SUMMERSET ASSISTED LIVING

Official classification

Type B

Official code

87468.2

Regulation authority

CCR

What the official deficiency says

Additional Personal Rights of Residents in Privately Operated Facilities (a) In addition to 87468.1, ...the elderly shall have all of the following personal rights:(1) To have ...in accommodations, medical treatment, personal care and assistance, visits, communications, telephone conversations... The licensee did not ensure that the above regulation was met when: Based on personal observations and interviews, mail for residents in memory care was being held until conservators could pick it up. This posed a potential threat to the health safety and personal rights of residents in care.

Official plan of correction

ED stated that a training will be held with all medication technicians by 5/30/25 regarding what mail should be delivered and what shoudl be held for responsible parties. ED will submit a outline of training along with signature sheets for participants to CCLASCPSacrementoRO@dss.ca.gov

Deadline recorded: May 30, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87608(a)(5)

Regulation authority

CCR

What the official deficiency says

" (5) Under no circumstances shall postural supports include tying, depriving, or limiting the use of a resident's hands or feet. " This requirement was not met as evidenced by: Based on interview and observation, a resident (R1) was limited in the use of their hands by large padded mittens, which poses an immediate health, safety, and/or personal rights risk.

Official plan of correction

Licensee agrees to provide LPA Moleski with a written plan regarding the use of these supportive devices, either discontinuance or requesting an exception from CCLD by POC due date. vincent.moleski@dss.ca.gov

Deadline recorded: Jan 29, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87468.1(a)(2)

Regulation authority

CCR

What the official deficiency says

“Residents in all residential care facilities for the elderly shall have all of the following personal rights: … To be accorded safe, [and] healthful … accommodations…” This requirement was not met as evidenced by: Based on interviews and record review, no fall prevention plan was developed or implemented for R1, despite suffering numerous falls between 9/10/18 and 11/10/23, which poses an immediate health, safety, and/or personal rights risk.

Official plan of correction

Licensee agrees to develop a written fall prevention plan for R1 by POC due date. Vincent.moleski@dss.ca.gov

Deadline recorded: Jul 2, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(g)

Regulation authority

CCR

What the official deficiency says

“(g) The licensee shall immediately telephone 9-1-1 if an injury or other circumstance has resulted in an imminent threat to a resident’s health…” This requirement was not met as evidenced by: Based on interviews and record review, R1 physician was not notified after suffering a fall on 7/19/23 which re-opened a surgical wound, and immediate professional medical attention was not provided for this wound, which poses an immediate health, safety, and/or personal rights risk.

Official plan of correction

Licensee agrees to conduct a staff training regarding injury response procedures and will send LPA Moleski an agenda of training topics by POC due date and a sign in sheet after completion. Vincent.moleski@dss.ca.gov

Deadline recorded: Jul 2, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87211(a)(1)(B)

Regulation authority

CCR

What the official deficiency says

“(1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below.... (B) Any serious injury as determined by the attending physician and occurring while the resident is under facility supervision.” This requirement was not met as evidenced by: Based on interviews and record review, R1’s RP was not notified after R1 suffered a fall on 7/19/23, and an incident report was not submitted to licensing, which poses a potential health, safety, and/or personal rights risk.

Official plan of correction

Licensee agrees to conduct a staff training regarding reporting requirements and will send LPA Moleski an agenda of training topics by POC due date and a sign in sheet after completion. Vincent.moleski@dss.ca.gov

Deadline recorded: Jul 15, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87464(f)(4)

Regulation authority

CCR

What the official deficiency says

“(f) Basic services shall at a minimum include: … (4) Personal assistance and care as needed by the resident…” This requirement was not met as evidenced by: Based on interviews, sufficient personal assistance and care with regard to nail care was not provided to R1, which poses a potential health, safety, and/or personal rights risk.

Official plan of correction

Licensee agrees to provide a written plan regarding nail care and podiatry care by POC due date. Vincent.moleski@dss.ca.gov

Deadline recorded: Jul 15, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

Maintenance and Operation 87303 (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include... services and procedures for the safety and well-being of residents, employees and visitors. The Licensee did not meet the above requirement as evidenced by: Based on a records review, interviews, and observations, there were no housekeeping services assigned on 3.5 days out of 7. Care staff scheduled were not able to immediately clean and disinfect when accidents happened, and 1 out 3 rooms observed needed to be cleaned.

Official plan of correction

Administrator has already increased housekeeping hours in memory care. This POC has been cleared.

Deadline recorded: Jun 22, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87303(i)(1)(A)

Regulation authority

CCR

What the official deficiency says

Maintenance and Operation 87303 (i) Facilities shall have signal systems...(1) All facilities...16 or more...shall have a signal system which shall: (A) Operate from each resident's living unit. The Licensee did not meet the above requirement as evidenced by: Based on interviews and observations, none of the residents were provided call pendants and the did not have call alerts in their living spaces, only in the bathrooms. The unit in R1's bathroom was inoperable because the cord was wrapped around the unit.

