DAMENIK'S HOME

Official classification

Type B

Official code

87463(h)(1)

Regulation authority

CCR

What the official deficiency says

REAPPRAISALS The licensee shall request that all residents receive an annual routine visit with a licensed medical professional once every 12 months, either in person or by video appointment. Documentation of the annual routine visit... shall be added to the resident's record. Documentation of a resident's refusal to receive an annual routine visit...shall be added to the resident's record. This requirement is not met, as MD reports for 6 out of 7 clients are dated over 12 months ago, altho MD signed medication lists are dated in 2026. No MD identified for client #3 MD report.

Official plan of correction

MD assessments for Clients #2, #3, #4, #6, #7, #8 will be updated and documented annually. Proof of correction will be sent to CCLD BY DUE DATE

Deadline recorded: Aug 5, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87463(a)

Regulation authority

CCR

What the official deficiency says

REAPPRAISALS The 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... 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 appraisals for 4 out of 8 clients are dated over 12 months ago.

Official plan of correction

Appraisals or Needs and Services Plans for clients #2, #4, #6, #8 will be updated and documented annually. Proof of correction will be sent to CCLD BY DUE DATE

Deadline recorded: Aug 5, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

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, the licensee did not comply with the section cited above in multiple medication stored in kitchen refrigerator not properly secured and accessible to residents, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/14/2024 Plan of Correction Administrator immediately removed medicaitons from refrigerator and agrees to implement lockbox to properly store medications requiring refridgeration. Photo proof of corrections to be submitted to CCLD by POC date 8/14/2024.

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 observation and record review along with staff medication count, the licensee did not comply with the section cited above in 1 out of 1 resident medicaitons, with missing medication dose, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/14/2024 Plan of Correction Licensee agrees to review regulation 87465 with staff and provide LIC9098 Proof of Corrections form ensuring facility will remain in compliance. Form to be submitted to CCLD by POC date 8/14/2024.

Official classification

Type B

Official code

87555(b)(23)

Regulation authority

CCR

What the official deficiency says

(b) The following food service requirements shall apply: (23) All readily perishable foods or beverages capable of supporting rapid and progressive growth of micro-organisms which can cause food infections or food intoxications shall be stored in covered containers at appropriate temperatures. 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 mulitiple milk cartons and fruits to be expired or have mold growth, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/20/2024 Plan of Correction Licensee agrees to remove all food items that are past expiration or spoiled and submit LIC9098 Proof of Corrections form indicating faciltiy will remain in compliance by POC date 8/20/2024.

Official classification

Type B

Official code

87705(j)

Regulation authority

CCR

What the official deficiency says

(j) The licensee shall have an auditory device or other staff alert feature to monitor exits, if exiting presents a hazard to any resident. 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 2 out of 2 auditory alarms found to be inoperable, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/20/2024 Plan of Correction Licensee agrees to install updated auditory alarms and submit photo proof of corrections by POC date 8/20/2024.