ATTENTIVE MANOR II

Official classification

Type A

Official code

87355(e)(1)

Regulation authority

CCR

What the official deficiency says

This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview, record review, the licensee did not comply with the section cited above in having staff # 1 (S1) working at the facility without a criminal record clearance from the DOJ for approximately a month which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/15/2023 Plan of Correction During the visit Licensee immediately removed S1 from the facility. S1 will be able to work again at the facility once criminal record clearance can be confirmed. Licensee will further conduct in-service training on the title 22 reguations regarding Criminal Record Clearance and provide proof of such by POC.

Official classification

Type A

Official code

87355(e)(2)

Regulation authority

CCR

What the official deficiency says

Criminal Record Clearance: (e) All individuals ....pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (2) Request a transfer of a criminal record clearance as specified... This requirement was not met as evidenced by: Based on record review, the Licensee did not comply with the above regulation with two staff (S1 & S2). LPA Colvin observed that S1 & S2 work at the facility but have not been associated. This is an immediate safety risk to all residents in care.

Official plan of correction

Licensee agrees to have S1 & S2 associated to the facility prior to them working their next shift. Licensee may submit transfer request online via Guardian system, or to the Riverside office in person. Proof of submission due by Plan of Correction date of 9/3/21.

Deadline recorded: Sep 3, 2021. 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: (l) The following initial and continuing requirements shall be met for the licensee to lock...perimeter fence gates:(2) The licensee shall ensure that the fire clearance includes approval of...locked perimeter fence gates. This requirement was not met as evidenced by: Based on record review and interview, the Licensee did not comply with the above regulation with two gates. LPA Colvin observed the front & side gates to have electronic locks. LPA Colvin confirmed with Fire Department that locked perimeter was not approved. This is an immediate safety risk.

Official plan of correction

Licensee agrees to have locked perimeter uninstalled until Licensee obtains both approval from CCL and Fire Department to utilize locked perimeter. LPA Colvin to submit LIC850 to Fire Department for evaluation of approval for delayed egress. Licensee to self-certify to LPA Colvin that locks have been disabled.

Deadline recorded: Sep 3, 2021. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87216(d)

Regulation authority

CCR

What the official deficiency says

Bonding: (d) No licensee shall either handle money of a resident or handle amounts greater than those stated in the affidavit submitted by him or for which his bond is on file without first notifying the licensing agency and filing a new or revised bond... This requirement was not met by: Based on interviews and record review, the Licensee did not comply with the above regulation with all residents. LPA Colvin observed the facility holds petty cash for all residents, but has an affidavit on file with CCL that they will not handle resident funds. This is a potential personal rights violation.

Official plan of correction

Licensee to submit a new Affidavit to CCL, or to cease holding money for residents. Affidavit or statement confirming cease of holding resident funds to be submitted to LPA Colvin by plan of correction date of 9/16/21.

Deadline recorded: Sep 16, 2021. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87216(a)

Regulation authority

CCR

What the official deficiency says

Bonding: (a) Each licensee, other than a county, who is entrusted to safeguard resident cash resources, shall file or have on file with the licensing agency a copy of a bond issued by a surety company to the State of California as principal. This requirement was not met by Based on interviews and record review, the Licensee did not comply with the above regulation with all residents. LPA Colvin observed the facility holds petty cash for all residents but does not have a Surety Bond to cover these funds. This is a potential personal rights risk to all residents.

Official plan of correction

Licensee to obtain and submit a copy of their Surety Bond (as noted in regulation section 87216) to CCL, or to cease holding money for residents. Surety Bond or statement confirming cease of holding resident funds to be submitted to LPA Colvin by plan of correction date of 9/16/21.

Deadline recorded: Sep 16, 2021. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87217(g)(1)

Regulation authority

CCR

What the official deficiency says

Safeguards for Resident Cash...:(g) Each licensee shall maintain adequate safeguards and accurate records of cash resources...including...: (1) Records...shall include a ledger accounting (columns for income, disbursements and balance) for each resident... This requirement was not met by: Based on interview and record review, the Licensee did not comply with the above regulation with all residents. LPA Colvin observed that the Licensee did not maintain a ledger for resident funds, only receipts. This is a potential personal rights violation for all residents.

