ANGELIC MANOR

Official classification

Type A

Official code

87411(g)(1)

Regulation authority

CCR

What the official deficiency says

87411 Personnel Requirements - General (g) Prior to employment or initial presence in the facility, all employees and volunteers subject to a criminal record review shall: (1) Obtain a California clearance or a criminal record exemption as required by law or Department regulations... 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 in that Staff #1 (S1) did not have a criminal record clearance or an exemption which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/06/2025 Plan of Correction LPA observed S1 leave the facility, and the licensee agrees that S1 will not return to the facility until they have a criminal record clearance.

Official classification

Type B

Official code

87307(c)

Regulation authority

CCR

What the official deficiency says

(c) Individual privacy shall be provided in all toilet, bath and shower areas. 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 one (1) out of two (2) toilet, bath, and shower areas, Bathroom #1, did not maintain individual privacy which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/04/2025 Plan of Correction Licensee agrees to install a door on the bathroom and send proof of the door's installation to the Department by POC date of 12/04/2025.

Official classification

Type A

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 ensuring that Staff #2 (S2) completed the required Health Screening Report which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/19/2024 Plan of Correction Licensee stated to submit S2 medical appointment to complete the required Health Screening Report to LPA Brown on Plan of Correction (POC) due date.

Official classification

Type A

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 observation, interview and record review, the licensee did not comply with the section cited above by not ensuring Staff #2 (S2) and Staff #3 (S3) complete the required 10 hours of Initial Training which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/19/2024 Plan of Correction Licensee stated to train all staff on HSC1569.69(a)(2) and submit proof to LPA Brown on Plan of Correction (POC) due date.

Official classification

Type A

Official code

87608(a)(5)(B)

Regulation authority

CCR

What the official deficiency says

(B) Bed rails that extend the entire length of the bed are prohibited except for residents who are currently receiving hospice care and have a hospice care plan that specifies the need for full bed rails. 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 allowing Resident #3 (R3) to have full bed rail and R3's not on hospice and no letter was submitted to CCLD for approval for the full bed rail which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/19/2024 Plan of Correction Licensee removed R3 full bed rail during the visit. Plan of Correction (POC) cleared.

Official classification

Type A

Official code

87705(c)(4)(A)

Regulation authority

CCR

What the official deficiency says

(c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following: (4) There is an adequate number of direct care staff to support each resident's physical, social, emotional, safety and health care needs as identified in his/her current appraisal. (A) In addition to requirements specified in Section 87415, Night Supervision, a facility with fewer than 16 residents shall have at least one night staff person awake and on duty if any resident with dementia is determined through a pre-admission appraisal, reappraisal or observation to require awake night supervision. 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 scheduling a staff to work the night shift, awake and on duty as required for facility with dementia residents which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/19/2024 Plan of Correction Licensee stated to submit an updated Peronnel Report (LIC500) showing a staff scheduled to work the night shift to LPA Brown on POC due date.

Official classification

Type B

Official code

87470(c)

Regulation authority

CCR

What the official deficiency says

(c) An Infection Control Plan shall be developed by the licensee and shall be included in the Plan of Operation required by Section 87208. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview and record revie], the licensee did not comply with the section cited above by not developing the required Infection Control Plan which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/25/2024 Plan of Correction Licensee stated to submit a copy of the required Infection Control Plan to LPA Brown on Plan of Correction (POC) due date.

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 observation, interview and record review, the licensee did not comply with the section cited above by not esuring that Staff #2 (S2) and Staff #3 (S3) complete the required 20 hours training annually which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/25/2024 Plan of Correction Licensee stated to submit proof of S2 and S3 completed 20 hours annual training to LPA Brown on POC due date.

Official classification

Type B

Official code

87456(a)(2)

Regulation authority

CCR

What the official deficiency says

(a) Prior to accepting a resident for care and in order to evaluate his/her suitability, the facility shall, as specified in this article 8: (2) Perform a pre-admission appraisal. 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 ensuring that Resident #2 (R2) and Resident #3 (R3) have their Pre-Admission Appraisal in their facility file which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/25/2024 Plan of Correction Licensee stated to complete R2 and R3 Pre-Admission Appraisal and submit copies to LPA Brown on Plan of Correction (POC) due date.

