SHADY OAKS CARE HOME

Official classification

Type A

Official code

87465(h)(2)

Regulation authority

CCR

What the official deficiency says

(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: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above in as multiple unlocked medications requiring refrigeration were observed in the main refrigerator, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/11/2026 Plan of Correction Licensee/Administrator immediately placed the unlocked medications in a drawer in the refrigerator until a locked box can be purchased, later today. Administrator to provide LPA with photos showing the medications requiring refrigeration have been secured by February 11, 2026.

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 (3) out of (3) staff files, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/13/2024 Plan of Correction Licensee/Administrator agree to have all staff (S1, S2 and S3) complete certification in First Aid and CPR and ensure it is renewed every (2) years, as required. Send in current certification by 3/13/24.

Official classification

Type B

Official code

87463(c)

Regulation authority

CCR

What the official deficiency says

(c) 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, when there is significant change in the resident's condition, or once every 12 months, whichever occurs first, as specified in Section 87467, Resident Participation in Decision Making. 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 (2) out of (3) resident care plans, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/13/2024 Plan of Correction Licensee/Administrator agree to update the care plans for residents (R1 and R2), and ensure all other residents have an updated care plan at least every 12 months. Copies of updated care plan due by 3/13/24.

Official classification

Type B

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 record review, the licensee did not comply with the section cited above in out (1)of (3) resident files reviewed, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/13/2024 Plan of Correction Administrator stated resident (R2) has an appointment with the physician on 2/29/24 and an updated LIC602 will be requested at that time and submitted to the department upon receipt.

Official classification

Type B

Official code

87111(b)(1)

Regulation authority

CCR

What the official deficiency says

87111 Continuation of License Under Emergency Conditions (b) In the event of a licensee's death, an adult who has control of the property, and had been designated by the licensee as the party responsible to continue operation of the facility upon a licensee’s death shall: (1) notify the Department by the next working day of the licensee’s death; This requirement is not met as evidenced by: Based on e-mail communication with Administrator, the death of Co-Licensee on 8/14/2022 was not reported to the Department until 10/31/2022, which posed a potential health and safety risk to residents in care.

Official plan of correction

LIcensee/Administrator agree to read Regulation 87111 and submit a signed statement that it is understood. Licensee/Administrator also agree to contact CAB unit to discuss options for a new application or to take Co-LIcensee's name off and inform LPA what the decision is by 11/23/22.

Deadline recorded: Nov 23, 2022. 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 observation on 10/25/22, at approximately 11:30 am, LPA observed (1) bubble pack of unlocked medications on top of the medication cabinet for resident (R3), expired medication for R1, and medications for R1 and R2 to not be secured due to the lock not functioning correctly on the medication cabinet, which poses an immediate health and safety risk to residents in care.

Official plan of correction

Licensee/Administrator agrees to move the medications to a locked location or fix the lock on the file cabinet. Administrator agrees to send a photo of where medications will be stored and locked to CCLD by 10/27/22.

Deadline recorded: Oct 26, 2022. 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

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 keeping facility clean which poses a potential health, safety and personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/04/2022 Plan of Correction Administrator agrees to deep clean the facility floors, bathrooms, walls, and kitchen. In addition administrator to send into CCL a plan of how staff will consistently keep facility clean. POC due on 3/4/22.