SPRING GLEN ELDERLY CARE VILLA

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 LPA's observations, the facility did not ensure that medications were kept in a safe and locked place when medications were observed to be accessible to residents in staff bedroom, which poses an immediate health, safety, and personal rights risk to the residents in care.

Official plan of correction

POC Due Date: 06/18/2026 Plan of Correction Facility will ensure that all medications at the care home are kept in a safe and locked place. Facility will complete an in-service training for all care staff regarding resident safety. Facility will submit training date and materials to LPA by POC due date of June 18, 2026. Facility will submit proof of training to LPA once completed.

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

(a) 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 LPA's observations, the facility did not ensure the premises was clean and in good repair, including backyard fence in disrepair, debris in backyard, interior floors in disrepair, dishes in kitchen sink, and dish washer in disrepair, which poses a potential health, safety, and personal rights risk to the residents in care.

Official plan of correction

POC Due Date: 07/16/2026 Plan of Correction Facility will repair fence, interior floors, and dish washing machine. Facility will also clean debris from backyard area and ensure dishes in kitchen sink are cleaned. Facility will provide proof that all items listed above have been addressed by POC due date July 16, 2026.

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: Based on LPAs' observations and records reviewed, facility did not ensure that staff received initial training and documentation for initial training was maintained at the facility, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Facility will ensure to complete initial training for all newly hired staff and maintain documentation for training at the facility at all times. Facility will complete initial training for any staff missing initial training and submit documentation for initial training to LPA by POC due date of 9/25/2024. A civil penalty in the amount of $250 was assessed for repeat violation.

Deadline recorded: Sep 25, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87555(b)(26)

Regulation authority

CCR

What the official deficiency says

87555 General Food Service Requirements (b) The following food service requirements shall apply: (26) Supplies of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days shall be maintained on the premises. This requirement is not met as evidenced by: Based on LPAs' observations, facility did not ensure to have a seven (7) day nonperishable food supply on cite, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Facility will ensure to have a two (2) day perishable and seven (7) day nonperishable food supply on cite. Licensee will complete a statement of understanding regarding regulation 87555 and submit statement to LPA by POC due date of 9/25/2024.

Deadline recorded: Sep 25, 2024. A deadline is not proof that correction was completed.

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: Based on LPAs' observations, the facility did not ensure that storages for disinfectants, cleaning solutions, and knives were locked and inaccessible to the residents at all times, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

Facility will conduct an in-service training for staff regarding regulation 87309. Facility will submit date of training and materials to LPA by POC due date of 9/11/2024. A civil penalty in the amount of $250 was assessed for repeat violation.

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

Official classification

Type A

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: Based on LPAs' observations and records reviewed, facility did not ensure to document medications on Centrally Stored Medication Forms for all residents with some medications having no identifiable start date, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

Facility will complete a weekly medication audit and document audit for the next month. Facility will submit documentation for weekly audit to LPA each week. A civil penalty in the amount of $250 was assessed for repeat violation.

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

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 LPA's observations, the facility did not ensure that storage for disinfectants, cleaning solutions, knives, and other hazardous items were locked and inaccessible to the residents at all times, including shed in backyard area, storage in kitchen area, and storage in laundry room, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/20/2024 Plan of Correction Facility will ensure that all storage for hazardous items is locked at all times and hazardous items are inaccessible to residents at all times. Administrator will complete a statement of understanding regarding regulation 87309 and submit statement to LPA by POC due date of 6/20/2024.

Official classification

Type A

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 LPA's observations and records reviewed, facility did not ensure to document medications on Centrally Stored Medication Forms for all residents with some medications having no identifiable start date, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/20/2024 Plan of Correction Facility will ensure that Centrally Stored Medication Forms are completed for all residents to identify start dates for all medications administered. Administrator will complete a statement of understanding regarding regulation 87465 and submit statement to LPA by POC due date of 6/20/2024.

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 LPA's observations, facility did not ensure that medication room was locked and inaccessible to the residents at all times, and medications stored in refrigerator were accessible to the residents, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/20/2024 Plan of Correction Facility will ensure that medication room is locked and inaccessible to the residents at all times and medications stored in refrigerator are locked and inaccessible to the residents. Administrator will complete a statement of understanding regarding regulation 87465 and submit statement to LPA by POC due date of 6/20/2024.

