WALNUT HOUSE

Official classification

Type A

Official code

87468.2(1)(1)

Regulation authority

CCR

What the official deficiency says

Additional Personal Rights of Residents in Privately Operated Facilities - (a) (1) To have a reasonable level of personal privacy in accommodations,...This requirement was not met based on interviews that found R1 was photographed without knowledge or consent and the inforation was shared with others. This posed an immediate risk to resident rights.

Official plan of correction

Administrator agrees to provide a plan, by the POC date, for staff retraining regarding resident rights, facility photo policy and mandated reporting. The plan for training will include training be completed by 10/22/25. Administrator also agrees to inform LPA of supervisory action to be taken with S1 pending an internal investigation

Deadline recorded: Oct 16, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87466

Regulation authority

CCR

What the official deficiency says

Observation of the Resident: The licensee shall ensure that residents are regularly observed for changes ...and that appropriate assistance is provided when such observation reveals unmet needs. When changes such as …, deterioration of mental ability or a physical health condition are observed, the licensee shall ensure... changes are... brought to the attention of the resident's physician and... This requirement was not met based on records and statements which found R1’s changes to physical and social function were not responded to. This posed an immediate risk to R1. Civil Penalty Applied.

Official plan of correction

Administraor agreed to provide training to all staff regarding observation and communication of resident status. The POC is to provide a date that training will be completed by. Training to be comleted by 3/12/25. Proof of training completed will include procedures for observation and communication throughout all employees for obsrving residents and alerting to changing in condition or activity. Proof of training to be submitted when completed.

Deadline recorded: Mar 26, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87468.2(a)(4)

Regulation authority

CCR

What the official deficiency says

Additional Personal Rights of Residents in Privately Operated Facilities (a)Residents shall .. rights: (4) To care, supervision, and services …by staff that are sufficient in numbers, qualifications, and competency to meet their needs. This requirement was not met based on records and statements that found staff did not recognize and respond to R1’s change of condition and increased need for assistance. This posed an immediate risk to R1.

Official plan of correction

Administraor agreed to provide training to all staff regarding awareness of changes and communication skills for communicating with residents with communication disabilities. The POC is to provide a date that training will be completed by. Training to be comleted by 3/12/25. Proof of training completed will include General observations of residents for what would possible indicate a change for that resident as well as types of communication strategies for non-verbal residents. Proof of training to be submitted when completed.

Deadline recorded: Feb 26, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by: Based on LPA's observations, the facility did not ensure that the premises was clean and in good repair when R5's apartment had linoleum coming apart and R6 and R7's apartment had feces on the toilet, which poses a potential health, safety, and personal rights violation to the residents in care.

Official plan of correction

Facility will conduct an in-service training for staff regarding observation of the premises and reporting if housekeeping or repairs are needed. Facility will submit proof of training to LPA by POC due date on 3/07/2025. A civil penalty for $250 was assessed for a repeat violation.

Deadline recorded: Mar 7, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87465(h)(2)

Regulation authority

CCR

What the official deficiency says

87465(h)(2) Incidental Medical and Dental Care: (h) The following requirements shall apply to medications which are centrally stored: (2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. This requirement was not met as evidenced by: Based on an interview with the Administrator, Administrator acknowledged that after seeing a bad Yelp review, medications were found in the former residents room which presents a potential health, safety and personal rights risk to the residents in care.

Official plan of correction

Licensee/Administrator shall fill out an LIC 9098-Self Certification understanding of the regualtion. Licensee/Administrator shall conduct staff training and provide proof of staff training. Licensee/Administrator shall provide a statement on how future compliance will be met. POC Due date: January 28, 2025.

Deadline recorded: Jan 28, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87309(a)

Regulation authority

CCR

What the official deficiency says

87309 Storage Space (a) Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients. This requirement is not met as evidenced by: Based on observation, Licensee did not comply with the section above as LPA observed two cleaning supplies in R1's vacant room. LPA was informed family members may have dropped it off to resident as facility does not use the folowing cleaning supply, which poses a potential risk for residents in care.

Official plan of correction

-Cleaning supply was confiscated immediately by staff on the floor. -Licensee will provide a newletter to residents and their responsible party a reminder that no chemicals are to be purchased and dropped off to resident's room. POC is due by next Friday October 25.

Deadline recorded: Oct 25, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by: Based on LPA's observation, Licensee did not comply to the section cited above as LPA observed R1's room to have an approximate two-feet brown stain next to R1's bed, used urinal bottle on top of night stand and red stains on linens which poses a potential risk to residents in care.

