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Official classification

Type A

Official code

87202(a)

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: This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA observations, the licensee did not comply with the section cited above by not having fire clearance for room#8 which is currently occupied by Resident #1 (R1) which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/13/2026 Plan of Correction The licensee/Administrator shall remove resident from room or provide documenation of that the room is cleared for resident occupancy by POC due date.

Official classification

Type B

Official code

87463(a)

Regulation authority

CCR

What the official deficiency says

(a) The pre-admission appraisal, as specified in Section 87457, Pre-Admission Appraisal, shall be updated, in writing as frequently as necessary or once every 12 months, whichever occurs first, to note significant changes in condition, as defined in Section 87101, Definitions, and to keep the appraisal accurate. For the purposes of this section, the updated pre-admission appraisal shall be referred to as the reappraisal. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA observation, the licensee did not comply with the section cited above by resident #2 (R2) and Resident #3 (R3) last appraisals were conducted in September 2023; which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/13/2026 Plan of Correction The Licensee/Administrator shall provide documentation of a reappraisal for R2 & R3 to the licensing agency by POC due date.

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 inaccessible to clients. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA record review, the licensee did not comply with the section cited above by not maintaining cleaning solutions 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: 09/19/2024 Plan of Correction The staff removed the cleaning solutions and placed them in a locked cabinet. No futher action is required.

Official classification

Type A

Official code

87465(c)(2)

Regulation authority

CCR

What the official deficiency says

(c) If the resident's physician has stated in writing that the resident is unable to determine his/her own need for nonprescription PRN medication, but can 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: (2) Once ordered by the physician the medication is given according to the physician's directions. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA observations, the licensee did not comply with the section cited above by R1's prescribed medication from 9/7 was still in the medication packet and staff logged medication as given on that day; which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/20/2024 Plan of Correction The Licensee/Administrator shall provide medication administration training to staff and submit proof of training to licensing by POC due date.

Official classification

Type A

Official code

87506(a)

Regulation authority

CCR

What the official deficiency says

Resident records (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 LPA observations, the licensee did not comply with the section cited above by PA observed that resident #1 (R1) medication log was not up-to-date. Staff did not log when resident's pm medication were given on several days; which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/20/2024 Plan of Correction The Licensee Licensee/Administrator shall provide medication administration training to staff and submit proof of training to licensing by POC due date.

Official classification

Type A

Official code

87355(e)

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: 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 in not providing criminal record clearance of (S2) which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/12/2023 Plan of Correction Administrator stated that she will remove (S2) from schedule and follow up with (S2) and Guardian to get approval clearance on her in process status. Administrator will provide proof of clearance to LPA via email once it is approved.

Official classification

Type A

Official code

87555(b)(26)

Regulation authority

CCR

What the official deficiency says

(b) The following food service requirements shall apply: (26) Supplies of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days shall be maintained on the premises. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and interview, the administrator did not comply with the section cited above in maintaining one week of nonperishable and two days of perishable foods for residenst in care after disposing the expired nonperishable and perishable food which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/12/2023 Plan of Correction Administrator stated that she will replenish one week of nonperishable and two day of perishable foods and provide proof of receipt and pictures to LPA via email by POC due date. Administrator stated that she will conduct a staff training and submit proof to LPA via email.

Official classification

Type B

Official code

87470(c)

Regulation authority

CCR

What the official deficiency says

(c) An Infection Control Plan shall be developed by the licensee and shall be included in the Plan of Operation required by Section 87208. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and record review, the administrator did not comply with the section cited above in providing an Infection Control Plan in the facility file which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/18/2023 Plan of Correction Administrator stated that she will create and submit an Infection Control Plan to LPA via email by POC due 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 observation and record review, administrator did not comply with the section cited above in maintaining complete personnel records for (S1) and (S2) which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/18/2023 Plan of Correction Administrator stated that she will have (S1) and (S2) complete and sign all required forms for their personnel records. Administrator stated that she will submit proof to LPA via email by POC due date.

