DEVON PLACE HOME CARE

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 in having one (1) individual (S1) working at the facility providing care and supervision to residents in care without having fingerprint clearance which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/27/2024 Plan of Correction Licensee will ensure all staff members working at the facility who provides care and supervision to residents in care will have fingerprint clearance prior to working. S1 must be fingerprint cleared prior to returning back to the facility.

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 observation, the licensee did not comply with the section cited above in having disinfectants and cleaning solutions accessible to residents in care. Cabinet under the sink was unlocked which contained disinfectants and bug spray which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/02/2024 Plan of Correction Licensee will ensure disinfectants, cleaning solutions, poisons, and other items which could pose a danger to residents in care are inaccessible at all times. Licensee will conduct in-service staff training regarding this regulation and will send training materials and staff sign-in sheet to LPA by plan of correction date 08/02/2024.

Official classification

Type B

Official code

87465(d)(3)

Regulation authority

CCR

What the official deficiency says

(d) If the resident is unable to determine his/her own need for a prescription or nonprescription PRN medication, and is unable to 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: (3) The date and time the PRN medication was taken, the dosage taken, and the resident's response shall be documented and maintained in the resident's facility record. 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 for R1 and R2 having dispensed PRN medication without documenting either time and/or date the dosage was taken which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/02/2024 Plan of Correction Licensee will ensure PRN medication assistance for all residents in care will be documented following the regulation listed above by staff. Licensee will conduct in-service staff training with staff regarding this regulation and will provide LPA with the training materials provided to staff and staff sign-in sheet by plan of correction date 08/02/2024.

Official classification

Type B

Official code

87457(c)

Regulation authority

CCR

What the official deficiency says

(c) Prior to admission a determination of the prospective resident's suitability for admission shall be completed and shall include an appraisal of his/her individual service needs in comparison with the admission criteria specified in Section 87455, Acceptance and Retention Limitations. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, the licensee did not comply with the section cited above in having pre-admission appraisal available for records review for Resident One (R1), Resident Two (R2), and Resident Three (R3) which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/02/2024 Plan of Correction Licensee will ensure all residents who are currently admitted or will be admitted to this facility have the resident pre-admission appraisal completed to determine resident's needs and services. Licensee will submit Resident Appraisal to LPA for R1, R2, and R3 by plan of correction date 08/02/2024.

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 observation, interview, and record review, the licensee did not comply with the section cited above in conducting a quarterly disaster drill with staff for each shift which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/02/2024 Plan of Correction Licensee will ensure quarterly disaster drills will be conducted with staff to ensure the safety of the residents in care. Licensee will submit disaster drill training materials and staff sign in sheet for each shift to LPA by the plan of correction date 08/02/2024.

Official classification

Type B

Official code

1569.695(e)(1)

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: (1) A resident roster with the date of birth for each resident. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and records review, the licensee did not comply with the section cited above in having an updated roster with the current residents which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/02/2024 Plan of Correction Licensee will ensure a resident roster will be updated as needed and readily available to facility staff during an emergency. Licensee will submit updated resident roster to LPA by plan of correction date 08/02/2024.

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 observation, the licensee did not comply with the section cited above in having sharp objects and scissors in a unlocked kitchen drawer which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/02/2024 Plan of Correction Licensee will ensure sharp objects and other items that could pose a danger to resident in care are inaccessible at all times. Licensee will conduct in-service staff training regarding this regulation and will send training materials and staff sign-in sheet to LPA by plan of correction date 08/02/2024.

Official classification

Type B

Official code

87465(i)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care (i) Prescription medications which are not taken with the resident upon termination of services, not returned to the issuing pharmacy, nor retained in the facility as ordered by the resident’s physician and documented in the resident’s record nor disposed of according to the hospice’s established procedures or which are otherwise to be disposed of shall be destroyed in the facility by the facility administrator and one other adult who is not a resident... 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 having expired medication prescribed to Resident six (R6) marked as " Back-up meds " with a use before date of 10/01/2022 which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/02/2024 Plan of Correction Licensee will ensure all medication will be discarded and destroyed by the facility as ordered by resident's physician and documented in centrally stored medication record. Licensee will conduct in-service training with staff and provide LPA with training materials and staff sign in sheet by plan of correction date 08/02/2024.

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

87303 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 is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above in having a three (3) inch oval hole in the floor near the dining room which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/02/2024 Plan of Correction Licensee will ensure facility is in good repair at all times for residents, employees, and visitors at all times. Licensee will submit a plan to LPA on how they will fix the damaged floor near the dining room kitchen by plan of correction date 08/02/2024.

Official classification

Type B

Official code

87705(c)(5)

Regulation authority

CCR

What the official deficiency says

Care of Persons with Dementia: (c) Licensees...shall be responsible for ensuring the following: (5) Each resident with dementia shall have an annual medical assessment...and a reappraisal done at least annually... This requirement was not met by: Deficient Practice Statement Based on record review, the licensee did not comply with the section cited above in having an annual medical assessment conducted for Resident Two (R2), Resident Three (R3), Resident Four (R4), and Resident Five (R5) which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/02/2024 Plan of Correction Licensee will ensure residents with a diagnosis of Dementia will have a annual medical assessment conducted and documented to ensure the appropriate needs and services of the residents are being met. Licensee will submit updated LIC 602 to LPA by the plan of correction date 08/02/2024.