Official plan of correction

R1's carpet was cleaned immediately during LPA's visit. Licensee will conduct an in-service staff training regarding facility's expectation of cleanliness and sanitary conditions of resident's room. Licensee is to notify LPA Yang of completion. $250 Repeat Violation Civil Penalty assessed

Deadline recorded: Mar 22, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(a)(4)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following:(4) The licensee shall assist residents with self-administered medications as needed. This requirement is not met as evidenced by: Based on file review of R1 and R2's medication administration records and medication audit, licensee did not comply with the section cited above as LPA and Regional Nurse observed four different medication counts to be inconsistent with MAR, which poses an immediately risk to residents in care.

Official plan of correction

This matter will be discussed during noncompliance conference on 1/31/2024. Deficiency will be cleared afterwards.

Deadline recorded: Jan 26, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87411(a)

Regulation authority

CCR

What the official deficiency says

87411 Personnel Requirements - General (a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. In facilities licensed for sixteen or more, sufficient support staff shall be employed to ensure provision of personal assistance and care as required in Section 87608, Postural Supports. Additional staff shall be employed as necessary to perform office work, cooking, house cleaning, laundering, and maintenance of buildings, equipment and grounds... This requirement is not met as evidenced by: Based on interviews, the licensee did not comply with the section cited above as R1 and R2 both stated there is staff shortage at the facility resulting to delays on level of care, which poses a potential health and safety risk for residents in care.

Official plan of correction

Staffing concerns will be discussed with Licensee during in-person noncompliance conference.

Deadline recorded: Jan 26, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(h)(2)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care (h) The following requirements shall apply to medications which are centrally stored: (2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. This requirement is not met as evidenced by: Based on LPAs' observation and interview with R1, Licensee did not comply with the section above as LPA Yang and LPA Ratajczak observed R1 to have Ondansetron in her room, which poses an immediate health and safety risk for residents in care.

Official plan of correction

Medication is to be removed immediately and centrally stored. This matter will be discussed in office meeting with Licensees.

Deadline recorded: Oct 12, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by: Based on observation, Licensee did not comply with the regulation above as LPA Yang and LPA Ratajczak observed R1's room to have a strong odor of urine, unsecured headboard and multiple discoloration on bathroom floor, which poses an immediate health and safety risk to residents in care.

Official plan of correction

Housekeeper was asked to clean R1's room and bathroom immediately. Licensee will notify LPA Yang when headboard and bathroom faucet is fixed. This matter will be discussed during office meeting with Licensees.

Deadline recorded: Oct 12, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(a)(4)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following: (4) The licensee shall assist residents with self-administered medications as needed. This requirement is not met as evidenced: Based on observation of medication audit, Licensee comply to the section cited above as LPAs observed R1's medication to have one tablet missing from the original bottle which was also not signed off on the MAR, which poses an immediate health and safety risk for residents in care.

Official plan of correction

An office meeting will be held to discuss this matter. LPA will reach out to Administrator and Licensee representatives to schedule a meeting.

Deadline recorded: Sep 29, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.1(a)(1)

Regulation authority

CCR

What the official deficiency says

87468.1 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: (1) To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement is not met as evidenced by: Based on interviews conducted, Licensee did not ensure residents in care to be accorded dignity, as residents informed LPA and LPM the PM shift staffs are rude and disrespectful, which poses a potential risk to residents in care.

Official plan of correction

Licensee is to provide all staff a training of residents rights. Licensee is to send CCLD a copy of the training materials and proof of attendees by Friday August 1, 2023.

Deadline recorded: Sep 1, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(a)(4)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical... provide for assistance in obtaining such care, by compliance with the following: (4) The licensee shall assist residents with self-administered medications as needed. This requirement is not met as evidenced by: Based on observation during medication audit, Licensee did not ensure medications were administered, as LPA and LPM observed MARs was not sign if medications were administered to residents, Rooms #1-47. Days of missing signatures ranged from 3-6 days from the date of inspection, which poses an immediate risk to residents in care.

Official plan of correction

Licensee is to schedule a training for all Med Techs of how to complete the Medication Administration Record (MAR) correctly. Please notify LPA the date of training by Friday 8/25/2023. Licensee is to provide CCLD a copy of the training materials and list of attendees by Thursday 8/31/2023.

Deadline recorded: Aug 25, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.2(a)(6)

Regulation authority

CCR

What the official deficiency says

87468.2 Additional Personal Rights of Residents in Privately Operated Facilities (a) In addition to the rights listed in Section 87468.1, 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: (6) To make choices concerning their daily lives in the facility. This requirement is not met as evidenced by: Based on interviews and file review, Licensee did not ensure that residents have the rights to make choices concerning their daily lives in the facility as smoking residents are to wait 10 minutes after mealtime in able to go outside to smoke, which poses a potential health safety and personal rights risk to residents in care as it is not listed in the House Rules.

Official plan of correction

Licensee is to submit an addendum to House Rules implementing the 10 minutes after mealtime smoking rule to CCLD by 8/30/2023. Licensee is to provide all residents in care the copy of the House Rule addendum immediately.

