SACRAMENTO SENIOR LIVING II

Official classification

Type B

Official code

87405(a)

Regulation authority

CCR

What the official deficiency says

87405 Administrator - Qualifications and Duties (a) All facilities shall have a qualified and currently certified administrator. The licensee and the administrator may be one and the same person… and shall be on the premises a sufficient number of hours to permit adequate attention to the management and administration of the facility... This requirement was not met as evidenced by: The licensee did not ensure a qualified facility administrator was present at the facility as required. Interviews revealed that the administrator was not present at the facility for the minimum required hours necessary to oversee facility operations.

Official plan of correction

The licensee will submit a statement of acknowledgement of the regulation cited. Additionally, the licensee will designate a facility administrator approved by CCLD, update the facility LIC 500 Personnel Report, and LIC 308 Designation of Facility Responsibility. Licensee will email administrator.. documents, LIC 308, LIC 500 to LPA by 06/29/2026.

Deadline recorded: Jun 29, 2026. 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 may require...(1)A written report shall be submitted to the licensing agency... for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below. This requirement was not met as evidenced by: The licensee did not ensure that a written report was provided to the Dept as required after (1)occurrences in which resident (R1) eloped from the facility.

Official plan of correction

The licensee will ensure the facility remains in compliance with Title 22 regulations 87211 at all times. The licensee agrees to submit written reports within 7 days for any occurrence in the facility which threatens the health, safety, and welfare of residents in care.

Deadline recorded: Feb 13, 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 Requirements (a) Each licensee shall furnish to the licensing agency such reports as the Department may require... (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… (D) Any incident which threatens the welfare, safety or health of any resident, such as psychological abuse of a resident by staff or other residents, or unexplained absence of any resident. This requirement was not met as evidence by: Based on interviews and record review an incident report was not reported to CCLD after R1 left the facility unsupervised and was brought back to the facility by law enforcement which poses a potential health, safety, and/or personal rights risk.

Official plan of correction

Licensee agrees to send LPA Hughes an incident report, and to review the applicable 22 CCR sections regarding reporting requirements, and to send LPA a signed Hughes statement acknowledging these requirements by POC due date 05/24/25 end of day 5:00 PM.

Deadline recorded: May 24, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87464(f)(1)

Regulation authority

CCR

What the official deficiency says

87464(f)(1) Basic Services (f) Basic services shall at a minimum include: (1) Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). This was not met as evidenced by: Based on records review, and interview with the administrator and care giver the facility did not ensure staff provide care and supervision to R1. Due to not providing care and supervision, R1 left the facility unassisted. This posed an immediate risk to residnets in care.

Official plan of correction

Administrator agrees to conduct basic services (to include care and supervision) training for all staff using an approved vender through CCLD. Administrator will read the regulation cited and provide LPA Hughes a letter of acknowledgement that the regulation cited was reviewed and understood. Administrator will also put a plan in place for residents who are wonderers to ensure the residents safety. Administrator will email documents used for training and sign in sheet and plans in place for residents who are wonderers by POC Date 05/24/2025 by end of day 5:00pm.

Deadline recorded: May 24, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87464(f)(1)

Regulation authority

CCR

What the official deficiency says

(f) Basic services shall at a minimum include: 87464 (f) (1) Basic services (f) Basic services shall at a minimum include: (1) Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code This requirement is not met as evidenced by: Based on observation, file review, and interview with the administrator did not ensure staff provide care and supervision to R1. Due to not providing care and supervision, R1 left the facility unassisted.

Official plan of correction

Administrator agrees to conduct basic services training for all staff. Administrator will read the regulation cited and provide LPA Hughes a letter of acknowledgement that the regulation cited was reviewed. Administrator will email documents used for training and sign in sheet by POC Date 04/31/2025 by end of day 5:00pm.

Deadline recorded: Apr 23, 2025. 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(a)(4). Incidental Medical and Dental Care. (a) A plan for incidental medical and dental care shall be developed by each facility… (4) The licensee shall assist residents with self administered medications as needed. This requirement was not met as evidenced by: Based on record review, Licensee did not ensure R5 was assisted with prescribed medication. This posed an immediate health and safety risk to resident in care.

Official plan of correction

Licensee to submit a plan ensuring the timely and accurate delivery of prescribed medication to residents in care. Plan to be submitted to LPA by POC due date. Licensee to read regulation 87465(a)(4) and submit a signed declaration of understanding to LPA by POC due date.

Deadline recorded: Jul 26, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87305(b)

Regulation authority

CCR

What the official deficiency says

87305(b) Alterations to Existing Building or New Facilities: The licensing agency may require the facility to acquire a local building inspection where the agency determines that a suspected hazard to health and safety exists. This requirement is not met as evidence by: Based on the LPA's findings, the facility has converted the office into a staff room. The facility failed to submit the plan to licensing, which poses a potential Health, Safety risk to residents in care.