Official plan of correction

Administrator will provide LPA with a list of all Memory Care residents with call pendants/ room buttons and a roster for comparison. This information will be emailed to kimberly.viarella@dss.ca.gov by 6/22/24.

Deadline recorded: Jun 22, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87470(2)(A)

Regulation authority

CCR

What the official deficiency says

Infection Ctrl Requirements: 87470(2)(A) (2) Environmental cleaning & disinfection activities... (A) Surfaces ...shall be sani-tary ... soiled with blood or body fluids or other potentially infectious material. The Licensee did not meet the above requirement as evidenced by: Based on interviews, 2 of 3 staff members stated the restrooms in the common areas were not being cleaned and disinfected between resident use.

Official plan of correction

Administrator has already stocked disinfecting and cleaning solutins in a locked cabinet in each common area bathroom and completed a re-training on handwashing. This POC has been cleared.

Deadline recorded: Jun 22, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87615(a)(1)

Regulation authority

CCR

What the official deficiency says

Prohibited Health Cond: 87615(a)(1) (a) Persons ... shall not be admitted or retained in a residential care facility for the elderly: (1) Stage 3 and 4 pressure injuries. The Licensee did not meet the above requirement as evidenced by: R1 was a resident the care at Summerset Assisted Living diagnosed with a stage 3 pressure injury, which by regulation, is a prohibited health condition.

Deadline recorded: Jun 22, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(a)(1)

Regulation authority

CCR

What the official deficiency says

Incidental Medical & Dental: 87465(a)(1) (a) A plan for incidental medical and dental care shall be developed... (1) The licensee shall arrange, or assist in arranging, for medical ...appropriate to...needs of residents. The Licensee did not meet the requirements above as evidenced by: Based on a review of medical records, shower and communication logs, interviews and photographs, the facility did not send R1 out for medical assessment and treatment of a pressure injury in an appropriate and timely manner resulting in it becoming a stage 3 pressure injury.

Official plan of correction

Administrator has hired a new Director of Memory Care, (start date 4/16/24). Administrator has scheduled an in-service with First Call Hospice to train on pressure wounds and injuries on 7/8/24. This POC has been cleared.

Deadline recorded: Jun 22, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87470(b)(2)(A)

Regulation authority

CCR

What the official deficiency says

" (A) The licensee shall consult with a medical professional, local health official, health department, or other research-based medical authority to determine the type of PPE to be used based on the contagious disease present in the facility. " This requirement was not met as evidenced by: Based in interview, Barry admitted not having contacted public health or other like public health authority for guidance on the use of PPE, which poses an immediate health and safety risk.

Official plan of correction

Licensee agrees to contact public health by POC due date for guidance on PPE use, and other guidance as required by Title 22. Licensee shall include LPA Moleski in correspondence with public health. vincent.moleski@dss.ca.gov

Deadline recorded: Apr 16, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87470(b)(2)

Regulation authority

CCR

What the official deficiency says

" (2) All staff and volunteers providing direct care to a resident who has a contagious disease shall wear appropriate Personal Protective Equipment (PPE) to prevent exposure to infectious agents or chemicals through the respiratory system, skin, or mucous membranes of the eyes, nose, or mouth. PPE may include gloves, gowns, masks, respirators, shoe coverings and eye protection. " This requirement was not met as evidenced by: Based on observation, S2 and S3 were not wearing gowns, which are appropriate to prevent the spread of scabies, which poses an immediate health and safety risk.

Official plan of correction

Licensee agrees to immediately implement the use of gowns when caring for R2. Licensee shall provide photos of PPE stations to LPA Moleski by POC due date. vincent.moleski@dss.ca.gov

Deadline recorded: Apr 16, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87470(b)(2)(B)

Regulation authority

CCR

What the official deficiency says

" (B) PPE shall be removed and discarded in the nearest appropriate waste receptacle with a tight-fitting cover immediately following the assisting with direct care for each resident. " This requirement was not met as evidenced by: Based on observation, staff members discarded used PPE in uncovered waste receptacles, which pose an immediate health and safety risk.

Official plan of correction

Licensee agrees to conduct a staff training regarding the proper use of PPE by POC due date. Licensee shall provide LPA Moleski a copy of the staff sign-in sheet. vincent.moleski@dss.ca.gov

Deadline recorded: Apr 16, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87224(d)

Regulation authority

CCR

What the official deficiency says

" (d) The licensee 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 was not met as evidenced by: Based on record review, R1 was served an unlawful eviction notice, which poses a potential health, safety, and/or personal rights risk.

Official plan of correction

Licensee agrees to rescind the eviction notice, and to send notice of having rescinded the notice to the resident and/or resident's responsible parties by the POC due date.

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

Official classification

Type A

Official code

87355(e)(2)

Regulation authority

CCR

What the official deficiency says

" 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: ... (2) Request a transfer of a criminal record clearance as specified in Section 87355(c) ... " This requirement was not met as evidenced by: Based on review of Guardian records and interview with Barry, Barry was not associated before starting work at this facility, which poses an immediate health and safety risk.

