REST HAVEN CARE HOME

Official classification

Type B

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) (interview) (record review)], the licensee did not comply with the section cited above by not having residents medication locked inaccessible to residents which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/31/2026 Plan of Correction Licensee has agreed to lock medication and provide proof to LPA by POC due date

Official classification

Type B

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 [(observation) (interview) (record review)], the licensee did not comply with the section cited above by having missed punched medication and not having accurrate dates of dispensed medication which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/06/2026 Plan of Correction Licensee will read the regulation being cited provide proof of understanding to LPA by POC due date, moving forward Licensee has agreed to punch the holes of medication on the date it is received.

Official classification

Type B

Official code

1569.695(a)

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: 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 by not having an emergency disaster plan available for review which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/06/2026 Plan of Correction Licensee has agreed to create an emergency disaster plan (LIC 610E) and provide proof to LPA by POC due date

Official classification

Type B

Official code

1569.695(e)(2)

Regulation authority

HSC

What the official deficiency says

(e) A facility shall have all of the following information readily available to facility staff during an emergency: (2) An appraisal of resident needs and services plan for each resident. 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 by Resident #2 (R2) not having a needs and service plan which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/06/2026 Plan of Correction Licensee has agreed to create and needs and service plan (LIC 625) for R2 and provide proof to LPA by POC due date.

Official classification

Type A

Official code

1569.311

Regulation authority

HSC

What the official deficiency says

Every residential care facility for the elderly shall have one or more carbon monoxide detectors in the facility that meet the standards established in Chapter 8 (commencing with Section 13260) of Part 2 of Division 12. The department shall account for the presence of these detectors during inspections. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and interview, the licensee did not comply with the section cited above by not having a working smoke alarm and carbon monoxide system which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/20/2025 Plan of Correction Licensee has agreed to install new fire and carbon monoxide alarms in the facility and provide proof to LPA by POC due date.

Official classification

Type B

Official code

87465(c)(3)

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....(3)A record of each dose is maintained in the resident's record. The record shall include the date and time the PRN medication was taken, the dosage taken, and the resident's response.This requirement was not met as evidenced by: The administrator stated and could not provide records of medications being given to residents in care which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

The administrator/licensee will provide LPA a copy of the MARS documenting medications administered by staff that will be used. She will also conduct training and submit a written statement of understanding of the cited regulation, signed by all staff members by January 3, 2025.

Deadline recorded: Jan 3, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87219(a)

Regulation authority

CCR

What the official deficiency says

(a) -(i) (1)Residents shall be encouraged to maintain and develop their fullest potential for independent living through participation in planned activities. The activities made available shall include:..This requirement was not met as evidenced by: LPA asked to review a schedule of activities that could not be provided. She said residents simply watch TV or engage in activities of their choice. The licensee has agreed to provide a written schedule of activites and will encourange residents to engage in activites daily.

Official plan of correction

The administrator/licensee will provide a copy of the monthly planned activities for residents. She will also train all staff on the cited regulation and submit a written statement of understanding, signed by all staff members assisting with activities, by January 3, 2025.

Deadline recorded: Jan 3, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

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 in not having an updated CPR certificate for S#2 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 Licensee agreed to submit an updated CPR certificate for S#2 by the POC due date.

Official classification

Type B

Official code

87208(a)(12)

Regulation authority

CCR

What the official deficiency says

(a) Each facility shall have and maintain a current, written definitive plan of operation. The plan and related materials shall be on file in the facility and shall be submitted to the licensing agency with the license application. Any significant changes in the plan of operation which would affect the services to residents shall be submitted to the licensing agency for approval. The plan and related materials shall contain the following: (12) The Infection Control Plan pursuant to Section 87470. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and record review, the licensee did not comply with the section cited above by not developing the required Infection Control Plan for the facility which poses a potential health, safety or personal rights risk to persons in care

Official plan of correction

POC Due Date: 09/30/2024 Plan of Correction Licensee stated to develop the required Infection Control Plan and submit to LPA Ramirez by Plan of Correction (POC) due date.

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 observation and interviews, the licensee did not comply with the section cited above by client 1's (C1) medication packet was empty. Administrator stated medication was refilled and will arrive todaywhich 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 Licensee/Administrator shall submit to the licensing agency proof of client medication received by POC date.

Official classification

Type B

Official code

1569.605

Regulation authority

HSC

What the official deficiency says

On and after July 1, 2015, all residential care facilities for the elderly, except those facilities that are an integral part of a continuing care retirement community, shall maintain liability insurance covering injury to residents and guests in the amount of at least one million dollars ($1,000,000) per occurrence and three million dollars ($3,000,000) in the total annual aggregate, caused by the negligent acts or omissions to act of, or neglect by, the licensee or its employees. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA observation and interviews, the licensee did not comply with the section cited above by not maintaining injury liability insurance. Administrator stated that the insurance was cancelled due to having to pay high rates, this poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/30/2023 Plan of Correction Licensee/Administrator shall submit to the licensing agency proof of insurance by POC date.

Official classification

Type B

Official code

87303(i)

Regulation authority

CCR

What the official deficiency says

(i) Facilities shall have signal systems which shall meet the following criteria: This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA observations and interviews, the licensee did not comply with the section cited above, LPA observed front door signal system was not operating. Administrator stated the signal was turned off during maintenance. Administrator stated they are not sure when the maintenance person will be returning, this poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/30/2023 Plan of Correction Licensee/Administrator shall submit to the licensing agency proof of operating signal system by POC date.

Official classification

Type B

Official code

Not listed

Regulation authority

Not listed

What the official deficiency says

87465. Incidental Medical and Dental Care. (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. Based on observation, the licensee did not comply with the section cited above by pre-prepping medication and storing medication in an alternative container. The medication was not stored in the original container received from the pharmacy which poses an immediate health, safety, or personal rights risk to persons in care.

Deadline recorded: Jun 16, 2022. A deadline is not proof that correction was completed.