Official plan of correction

The Licensee shall read regulation 87305 and submit a signed declaration of understanding to LPA by POC due date. The Administrator has removed the bed and no longer uses the room as a staff room.

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

Official classification

Type A

Official code

87625(b)(3)

Regulation authority

CCR

What the official deficiency says

Managed Incontinence. (b) In addition to Section 87611, General Requirements for Allowable Health Conditions, the licensee shall be responsible for the following: (3) Ensuring that incontinent residents are kept clean and dry and that the facility remains free of odors from incontinence. This requirement is not met as evidence by: Based on observation, the licensee did not ensure the facility free of odors from incontinence. LPA discovered strong urine odor in the hallway especially in the resident bedrooms.

Official plan of correction

The Licensee agrees to submit a plan to CCL on how the facility presenting malodorous will be addressed by POC due date.

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

Official classification

Type A

Official code

87464(f)(1)

Regulation authority

CCR

What the official deficiency says

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 evidenced by statements from staff and residents that the staff member did not respond to resident pages when he sustained a fall at the facility which poses an immediate health, safety and personal rights risk to residents in care.

Official plan of correction

facility will conduct additional training with staff and a written plan of correction that indicates the appropriate response time for assisting residents with care.

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

Official classification

Type A

Official code

87303(e)(2)

Regulation authority

CCR

What the official deficiency says

Maintenance and Operation: 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 degree C) and not more than 120 degree F (49 degree C). this requirement was not met as evidenced by LPA testing of hot water temperature which poses an immediate health, safety or personal rights risk to residents in care.

Official plan of correction

facility staff turned down the hot water temperature, Facility will provide a written plan of correction indicating how the facility will ensure the hot water temperature meets regulations and the frequency of hot water testing by facility staff on a regular basis.

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

Official classification

Type A

Official code

87705(c)(4)(A)

Regulation authority

CCR

What the official deficiency says

Care Of Person's With Dementia: In addition to requirements specified in Section 87415, Night Supervision, a facility with fewer than 16 residents shall have at least one night staff person awake and on duty if any resident with dementia is determined through a pre- admission appraisal, reappraisal or observation to require awake night supervision. this requirement was not met as evidenced by statements obtained from staff and residents and R1's assessment that indicates the need for awake staff and nighttime supervision due to diagnosis of dementia which poses an immediate health/safety and personal rights risk to residents in care.

Official plan of correction

Facility will provide a written plan of correction that will become part of their plan of opperation: The POC will include details for night supervision of resident with an awake staff member on duty and awake at all times and a detailed description of staff duties while awake during overnight shift.

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

Official classification

Type A

Official code

87468.1(a)(3)

Regulation authority

CCR

What the official deficiency says

87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (3) To be free from punishment, humiliation, intimidation, abuse, ... This requirement is not met as evidenced by: Based on interviews and records review, the licensee did not comply with the regulation cited above. R3 was left in soiled garments overnight. This poses an immediate health and safety risk to residents in care.

Official plan of correction

Licensee shall submit a plan of correction to LPA on how the facility will be in compliance with regulation 87468.1(a)(3) at all times by POC due date 12/7/2023.

Deadline recorded: Dec 7, 2023. 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. Basic Services. (f) Basic services shall at a minimum include… (1) Basic services care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). This requirement is not met as evidence by: Based on interviews and records review, the Licensee did not ensure resident's hygiene needs are met. Staff did not provide showers to R1. This poses a potential health and safety risk to residents in care.

Official plan of correction

Licensee shall submit a plan of correction to LPA on how the facility will ensure that residents' hygiene needs are met by POC due date 12/13/23.

Deadline recorded: Dec 13, 2023. 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 and Dental Care: The licensee shall arrange, or assist in arranging, for medical and dental care appropriate to the conditions and needs of residents. This requirement was not met as evidence by LPA review of all resident MARs and observation of incomplete documentation of medication administration with poses an immediate health, safety and personal rights risk to residents in care.

Official plan of correction

facility will provide training to all staff member who administer medications and the appropriate steps in documenting medication once it is given to the residents.

Deadline recorded: Dec 2, 2023. 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

Incidental Medical and Dental Care: Once ordered by the physician the medication is given according to the physician's directions. the requirement was not met as evidenced by LPA observed there were several days resident did not receive medications due the waiting on refill and LPA observed in documentation the refill request was made once med the medication refill order was not made until resident was out of medications which poses an immediate health safety and personal rights risk to residents in care

Official plan of correction

facility will provide a written plan of correction indicating the changes and steps the facility will make to ensure resident medications are refilled and available for residents as prescribed by the physician.

