MERCY HOME

Official classification

Type A

Official code

87412(a)(12)

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: (12) Hazardous health conditions documents 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 #1 (S1), and Staff #2 (S2) complete the required Tuberculosis (TB) Test which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/24/2024 Plan of Correction Licensee stated to submit proof of medical appointment for S1 and S2 to complete the required TB Test to LPA Brown on Plan of Correction (POC) due date.

Official classification

Type A

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, record review, the licensee did not comply with the section cited above by not ensuring that Staff #1 (S1), Staff #2 (S2) and Staff #3 (S3)eceive the appropriate training in first aid from persons qualified by such agencies as the American Red Cross which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/24/2024 Plan of Correction Licensee stated to submit proof of S1, S2 and S3 proof of enrollment on CPR/First Aid Training or proof of completed CPR/First Aid whichever is available to LPA Brown on POC due date.

Official classification

Type A

Official code

87465(c)(2)

Regulation authority

CCR

What the official deficiency says

(c) If the resident's physician has stated in writing that the resident is unable to determine his/her own need for nonprescription PRN medication, but can communicate his/her symptoms clearly, facility staff designated by the licensee shall be permitted to assist the resident with self-administration, provided all of the following requirements are met: (2) Once ordered by the physician the medication is given according to the physician's directions. 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 updating Resident #2 (R2) Medication Administration Record (MAR) after dispensing R2's medication per R2's physician direction which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/24/2024 Plan of Correction Licensee state to train all staff on CCR 87465(c)(2) and submit proof of all staff training log to LPA Brown on Plan of Correction (POC) due date.

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, record review, the licensee did not comply with the section cited above by not ensuring that there's a night staff, that's 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: 07/24/2024 Plan of Correction Licensee stated to submit updated Personnel Report (LIC500) and updated Staff Schedule showing a staff scheduled to work night shift as required 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 review, the licensee did not comply with the section cited above by not developing the Infection Control Plan as required which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/05/2024 Plan of Correction Licensee stated to submit the required Infection Control Plan to LPA Brown on 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 #2 (S2) criminal background clearance to the facility prior to employment which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/05/2024 Plan of Correction Licensee stated to transfer S2 criminal background clearance to the facility and submit proof to LPA Brown on Plan of Correction (POC) due date.

Official classification

Type B

Official code

87507(c)

Regulation authority

CCR

What the official deficiency says

(c) Admission agreements shall be signed and dated, acknowledging the contents of the document, by the resident or the resident's representative, if any, and the licensee or the licensee's designated representative no later than seven days following admission. Attachments to the agreement may be utilized as long as they are also signed and dated as prescribed above. 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) Admission Agreement was signed and dated as required by the resident or the resident's representative, if any, and the licensee or the licensee's designated representative which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/05/2024 Plan of Correction Licensee stated to ensure R2's Admission Agreement was signed was and dated as required by the resident or the resident's representative, if any, and the licensee or the licensee's designated representativeand submit proof to LPA Brown on Plan of Correction (POC) due date.

Official classification

Type A

Official code

87412(a)(11)

Regulation authority

CCR

What the official deficiency says

87412 Personnel Records (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 #1 (S1) and Staff #2 (S2) complete the required Health Screenig Report which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/24/2024 Plan of Correction Licensee stated to submit S1 and S2 Medical Appointment to complete the required Health Screening Report to LPA Brown on Plan of Correction (POC) due date.

Official classification

Type B

Official code

1569.655(a)

Regulation authority

HSC

What the official deficiency says

HSC1569.655 (a) If a licensee of a residential care facility for the elderly increases the rates of fees for residents or makes increases in any of its rate structures for services, the licensee shall provide no less than 60 days' prior written notice to the residents or the residents' representatives setting forth the amount of the increase, the reason for the increase, and a general description of the additional costs, except for an increase in the rate due to a change in the level of care of the resident. This subdivision shall not apply to optional services that are provided by individuals, professionals, or organizations under a separate fee-for-service arrangement with residents. Based on interview and record review, the licensee did not comply with the section cited above evidenced by not providing the resident with a sixty (60) notice of rate increase which poses a potential health, safety, or personal rights risk to persons in care.

Official plan of correction

The licensee has agreed to read health and safety code 1569.655 entirely and send LPA a self-certified letter that the code was read and understood. The licensee has agreed to provide a sixty (60) day written notice to all residents moving forward when there is a rate increase. POC is due by 10/30/2023.

Deadline recorded: Oct 30, 2023. A deadline is not proof that correction was completed.