ALPINE BOARD AND CARE

Official classification

Type A

Official code

87465(c)(3)

Regulation authority

CCR

What the official deficiency says

(c) If the resident's physician has stated in writing that the resident is unable to determine his/her own need for nonprescription PRN medication, but can communicate his/her symptoms clearly, facility staff designated by the licensee shall be permitted to assist the resident with self-administration, provided all of the following requirements are met: (3) A record of each dose is maintained in the resident's record. The record shall include the date and time the PRN medication was taken, the dosage taken, and the resident's response. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview and record review, the licensee did not comply with the section cited above in one out of four resident MAR did not have record of two resident medications and the MAR was not signed on mulitple dates which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/29/2026 Plan of Correction Administrator will update each residents MAR with medication orders with friday audits. Administrator will retrain staff with importance of signitaures on the MAR after each medication pass. Administrator will notify LPA when completed training and MAR medication are updated.

Official classification

Type A

Official code

87202(a)(1)

Regulation authority

CCR

What the official deficiency says

(a) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, or the State Fire Marshal. Prior to accepting or retaining any of the following types of persons, the applicant or licensee shall notify the licensing agency and obtain an appropriate fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, or the State Fire Marshal: (1) Nonambulatory persons. This requirement is not met as evidenced by: Deficient Practice Statement Based on records reviewed, the facility did not ensure to obtain a fire clearance for more than four (4) nonambulatory residents prior to retaining more than four (4) nonambulatory residents, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/21/2024 Plan of Correction Facility is in the process of obtaining a fire clearance for six (6) nonambulatory. LPA will follow up with facility regarding status of fire clearance.

Official classification

Type A

Official code

87309(a)

Regulation authority

CCR

What the official deficiency says

(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: Deficient Practice Statement Based on observations, facility did not ensure that all disinfectants were locked and inaccessible to the residents in care, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/21/2024 Plan of Correction Facility will ensure that all disinfectants are locked and inaccessible to the residents in care. Facility locked disinfectants during visit and LPA cleared deficiency at conclusion of visit.

Official classification

Type A

Official code

87355(j)

Regulation authority

CCR

What the official deficiency says

(j) The licensee shall maintain documentation of criminal record clearances or criminal record exemptions of employees in the individual's personnel file as required in Section 87412, Personnel Records. This requirement is not met as evidenced by: Deficient Practice Statement Based on records reviewed, facility did not ensure that a criminal record clearance was obtained for one (1) staff member, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/21/2024 Plan of Correction Facility will complete a statement of understanding regarding criminal background clearances and ensure that new staff obtain a criminal background clearance before working with residents. Facility will submit statement to LPA by POC due date. A civil penalty in the amount of $500 was assessed for today's date regarding staff not having a criminal background clearance.

Official classification

Type B

Official code

1569.625(b)(1)

Regulation authority

HSC

What the official deficiency says

(1) The department shall adopt regulations to require staff members of residential care facilities for the elderly who assist residents with personal activities of daily living to receive appropriate training. This training shall consist of 40 hours of training. A staff member shall complete 20 hours, including six hours specific to dementia care, as required by subdivision (a) of Section 1569.626 and four hours specific to postural supports, restricted health conditions, and hospice care, as required by subdivision (a) of Section 1569.696, before working independently with residents. The remaining 20 hours shall include six hours specific to dementia care and shall be completed within the first four weeks of employment. The training coursework may utilize various methods of instruction, including, but not limited to, lectures, instructional videos, and interactive online courses. The additional 16 hours shall be hands-on training. This requirement is not met as evidenced by: Deficient Practice Statement Based on records reviewed, facility did not ensure that initial training was being completed for all care staff in accordance with Health and Safety code, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/09/2024 Plan of Correction Facility will ensure that initial training is completed for all staff in accordance with Health & Safety code. Facility will submit documentation of missing training to LPA by POC due date of 6/9/2024.

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 observation and records reviewed, facility did not ensure to conduct and document quarterly drills, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/09/2024 Plan of Correction Facility will ensure that quarterly drills are completed and documented at the facility. Facility will submit documentation for first quarterly drill by POC due date of 6/09/2024.

Official classification

Type B

Official code

87705(c)(4)(A)

Regulation authority

CCR

What the official deficiency says

(c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following: (4) There is an adequate number of direct care staff to support each resident's physical, social, emotional, safety and health care needs as identified in his/her current appraisal. (A) In addition to requirements specified in Section 87415, Night Supervision, 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 or observation to require awake night supervision. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and records reviewed, facility did not ensure that one (1) resident with a dementia diagnosis was receiving night supervision in accordance with their pre-admission appraisal, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/09/2024 Plan of Correction Facility will submit an updated LIC 500 to LPA indicating at least one night staff awake and on duty at night by POC due date of 6/09/2024.

Official classification

Type B

Official code

1569.683(a)

Regulation authority

HSC

What the official deficiency says

§1569.683 Eviction notices; reasons for eviction contents; service (a) In addition to complying with other applicable regulations, a licensee of a residential care facility for the elderly who sends a notice of eviction to a resident shall set forth in the notice to quit the reasons relied upon for the eviction, with specific facts to permit determination of the date, place, witnesses, and circumstances concerning those reasons. (...) This requirement is not met as evidenced by: Based on interviews conducted and records reviewed, the facility did not issue a lawful 30-day notice to R1's representative regarding eviction, which poses an potential health, safety, and personal rights risk to residents in care.

Official plan of correction

Facility will complete a statement of understanding regarding regulation 1269.683. Facility will submit statement of understanding to LPA by POC due date of 6/09/2024.

Deadline recorded: Jun 9, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87555(b)(8)

Regulation authority

CCR

What the official deficiency says

87555 General Food Service Requirements (b) The following food service requirements shall apply: (8) All food shall be of good quality. (...) Food in damaged containers shall not be accepted, used or retained. This requirement is not met as evidenced by: Based on observation, facility did not ensure food items were of good quality and stored in sealed containers, which poses a potential health, safety, and personal rights risk to the residents in care.

Official plan of correction

Facility purged food items during visit conducted on 11/29/2023. LPA observed a sufficient supply of food of good quality during all subsequent visits. LPA cleared deficiency at the conclusion of this investigation.

Deadline recorded: May 31, 2024. A deadline is not proof that correction was completed.