia care, as required by subdivision (a) of Section 1569.626 and four hours specific to postural supports, restricted health conditions, and hospice care, as required by subdivision (a) of Section 1569.696, before working independently with residents. The remaining 20 hours shall include six hours specific to dementia care and shall be completed within the first four weeks of employment. The training coursework may utilize various methods of instruction, including, but not limited to, lectures, instructional videos, and interactive online courses. The additional 16 hours shall be hands-on training. 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 because there are no staff training logs which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/28/2022 Plan of Correction Licensee shall submit in writing how they shall ensure all staff are trained per the regulations and how they are going to maintain verification of the training. LPA did observed staff worked at a previous residential care facility for the elderly prior to this facility.

Official classification

Type B

Official code

1569.69(a)(2)

Regulation authority

HSC

What the official deficiency says

(a) Each residential care facility for the elderly licensed under this chapter shall ensure that each employee of the facility who assists residents with the self-administration of medications meets all of the following training requirements: (2) In facilities licensed to provide care for 15 or fewer persons, the employee shall complete 10 hours of initial training. This training shall consist of 6 hours of hands-on shadowing training, which shall be completed prior to assisting with the self-administration of medications, and 4 hours of other training or instruction, as described in subdivision (f), which shall be completed within the first two weeks of employment. 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 because there is no proof of staff training which poses/posed a potential health, safety or personal rights risk to persons in care. Caregiver did describe to LPA the process of the training the licensee gave her regarding medication

Official plan of correction

POC Due Date: 12/28/2022 Plan of Correction Licensee shall submit in writing how they shall ensure all staff have the required medication training and how they shall verify the training. LPA did observed staff worked at a previous residential care facility for the elderly prior to this facility.

Official classification

Type B

Official code

1569.69(a)(3)

Regulation authority

HSC

What the official deficiency says

(a) Each residential care facility for the elderly licensed under this chapter shall ensure that each employee of the facility who assists residents with the self-administration of medications meets all of the following training requirements: (3) An employee shall be required to complete the training requirements for hands-on shadowing training described in this subdivision prior to assisting any resident in the self-administration of medications. The training and instruction described in this subdivision shall be completed, in their entirety, within the first two weeks of employment. 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 because there is no proof of staff training which poses/posed a potential health, safety or personal rights risk to persons in care. Caregiver did describe to LPA the process of the training the licensee gave her regarding medication

Official plan of correction

POC Due Date: 12/28/2022 Plan of Correction Licensee shall submit in writing how they shall ensure all staff have the required medication training and how they shall verify the training. LPA did observed staff worked at a previous residential care facility for the elderly prior to this facility.

Official classification

Type B

Official code

87506(a)

Regulation authority

CCR

What the official deficiency says

(a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff. 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 the resident files are incompletewhich poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/28/2022 Plan of Correction Licensee shall submit in writing how they shall ensure resident files are complete

Official classification

Type B

Official code

87506(b)(9)

Regulation authority

CCR

What the official deficiency says

(b) Each resident's record shall contain at least the following information: (9) Name, address and telephone number of physician and dentist to be called in an emergency. 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 residents are missing emergency contact information which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/28/2022 Plan of Correction Licensee shall submit in writing how they shall ensure resident files are complete

Official classification

Type B

Official code

87506(b)(16)

Regulation authority

CCR

What the official deficiency says

(b) Each resident's record shall contain at least the following information: (16) Records of resident's cash resources as specified in Section 87217, Safeguards for Resident Cash, Personal Property, and Valuables. This requirement is not met as evidenced by: Deficient Practice Statement cited in error. NO deficiency

Official plan of correction

POC Due Date: 11/28/2022 Plan of Correction cited in error. NO deficiency

Official classification

Type B

Official code

87456(a)

Regulation authority

CCR

What the official deficiency says

(a) Prior to accepting a resident for care and in order to evaluate his/her suitability, the facility shall, as specified in this article 8: 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 based on none of the residents having pre-appraisals in the file poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/28/2022 Plan of Correction Licensee shall submit in writing how they shall ensure all residents have pre-appraisals done prior to being admitted.

Official classification

Type B

Official code

87456(a)(2)

Regulation authority

CCR

What the official deficiency says

(a) Prior to accepting a resident for care and in order to evaluate his/her suitability, the facility shall, as specified in this article 8: (2) Perform a pre-admission appraisal. 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 because none of the residents have written pre-appraisals which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/28/2022 Plan of Correction Licensee shall submit in writing how they shall ensure all residents have pre-appraisals done prior to being admitted.

Official classification

Type B

Official code

87457(c)

Regulation authority

CCR

What the official deficiency says

(c) Prior to admission a determination of the prospective resident's suitability for admission shall be completed and shall include an appraisal of his/her individual service needs in comparison with the admission criteria specified in Section 87455, Acceptance and Retention Limitations. 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 none of the residents have individual service needs plans which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/28/2022 Plan of Correction Licensee shall submit in writing how they shall ensure all residents have individual service plans.