Official classification

Type B

Official code

1569.695(e)(2)

Regulation authority

HSC

What the official deficiency says

(e) A facility shall have all of the following information readily available to facility staff during an emergency: (2) An appraisal of resident needs and services plan for each resident. 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 ensuring that Resident #2 (R2) and Resident #3 (R3) have their Pre-palcement Needs & Services Plan in their facility file which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/25/2024 Plan of Correction Licensee stated to complete and submit copies of R1 and R3 Pre-palcement Needs and Services Plan to LPA Brown on POC due date.

Official classification

Type A

Official code

87705(c)(5)

Regulation authority

CCR

What the official deficiency says

87705 Care of Persons with Dementia (c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following: (5) Each resident with dementia shall have an annual medical assessment as specified in Section 87458, Medical Assessment, and a reappraisal done at least annually, both of which shall include a reassessment of the resident’s dementia care needs. 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 ensuring that Resident #1 (R1) has an annual medical assessment as required for resident with dementia which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/19/2024 Plan of Correction Licensee stated to submit R1 medical appointment to complete the required annual medical assessment to LPA Brown on Plan of Correction (POC) due date.

Official classification

Type A

Official code

87705(f)(1)

Regulation authority

CCR

What the official deficiency says

87705 Care of Persons with Dementia (f) The following shall be stored inaccessible to residents with dementia: (1) Knives, matches, firearms, tools and other items that could constitute a danger to the resident(s). 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 ensuring that the two (2) sharp metal skewers were locked and not accessible to residents in care which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/19/2024 Plan of Correction Licensee stated to train all staff on CCR 87705(f)(1) and submit proof of staff training log to LPA Brown on POC due date.

Official classification

Type B

Official code

87412(a)

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: This requirement is not met as evidenced by: Deficient Practice Statement This requirement is not met as evidenced by interview, document review, and observation, the licensee did not comply with the section cited above evidenced by not having a staff file for staff S1 which poses a potential health, safety, or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/29/2023 Plan of Correction The licensee has agreed to read regulation 87412 entirely and send LPA a self-certified letter that the regulation was read and understood. The licensee has agreed to create a staff file for S1 and store the file at the facility by the POC due date. POC is due by 12/29/2023.

Official classification

Type B

Official code

87705(c)(5)

Regulation authority

CCR

What the official deficiency says

(c)Licensees who accept and retain residents with dementia shall be responsible for ensuring the following: (5) Each resident with dementia shall have an annual medical assessment as specified in Section 87458, Medical Assessment, and a reappraisal done at least annually, both of which shall include a reassessment of the resident’s dementia care needs. This requirement is not met as evidenced by: Deficient Practice Statement This requirement is not met as evidenced by interview, observation, and document review, the licensee did not comply with the section cited above evidenced by not having an annual medical assessment completed for Resident’s R1, R2, and R3 which poses a potential health, safety, or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/31/2024 Plan of Correction The licensee has agreed to read regulation 87705 entirely and send LPA a self-certified letter that the regulation was read and understood. The licensee has agreed to have updated medical assessments completed for R1, R2, and R3 by the POC due date. POC is due by 1/31/2024.

Official classification

Type A

Official code

87608(1)(3)

Regulation authority

CCR

What the official deficiency says

Postural supports shall be limited to appliances or devices such as braces, spring release trays, or soft ties, used to achieve proper body position and balance... rather than restrict movement... A written order from a physician indicating the need for the postural support... The facility did not meet this requirement as evidenced by failure to obtain a physician's order for the postural support used. This poses a risk to the health and safety of residents in care.

Official plan of correction

Administrator agrees to review the regulation cited for postural support as well as regulations pertaining to personal rights. Administrator to submit statement of understanding of regulations reviewed by POC due date.

Deadline recorded: Mar 2, 2022. A deadline is not proof that correction was completed.