Deadline recorded: Dec 2, 2023. 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 Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: (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… (D) Any incident which threatens the welfare, safety, or health of any resident… Based on interviews, observations and records review, the licensee did not ensure two incidents were reported to the licensing agency or responsible parties. This poses a potential health, safety, and personal rights risks to residents in care.

Official plan of correction

Licensee agrees to review section 87211(a)(1)(D) and provide LPA Lee a written statement acknowledging the importance of sending incident reports and summarize her understanding of the regulation. Licensee agrees to email POC by POC date 08/14/2023 by 5:00 PM by end of day.

Deadline recorded: Aug 14, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

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. Licensee did not ensure 3 out of 3 staff had first aid and CPR training. 3 out of 3 staff files had no documentation of current trainings, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/23/2023 Plan of Correction Licensee agrees to conduct first aid and CPR trainings for all staff. Licensee also agrees to conduct required medical trainings to all staff. Licensee will email training materials/documents along with staff sign in sheet to LPA Lee by POC 06/23/2023 by 5:00 PM.

Official classification

Type A

Official code

87506(a)

Regulation authority

CCR

What the official deficiency says

(a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review 6 out of 6 resident files were not complete. Files were missing documents. Some documents were signed, but was not filled out. Documents was also signed by licensee, but not signed by residents. Some documents had a different facility name that does not align with this facility. The licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/23/2023 Plan of Correction Licensee agrees to review resident files and complete the blank documents. Licensee also agrees to go over the documents with the residents/family members and have those documents signed. Licensee agrees to review the regulations and submit a statement acknowledging that licensing have read and understood the regulations by POC date 06/23/2023 by 5:00 PM. LPA will complete a POC visit.

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above. The licensee did not ensure the outside exterior was in good repair. The exterior wood is chipping and has a hole. The licensee also did not ensure the dining table was in good repair. The dining table is not balance and is broken, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/23/2023 Plan of Correction Licensee agrees to have the exterior hole repair and the dining table repair by POC date 06/23/2023 by 5:00 PM. Licensee will email POC to LPA Lee by POC date.

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 comply with the section cited above. The licensee did not ensure 3 out of 3 staff files are complete, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/23/2023 Plan of Correction Licensee agrees to complete all staff files. Licensee also agrees to review regulations and write a statement acknowledging licensee understood regulations and documents that needs to stay in the staff files.

Official classification

Type A

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 in accessible to clients. This requirement is not met as evidenced by: Deficient Practice Statement Based on obserview, the licensee did not comply with the section cited above. The licensee did not ensure the chemical cabinet was made inaccessible to residents in care, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/16/2023 Plan of Correction Licensee will purchase a lock and installed for the chemical cabinets by POC date 06/16/2023 by 5:00 PM. Licensee will send proof of POC to LPA Lee by POC due date.

Official classification

Type A

Official code

87411(g)(2)

Regulation authority

CCR

What the official deficiency says

87411(g)(2) Personnel Requirements-General (g) Prior to employment or initial presence in the facility, all employees and volunteers subject to criminal record review shall: (2) Request a transfer for a criminal record clearance as specified in section....... 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 staff 1 was associated to the facility prior to working at the facility. which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/16/2023 Plan of Correction During the visit, Licensee called CCL to have staff 1 associated to the facility. Licensee stated that CCL technician stated it will take two business days to have S1 associated in the system. Licensee will email proof of LIC 9182 that Licensee emailed to CCL to have S1 associated. Licensee will send POC to LPA Lee by POC date 06/16/2023 by 5:00 PM.

Official classification

Type A

Official code

87465(a)

Regulation authority

CCR

What the official deficiency says

A plan for incidental medical and ental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for aswsistance in obtaining such care, by compliance with... This requirement is not met as evidenced by: The Licensee did not ensure 5 out of 6 residents MAR sheet was maintained. MAR section was not initialed, and it is unknown if medication were administered per care staff. This posed a immediate health and staff rish to residents in care. Deficient Practice Statement Based on record review, the licensee did not comply with the section cited above. Licensee did not ensure 5 out of 6 resident MAR shees was maintained. MAR section was not initial and it is unknown if medication were administer to resident, which poses an immediate health, safety or personal rights risk to residents in care.

Official plan of correction

POC Due Date: 06/23/2023 Plan of Correction Licensee agrees to conduct incidental medcial and dental training for all staff by POC date 06/23/2023 by 5:00 PM. Licensee agrees to email training documents along with staff signature to LPA Lee by POC date.