Official classification

Type B

Official code

1569.696(a)

Regulation authority

HSC

What the official deficiency says

(a) All residential care facilities for the elderly shall provide training to direct care staff on postural supports, restricted conditions or health services, and hospice care as a component of the training requirements specified in Section 1569.625. The training shall include all of the following: This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and record review, the administrator did not comply with the section cited above in providing proof of training, first aid/cpr certification, and medication training for staff which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/18/2023 Plan of Correction Administrator stated that she will have staff complete required training along with first aid/cpr and medication training and submit proof to LPA via email by POC due date.

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 Based on observation and record review, the administrator did not comply with the section cited above in maintaining complete resident records for (R1) like the physician's report and appraisal/needs & services which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/18/2023 Plan of Correction Administrator stated that she will complete (R1) resident records and submit proof to LPA via email by POC due date.

Official classification

Type B

Official code

1569.695(d)

Regulation authority

HSC

What the official deficiency says

(d) A facility shall review the plan annually and make updates as necessary, including changes in floor plans and the population served. The licensee or administrator shall sign and date documentation to indicate that the plan has been reviewed and updated as necessary. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and record review, the administrator did not comply with the section cited above in reviewing annually the emergency disaster plan which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/18/2023 Plan of Correction Administrator stated that she will submit the updated emergency disaster plan and submit proof to LPA via email by POC due date.

Official classification

Type B

Official code

87705(l)(1)

Regulation authority

CCR

What the official deficiency says

(l) The following initial and continuing requirements shall be met for the licensee to lock exterior doors or perimeter fence gates: (1) Licensees shall notify the licensing agency of their intention to lock exterior doors and/or perimeter fence gates. 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 in notifying the licensing agency of their intention to lock the exterior door/gate which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/18/2023 Plan of Correction Administrator stated that she will submit a request of their intent to lock the exterior door/gate to the licensing agency by POC due date via certified mail and submit a copy to LPA via email.

Official classification

Type B

Official code

80072(a)(3)

Regulation authority

CCR

What the official deficiency says

80072 Personal Rights (a)(3) (3) To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of a punitive ... This requirement is not met as evidenced by: Deficient Practice Statement Based on observation the licensee did not comply with the section cited above by placing locks on the pantry and refrigerators without approved waiver. Which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/30/2022 Plan of Correction Licensee shall remove the locks on pantry and refrigerators. Licensee shall submit a waiver to the deparment for approval to place locks on the pantry and refrigerators. Licensee shall submit proof of correction to LPA by the due date 06/30/2022.

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 has not been met as evidenced by: Based on interviews, the Licensee did not ensure the personal rights of R1. This is an immediate personal rights risk to resident's in care.

Official plan of correction

The Licensee shall conduct training on Regulation 87468.1 for all staff and send proof to the Department by POC date.

Deadline recorded: Apr 7, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87468.1(a)(16)

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: (16) To receive or reject medical care or other services. This requirement has not been met as evidenced by: Based on interviews, the Licensee did not seek timely medical attention for R1. This is a immediate health and safety risk to resident's in care.

Official plan of correction

The Licensee shall conduct training on Regulation 87468.1 for all staff and send proof to the Department by POC date.

Deadline recorded: Apr 7, 2022. 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

87211 - Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports as the Department may require... (1)... (B) Any serious injury as determined by the attending physician and occurring while the resident is under facility supervision. This requirement has not been met as evidenced by: Based on interviews and observations, the Licensee did not ensure that serious injuries were reported to the Department in a timely manner. This is a potential health and safety risk to resident's in care.

Official plan of correction

The Licensee shall conduct training on Regulation 87211(a)(1)(B) for all staff and send proof to the Department by POC date.

Deadline recorded: Apr 13, 2022. A deadline is not proof that correction was completed.