ELITE ELDERLY CARE HOME

Official classification

Type B

Official code

87506(b)(17)(E)

Regulation authority

CCR

What the official deficiency says

" (b) Each resident’s record shall contain at least the following information: (17) Documents and information required by the following: ... (E) Section 87463, Reappraisals ... " This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, two residents did not have a reappraisal on file dated within the last year, as required by Section 87463, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/06/2025 Plan of Correction Licensee agrees to provide LPA Moleski with updated appraisals for these residents by POC due date. vincent.moleski@dss.ca.gov

Official classification

Type A

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 and record review, a staff member worked for more than five days in this facility without a criminal record association, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/30/2025 Plan of Correction Licensee agrees to associate S1 to this facility by POC due date. vincent.moleski@dss.ca.gov

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 Based on record review, two staff members (S2 & S3) were missing several required documents, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/06/2025 Plan of Correction Licensee agrees to provide the missing documents by POC due date. vincent.moleski@dss.ca.gov

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 interview and observation, documentation on fire drills was not maintained, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/06/2025 Plan of Correction Licensee either agrees to locate documentation of monthly fire drills performed for the last year, or to provide a written acknowledgement that drills will be documented monthly in the future. vincent.moleski@dss.ca.gov

Official classification

Type B

Official code

87506(a)

Regulation authority

CCR

What the official deficiency says

Resident Records The licensee shall ensure...record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff This requirement is not met as evidenced by: Based on Confirmation from Licensee the file for R1 is unavailable for review or copying. This poses a potential health and safety risk to residents in care.

Official plan of correction

Licensee shall submit a copy of R1's complete file to the office by 12/24/24 as well as a written statement indicating the Title 22 regulations will be upheld at all times.

Deadline recorded: Dec 24, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87623(a)(1)(A)

Regulation authority

CCR

What the official deficiency says

(A) Irrigation shall only be performed by an appropriately skilled professional in accordance with the physician's orders. Based on observation and interview R(1) has a catheter. S(1) states training in catheter care has not occured.This poses an imediate risk to residents in care.

Official plan of correction

Licensee states she will request an exception for cathether by POC date of correction. Request will be emailed to LPA Fain at jennifer.fain@dss.ca.gov

Deadline recorded: Aug 31, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87705(c)(4)(a)

Regulation authority

CCR

What the official deficiency says

..., 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 .... This requirement was not met as evidenced by: Based on obervation, interview and file review, the live in staff sleep through the night waking 1-2 times for resident checks.

Official plan of correction

Licensee states she will send an updated schedule reflecting the dementia requirement by close of business on POC date. Proof should be sent to jennifer.fain.dss.ca.gov Licensee states that she will be awake staff tonight.

Deadline recorded: Aug 31, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87303(e)(2)

Regulation authority

CCR

What the official deficiency says

Maintenance and Operation...Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degree C) and not more than 120 degree F (49 degree C). This rfequirement was not met as evidenced by: Based on LPA Jensen's measurements of the water temperature in the bedroom hallway bathroom of 100.5 degrees or less. This poses a potential risk to the health, safety and personal rights of residents in care.

Official plan of correction

Licensee agrees to conduct a daily water temperature reading and log results. Licensee will email a weekly log to maja.jensen@dss.ca.gov for 4 weeks beginning 4/12/23.

Deadline recorded: Apr 4, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

1569.185

Regulation authority

HSC

What the official deficiency says

The failure of an applicant for licensure or a licensee to pay all applicable and accrued fees and civil penalties shall constitute grounds for denial or forfeiture of a license. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA Jensen's record review of payment history, the licensee has not paid annual fees since 2019 and therefore the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/20/2023 Plan of Correction Licensee will submit proof that annual licensing fees have been paid and are current to maja.jensen@dss.ca.gov by plan of correction due date.

Official classification

Type B

Official code

1569.655

Regulation authority

HSC

What the official deficiency says

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 requirement is not met as evidenced by: Deficient Practice Statement Based on LPA Jensen's review of resident files and Admission Agreements, the licensee did not comply with the section cited above in 5 of 5 counts, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/30/2023 Plan of Correction Licensee agrees to create new admission agreements and have them signed by all residents responsible parties within 7 days. The new signed agreements will be emailed to maja.jensen@dss.ca.gov by the Plan of Correction due date.

Official classification

Type B

Official code

1569.652(c)

Regulation authority

HSC

What the official deficiency says

A refund of any fees paid in advance covering the time after the resident’s personal property has been removed from the facility shall be issued to the individual, individuals, or entity contractually responsible for the fees or, if the deceased resident paid the fees, to the resident’s estate, within 15 days after the personal property is removed. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA Jensen's review of resident Admission Agreements, the licensee did not comply with the section cited above in 4 of 5 counts which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/30/2023 Plan of Correction Licensee agrees to have new admission agreements signed by all residents responsible parties and will email the admission agreements to maja.jensen@dss.ca.gov by plan of correction due date.