GENESIS MANOR VI

Official classification

Type A

Official code

87202(a)(2)

Regulation authority

CCR

What the official deficiency says

(a) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, or the State Fire Marshal. Prior to accepting or retaining any of the following types of persons, the applicant or licensee shall notify the licensing agency and obtain an appropriate fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, or the State Fire Marshal: (2) Bedridden persons This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview and record review, the administrator did not comply with the section cited above by having two bedridden residents occupying two separate nonambulatory bedrooms which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/06/2026 Plan of Correction Administrator stated that she will create and provide a plan on accomodating the two bedridden residents and will send proof to LPA via email by POC due date.

Official classification

Type A

Official code

87204(a)

Regulation authority

CCR

What the official deficiency says

(a) A licensee shall not operate a facility beyond the conditions and limitations specified on the license, including specification of the maximum number of persons who may receive services at any one time. An exception may be made in the case of catastrophic emergency when the licensing agency may make temporary exceptions to the approved capacity. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview and record review, the administrator did not comply with the section cited above by having two bedridden residents in a licensed and fire clearance capacity for 1 bedridden resident which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/06/2026 Plan of Correction Administrator stated she will submit a application for increase for the number of residents in care needing bedridden accommadations. Administrator agrees to submit completion of application to LPA by POC due date via email.

Official classification

Type A

Official code

87309(a)(1)

Regulation authority

CCR

What the official deficiency says

(a) Except as specified in subsection (b), the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances, knives, matches, tools, sharp objects, and other similar items which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage. (1) Disinfectants, cleaning solutions, and poisonous substances shall be stored in areas separate from food supplies as specified in Section 87555, General Food Service Requirements. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the administrator did not comply with the section cited above by having cleaning supplies in the residents bathroom under the sink and not locked and secured which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/06/2026 Plan of Correction Staff immediately locked chemicals after being instructed by LPA. Administrator stated that she will conduct training with staff on the regulation cited and submit proof to LPA via email by POC due date.

Official classification

Type A

Official code

87555(b)(8)

Regulation authority

CCR

What the official deficiency says

(8) All food shall be of good quality. Commercial foods shall be approved by appropriate federal, state and local authorities. Food in damaged containers shall not be accepted, used or retained. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the administrator did not comply with the section cited above by having an expired parmesan grated cheese and peanut butter in the pantry which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/06/2026 Plan of Correction Administrator agrees to inspect all perishable and nonperishable foods and discard expired items. Administrator stated that she will submit a statement of understanding on regulation cited and submit proof to LPA via email by POC due date.

Official classification

Type A

Official code

87465(a)(4)

Regulation authority

CCR

What the official deficiency says

(4) The licensee shall assist residents with self-administered medications as needed. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview and record review, the administrator did not comply with the section cited above by not maintaining an accurate centrally stored medication record where 1 out of 2 residents bubble pack did not match the number of medication remaining in the bubble from the start date the medication was administered. There was less medication available to be dispensed. The medication start date was 1/12/2026 and only one medication remained in the bubble pack. which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/06/2026 Plan of Correction Administrator agrees to conduct a training on common error of medication and medication dispensing procedure and submit a statement of understanding and training log to LPA by POC due date.

Official classification

Type B

Official code

87705(c)(4)

Regulation authority

CCR

What the official deficiency says

Care of Persons with Dementia: Licensees who accept and retain residents with dementia shall be responsible for ensuring the following: (4) There is an adequate number of direct care staff to support each resident’s physical, social, emotional, safety and health care needs as identified in his/her current appraisal. This regulation was not met as evidenced by interviews with S1 and S2 that residents engaged in inappropriate behavior. This poses as a potentiatl health and safety risk to residents in care.

Official plan of correction

The Administrator will by Plan of Correction (POC) due date provide in-service training to care givers regarding Providing Care to Residents with Dementia. Administrator will provide proof of training to LPA in the form of a scanned document that states the. trainnig provided, the date, printed names and signatures of all trainees by POC due date

Deadline recorded: May 11, 2022. A deadline is not proof that correction was completed.