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 LPA's observation, facility did not ensure that debris was cleared from backyard area, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/01/2024 Plan of Correction Facility will ensure that debris is cleared from backyard area by POC due date of 7/1/2024.

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 LPA's observation and records reviewed, facility did not ensure that there was a staff member with CPR training at the facility at all times, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/05/2024 Plan of Correction Facility will ensure that there is at least one (1) staff member at the facility at all times with CPR training. Administrator will complete a statement of understanding regarding regulation 1569.618 and submit statement to LPA by POC due date of 7/5/2024.

Official classification

Type B

Official code

1569.618(a)

Regulation authority

HSC

What the official deficiency says

(a) The administrator designated by the licensee pursuant to paragraph (11) of subdivision (a) of Section 1569.15 shall be present at the facility during normal working hours. A facility manager designated by the licensee with notice to the department, shall be responsible for the operation of the facility when the administrator is temporarily absent from the facility. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA's observations and records reviewed, facility did not ensure that an individual who can act as the Administrator or house manager was present at the facility during business hours, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/05/2024 Plan of Correction Facility will update an LIC 500 with Administrator and house manager hours and submit to LPA by POC due date of 7/5/2024.

Official classification

Type B

Official code

87412(a)(11)

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: (11) A health screening as specified in Section 87411, Personnel Requirements - General. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA's observations and records reviewed, facility did not ensure that health screenings were completed for all staff, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/05/2024 Plan of Correction Facility will complete a health screening for all care staff and maintain documentation at the facility at all times. Facility will submit documentation for health screenings to LPA by POC due date of 7/5/2024.

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 LPA's observations and records reviewed, facility did not ensure that staff received initial training and documentation for initial training was maintained at the facility, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/05/2024 Plan of Correction Facility will ensure to complete initial training for all newly hired staff and maintain documentation for training at the facility at all times. Facility will complete initial training for any staff missing initial training and submit documentation for initial training to LPA by POC due date of 7/5/2024.

Official classification

Type B

Official code

87411(c)(1)

Regulation authority

CCR

What the official deficiency says

(1) Staff providing care shall receive appropriate training in first aid from persons qualified by such agencies as the American Red Cross. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA's observation and records reviewed, facility did not ensure that all care staff received first aid training, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/05/2024 Plan of Correction Facility will ensure that all care staff receive training in first aid and documentation for training is maintained at the facility at all times. Facility will submit proof of first aid training for all care staff by POC due date of 7/5/2024.

Official classification

Type B

Official code

87506(b)(16)

Regulation authority

CCR

What the official deficiency says

(b) Each resident's record shall contain at least the following information: (16) Records of resident's cash resources as specified in Section 87217, Safeguards for Resident Cash, Personal Property, and Valuables. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA's observations and records reviewed, facility did not ensure that all residents in care had a safeguard for personal property and valuables, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/05/2024 Plan of Correction Facility will ensure to complete a safeguard of resident personal property and valuables and cash resources (if applicable) for all residents at the facility and maintain documentation at the facility at all times. Facility will submit safeguard forms to LPA by POC due date of 7/5/2024.

Official classification

Type A

Official code

87203

Regulation authority

CCR

What the official deficiency says

87203 Fire Safety - All facilities shall be maintained in conformity with the regulations adopted by the State Fire Marshal for the protection of life and property against fire and panic. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA's observations, three fire exits (exits 3, 4, and 6) were obstructed, smoke alarm in room #3 was inoperable, and fire extinguisher wasn't serviced, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/20/2024 Plan of Correction Facility will service fire extinguisher, repair smoke alarm in room #3, and clear all fire exits by POC due date of 6/20/2024. An immediate civil penalty of $500 was assessed due to a fire clearance violation.

Official classification

Type A

Official code

87202(a)(2)

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: (2) Bedridden persons This requirement is not met as evidenced by: Deficient Practice Statement Based on records reviewed, facility did not ensure that they had a fire clearance for bedridden persons before accepting and retaining a resident who was considered bedridden according to their LIC 602A, which poses an immediate health, safety, and personal rights risk to the residents in care.