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

Official classification

Type B

Official code

Not listed

Regulation authority

CCR

What the official deficiency says

Deficiency narrative not available.

Official classification

Type B

Official code

87411(a)

Regulation authority

CCR

What the official deficiency says

87411 Personnel Requirements - General (a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. In facilities licensed for sixteen or more, sufficient support staff shall be employed to ensure provision of personal assistance and care as required in Section 87608, Postural Supports. Additional staff shall be employed as necessary to perform office work, cooking, house cleaning, laundering, and maintenance of buildings, equipment and grounds. The licensing agency may require any facility to provide additional staff whenever it determines through documentation that the needs of the particular residents, the extent of services provided, or the physical arrangements of the facility require such additional staff for the provision of adequate services. This requirement is not met as evidenced by: Based on record review and interviews conducted, the Licensee did not ensure that staff responded timely to resident's (R1) request for assistance when the call button was used on 7/5/22, 7/14/22 and on 7/20/22, which posed a potential health and safety risk and/or personal rights violation to residents in care.

Official plan of correction

Licensee/Administrator agree to conduct staff traiining on reiterating the importance of resetting the call light button at the time care is provided. Training to be conducted also on communicating with team members about covering all calls, in elvery hall, if a caregiver is busy with another resident or on break, so the call be answered timely. Documentation to be submitted to CCLD by fax/email by 12/9/22.

Deadline recorded: Dec 1, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.2(a)(2)

Regulation authority

CCR

What the official deficiency says

Additional Personal Rights of Residents in Privately Operated Facilities. (a)(2)To have their records and personal information remain confidential and to approve their release, except as authorized by law. This requirement was not met as evidenced by interviews and observation that found personal information was posted in the dining area and was able to be seen by others. This posed a potential violation of resident rights.

Official plan of correction

The situation has been corrected. Licensee will submit a statement of understanding of this requirement.

Deadline recorded: May 10, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.2(a)(6)

Regulation authority

CCR

What the official deficiency says

Additional Personal Rights of Residents in Privately Operated Facilities. (a)(6) To make choices concerning their daily lives in the facility. This requirement was not met as R1 was told that she must transfer from her wheel chair at meal. This posed a potential violation of R1's personal rights.

Official plan of correction

The situation has been corrected. Licensee will submit a statement of understanding of this requirement.

Deadline recorded: May 10, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87464(d)

Regulation authority

CCR

What the official deficiency says

87464(d) Basic Services (d) … the facility shall be responsible for meeting the resident's needs as identified in the pre-admission appraisal ...This requirement is not met as evidenced by: Based on interviews and documentation reviewed, the Licensee did not ensure that resident’s (R1) care needs were met including hygiene, repositioning every 2 hours and changing briefs, resulting in pressure sore to worsen which posed an immediately health and safety risk to residents in care.

Official plan of correction

The resident identified in this complaint is no longer at the facility. Licensee will present a detailed plan of identifying resident needs, staffing to be provided, documentation of condition changes and communication with health care providers with CCLD by POC date of 4/22/22.

Deadline recorded: Apr 22, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87606(c)

Regulation authority

CCR

What the official deficiency says

Care of Bedridden Residents - (c) To accept or retain a bedridden person, other than for a temporary illness or recovery from surgery, a facility shall obtain and maintain an appropriate fire clearance as specified in Section 87202(a). This requirement has not been met as evidenced by: Based on document review, the facility does not have an approved fire clearance for bedridden residents and the resident was not identified as Hospice which poses a potential health and safety risk to residents in care.

Official plan of correction

Licensee will submit a statement of understanding of the requirement for when a fire clearance is needed and notification requirements to CCL if a resident becomes bedridden. Statement to be provided by POC date of 4/22/22.

Deadline recorded: Apr 22, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87411(a)

Regulation authority

CCR

What the official deficiency says

Personnel Requirements - General (a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. This requirement was not met based on records and statements showing insufficient staffing to meet the needs of residents. On 7/13/21 this posed an immediate risk to Resident health.

Official plan of correction

Licensee will monitor responding to log records and submit a detailed plan to insure staffing to meet the needs of residents. POC due monday 4/4/22

Deadline recorded: Apr 4, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87211(a)

Regulation authority

CCR

What the official deficiency says

Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports ...(2) Occurrences, such as ..., catastrophes ... which threaten the welfare, safety or health of residents...within 24 hours ... This requirement was not met based on records and statemets that the January 27/2021 power outage was not reported as required. This posed a potential risk to residents.

Official plan of correction

Licensee will update their Emergency Plan to specify reporting requirements procedures. to CCL by the POC date of 4/22/22.

