ALTA LOMA GARDENS RESIDENTIAL CARE #1

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 observation, interview, and record review, the licensee did not comply with the section cited above by not ensuring the facility maintained Liability Insurance which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/24/2026 Plan of Correction The Licensee agrees to review the regulation cite, and purchase the required Policy and provide proof to LPA by POC due date.

Official classification

Type B

Official code

87309(a)

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. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above in 1 out of 3 bathrooms by ensuring that all disinfectants were locked and stored and inaccessible to residents which posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/13/2026 Plan of Correction Licensee agrees to review the regulation with all staff and conduct a training and submit proof of the training to LPA by POC due date.

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 3 out of 4 personnel records by not ensuring health screening, training records,TB test, job description, and application are in the personnel files which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/17/2025 Plan of Correction Licensee agrees to update and complete personnel records for herself and all staff working in the facility to ensure all required documents are in the file. The following items shall be included but is not liimited to these items: Health screening, criminal background, TB test, Training, CPR/First Aid Cert, Job description, application, etc, by POC date.

Official classification

Type A

Official code

87412(a)(13)(B)

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: (13) For employees that are required to be fingerprinted pursuant to Section 87355, Criminal Record Clearance: (B) Documentation of either a criminal record clearance or a criminal record exemption as required by Section 87355(e). 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 1 out of 4 staff records, by not ensure a backgroung clearance was completed and current which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/03/2025 Plan of Correction LIcensee agrees to ensure that all staff will complete a background clearance prior to working with resident in care. Licensee will immediately remove the one staff that is not clearance and replace with a cleared caregiver until such clearance is completed.

Official classification

Type A

Official code

87465(a)(6)

Regulation authority

CCR

What the official deficiency says

(6) When requested by the prescribing physician or the Department, a record of dosages of medications which are centrally stored shall be maintained by the 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 in 3 out of 3 resident MARS by not ensuring the record was accurate, medication are log, staff are signing and dated when medication is issued which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/24/2025 Plan of Correction Licensee agrees to conduct a training for all staff that assist with medications, for the procedures of logging, dating, maintaining medication, storage, and securing such items. Licensee will ensure all staff understand and review the regulation by POC.

Official classification

Type A

Official code

87463(h)

Regulation authority

CCR

What the official deficiency says

(h) The licensee shall request that all residents receive an annual routine visit with a licensed medical professional once every twelve months, either in person or by video appointment. 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 2 out of 3 resident in care by not ensuring each resident have a current physician report, and needs and service plan on file, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/05/2025 Plan of Correction Licensee agrees to schedule all resident in care with their appointed doctors to complete a LIC602. Licensee agrees to maintain and update annually the resident LIC602, and needs and service plan. Licensee agrees to complete this within 30 days for the LIC 602, and needs and service plan by POC date.

Official classification

Type A

Official code

1569.695(c)

Regulation authority

HSC

What the official deficiency says

(c) A facility shall conduct a drill at least quarterly for each shift. The type of emergency covered in a drill shall vary from quarter to quarter, taking into account different emergency scenarios. An actual evacuation of residents is not required during a drill. While a facility may provide an opportunity for residents to participate in a drill, it shall not require any resident participation. Documentation of the drills shall include the date, the type of emergency covered by the drill, and the names of staff participating in the drill. 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 ensure the facility is conducting quarterly fire and emergency drill which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/04/2025 Plan of Correction Licensee agrees to maintain and conduct monthly or quarterly fire and emergency drill effective 4/4/2025. Licensee agrees to keep a separate log which show proof of staff and residents in attendance. These drills shall be conducted at varies times of the day (morning, afternoon, and night).

Official classification

Type B

Official code

87755(c)

Regulation authority

CCR

What the official deficiency says

87755(c) The licensing agency shall have the.. audit...resident or..facility..demand during normal business..requirements in Sections 87412(f), 87506(d), and 87508(b). This requirement is not met as evidenced by: Based on observation, and interviews the administrator did not comply with the section cited above by not maintaining personnel records and having them accessible for LPAs review which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Administrator stated she will update the personnel record and ensure they are accessible for upon request. Administrator stated she will review the regulation cited and submit a statement of understanding to LPA via email by 10/29/2024.

