COMMONS AT ELK GROVE, THE

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) ... " This requirement was not met as evidenced by: Based on interview and record review, the facility's executive director was not associated to this facility's roster for more than five days since starting work, which poses an immediate health, safety, and/or personal rights risk.

Official plan of correction

Licensee agrees to associate Ocegueda by POC due date. vincent.moleski@dss.ca.gov

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

Official classification

Type B

Official code

87211(g)

Regulation authority

CCR

What the official deficiency says

" (g) The licensee shall notify the Department, in writing, within thirty (30) days of the hiring of a new administrator. The notification shall include the following: ,,, " This requirement was not met as evidenced by: Based on record review, LPA Moleski did not receive written notification of the hiring of an interim director within 30 days of Meggin Cortez's departure, which poses a potential health, safety, and/or personal rights risk.

Official plan of correction

Licensee agrees to provide LPA Moleski with written confirmation of which individual was working as interim administrator prior to Ocegueda's start date by POC due date.

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

Official classification

Type B

Official code

87211(a)(1)

Regulation authority

CCR

What the official deficiency says

“(a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: (1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below…” This requirement was not met as evidenced by: Based on record review and interview, multiple incident reports were not sent to the Community Care Licensing Division within the required seven-day timeline, which poses a potential health, safety, and/or personal rights risk.

Official plan of correction

Licensee agrees to conduct a training on reporting requirements and to send LPA Moleski a copy of the sign-in sheet from the training. Vincent.moleski@dss.ca.gov

Deadline recorded: Nov 11, 2024. A deadline is not proof that correction was completed.

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 Based on review of R4 and R5's files, the licensee did not ensure two residents with dementia had an LIC 602 updated annually, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/29/2023 Plan of Correction Licensee agrees to acquire new LIC 602 forms for R4 and R5 by the POC due date. Licensee agrees to email these forms to LPA Moleski. vincent.moleski@dss.ca.gov