PLC 7117 MAIN, LLC

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..... (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 was not met as evidenced by; The investigation revealed that on 01/14/2026, resident, R1 sustained a fall during a transfer by staff , S1. A review of R1’s needs and service plan documents R1 requires a 2-person physical assist and notes “always use gait belt”, which poses a immediate health and safety risks to residents in care.

Official plan of correction

Licensee/Administrator shall send a letter of understanding of this Regulation and shall conduct all staff training. All POC documents are due by 3/31/26.

Deadline recorded: Mar 31, 2026. 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

87211(a)(1)(D) -Reporting Requirement- Any incident which threatens the welfare, safety or health of any resident, such as..... This requirement is not met as evidenced by; Based on the records review and interviews, it has been determined that the facility did not report an incident where resident R1 had a fall incident while staff transfer around 01/14/26 which poses an potential health and safety risks to residents in care.

Official plan of correction

Licensee /Administrator shall send a written statement to CCL of understanding of regulation for 87211 for reporting requirements and shall do training with staff. POC documents should be sent to CCL by POC date-3/4/26.

Deadline recorded: Mar 4, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(h)(2)

Regulation authority

CCR

What the official deficiency says

87465- (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: Based on observation ,medications were left unattended and accessible to residents (R1,R2,R3) without staff's supervision which poses a immediate health, safety or personal rights risk to persons in care.

Official plan of correction

Licensee/ Administrator shall send a letter of understanding of this regulation and conduct staff training. All POC documents are due by 02/19/26.

Deadline recorded: Feb 19, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

80061(b)

Regulation authority

CCR

What the official deficiency says

80061-(b) Upon the occurrence, during the operation of the facility, of any of the events specified in (1) below, a report .... (2) below shall be submitted to the licensing agency within seven days following the occurrence of such event…. This requirement is not met as evidenced by; Based on documents reviewed, the facility did not meet reporting requirements for incidents that occurred around 08/22/24 for resident, R1 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 and shall conduct all staff training and will send proof to department within 15 days. Additionally, Administrator shall ensure to send all incidents to department in timely manner and shall keep records for sending those reports. All POC documents are due by 09/19/24.

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

Official classification

Type A

Official code

87465(c)(2)

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: (2) Once ordered by the physician the medication is given according to the physician's directions. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, staff's interviews and record review, the licensee did not comply with the section cited above as Resident ,R2, physician's order for Quietiapinel 50mg for 4 tablets daily but facility was giving 5 tablets daily and Levetiracem 500 mg order for 3 tablets daily but facility was giving 2 tablets daily .Centrally stored Log was not maintianed correctly for R2s medications. which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/21/2024 Plan of Correction Administrator shall send a letter of understanding of this Regulation by 08/21/24 to Department and shall do staff training regarding medication management and shall keep proper record of Centrally Stored Log for all medications. All POC documents are due by 08/21/24.

Official classification

Type B

Official code

87303(e)(2)

Regulation authority

CCR

What the official deficiency says

(e) Water supplies and plumbing fixtures shall be maintained as follows: (2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degrees C) and not more than 120 degree F (49 degrees C). This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and staff's interview, the licensee did not comply with the section cited above as Hot Water measured at 150-155 degree in residents' bathroom and in facility's kitchen which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/03/2024 Plan of Correction Administrator shall send letter of understanding of this Regulation and shall conduct staff's training. Facility shall ensure that hot water temperature reading is within required range per this Regulation. All POC documents are due by 09/03/24.

Official classification

Type A

Official code

87465(a)(4)

Regulation authority

CCR

What the official deficiency says

87465(a)(4) 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 evidence by: Based on records review and interviews conducted, the facility did not ensure R1 had prescribed medication. This poses an immediate health and safety risk to residents in care.

Official plan of correction

By POC date- 06/03/22, Licensee will complete a statement of understanding indicating that the facility is aware of regulation 87465 and will also complete a training regarding medication administration. Facility will submit statement of understanding and schedule for training to department by POC date-06/03/22.

Deadline recorded: Jun 3, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(a)(5)

Regulation authority

CCR

What the official deficiency says

87465(a)(5)-Incidental Medical and Dental Care-A plan for incidental medical and dental care shall be developed by each facility. The licensee shall assist residents with self-administered medications as needed. This requirement is not met as evidenced by: Based on interviews, admission and accounting, licensee did not administer medication in accordance to MD orders. Narcotic medication came up short 12 dosages when counted. This is in violation of this section. This poses an immediate health and safety risk to residents in care.

Official plan of correction

Facility has implemented a narcotic medication log, where each shift at the beginning and end of each shift will count, document the number and sign off on the number of narcotic medications remaining. ***Deficiency cleared during visit***

Deadline recorded: Oct 7, 2021. A deadline is not proof that correction was completed.