PADUA ASSISTED LIVING 2

Official classification

Type B

Official code

87405(d)(2)

Regulation authority

CCR

What the official deficiency says

Administrator – Qualification and Duties: The administrator shall have the qualifications… Knowledge of and ability to conform to the applicable laws, rules and regulations This requirement is not met as evidenced by: Based on interviews and record reviews, the licensee did not comply with the regulation cited above. The licensee did not meet the terms of the federal wage settlement agreement. This poses a potential health, safety, and/or personnal rights risks to residents in care.

Official plan of correction

Corrected prior to this visit. Angelita issued the full restitution payment via mailed check to S1 on April 15, 2026 and provided the documented proof during this visit

Deadline recorded: May 1, 2026. 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

(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 report shall include the resident's name, age, sex and date of admission; date and nature of event; attending physician's name, findings, and treatment, if any; and disposition of the case. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and record review, a report was not received for an incident which occurred on 6/25/24, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/20/2024 Plan of Correction Licensee agrees to submit a completed incident report to LPA Moleski by POC due date. vincent.moleski@dss.ca.gov

Official classification

Type B

Official code

87211(a)(1)(D)

Regulation authority

CCR

What the official deficiency says

Reporting Requirements: " (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 report shall include the resident's name, age, sex and date of admission; date and nature of event; attending physician's name, findings, and treatment, if any; and disposition of the case. (D) Any incident which threatens the welfare, safety or health of any resident, such as psychological abuse of a resident by staff or other residents, or unexplained absence of any resident. " This requirement was not met as evicenced by: Based on observation and interviews, a resident suffered injuries after a fall on Monday, August 28, 2023, and an incident report was not sent to licensing within seven days, as required, which poses a potential health and safety risk.

Official plan of correction

Licensee agrees to conduct a staff training regarding reporting requirements by the POC due date. Licensee further agrees to send a sign-in sheet to LPA Moleski. vincent.moleski@dss.ca.gov

Deadline recorded: Sep 13, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87211(a)(1)(D)

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 report shall include the resident's name, age, sex and date of admission; date and nature of event; attending physician's name, findings, and treatment, if any; and disposition of the case. (D) Any incident which threatens the welfare, safety or health of any resident, such as psychological abuse of a resident by staff or other residents, or unexplained absence of any resident. " This requirement was not met as evidenced by: Based on interviews with R1, S2, and based on observation of burnt fencing in the facility's backyard and review of licensing records, the licensee did not submit an incident report for this fire, which poses a potential health and safety risk.

Official plan of correction

The licensee previously conducted a staff training on incident reporting and sent a copy to LPA Moleski. This POC will be cleared.

Deadline recorded: Aug 24, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87211(a)(1)(D)

Regulation authority

CCR

What the official deficiency says

Reporting Requirements 22 CCR Section 87211(a)(1)(D): " (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 report shall include the resident's name, age, sex and date of admission; date and nature of event; attending physician's name, findings, and treatment, if any; and disposition of the case. (D) Any incident which threatens the welfare, safety or health of any resident, such as psychological abuse of a resident by staff or other residents, or unexplained absence of any resident. " This requirement was not met as evidenced by: Based on interviews and record review conducted during a complaint investigation, no incident reports were sent for R1 and R2's unauthorized absences, which poses a potential health and safety risk.

Official plan of correction

Licensee agrees to review reporting requirements and send LPA Moleski a statement asserting so. vincent.moleski@dss.ca.gov

Deadline recorded: Aug 24, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87411(f)

Regulation authority

CCR

What the official deficiency says

(f) All personnel, including the licensee and administrator, shall be in good health, and physically and mentally capable of performing assigned tasks. Good physical health shall be verified by a health screening, including a chest x-ray or an intradermal test, performed by a physician not more than six (6) months prior to or seven (7) days after employment or licensure. A report shall be made of each screening, signed by the examining physician. The report shall indicate whether the person is physically qualified to perform the duties to be assigned, and whether he/she has any health condition that would create a hazard to him/herself, other staff members or residents. A signed statement shall be obtained from each volunteer affirming that he/she is in good health. Personnel with evidence of physical illness or emotional instability that poses a significant threat to the well-being of residents shall be relieved of their duties. This requirement is not met as evidenced by: Deficient Practice Statement Based on review of S2's personnel file, the licensee did not ensure S2 had proof of either a tuberculosis skin test or a chest x-ray, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/07/2023 Plan of Correction Licensee agrees to have S2 conduct another health screening, including either a tuberculosis skin test or a chest x-ray. Licensee agrees to send new health screening to LPA Moleski. vincent.moleski@dss.ca.gov

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

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: Deficient Practice Statement Based on observation of a bed bug shell and spotting on beds in a resident bedroom, the licensee did not ensure the facility was clean and/or sanitary, such that bed bugs proliferated in a resident bedroom, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/07/2023 Plan of Correction Licensee agrees to procure extermination services for bed bugs. Licensee agrees to send LPA Moleski proof of having aquired or scheduled these services by the POC due date. vincent.moleski@dss.ca.gov

Official classification

Type B

Official code

87465(a)(4)

Regulation authority

CCR

What the official deficiency says

(4) The licensee shall assist residents with self-administered medications as needed. This requirement is not met as evidenced by: Deficient Practice Statement Based on review of R4's medications, MARs, and centrally stored medication list, the licensee did not ensure accurate records of medication administrations were maintained, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/30/2023 Plan of Correction Licensee agrees to conduct a staff training regarding medication administration. Licensee agrees to send a sign-in sheet from this training to LPA Moleski. vincent.moleski@dss.ca.gov