Deadline recorded: Oct 29, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87303(d)

Regulation authority

CCR

What the official deficiency says

(d) There shall be lamps or light appropriate for the use of each room and sufficient to ensure the comfort and safety of all persons in the facility. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA Delgado's observation and interview on April 3, 2024, the licensee did not comply with the section cited above in which Bedroom #4 there was no lamp which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/19/2024 Plan of Correction Licensee will obtain and provide a lamp and send a picture by email to LPA by POC Due date.

Official classification

Type B

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 Delgado's observation and interview on April 3, 2024, the licensee did not comply with the section cited above in which LPA and Administrator found the medication door unlocked which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/19/2024 Plan of Correction Licensee immediately secured the door on April 3, 2024 and will submit in-service training for Staff to review section cited as noted and provide a copy to LPA by POC due date.

Official classification

Type B

Official code

1569.695(c)

Regulation authority

HSC

What the official deficiency says

(c) A facility shall conduct a drill at least quarterly for each shift. The type of emergency covered in a drill shall vary from quarter to quarter, taking into account different emergency scenarios. An actual evacuation of residents is not required during a drill. While a facility may provide an opportunity for residents to participate in a drill, it shall not require any resident participation. Documentation of the drills shall include the date, the type of emergency covered by the drill, and the names of staff participating in the drill. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA Delgado's observation and interview, the licensee did not comply with the section cited above in the diaster drills was requested to be reviewed and was unable to be provided by staff which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/19/2024 Plan of Correction Licensee will provide and email copies for the last three months of diaster drill to LPA by POC due date.

Official classification

Type B

Official code

87705(f)(1)

Regulation authority

CCR

What the official deficiency says

(f) The following shall be stored inaccessible to residents with dementia: (1) Knives, matches, firearms, tools and other items that could constitute a danger to the resident(s). This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA Delgado's and Administrator observation and interview on April 3, 2024, the licensee did not comply with the section cited above in which the cabinet for sharps was unlocked which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/19/2024 Plan of Correction Licensee immediately secured the door as staff stated they were preparing for dinner. Licensee will do in-service training with staff with the section noted and submit copy to LPA by POC due date.

Official classification

Type B

Official code

87755(c)

Regulation authority

CCR

What the official deficiency says

Inspection Authority of the Licensing Agency: (c) The licensing agency shall have the authority to inspect, audit, and copy resident or facility records upon demand during normal business hours. Records may be removed if necessary for copying. Removal of records shall be subject to the requirements in Sections 87412(f), 87506(d), and 87508(b). This requirement is not met as evidenced by: Deficient Practice Statement Based on observations and review of records the licensee did not comply with the section cited above by not being able to produce any records for staff or residents. During the visit, staff did not have access to records. Administrator not available for contact to request such records; which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/13/2024 Plan of Correction Administrator/Licensee agrees to contact Community Care Licensing to produce records for both staff and residents. Records such as, Physician's Reports, Needs and Services, Admissions Agreements, Verification of Required Staff Trainings, Proof of Fingerprints/Background Checks/Facility Associations, Health Screenings. These records or proof their of are to be submitted to Community Care Licensing within the next 30 business days.

Official classification

Type B

Official code

87208(c)

Regulation authority

CCR

What the official deficiency says

Plan of Operation - A licensee who accepts or retains residents diagnosed by a physician to have dementia shall include additional information in the plan of operation as specified in Section 87705(b). This requirement was not met as evidenced by: Resident 1 has a diagnosis of Dementia. This poses a potential health and safety risk to residents in care.

Official plan of correction

Licensee shall submit to the Department a memorandum of understanding of sections 87208(c) and 87705 no later than then end of POC date. Resident 1 has not lived at this facility since December 2021.

Deadline recorded: May 12, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87506(b)

Regulation authority

CCR

What the official deficiency says

Resident Records - Each resident’s record shall contain at least the following information... This requirement was not met as evidenced by: Records received by LPA for Resident 1 are missing admissions agreement, hospice notes, incomplete functional assessment, and appraisal. This poses a potential health and safety risk to residents in care.

Official plan of correction

Licensee shall evaluate all resident records for accuracy and submit to the Department a memorandum of understanding of section 87506 no later than then end of POC date.

