AVERY GARDEN ASSISTED LIVING INC.

Official classification

Type B

Official code

87412(a)(11)

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: (11) A health screening as specified in Section 87411, Personnel Requirements - General. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview and record review, the licensee did not comply with the section cited above by not having a completed Health Screening Report for Staff #7 (S7) as S7 does not have TB Test Result/Information on S7 file which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/08/2024 Plan of Correction The Licensee stated to submit a copy of S7's completed Health Screening Report to LPA Brown at Plan of Correction (POC) due date.

Official classification

Type B

Official code

87355(e)(3)

Regulation authority

CCR

What the official deficiency says

(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (3) Request a transfer of a criminal record clearance as specified in Section 87355(c) or This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview and record review, the licensee did not comply with the section cited above by not transferring Staff #3 (S3) criminal record clearance to the facility which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/08/2024 Plan of Correction The Licensee transferred S3 criminal background clearance to the facility during the visit. POC cleared. The Licensee will submit Signed Statement of Understanding on CCR 87355(e)(3) to LPA Brown at POC due date.

Official classification

Type B

Official code

87411(c)(1)

Regulation authority

CCR

What the official deficiency says

(1) Staff providing care shall receive appropriate training in first aid from persons qualified by such agencies as the American Red Cross. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview and record review, the licensee did not comply with the section cited above by not having Staff #2 (S2), Staff #3 (S3), Staff #4 (S4) and Staff #8 (S8) complete their First Aid Certification and maintain it in their file which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/08/2024 Plan of Correction The Licensee stated to submit S2, S3, S4 and S8 proof of completed First Aid Certification to LPA Brown at Plan of Correction (POC) due date.

Official classification

Type B

Official code

1569.626(a)(1)

Regulation authority

HSC

What the official deficiency says

(a) All residential care facilities for the elderly shall meet the following training requirements, as described in Section 1569.625, for all direct care staff: (1) Twelve hours of dementia care training, six of which shall be completed before a staff member begins working independently with residents, and the remaining six hours of which shall be completed within the first four weeks of employment. All 12 hours shall be devoted to the care of persons with dementia. The facility may utilize various methods of instruction, including, but not limited to, preceptorship, mentoring, and other forms of observation and demonstration. The orientation time shall be exclusive of any administrative instruction. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview and record review, the licensee did not comply with the section cited above by not having Staff #8 (S8) and Staff #7 (S7) complete the required six (6) hours of dementia training as required by subdivision (a) of Section 1569.696 before working independently with residents which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/08/2024 Plan of Correction The Licensee stated to submit proof of S8, S7 completed six (6) hours of dementia training to LPA Brown at POC due date.

Official classification

Type B

Official code

1569.626(a)(2)

Regulation authority

HSC

What the official deficiency says

(a) All residential care facilities for the elderly shall meet the following training requirements, as described in Section 1569.625, for all direct care staff: (2) Eight hours of in-service training per year on the subject of serving residents with dementia. This training shall be developed in consultation with individuals or organizations with specific expertise in dementia care or by an outside source with expertise in dementia care. In formulating and providing this training, reference may be made to written materials and literature on dementia and the care and treatment of persons with dementia. This training requirement may be satisfied in one day or over a period of time. This training requirement may be provided at the facility or offsite and may include a combination of observation and practical application. 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 by not having Staff #2 (S2), Staff #4 (S4), Staff #7 (S7) and Staff #8 (S8) complete the required additional eight (8) hours of dementia training as required by subdivision (a) of Section 1569.626 which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/08/2024 Plan of Correction The Licensee stated to submit proof of S2, S4, S7 and S8 completed eight (8) hours of dementia training to LPA Brown at POC due date.

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 observation, interview and record review, the licensee did not comply with the section cited above by not conducting the required earthquake drill on all shifts at the facility which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/08/2024 Plan of Correction The Licensee stated to submit proof of completed Earthquake drill on all shifts at the facility to LPA Brown at Plan of Correction due date.

Official classification

Type B

Official code

87608(a)(5)(A)

Regulation authority

CCR

What the official deficiency says

(A) A bed rail that extends from the head half the length of the bed and used only for assistance with mobility shall be allowed. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview and record review, the licensee did not comply with the section cited above by not having a record/documentation or written order from R2's physician indicating the need for half bed rail for R2's mobility. which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/08/2024 Plan of Correction The Licensee removed R2's half bedrail during the visit. POC cleared.

Official classification

Type B

Official code

87705(c)(6)

Regulation authority

CCR

What the official deficiency says

(c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following: (6) Appraisals are conducted on an ongoing basis pursuant to Section 87463, Reappraisals. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview and record review, the licensee did not comply with the section cited above by not completing the required yearly reappraisal for Resident #2 (R2) at the facility which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/08/2024 Plan of Correction The Licensee stated to complete the required yearly reappraisal for Resident #2 (R2) and submit copy of completed R2 reappraisal to LPA Brown at Plan of Correction (POC) due date.

Official classification

Type A

Official code

87608(a)(5)

Regulation authority

CCR

What the official deficiency says

Bed rails that extend the entire length of the bed are prohibited except for residents .... hospice care and have a hospice care plan that specifies the need for full bed rails.The facility has not met this requirement as evidenced by LPA observed that R1 has full bed rails on their bed. R1 is not on receiving hospice services. This poses a risk to the health and safety of residents in care.

Official plan of correction

Licensee will discuss with R1's physician alternative saftey measures for R1 by POC due date 10/28/22 and provide in writing discussed changes and plan of compleation to CCL.

Deadline recorded: Oct 28, 2022. A deadline is not proof that correction was completed.