TRAJAN VILLA CARE HOME

Official classification

Type B

Official code

87211(a)(1)(D)

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 was not met as evidenced by: Based on interviews and records review, the facility did not comply with the section cited above by not reporting incident which threatened the welfare of R1. This poses a potential health, safety, and/or personal rights risk to residents in care.

Official plan of correction

Licensee to review section 87211 Reporting Requirements and send a letter of understanding to Community Care Licensing. Additionally, licensee to ensure incident reports are filled out and faxed to CCL with confirmation. All POC documents are due by 05/05/24.

Deadline recorded: May 5, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

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 facility observations, LPA observed cleaning products and laundry detergent were left open and accessible to residents in laundry area which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/05/2024 Plan of Correction Licensee/administartor shall send letter of understanding of this regulation and shall conduct staff training regarding this matter . POC documents shall be send to depratment by POC date-04/05/24.

Official classification

Type B

Official code

87412(a)

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: This requirement is not met as evidenced by: Deficient Practice Statement Based on staff interviews and record review, LPA found out that staff,S2 was fingerprint cleared but was not associated to facility and facility does not have paperwork or file for S2 which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/19/2024 Plan of Correction Licensee/administrator shall ensure that staff,S2 or any other staff is associated to facility and complete staff's file for all required documents by this regulation before any staff working at facility. All POC documents are due by 04/19/24.

Official classification

Type B

Official code

87506(b)

Regulation authority

CCR

What the official deficiency says

(b) Each resident's record shall contain at least the following information: This requirement is not met as evidenced by: Deficient Practice Statement Record review and staff interviews indicated that facility does not have pre-admission appraisal, needs and service plan, ID form, Consent form, Residents rights form,Personal belongings form and other required documents per this regulation in resident, R1 file who got admitted on 03/09/24, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/19/2024 Plan of Correction Licensee/administartor shall complete pre-admission appraisal, needs and service plan, ID form, Consent form, Residents rights form,Personal belongings form and other required documents per this regulation in resident, R1 file and will send copy to department upon completion. All POC documents are due by 04/19/24.