Deadline recorded: May 12, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87755(c)

Regulation authority

CCR

What the official deficiency says

Inspection Authority of the Licensing Agency: (c) The licensing agency shall have the authority to inspect, audit, and copy resident or facility records upon demand during normal business hours. Records may be removed if necessary for copying. Removal of records shall be subject to the requirements in Sections 87412(f), 87506(d), and 87508(b). This requirement was not met as evidenced by: LPA was not able to review any records requested for complaint# 18-AS-20211223163003.

Official plan of correction

Licensee shall submit all requested records in person or electronically to LPA Bueno and/or the San Bernardino Regional office no later than close of business POC date.

Deadline recorded: Feb 23, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87355(e)(2)

Regulation authority

CCR

What the official deficiency says

Criminal Record Clearance (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: (2) Request a transfer of a criminal record clearance as specified in Section 87355(c) or This requirement was not met as evidenced by: LPA Bueno confirmed that S1 has a person number but is not associated to this facility. This poses an immediate health and safety risk to residents in care.

Official plan of correction

Licensee shall associate S1 to this facility no later than close of business POC date.

Deadline recorded: Feb 22, 2023. 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 staff interview and record review, the licensee did not comply with the section cited above as LPA confirmed on Guardian that Staff 1 was not associated to the facility which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/21/2022 Plan of Correction Licensee shall submit a Criminal Record Clearance Transfer Request to Community Care Licensing for Staff 1 by the Plan of Correction (POC) date of 6/22/2022. Proof of submission to be submitted to LPA Bueno by end of POC day.

Official classification

Type A

Official code

87355(e)(2)

Regulation authority

CCR

What the official deficiency says

Criminal Record Clearance: (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: (2) Request a transfer of a criminal record clearance as specified in Section 87355(c) This requirement was not met by: Based on record review and observation, the Licensee did not comply with the above requirement with one staff. LPA Colvin observed that S1 did not have their criminal record clearanced transferred to the facility. This is an immediate safety risk for all residents.

Official plan of correction

Licensee agrees to either submit the paperwork required to the Riverside Regional Office to have S1's criminal record clearance trasnferred to the facility, or for the Licensee to mannual complete the transfer via Guardian website. Licensee to provide LPA Colvin with proof of transfer by the Plan of Correction date.

Deadline recorded: Dec 22, 2021. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87305(a)

Regulation authority

CCR

What the official deficiency says

Alterations to Existing Building or New Facilitie: (a) Prior to construction or alterations, all facilities shall obtain a building permit. This requirement was not met as evidenced by " Based on observations and record review, the Licensee did not comply with the above regulation with one room of the facility. LPA Colvin observed the master bedroom to have two new walls installed to seperate the room. CCL was not notified of the construction. This is a potential safety risk to residents in care.

Official plan of correction

Licensee agrees to submit proof of a building permit to CCL and to consult with the Fire Marshall and County Code Enforcement regarding the safety and permission from both agencies for the construction. Licensee to provide written approval of construction from both agencies to LPA Colvin by the Plan of Correction date of 1/11/22.

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

Official classification

Type B

Official code

1569.185(e)

Regulation authority

HSC

What the official deficiency says

Fees for license or applications; use of revenues; collected; denial or forfeiture: (e) The failure of an applicant for licensure or a licensee to pay all applicable and accrued fees and civil penalties shall constitute grounds for denial or forfeiture of a license. This requirement was not met as evidenced by: Based on record review, the Licensee did not comply with the above regulation with the facility's licensing fees. LPA Colvin observed that the Licensee owes $742. This is a potential safety risk for all residents, as the license may be revoked.

Official plan of correction

Licensee agrees to pay all fees due by Plan of Correction date of 12/13/21. Licensee may self-certify to LPA Colvin once payment has been made.

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

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

Maintenance and Operation: (a) 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 was not met by: Based on observatons, the Licensee did not comply with the above regulation with one area of the facility. LPA Colvin observed a 4-5 foot area of concrete in the driveway which was cracked and uneven, with height differences of approximately 2 inches. This is a potential safety risk to residents & visitors

Official plan of correction

Licensee agrees to have the conrete in the driveway repaired so that it does not present a potential fall risk to persons entering or exiting the facility. Licensee to provide LPA Colvin with photographic proof of the repaired driveway by the Plan of Correction date of 1/11/22.

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