SMITH ROAD ASSISTED LIVING

Official classification

Type A

Official code

87705(e)(5)

Regulation authority

CCR

What the official deficiency says

87705Care of Persons with Dementia (e) Licensees that use delayed egress devices on exterior doors and perimeter fence gates shall meet the following…:(5)Facility staff shall ensure the continued safety of residents if they wander away from the facility … in Privately Operated Facilities. This requirement was not being met as evidenced by: Based on interviews and records reviewed, facility staff failed to redirect Elopement risk or to monitor for continued safety. This poses an immediate, safety and personal rights risks to persons in care.

Official plan of correction

The facility will conduct an in-service staff training regarding elopement procedures and insuring all exit doors to have functioning alarms. Licensee will provide LPA proof of training by POC date.

Deadline recorded: Feb 20, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87628(a)

Regulation authority

CCR

What the official deficiency says

a)The licensee shall be permitted to accept or retain a resident who has diabetes if the resident is able to perform his/her own glucose testing…and is able to administer his/her own medication including…injection, or has it administered by an appropriately skilled professional.This requirement was not met as evidenced by: Based on LPA Perez's observation, interview and record review, the licensee did not comply with the section cited above in R1'S medical file observed a restricted health care plan for diabetes and no approved exception was observed for the facility which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

The licensee will conduct in-house training on the proper care of residents with restricted health conditions. Licensee will also review the regulations governing restricted health conditions and formally acknowledge their commitment to following proper protocol when submitting exceptions for future residents who fall under these regulations. Licensee will email LPA by POC date.

Deadline recorded: Jan 6, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87211(b)

Regulation authority

CCR

What the official deficiency says

87211 Reporting Requirements (b)Any suspected physical abuse that results in serious bodily injury of an elder or dependent adult shall be reported to the local ombudsman, the corresponding licensing agency, and the local law enforcement agency within two (2) hours as required by Welfare and Institutions Code Section 15630(b)(1). This requirement is not met as evidenced by: Based on interviews, the licensee did not comply with the section cited above, assuring the incident was reported to the local ombudsman within 2 hours of the incident, which poses a potential health and safety risk to residents in care.

Official plan of correction

Licensee stated they will schedule training for themselves and all staff on mandated reporting requirements. Proof of training will be submitted to the Department by the POC due date

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

Official classification

Type B

Official code

80072(a)(1)

Regulation authority

CCR

What the official deficiency says

Personal Rights: Each client shall have personal rights which include, but are not limited to, the following: 1. To be accorded dignity in his/her personal relationships with staff and other persons. This requirement was not being met as evidenced by: This requirement was not met as evidenced by: Administrator refused C1 entrance into the facility. This poses an immediate health safety or personal rights risk to clients in care.

Official plan of correction

The Administrator agreed to conduct personal rights training with staff. Documentation to be submitted to LPA by poc due date. Administrator agreed to send LPA.

Deadline recorded: Mar 24, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

80072(a)(1)

Regulation authority

CCR

What the official deficiency says

Personal Rights: Each client shall have personal rights which include, but are not limited to, the following: 1. To be accorded dignity in his/her personal relationships with staff and other persons. This requirement was not being met as evidenced by: This requirement was not met as evidenced by: Administrator refused C1 entrance into the facility. This poses an immediate health safety or personal rights risk to clients in care.

Official plan of correction

The Administrator agreed to conduct personal rights training with staff. Documentation to be submitted to LPA by poc due date. Administrator agreed to send LPA.

Deadline recorded: Mar 24, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87224(d)

Regulation authority

CCR

What the official deficiency says

(d) The licensee shall set forth in the notice to quit the reasons relied upon for the eviction with specific facts to permit determination of the date, place, witnesses, and circumstances concerning those reasons. This requirement was not met as evidenced by: Based on record review of R1's eviction, the licensee did not provide R1 with specific facts related to the reasons for eviction notice. R1's eviction lacked informative dates, places, witnesses, and/or circumstances related to alleged violations of the house rules. Licensee was interviewed and reported the supporting information was not provided to R1 in the eviction notice. This poses a potential health, safety, and personal rights risk to residents in care.

Official plan of correction

Licensee reported they will rescind the 12/30/2024 eviction letter provided to R1 by 02/01/2025 and submit proof of correction to the Department by close of business 02/03/2025.

