CALI CARE RETIREMENT HOME

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 record review, the licensee did not have personnel records for 3 out of the 4 files reviewed, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/03/2024 Plan of Correction Licensee agrees to have the personnel records complete by the POC date. Holly.Williams@dss.ca.gov

Official classification

Type B

Official code

87609(a)(b)(4)(A)

Regulation authority

CCR

What the official deficiency says

(a) A licensee shall be permitted to accept or retain persons who have a health condition(s) which requires incidental medical services including, but not limited to, the conditions specified in Section 87612, Restricted Health Conditions. (b)Incidental medical care may be provided to residents through a licensed home health agency provided the following conditions are met: (4)The licensee and hiome health agency agree in wreiting on the responsibilities of the home health agency, and those of the licensee in caring for the residents conditions. (A)The written agreement shall reflect the services , frequency, and duration of care. This requirement is not met as evidenced by: This requirement is not met as evidenced by: Deficient Practice Statement Based on record review the licensee did not include a care plan for the cather that the resident has which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/03/2024 Plan of Correction Licensee agrees to develop a care plan for the resident that has the catheter and email it to Holly.williams@dss.ca.gov by POC date.

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 observation, the licensee did not keep medications locked up which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/27/2024 Plan of Correction Licensee agrees lock up medication and provide training to staff. Licensee agrees to send statment by POC due date of the regulation and plan for training to be done. and send sign in sheet. Holly.williams@dss.ca.gov

Official classification

Type B

Official code

87224(a)

Regulation authority

CCR

What the official deficiency says

" The licensee may evict a resident for one or more of the reasons listed in Section 87224(a)(1) through (5). " This requirement was not met as evidenced by: Based on record review, the licensee issued an eviction notice which did not specify what needs previously not identified R1 had developed, if and/or when a reappraisal was conducted to determine if R1's level of care was insufficient, and furthermore did not identify any other legitimate cause for eviction, which poses a potential health, safety, and/or personal rights risk.

Official plan of correction

Licensee agrees to send a notice to R1's responsible party to rescind the eviction notice, and to copy LPA Moleski on the email. vincent.moleski@dss.ca.gov

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

Official classification

Type A

Official code

87355(e)(3)

Regulation authority

CCR

What the official deficiency says

(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: (3) Request a transfer of a criminal record clearance as specified in Section 87355(c) or This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview and record review, the licensee did not comply with the section cited above. Licensee did not ensure one caregiver on the premisis are associated to the facility prior to working at the facility, which poses an immediate health, safety or personal rights risk to persons in care. Two staff was not background clear in guardian, but has DOJ documents in file.

Official plan of correction

POC Due Date: 08/04/2023 Plan of Correction Licensee agrees to get the two caregiver staff associated to the facility. LIcensee will email LPA Lee two staff association by POC date 08/04/2023 by 5:00 PM end of day.

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 observation, the licensee did not comply with the section cited above. Licensee did not ensure chemical toxic are locked and made inaccessable to residents in care, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/01/2023 Plan of Correction LPA Lee observed licensee removed all chemical toxic and placed them in a locked cabinet.

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 observation, interview and record review, the licensee did not comply with the section cited above. Licensee did not ensure 1 out 5 staff had a LIC 503 Health Screening and TB completed prior to working with residents, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/11/2023 Plan of Correction Licensee agrees to make an appointment for the staff and get her Health Screening and TB complete. Licensee will email LPA Lee staff LIC 503 Health Screening and TB by POC date 08/11/2023 by 5:00 PM by end of day.

Official classification

Type B

Official code

87411(d)

Regulation authority

CCR

What the official deficiency says

(d) All personnel shall be given on the job training or have related experience in the job assigned to them. This training and/or related experience shall provide knowledge of and skill in the following, as appropriate for the job assigned and as evidenced by safe and effective job performance: This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview, and record review, the licensee did not comply with the section cited above. Licensee did not ensure 4 out of 5 files had medical training verfication in the staff file, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/11/2023 Plan of Correction Licensee agrees to have 4 of the staff attend medical training courses and email LPA Lee documents or certificate of the classes attend. Licensee will email POC to LPA Lee by 08/11/2023 by end of day by 5:00 PM.