Official plan of correction

Licensee agrees to either associate Barry through Guardian or submit appropriate transfer documents to sacasctransferrequest@dss.ca.gov by the POC due date. Licensee shall send LPA Moleski a copy of the updated roster and/or cc LPA Moleski on the email to sacasctransferrequest.dss.ca.gov. vincent.moleski@dss.ca.gov

Deadline recorded: Feb 22, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87411(a)

Regulation authority

CCR

What the official deficiency says

" (a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. In facilities licensed for sixteen or more, sufficient support staff shall be employed to ensure provision of personal assistance and care as required in Section 87608, Postural Supports. Additional staff shall be employed as necessary to perform office work, cooking, house cleaning, laundering, and maintenance of buildings, equipment and grounds. The licensing agency may require any facility to provide additional staff whenever it determines through documentation that the needs of the particular residents, the extent of services provided, or the physical arrangements of the facility require such additional staff for the provision of adequate services. " This requirement was not met as evidenced by: Based on interviews, observations, and record review, staffing was not sufficient to meet the needs of residents, which poses an immediate health, safety and/or personal rights risk.

Official plan of correction

Licensee agrees to develop a written plan addressing staffing needs at this facility, which shall rectify the insufficient staffing levels as described in this report. Licensee shall send a copy of this plan to LPA Moleski by the POC due date. vincent.moleski@dss.ca.gov

Deadline recorded: Feb 2, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87464(f)(4)

Regulation authority

CCR

What the official deficiency says

" (f) Basic services shall at a minimum include: ... Personal assistance and care as needed by the resident ... with those activities of daily living such as ... bathing ... " This requirement was not met as evidenced by: Based on interviews and record review, bathing services were not provided as needed and/or as indicated on resident assessments, which poses an immediate health, safety, and/or personal rights risk.

Official plan of correction

Licensee agrees to develop a written plan addressing bathing needs. Licensee agrees to send LPA Moleski a copy of this plan by POC due date. vincent.moleski@dss.ca.gov

Deadline recorded: Feb 2, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.2(a)(25)

Regulation authority

CCR

What the official deficiency says

Additional Personal Rights of Residents in Privately Operated Facilities: To protection of their property from theft or loss according to Health and Safety Code sections 1569.152, 1569.153, and 1569.154. This requirement was not met as evidenced by resident's family's allegation and corroborated by staff interviews that former residents clothing and items brought to the facility were not able to me maintained from loss which poses a potential health safety and personal rights risk to residents in care.

Official plan of correction

Facility has agreed to submit an updated Facility theft/loss program for licensing to review to ensure resident's property is maintained according to regulations.

Deadline recorded: Oct 21, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

Not listed

Regulation authority

Not listed

What the official deficiency says

87705(f)(2)Care of Persons with Dementia: The following shall be stored inaccessible to residents with dementia: 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 was not met as evidence by: Based on observation, toxins were made accessible to Dementia residents on the second floor. This posed an immediate health and safety risk to residents in care.

Deadline recorded: Jun 29, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87405(d)(2)

Regulation authority

CCR

What the official deficiency says

Administrator - Qualifications and Duties: (d) The administrator shall have the qualifications specified in Sections 87405(d)(1) through (7). If the licensee is also the administrator, all requirements for an administrator shall apply. (2) Knowledge of and ability to conform to the applicable laws, rules and regulations. This requirement was not met as evidenced by the facilities non-compliance with Department regulations and Public Health orders including staff testing and obtaining staff vaccination exemptions.

Official plan of correction

The facility must be in compliance with Public Health orders by POC due date. A written plan will be submitted to the department indicating what steps the facility will take to ensure the Administrator can obtain compliance with public health orders.

Deadline recorded: Dec 24, 2021. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

1569.50(a)(3)

Regulation authority

HSC

What the official deficiency says

On 12/13/21, administrator failed to protect the personal rights of clients in care to receive safe and healthful accommodations and engaged in conduct inimical to the health, welfare, and safety of clients in care, in that facility staff failed to wear face coverings while working in the licensed facility, in violation of official government orders requiring the wearing of face coverings while working under specified conditions. This requirement was not met as evidenced by LPA Tung observing several staff members without appropriate PPE which poses an immediate health, safety and personal rights risk for residents in care.

Official plan of correction

Facility must be in compliance with COVID 19 Public Health orders by the POC due date and submit a written plan to ensure the facility is in compliance with public health orders and ensure all staff are wearing appropriate PPE at all times in the facility.

Deadline recorded: Dec 24, 2021. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87468.1(a)(2)

Regulation authority

CCR

What the official deficiency says

Personal Rights of Residents in All Facilities: To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This Requirement was not met as evidenced by statements obtained from Administrator stating the facility does not maintain a record of staff vaccination exemptions and has not met requirements for testing unvaccinated staff members which poses an immediate health, safety and personal rights risk to residents in care.

Official plan of correction

Facility must be in compliance with COVID 19 Public Health orders by the POC due date and submit to the department documentation of staff vaccination exemptions and a written plan stating how the facility plans to obtain compliance with testing of unvaccinated staff and obtain staff vaccination exemptions.

Deadline recorded: Dec 24, 2021. A deadline is not proof that correction was completed.