BUENA VISTA ASSISTED LIVING

Official classification

Type B

Official code

80061(b)(1)(E)

Regulation authority

CCR

What the official deficiency says

80061 Reporting Requirements (b) ...during the operation of the facility... a report shall be made to the licensing agency...(1) Events reported shall include the following(E) Any unusual incident or client absence which threatens the physical or emotional health or safety of any client. Requirement was not being met as evidenced by: Licensee did not report SIRs to the Department for the power outage that occured on 1-8-25 at 12:30 PM

Official plan of correction

Licensee will conduct staff training on the reporting requirements and provide proof of training and training material to LPA by the plan of correction date.

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

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: the licensee failed to ensure that 1 out of 1 resident records were maintained with the necessary information for LPA to review. This poses a potential health, safety and personal rights risk to persons in care.

Official plan of correction

The licensee agrees to conduct an audit of resident records, and will submit a copy of facility audit checklist. Proof of POC is to be submitted to the department by 5pm on the due date indicated.

Deadline recorded: Nov 6, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.2(a)(4)

Regulation authority

CCR

What the official deficiency says

87468.2 Additional Personal Rights of Residents in Privately Operated Facilities (a) ... 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 requirement is not met as evidenced by: the licensee failed to ensure that residents were checked and chanaged as required.

Official plan of correction

The licensee agrees to increase staffing on the NOC shift, by adding an additional staff. Proof of POC is to be submitted to the department by 5pm on the due date indicated.

Deadline recorded: Nov 6, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(i)(3)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care Prescription medications which are not taken with the resident upon termination of services, not returned to the issuing pharmacy, nor retained in the facility as ordered by the resident’s physician and documented in the resident’s established record procedures or which are otherwise to be disposed of shall be destroyed in the facility by the facility administrator and one other adult who is not a resident. Both shall sign a record, to be retained for at least three years, which lists the following:

Official plan of correction

The requirement is not met as evidenced by: the licensee failed to destroy a discontinued medication 1 out of 1 times. This poses a potential heath, and safety risk to persons in care. The licensee agrees to conduct an audit of medications and physician orders, and destroy and needed medication. Proof of POC is to be submitted to the department by 5pm on the due date indicated.

Deadline recorded: Oct 23, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87355(b)

Regulation authority

CCR

What the official deficiency says

87355 Criminal Record Clearance (b) Prior to the Department issuing a license, the applicant, administrator and any adults other than a client, residing in the facility shall have a criminal record clearance or exemption. Based on observation, interview and record review This is a requirement is not met as evidenced by: 1 out of 1 times the licensee failed to have staff obtain proper fingerprint clearance before at the facility. This poses an immediate health, safety and personal rights risk to persons in care.

Official plan of correction

The licensee agrees to have S1 obtain fingerprint clearance and associated S1 to the facility. POC is to be submitted to the department by 5pm on the due date indicated.

Deadline recorded: Jun 21, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87465(2)(c)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care:(c) If the resident's physician has stated in writing ...(2) Once ordered by the physician the medication is given according to the physician's directions. Based on observation and interviews this requirement was not met as evidence by: interviews with staff revealed that resident # 1 (R1) was not given their medications as prescribed, as the keys were taken home. This poses a potential health, safety and personal rights risk to the resident in care.

Official plan of correction

The Licensee agrees have an extra set of keys made and issued to the Senior Med Tech and Nurse Consultant, in addition to the set the administrator has. Proof of POC is to be submitted to the department by 5pm on the due date indicated.

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

Official classification

Type A

Official code

87211(a)(1)(D)

Regulation authority

CCR

What the official deficiency says

Reporting Requirements: (a) Each licensee shall furnish…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 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 at least one outbreak of COVID-19, which posed an immediate health and safety risk to persons in care. LPA Colvin learned that while the Administrator left a message for Community Care Licensing on a voicemail regarding the COVID-19 positive cases, no additional follow-up to ensure the report went through was made, including a written incident report.

Official plan of correction

POC Due Date: 07/27/2022 Plan of Correction Licensee to submit Statement of Understnading regarding the requirements for reporting COVID-19 cases, as well as submit the requested COVID-19 positive case summary (provided by LPA Colvin) for each case from the last outbreak. Statement of Understanding and Positive Case SUmmaries due by Plan of Correction date of 7/26/22.

Official classification

Type B

Official code

1569.185(a)

Regulation authority

HSC

What the official deficiency says

Fees for license or applications; use of revenues; collected; denial or forfeiture: (e) The failure of an applicant for licensure or a licensee to pay all applicable and accrued fees and civil penalties shall constitute grounds for denial or forfeiture of a license. This requirement was not met by: 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 one year of Licensing Fees (2022) which poses a potential safety risk to persons in care. LPA Colvin observed that the Licensee has not yet paid the annual fees for 2022, which are now past due in the amount of $1,238.00.

Official plan of correction

POC Due Date: 08/09/2022 Plan of Correction Licensee agrees to pay all fees due to Licensing and provide LPA Colvin with a self-certification of fees paid by the Plan of Correction date of 7/26/22.

Official classification

Type A

Official code

87464(f)(1)

Regulation authority

CCR

What the official deficiency says

Basic Services: (f) Basic services shall at a minimum include: (1) Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). This requirement was not met as evidenced by: Based on interviews conducted, the Licensee did not comply with the above regulation with at least on resident. LPA Colvin confirmed that R1 did not obtain a negative COVID-19 test prior to R1's admission on 6/21/22. This was an immediate health risk to all residents, as there was a subsequent COVID-19 outbreak.

Official plan of correction

Licensee agrees to implement a recording process for all COVID-19 tests conducted by facility staff and maintain records in resident files. Licensee additionally agrees to submit Statement of Understanding regarding receiving a negative COVID-19 test for new residents. Plan for recordkeeping of all COVID tests conducted at facility and Statement of Understanding to be submited to LPA Colvin by Plan of Correction date of 7/27/22.

Deadline recorded: Jul 27, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468

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: (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This requirement was not met by: Based on record review, the Licensee did not comply with the above regulation with at least one resident. LPA Colvin observed in staff notes that on both 7/11/22 and 7/20/22 ants were observed to be infesting R2's bedroom. This was a potential personal rights violation of R2.

Official plan of correction

Licensee agrees to thuroughly inspection R2's room to ensure that the insect infestation has been corrected. Licensee additionally agrees to take further pest control measures in the future. Licensee may self-certify once inspection is complete. Self-certification due by Plan of Correction date of 8/9/22.

Deadline recorded: Aug 9, 2022. A deadline is not proof that correction was completed.