Deadline recorded: Apr 22, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87625(b)(3)

Regulation authority

CCR

What the official deficiency says

Managed Incontinence- b) In addition to Section 87611, General Requirements for Allowable Health Conditions, the licensee shall be responsible for the following: (3) Ensuring that incontinent residents are kept clean and dry and that the facility remains free of odors from incontinence. This requirement was not met Based on interviews conducted and documentation reviewed, the Licensee did not ensure that incontinent residents (R2 and R3) were toileted regularly, including throughout the night shift, which posed a potential health and safety risk to residents in care. Additionally, department LPA’s observed incontinent odors to be found on Hall 1, (room 57), on 10/21/2021 and on 11/10/2021.

Official plan of correction

Licensee will review all current incontinent resident care plans, update as needed to comply with regulation (including development and review by the appropriately skilled profession) and submit residents' incontinence care plans to CCL by the POC date 3/10/21.

Deadline recorded: Mar 10, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

1569.157(g)

Regulation authority

HSC

What the official deficiency says

§1569.157 Resident-oriented facility council (g) A facility shall not willfully interfere with the formation, maintenance, or promotion of a resident council, or its participation in the regulatory inspection process. For the purposes of this subdivision, willful interference shall include, but not be limited to, discrimination or retaliation in any way against an individual as a result of his or her participation in a resident council, refusal to publicize resident council meetings or provide appropriate space for either meetings or a bulletin board, or failure to respond to written requests by the resident council in a timely manner. This requirement is not met as evidenced by: Based on interviews conducted, the Licensee did not ensure that the facility did not willfully interfere as multiple facility staff attended a resident council meeting, held on 7/9/2021, and took control and adjourned the meeting and didn't allow the residents to lead their meeting, which posed a potential personal rights violation to residents in care.

Official plan of correction

Licensee/Administrator agree to read Health and Safety Code 1569.157 with facility staff and send a signed statement that the code is understood by staff. Documentation to be Faxed to CCLD by 8/4/2021.

Deadline recorded: Aug 4, 2021. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(h)(1)(B)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care (h) The following requirements shall apply to medications which are centrally stored: (1) Medications shall be centrally stored under the following circumstances: (B) Any medication is determined by the physician to be hazardous if kept in the personal possession of the person for whom it was prescribed. This requirement is not met as evidenced by: Based on interviews conducted, the Licensee did not ensure that all packages dropped off on 5/9/2020 were screened prior to giving to resident (R1) to ensure there were no hazardous items inside, including Tylenol medication. Receptionist stated that the contents of only 1 of 3 bags, which was the bag without tissue paper, was viewed prior to giving to resident, which posed an immediate health and safety risk to resident in care.

Official plan of correction

Facility began logging all incoming packages on/around 5/16/2020 following incident, provided training at that time, and established a written procedure of checking all incoming packages, including gifts. Administrator stated all staff are currently following this protocol. Administrator agrees to provide documentation of training agenda/attendees and also submit a written policy to CCLD by 1/8/2021.

Deadline recorded: Jan 8, 2021. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

1569.312(e)

Regulation authority

HSC

What the official deficiency says

§1569.312 Basic services requirements (e) Monitoring the activities of the residents while they are under the supervision of the facility to ensure their general health, safety, and well-being. This requirement is not met as evidenced by: Based on interviews conducted and documentation reviewed, the Licensee did not ensure that staff was regularly “monitoring resident’s (R1) emotion, frustration or anxiety” resulting from resident’s diagnosis of depression and keeping a daily log to document resident’s needs and care, as noted on resident’s plan of care dated 10/31/2019, which posed an immediate health and safety risk to resident.

Official plan of correction

Facility created a “Resident Change in Condition Form” on/around October 2020, to be used by both caregivers and Shift Managers and other staff when observing change(s) in condition in a resident. . Administrator agrees to conduct another staff training to remind staff to use the form, contact appropriate parties when a change in condition is observed, and update the care plan accordingly. Documentation of training agenda/attendees to be provided to CCLD by 1/8/2021.

Deadline recorded: Jan 8, 2021. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(a)(2)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following: (2) The licensee shall provide assistance in meeting necessary medical and dental needs. This includes transportation which may be limited to the nearest available medical or dental facility which will meet the resident's need. In providing transportation the licensee shall do so directly or make arrangements for this service. This requirement is not met as evidenced by: Based on interviews conducted and documentation reviewed, the Licensee did not ensure that essential medical information, including resident's (R1) history of attempted suicide with medications, was conveyed to emergency medical services personnel, on 5/10/2020, which posed an immediate health and safety risk to resident in care.

Official plan of correction

Administrator agrees to conduct staff training on communicating client medical history and/or recent change in conditions, as noted on most recent care plan, to EMT. Administrator will discuss how to document essential medical information to be given to EMT's amd provide a form if created. Documenattion of training agenda/attendees to be provided to CCLD by fax by 1/8/2021.

Deadline recorded: Jan 8, 2021. A deadline is not proof that correction was completed.