CHANTILLY LACE MANOR

Official classification

Type B

Official code

1569.695(a)(2)

Regulation authority

HSC

What the official deficiency says

(a)In addition to any other requirement of this chapter, a residential care facility for the elderly shall have an emergency and disaster plan that shall include, but not be limited to, all of the following: (2) Plans for the facility to be self-reliant for a period of not less than 72 hours immediately following any emergency or disaster, including, but not limited to, a short-term or long-term power failure. If the facility plans to shelter in place and one or more utilities, including water, sewer, gas, or electricity, is not available, the facility shall have a plan and supplies available to provide alternative resources during an outage. 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 not ensuring that the facility has the 72 hour emergency food and water included in the emergency bin which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/06/2026 Plan of Correction Licensee shall submit proof of purchase or pictures of the items for the 72-hour emergency food and water.

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 licensee did not comply with the section cited above by allowing a nonambulatory resident occupy a staff bedroom without fire clearance which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/08/2025 Plan of Correction Licensee stated that she will move the resident to a fire clearance approved bedroom. Licensee stated that she will submit a statement of understanding to LPA via email 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 licensee did not comply with the section cited above by allowing a staff assist residens without criminal background clearance for 3 days which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/07/2025 Plan of Correction Licensee removed staff without criminal background clearance immediately. Licensee stated that she will submit a statement of understanding to LPA via email by 2/8/25.

Official classification

Type B

Official code

87412(a)(11)

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: (11) A health screening as specified in Section 87411, Personnel Requirements - General. 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 by not having proof of a health screening and TB test for one caregiver which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/12/2025 Plan of Correction Licensee stated that she will send proof of the caregiver's health screening and TB test to LPA via email by POC due date.

Official classification

Type B

Official code

87209(a)(2)

Regulation authority

CCR

What the official deficiency says

87209 Program Flexibility (a) The use of alternate concepts, programs, services, procedures, techniques, equipment, space, personnel qualifications or staffing ratios, or the conduct of experimental or demonstration projects shall not be prohibited by these regulations provided that: (2) A written request for a waiver or exception and substantiating evidence supporting the request shall be submitted in advance to the licensing agency by the applicant or licensee. This requirement is not met as evidenced based on observation and interview, the licensee did not comply with the section cited above evidenced by having cameras in the resident’s bedrooms without a written approval from the department which poses a potential health, safety, or personal rights risk to persons in care.

Official plan of correction

The licensee has agreed to read regulation 87209 entirely and send LPA a statement of understanding that the regulation was read and understood. The licensee has agreed to remove the cameras from the resident’s bedrooms. The licensee has agreed to send a written request to have cameras in the resident's bedrooms and have approval from the department prior to installing the cameras in the resident’s bedrooms. The POC is due on 1/26/2024.

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

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 record review and interviews, the licensee did not comply with the section cited above by having S1 work without a criminal record clearance which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/22/2023 Plan of Correction Administrator had S1 leave the faciliy, and will send LPA via-email they have read and understood the regulation cited above.

Official classification

Type A

Official code

87465(h)(5)

Regulation authority

CCR

What the official deficiency says

(h) The following requirements shall apply to medications which are centrally stored: (5) Each resident's medication shall be stored in its originally received container. No medications shall be transferred between containers. 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 having lose medications not stored in its originally continer and medications transferred between containers which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/22/2023 Plan of Correction Administrator removed medications in containers and removed the lose medications. Administrator will send LPA via-email they have read and understood the regulation cuted above.

Official classification

Type B

Official code

87411(f)

Regulation authority

CCR

What the official deficiency says

87411 Personnel Requirements - General (f) All personnel, including the licensee and administrator, shall be in good health, and physically and mentally capable of performing assigned tasks. Good physical health shall be verified by a health screening... This requirement was not met as evidenced by: Based on file review, the licensee did not ensure to maintain health screenings on file, which poses a potential health, safety, personal rights violation to clients in care.

Official plan of correction

The Licensee shall submit proof of health screenings on all employees by the POC due date.

Deadline recorded: May 16, 2023. A deadline is not proof that correction was completed.