ALMOND GROVE ASSISTED LIVING

Official classification

Type B

Official code

87411(f)

Regulation authority

CCR

What the official deficiency says

87411(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 physical not more than six (6) months prior to or seven (7) days after employment or licensure. This requirement was not met as evidenced by: Record review indicated that facility did not complete TB test for 7 out of 8 new hired staff which get hired from August to September 2025 which poses potential health and safety risks to residents in care.

Official plan of correction

Administrator shall send a letter of understanding of this Regulation. The facility will ensure that all staff have a physical exam and TB test as per Regulation timelines. POC due date is 01/15/26.

Deadline recorded: Jan 15, 2026. 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

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 incident report and staff interview, it was concluded that administered wrong medications to resident, R1 which poses an immediate health and safety risk to residents in care.

Official plan of correction

Administrator shall conduct staff training for medication management and to send into CCL a copy of the training by POC date- 10/07/25.

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

Official classification

Type A

Official code

87468.2(a)(4)

Regulation authority

CCR

What the official deficiency says

87468.2-Additional Personal Rights of Residents in Privately Operated Facilities (a)-In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (4) To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs…this requirement is not met as evidenced by; Based on gathered information, it has been concluded that facility did not provide proper care of supervision to resident, R1 on 11/02/24 resulting R1 leaving the facility unattended which pose a immediate risk to health and safety of residents in care.

Official plan of correction

Licensee /Administrator shall submit a letter of understanding of this regulation and will do all staff training regarding this incident. Furthermore, facility shall submit written plan to provide proper care and supervision for residents with elopement risk. All POC documents are due by POC date-11/27/24. In addition, facility shall conduct monthly training with staff till January 2025 and send copy of those documents to Department.

Deadline recorded: Nov 27, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87211(a)

Regulation authority

CCR

What the official deficiency says

87211 Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports as the Department [...]: (1) A written report shall be submitted to the licensing agency and to the person responsible for the resident [...] (D) Any incident which threatens the welfare, safety or health of any resident [...]..This requirement is not met as evidenced by: Based on interviews and records review, the facility did not comply with the section cited above by not reporting incidents which threatened the welfare of residents, R1 and R2. This poses a potential health, safety, and/or personal rights risk to residents in care.

Official plan of correction

Licensee /Administrator to review section 87211- Reporting Requirements and send a letter of understanding to Community Care Licensing and will conduct staff training. Additionally, licensee to ensure incident reports are filled out and faxed to CCL with confirmation. All POC documents are due by 08/01/24.

Deadline recorded: Aug 1, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87468.2(a)(4)

Regulation authority

CCR

What the official deficiency says

87468.2-Additional Personal Rights of Residents in Privately Operated Facilities (a)-In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (4) To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs…this requirement is not met as evidenced by; Based on gathered information, it has been concluded that facility did not provide proper care of supervision to resident, R1 on 06/23/24 resulting R1 leaving the facility unattended which pose a immediate risk to health and safety of residents in care.

Official plan of correction

Licensee /Administrator shall submit a letter of understanding of this regulation and will do all staff training regarding this incident. Furthermore, facility shall submit written plan to provide proper care and supervision for residents with elopement risk. All POC documents are due by POC date-07/19/24.

Deadline recorded: Jul 19, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87705(f)(2)

Regulation authority

CCR

What the official deficiency says

(f) The following shall be stored inaccessible to residents with dementia: (2) Over-the-counter medication, nutritional supplements or vitamins, alcohol, cigarettes, and toxic substances such as certain plants, gardening supplies, cleaning supplies and disinfectants. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, LPA observed second door of laundry room which contained chemicals and cleaning supplies was accessible to residents in care which poses an immediate health, safety risk to persons in care.

Official plan of correction

POC Due Date: 03/28/2024 Plan of Correction Administrator shall submit a letter of understanding of this regulation and will train all staff regarding this regulation. All POC documents are due to LPA by 03/28/24.

Official classification

Type B

Official code

87412(c)

Regulation authority

CCR

What the official deficiency says

(c) Licensees shall maintain in the personnel records verification of required staff training and orientation. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, the licensee did not comply with the section cited above in 2 out of 5 staff files did not have initial training upon hire, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/26/2024 Plan of Correction Administrator shall ensure all staff have required initial training upon hire in staff records as required per this regulation. Facility shall send proof to department upon completion by POC due date 04/26/24

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 record review, the licensee did not comply with the section cited above in 4 out 5 staff do not have first aid certification as required which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/26/2024 Plan of Correction Administrator shall ensure all staff have required first aid training upon hire as required by this regulation. Facility shall send proof to department upon completion by POC due date 04/26/24

Official classification

Type B

Official code

87457(c)

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. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, the licensee did not comply with the section cited above in 3 out of 5 residents do not have LIC621 which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/26/2024 Plan of Correction Administrator shall complete pre- appraisal (LIC621) for all residents files and will send proof to the department by POC due date 04/26/24

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 record review, the licensee did not comply with the section cited above in 2 out 2 residents with DX dementia do not have updated LIC602 and reappraisal as required which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/26/2024 Plan of Correction Administrator shall complete LIC602 and reappraisal for all residents with DX dementia as required and will send proof to the department by POC due date 04/26/24

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 record review, the licensee did not comply with the section cited above in 4 out 5 staff do not have a health screening and TB which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/26/2024 Plan of Correction Administrator shall ensure that health screening and TB are completed for all staff files as required by this regulation. Facility will submit proof to the department by POC date 04/26/24

Official classification

Type B

Official code

87470(b)(3)

Regulation authority

CCR

What the official deficiency says

87470 Infection Control Requirements (b((3)-- (b) In addition to subsection (a), when one or more residents in the facility are diagnosed with a communicable disease, the following shall apply:(3) There shall be separation and care of residents whose illness requires separation, including quarantine or isolation, from others.This requirement is not met as evidence by, Facility did not separate R1 from R2 when R2 tested positive for covid-19 in December 2022 as required by above stated section which poses a potential health risks to residents in care for their health and safety.

Official plan of correction

Licensee/administrator will review regulation 87470 for Infection Control Requirements and complete a statement of understanding to Department. Facility will submit proof of submission and statement of understanding to Department by POC due date by 05/03/23.

Deadline recorded: May 3, 2023. A deadline is not proof that correction was completed.