Official plan of correction

POC Due Date: 07/21/2023 Plan of Correction Facility is in the process of obtaining fire clearance to accept and retain two (2) bedridden residents. LPA will follow up with facility regarding status of fire clearance.

Official classification

Type B

Official code

87506(e)

Regulation authority

CCR

What the official deficiency says

87506 Resident Records (e) Original records or photographic reproductions shall be retained for a minimum of three (3) years following termination of service to the resident.This requirement is not met as evidenced by: Based on interview conducted with Administrator, records for resident (R1) were not maintained at the facility following resident moving out on 1/24/22, which posed a potential health and safety risk to residents in care.

Official plan of correction

Licensee/Administrator agrees to read Regulation 87506 and provide the Department with a signed statement that it is understood. Statement to be faxed to the Department by 6/15/22.

Deadline recorded: Jun 15, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87465(d)(3)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care(d) If the resident is unable to determine his/her own need for a prescription or nonprescription PRN medication, and is unable to 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) The date and time the PRN medication was taken, the dosage taken, and the resident's response shall be documented and maintained in the resident's facility record. This requirement is not met as evidenced by: Based on record review and interviews conducted, the Licensee did not ensure that the facility maintained a record of PRN medications administered for Alpharazolam 0.5mg for resident (R3), which poses a potential health and safety risk to residents in care.

Official plan of correction

LIcensee/administrator agree to conduct staff training oni documentation of PRN medication. Documentation to be provided to department bt 6/10/22.

Deadline recorded: May 30, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87465(a)(4)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care(a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following: (4) The licensee shall assist residents with self-administered medications as needed. This requirement is not met as evidenced by: Based on documentation review, medications were not administered for residents, R2 and R3, per physician's orders, as medication exhausted before a refill was obtained. Additionally, MAR does not document that R3 received Atorvastatin-Calcium 40 mg, or Melatonin 10mg as ordered, which poses a potential health and safety risk to residents in care.

Official plan of correction

Licensee/Administrator agree to conduct medication management training to all staff, including correct documentation on MAR, LIC622, PRN, refill process. Administrator agrees to audit the remaining (3) resident files to ensure there are no discrepancies between doctor orders and medication being administered. Documentation of training- including topics discussed and staff who attended to be faxed to the department by 6/10/22.

Deadline recorded: Jun 10, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87457(c)(1)

Regulation authority

CCR

What the official deficiency says

(c) Prior to admission a determination of the prospective resident's suitability for admission shall be completed and shall include an appraisal of his/her individual service needs in comparison with the admission criteria specified in Section 87455, Acceptance and Retention Limitations. (1) The appraisal shall include, at a minimum, an evaluation of the prospective resident's functional capabilities, mental condition and an evaluation of social factors as specified in Sections 87459, Functional Capabilities and 87462 Social Factors.This requirement is not met as evidenced by: Based on interview with Administrator, the Licensee did not ensure that resident (R1) was evaluated in person prior to admission on 1/22/22, which posed a potential health and safety risk to residents in care. ,

Official plan of correction

Licensee/Administrator agrees to read Regulation 87457 and provide a signed statement to the department that it is undestood. Due by 6/10/22.

Deadline recorded: Jun 10, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87355(e)(1)

Regulation authority

CCR

What the official deficiency says

87355 Criminal Record Clearance (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: (1) Obtain a California clearance or a criminal record exemption as required by the Department. This requirement is not met as evidenced by: Based on interviews conducted and documentation reviewed, the Licensee did not ensure that staff (S1/S2) obtained a criminal record clearance prior to working, residing, volunteering at the facility, which posed an immediate health and safety risk to residents in care.

Official plan of correction

Staff S1 obtained a criminal record clearance on 2/8/2022 and has been associated effective 2/8/2022 to the faciilty. S2 no longer works/volunteers at the facility as of 2/7/2022. Licensee/Administrator agree to read regulation 87355 and submit a signed statement to the department by fax, by 2/10/2022, that it is understood.

Deadline recorded: Feb 10, 2022. A deadline is not proof that correction was completed.