MISSION LAKE VILLA, INC.

Official classification

Type B

Official code

87468.1(a)(8)

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: (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: Based on interviews, and record review, Licensee did not notify R1's representative when R1 was sent to the hospital. This poses a potential health and safety risk to residents in care.

Official plan of correction

Licensee agrees to conduct in-service training on the cited regulation. Training due by 5pm on POC date.

Deadline recorded: Jan 12, 2024. A deadline is not proof that correction was completed.

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 Based on interview and record review, the licensee did not comply with the section cited above in based on S1's file not being avaible during the visit which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/03/2024 Plan of Correction The staff stated they would send the LPA the staff file and training fro R1 by the POC due date.

Official classification

Type B

Official code

87465(a)(6)

Regulation authority

CCR

What the official deficiency says

(6) When requested by the prescribing physician or the Department, a record of dosages of medications which are centrally stored shall be maintained by the facility. This requirement is not met as evidenced by: Deficient Practice Statement Based on interview and record review, the licensee did not comply with the section cited above in with R1 not having a centrally stored list which posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/03/2024 Plan of Correction The staff stated that they would send the LPA the centrally stored list for R1 by the POC due date.

Official classification

Type B

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, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the 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 did not meet the requirement by: Based on LPA evidence review, the Licensee did not provide medications as ordered by the physician. This is a potential health and safety risk to residents in care.

Official plan of correction

Licensee agrees to conduct in-service training on the cited regulation, and provide proof of such to LPA by POC date.

Deadline recorded: Nov 3, 2023. 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 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. This report shall include the resident's name, age, sex and date of admission; date and nature of event; attending physician's name, findings, and treatment, if any; and disposition of the case. (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 was not being met as evidenced by: Based on interview withe staff, and record review, LPA determined that there was not a report submitted to the Department in reference to R1 going to the hospital to treat their medical condition. This poses a potential health and safety and personal rights risk to residents in care.

Official plan of correction

Licensee agrees to review the regulation, and submit in-service training with all staff on the cited regulation. Additionally, Licensee to submit Unusual Incident Report to the Department by POC date.

Deadline recorded: Oct 13, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87355(f)

Regulation authority

CCR

What the official deficiency says

Criminal Record Clearance.:An immediate civil penalty of $100 a day shall be assessed if an individual subject to a criminal record review has not obtained a clearance or exemption. This requirement has not been met by During visit it was revealed that an unclear individual was present on the premise of the facility. This poses a safety risk to residents in care. An immediate Civil Penalty has been issued.

Official plan of correction

Licensee immediately instructed individual to get a live scan. Individual left the facility during the visit. Licensee informed LPA that she will forward proof to CCLD that the live scan was conducted by 04/05/22.

Deadline recorded: Apr 5, 2022. A deadline is not proof that correction was completed.