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

Official classification

Type B

Official code

1569.618(c)(3)

Regulation authority

HSC

What the official deficiency says

(c)The facility shall employ, and the administrator shall schedule, a sufficient number of staff members to do all of the following: (3) Ensure that at least one staff member who has cardiopulmonary resuscitation (CPR) training and first aid training is on duty and on the premises at all times. This paragraph shall not be construed to require staff to provide CPR. 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 three out of three staff members (S1 - S3) who did not have current First Aid training on file. This poses a potential health, safety and personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/07/2024 Plan of Correction Administrator stated first aid training will be completed and proof of training will be submitted to the Department.

Official classification

Type B

Official code

1569.625(b)(2)

Regulation authority

HSC

What the official deficiency says

(2) In addition to paragraph (1), training requirements shall also include an additional 20 hours annually, eight hours of which shall be dementia care training, as required by subdivision (a) of Section 1569.626, and four hours of which shall be specific to postural supports, restricted health conditions, and hospice care, as required by subdivision (a) of Section 1569.696. This training shall be administered on the job, or in a classroom setting, or both, and may include online 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 in two out of two staff members (S2 and S4) who did not have the 20 hours of annual training This poses a potential health, safety and personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/31/2024 Plan of Correction Administrator stated the required training will be completed and proof submitted to the Department.

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 one out of one staff members (S2) who does not have the complete initial hours of training. S2 only has 2 hours of medication training from 05/30/2023. According to Administrator, S2 started employment on 05/30/2023. This poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/14/2024 Plan of Correction Administrator stated training will be completed and proof of training will be submitted to the Department.

Official classification

Type B

Official code

87465(h)(5)

Regulation authority

CCR

What the official deficiency says

(h) The following requirements shall apply to medications which are centrally stored: (5) Each resident's medication shall be stored in its originally received container. No medications shall be transferred between containers. 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 two out of two residents (R1 and R7) whose medications were being stored in weekly medication containers. This poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/31/2024 Plan of Correction Administrator removed the weekly medication containers from the centrally stored location at time of visit. POC cleared.

Official classification

Type B

Official code

87467(a)(3)

Regulation authority

CCR

What the official deficiency says

(a) Prior to, or within two weeks of the resident's admission, the licensee shall arrange a meeting with the resident, the resident's representative, if any, appropriate facility staff, and a representative of the resident's home health agency, if any, and any other appropriate parties, to prepare a written record of the care the resident will receive in the facility, and the resident's preferences regarding the services provided at the facility. (3) The licensee shall arrange a meeting with the resident and appropriate individuals identified in Section 87467(a)(1) to review and revise the written record as specified, when there is a significant change in the resident's condition, or once every 12 months, whichever occurs first. Significant changes shall include, but not be limited to occurrences specified in Section 87463, Reappraisals. 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 five out of five residents (R1 - R5) who did not have a written record of care on file. This poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/31/2024 Plan of Correction Administrator stated a written record will be created for each resident in care and submit a letter of certification to the Department.

Official classification

Type B

Official code

1569.39(b)

Regulation authority

HSC

What the official deficiency says

(b) A residential care facility for the elderly that accepts or retains residents with restricted health conditions, as defined by the department, shall ensure that residents receive medical care as prescribed by the resident’s physician and contained in the resident’s service plan by appropriately skilled professionals acting within their scope of practice. An appropriately skilled professional may not be required when the resident is providing self-care, as defined by the department, and there is documentation in the resident’s service plan that the resident is capable of providing self-care. 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 two out of two residents (R1 and R5) who have a restricted health condition and have no documentation on file indicating the residents can manage their own health conditions. This poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/07/2024 Plan of Correction Administrator stated written documentation showing the residents are able to manage their own health conditions and submit proof to the Department.

Official classification

Type B

Official code

87633(b)

Regulation authority

CCR

What the official deficiency says

(b) A current and complete hospice care plan shall be maintained in the facility for each hospice resident and include the following: 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 out of one residents (R6) who did not have a hospice care plan on file. This poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/31/2024 Plan of Correction The Administrator contacted the hospice agency and obtained a copy of the care plan during the LPA's visit. POC cleared.