Official classification

Type B

Official code

87465(d)(3)

Regulation authority

CCR

What the official deficiency says

(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: Deficient Practice Statement Based on observation, interview, record review, the licensee did not comply with the section cited above. Licensee did not ensure that 5 out of 5 resident's MAR sheets are accurent and current, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/11/2023 Plan of Correction Licensee agrees to talk to facility staff and train staff regarding administer medications to residents and documenting when the medications are given to residents. Licensee will review the regulation and send a statement acknowledging that facility staff understands the regulations.

Official classification

Type B

Official code

87466

Regulation authority

CCR

What the official deficiency says

87466 Observation of the Resident: The licensee shall ensure that residents are regularly observed for changes in physical, mental, emotional and social functioning and that appropriate assistance is provided when such observation reveals unmet needs. This requirement was not met as evidence by: Based on record review and interviews, the licensee did not ensure staff provided the appropriate assistance and care and supervision to meet R1's newly developed pressure injury needs. This posed a potential health and safety risk to R1.

Official plan of correction

Administrator agrees to conduct Observation of the residents training for all staff by POC date 10/25/2022. Administrator will email LPA Martinez training documents by 10/25/2022.

Deadline recorded: Oct 25, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87464(f)(1)

Regulation authority

CCR

What the official deficiency says

87464 (f) (1) Basic Services: Basic services shall at a minimum include: Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). This requirement was not met as evidence by: Based on record review and interviews, the licensee did not ensure that staff addressed R1's pressure injury and report pressure injury to R1's primary care physician and did not ensure R1 received proper pressure injury care. This posed a potential health and safety risk to R1.

Official plan of correction

Administrator agrees to conduct Basic Services training for all staff by 10/25/2022. Administrator will email LPA Martinez training documents by POC Date 10/25/2022.

Deadline recorded: Oct 25, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87463(a)(3)

Regulation authority

CCR

What the official deficiency says

87463(a)(3) Reappraisals: the pre-admission appraisal shall be updated, in writing as frequently as necessary to note significant changes...reappraisals shall document changes in the resident's physical, medical, mental, and social condition...Any illness, injury, trauma, or change in the health care needs This requirement was not met as evidence by: Based on observation, interviews and record review, the facility did not conduct a reappraisal after R1 developed a pressure injury. This posed an immediate health and safety risk to R1.

Official plan of correction

Administrator agrees to conduct a reappraisal and review change of health condition with Alta Regional Center. Administrator agrees to contact R1's Physician to report R1's change in condition. Administrator will email LPA Martinez reassessment by 10/05/2022.

Deadline recorded: Oct 5, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87507(a)

Regulation authority

CCR

What the official deficiency says

Admission Agreement (a) The licensee shall complete an individual written admissions agreement, as defined in Section 87101(a), with each resident or the resident's representative, if any. This requirement was not met as evidence by: Based on observation, interviews and record review, the facility did not ensure R1 had a completed admission agreement in their file. This posed a potential health and safety risk to R1.

Official plan of correction

Administrator agrees to complete an admission agreement for R1 by POC 10/18/2022. The administrator agrees to email the admission agreement LPA Martinez by POC Date 10/18/2022.

Deadline recorded: Oct 18, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87411(c)(1)

Regulation authority

CCR

What the official deficiency says

87411Personnel Requirements - generally RCFE (c)(1) staff who assist residents with personal activities of daily living shall receive initial and annual training as specified in Health and Safety Code sections 1569.625 and 1569.69. Staff providing care shall receive appropriate training in first aid from persons qualified by such agencies as the American Red Cross. this requirement was not met as evidence by Staff 1 did not complete First Aid training. This posed a potential health and safety risk to residents in care.

Official plan of correction

Facility staff agrees to train all staff on first aid by POC date 08/18/2022.

Deadline recorded: Aug 18, 2022. A deadline is not proof that correction was completed.