Official classification

Type A

Official code

1569.618(c)(3)

Regulation authority

HSC

What the official deficiency says

(c) The facility shall employ, and the administrator shall schedule, a sufficient number of staff members to do all of the following: (3) Ensure that at least one staff member who has cardiopulmonary resuscitation (CPR) training and first aid training is on duty and on the premises at all times. This paragraph shall not be construed to require staff to provide CPR. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation of facility records and staff's admission , the licensee did not comply with the section cited above in 2 out 2 staff members, and the administrator.which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/28/2023 Plan of Correction Administrator states that he will have the staff and his CPR/ First Aid training completed by the due date listed above. Administrator states he will make sure CPR/First Aid training is scheduled 1-2 months prior to the expiration date.

Official classification

Type A

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 observations knives were accessible to the residents, the licensee did not comply with the section cited above in 6 out 6 counts, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/28/2023 Plan of Correction Administrator states he will secure the knives and put them in a locked cabinet temporarily and purchase a locked cabinet for permanent location.

Official classification

Type B

Official code

87456(a)(3)

Regulation authority

CCR

What the official deficiency says

(a) Prior to accepting a resident for care and in order to evaluate his/her suitability, the facility shall, as specified in this article 8: (3) Obtain and evaluate a recent medical assessment. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation of facility records residents with dementia have no medical assessment., the licensee did not comply with the section cited above in 2 out of 5 resident files which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/11/2023 Plan of Correction Administrator states that he will work on getting resident assessments for current conditions for resident and provide medical assessments.

Official classification

Type B

Official code

1569.267(d)

Regulation authority

HSC

What the official deficiency says

(d) The licensee shall provide initial and ongoing training for all members of its staff to ensure that residents’ rights are fully respected and implemented. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation of interactions between R4 and S2 while at the facility and based on interview with R1, the licensee did not comply with the section cited above in 2 out of 5 residents which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/04/2023 Plan of Correction Administrator states that he will conduct an in-service regarding residents rights and communication.

Official classification

Type B

Official code

87465(d)(3)

Regulation authority

CCR

What the official deficiency says

(d) If the resident is unable to determine his/her own need for a prescription or nonprescription PRN medication, and is unable to 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: (3) The date and time the PRN medication was taken, the dosage taken, and the resident's response shall be documented and maintained in the resident's facility record. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and review of medication records, the licensee did not comply with the section cited above in 5 out of 5 for all residents which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/04/2023 Plan of Correction Administrator states that he will have the medication technician from hospice come to do a training. Administrator state he will continue to check the MAR's daily to make sure the records are kept in order and complete.

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 record review of the fire drills, the licensee did not comply with the section cited above in 2 out of 2 fire drills which were not completed, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/04/2023 Plan of Correction Adminstrator states he will conduct an in-service to conduct a fire drill with staff.

Official classification

Type B

Official code

87705(c)(5)

Regulation authority

CCR

What the official deficiency says

(c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following: (5) Each resident with dementia shall have an annual medical assessment as specified in Section 87458, Medical Assessment, and a reappraisal done at least annually, both of which shall include a reassessment of the resident's dementia care needs. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review of all resident files, the licensee did not comply with the section cited above in 5 out of 5 residents, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/11/2023 Plan of Correction Administrator states that he will have the medical assessments completed for all residents and continue to maintain physician reports on an annual basis by scheduling in advance.

Official classification

Type A

Official code

1569.695(f)(2)(D)

Regulation authority

HSC

What the official deficiency says

(f) A facility shall have both of the following in place: (2) A set of keys available to facility staff on each shift for use during an evacuation that provides access to all of the following: (D) All facility cabinets and cupboards or files that contain elements of the emergency and disaster plan, including, but not limited to, food supplies and protective shelter supplies. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation of the emergency food supply, there was none presen, the licensee did not comply with the section cited above in 1 out of 1, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/28/2023 Plan of Correction The Administrator states he will provide emergency food supplies for the residents and staff.

Official classification

Type B

Official code

87307(d)(2)

Regulation authority

CCR

What the official deficiency says

Personal Accomodations and Services- (d) The following space and safety provisions shall apply to all facilities: (2) The premises shall be maintained in a state of good repair and shall provide a safe and healthful environment. This requirement was not met as evidenced by: The Licensee did not ensure the facility flooring was in good repair. Based on LPA observations, the floor in the area of the dining area was observed to be peeling, bubbled, chipped away, and misshapen This poses a potential health, safety, and personal rights risks to residents in care.

Official plan of correction

The facility will repair or replace the floor in the dining area and submit proof to CCL by POC due date of 6/9/2022. If additional time is required to complete this POC, please conduct LPA prior to POC due date.

Deadline recorded: Jun 9, 2022. A deadline is not proof that correction was completed.