Official plan of correction

Licensee agrees to maintain an accounting log for all resident money kept by the facility. Licensee to self-certify to LPA Colvin confirmation of this as well as provide LPA Colvin with a copy of an accoutning ledger for each resident or statement confirming ceasing handling resident funds. Plan of Correction due 9/16/21.

Deadline recorded: Sep 16, 2021. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87507(g)(3)(C)(4)

Regulation authority

CCR

What the official deficiency says

Admission Agreements: (g) Admission agreements shall specify...:(3) Payment provisions, including...: (C) Any fee that is charged...after admission... 4.A licensee shall not require, request, or accept any funds...that constitutes a deposit against any possible damages by the resident. This was not met by: Based on interviews, the Licensee did not comply with the above regulation with one resident (R1). LPA Colvin learned that R1's POA was only provided $100 of the $200 funds given to the facility for R1, due to damages hte facility charged back to R1. This was a potential personal rights violation.

Official plan of correction

Licensee to refund $100 to R1's POA and provide proof of refund to LPA Colvin as well as submit Statement of Understanding to LPA Colvin that resident funds ( " petty cash " ) shall not be used as security deposit. Plan of Correction due 9/16/21.

Deadline recorded: Sep 16, 2021. 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

Reporting Requirements: (a) Each licensee shall furnish to the licensing agency such reports...including...: (1) A written report shall be submitted to the licensing agency within seven days of the occurrence of any of the events...(D) Any incident which threatens the welfare, safety or health of any resident... This requirement was not met by: Based on interviews and record review, the Licensee did not comply with the above regulation with one resident. LPA Colvin observe R1 did not have any incident reports despite numerous hospital stays. This was a potential safety risk for R1.

Official plan of correction

Licensee agrees to review Regulation Section 87211 in it's entirety and self-certify to LPA Colvin once complete. Self-certification to also include Statement of Understanding and confirmation to abide by Reporting Requirements. Plan of Correction due by 9/16/21.

Deadline recorded: Sep 16, 2021. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87507(g)(5)(E)(2)(b)

Regulation authority

CCR

What the official deficiency says

Admission Agreements: (g) Admission agreements shall specify...: (5) Refund conditions. (E) Preadmission fees shall be refunded...: 2....shall be refunded...: b. A refund of at least 60 percent...shall be provided if the resident leaves the facility...during the second month of residency. This was not met by: Based on interviews and record review, the Licensee did not comply with the above regulation with one resident (R1). R1's POA was not provided with a refund of the amount of the preadmission fee as laid out in this regulation and the Admissions Agreement. This was an immediate personal rights violation.

Official plan of correction

Licensee agrees to provide R1's POA of the applicable refund amount of the preadmission fee. Licensee to provide LPA Colvin with proof of refund and proof refund was submitted to R1's POA. Proof requested is due by Plan of Correction date of 9/6/21.

Deadline recorded: Sep 6, 2021. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87465(c)(2)

Regulation authority

CCR

What the official deficiency says

Incidental Medical and Dental Care: (c).... facility staff designated by the licensee shall be permitted to assist the resident with self-administration, provided all of the following requirements are met:(3) A record of each dose is maintained in the resident's record... This requirement was not met by: Based on interviews and lack of records, the Licensee did not comply with the above regulation with one resident (R1). LPA Colvin observed there was no record of PRN medication doses administered in R1's file. This was a potential health and safety risk of R1.

Official plan of correction

Licensee agrees to have applicable staff re-trained on record keeping. Licensee to provide LPA Colvin with proof of training by Plan of Correction date of 9/16/21.

Deadline recorded: Sep 16, 2021. 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

Personal Rights of Residents in All Facilities: (a) Residents...shall have all of the following...: (1) To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement was not met as evidenced by: Based on interviews conducted, the Licensee did not comply with the above regulation with one staff member (Licensee). Interviews revealed that Licensee has been verablly abusive to more than one resident in care. This was an immediate personal right violation to multiple residents, including R1.

Official plan of correction

Licensee agrees to have staff retrained on Reporting Requirements. Licensee to provide LPA Colvin with a date for staff training by the Plan of Correction date of 9/3/21, and a proof of staff training once completed.

Deadline recorded: Sep 6, 2021. A deadline is not proof that correction was completed.