BROOKDALE KETTLEMAN LANE

Official classification

Type A

Official code

Not listed

Regulation authority

Not listed

What the official deficiency says

Maintenance and Operation: Facilities shall have signal systems which shall meet the following criteria: Operate from each resident's living unit. This requirement was not met as evidenced by LPA pushing call buttons in mulitple resident rooms. Room 5 the call system did not notifiy of an alert from a resident's room and which poses an immediate health safety and personal rights risk to residents in care.

Deadline recorded: Jun 13, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87555(b)(23)

Regulation authority

CCR

What the official deficiency says

87555(b)(23) All readily perishable foods...shall be stored in covered containers at appropriate temperatures. This requirement is not met as evidenced by Based on observation, food was stored in the refrigerator uncovered.

Official plan of correction

Licensee agrees to conduct an in-service staff training on food cycling and food dating. Licensee agrees to send LPA Campbell a copy of a sign-in sheet for this training by the POC due date. Renee.cambell@dss.ca.gov

Deadline recorded: Dec 29, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

Not listed

Regulation authority

CCR

What the official deficiency says

Deficiency narrative not available.

Official classification

Type A

Official code

1569.312(a)

Regulation authority

HSC

What the official deficiency says

Basic Service Requirements. Every facility required to be licensed under this chapter shall provide at least the following basic services: (a) Care and supervision as defined in Section 1569.2. This requirement was not met as evidenced by: Based on record reviews and interviews, R1 sustained multiple falls over a period of seven month time frame without the Licensee ensuring appropriate intervention to aid in R1’s care and supervision resulting in injury. This posed an immediate risk to residents health, safety, and resident rights.

Official plan of correction

Facility Administrator agrees to develop a plan and conduct training for all staff by POC date 10/30/2023 on appropriate intervention to aid in care and supervision to prevent injury. Facility will email LPa the signed sheet of training compleated by 11/10/2023. Kesha.lewis@dss.ca.gov

Deadline recorded: Oct 30, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87463(a)(3)

Regulation authority

CCR

What the official deficiency says

87463 Reappraisals (a) The pre-admission appraisal shall be updated, in writing as frequently as necessary to note significant changes and to keep the appraisal accurate. The reappraisals shall document changes in the resident's physical, medical, mental, and social condition. Significant changes shall include but not be limited to:(3) Any illness, injury, trauma, or change in the health care needs of the resident that results in a circumstance or condition specified in Sections 87455(c) or 87615, Prohibited Health Conditions. Based on records review there was no updated needs and services plane done for R1 after falling multiple times. This posed an immediate risk to residents health, safety, and resident rights.

Official plan of correction

Licensee shall provide a statement of acknowledgement that appraisals are conducted on an ongoing basis by the POC date. Kesha.lewis@dss.ca.gov

Deadline recorded: Oct 27, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(a)(4)

Regulation authority

CCR

What the official deficiency says

Incidental Medical and Dental Care. (a) A plan for incidental medical and dental care shall be developed by each facility...(4) The licensee shall assist residents with self-administered medications as needed. This requirement was not met as evidenced by: Based on interview and record review,Licensee did not comply with section cited above in that R1 and R2 did not receive medication as prescribed by physician due to facility staff error. This posed an immediate health and safety risk ti residents in care.

Official plan of correction

Licensee will ensure completed staff training on proper assistance with self-administration of medication including but not limited to: Following physician orders. Training date to be submitted to LPA by POC due date. Training to be completed no later than 2 weeks from date of citation issuance. Proof of completed training to be submitted to LPA prior to citation clearance.

Deadline recorded: Mar 1, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87705(g)(1)

Regulation authority

CCR

What the official deficiency says

87705(g)(1) Care of Persons with Dementia. (g) As required by Section 87468(a)(12), residents with dementia shall be allowed to keep personal grooming and hygiene items in their own possession, unless there is evidence to substantiate that the resident cannot safely manage the items. (1)Evidence means documentation from the resident’s physician that the resident is at risk if allowed direct access to personal grooming and hygiene items. This requirement is not met as evidenced by: Based on records review The licensee did not ensure that staff met the care and supervision needs of R1 and R2 who had access to toxins in the facility when their 602 stated they would be at risk if allowed direct access to personal grooming products. This poses an immediate health and safety risk to residents in care.

Official plan of correction

Licensee agrees to submit a written plan ensuring that staff met the care and supervision needs of residents with Dementia. Plan of Correction is due on 01/18/2023

Deadline recorded: Jan 18, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87457(c)(1)

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. (1) The appraisal shall include, at a minimum, an evaluation of the prospective resident's functional capabilities, mental condition and an evaluation of social factors as specified in Sections 87459, Functional Capabilities and 87462 Social Factors. This requirement is not met as evidenced by: Based on records review R3 and R4 had missing pre appraisal which did not allow facility or LPA'S to determine residents needs upon arrival. This poses an potential health and safety risk to residents in care.

Official plan of correction

Licensee agrees to submit a written plan ensuring that staff met the care and supervision needs of residents with Dementia. Plan of Correction is due on 01/27/2023

Deadline recorded: Jan 27, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(c)(2)

Regulation authority

CCR

What the official deficiency says

87465(c)(2) Once ordered by the physician, nonprescription PRN medications shall be given in accordance with the physician’s directions. This requirement was not meet as evidenced by. LPA Received SIR for R1 being given an extra dose of medication.

Official plan of correction

By 11/22/2022 the Administrator shall evaluate the facility's medication distribution practices and submit a revised program plan on medication management to avoid any further medication errors. Further, additional medication training shall be completed by staff who handle medication.

Deadline recorded: Nov 22, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(d)(1-3)

Regulation authority

CCR

What the official deficiency says

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: Facility staff shall contact the resident's physician prior to each dose, describe the resident's symptoms, and receive direction to assist the resident in self-administration of that dose of medication. The date and time of each contact with the physician, and the physician's directions, shall be documented and maintained in the resident's facility record. 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: Records reviewed and interviews with the Administrator confirmed that the facility did not have the Physician identify the abilities of R1 to determine her needs for PRN medication as a result the facility administered Seroquel twice as a PRN which was not how the PRN was written. The facility does not have a current list of PRN medications sign by the Physician as to R1’s ability to determine if the medications are needed and whether are not the Physician needed to be contacted prior to or after

Official plan of correction

Licensee shall submit plan on when an in-service to medication staff will be completed. Completion shall be submitted with proof of attendance to CCL by 11/22/22, as well as updating the resident files to include a signed PRN letter for each resident that takes a PRN with the wishes of the assigning Physician

Deadline recorded: Nov 22, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87211(a)(1)(d)

Regulation authority

CCR

What the official deficiency says

Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: (1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below. This report shall include the resident's name, age, sex and date of admission; date and nature of event; attending physician's name, findings, and treatment, if any; and disposition of the case.(D) Any incident which threatens the welfare, safety or health of any resident, such as psychological abuse of a resident by staff or other residents, or unexplained absence of any resident. This requirement was not meet as evidenced by records review LPA'S reviewed R1'S file and found they were being treated for rash that was later identified as scabies, (SIR) serious incident report was not sent to CCL until 10/04/2022. Rash first identified in June 30th 2022. This poses an immediate health and safety risk to residents in care.

Official plan of correction

Administrator will review Title 22 Regulations Section 87211 and have an In-service training with all Staff regarding Reporting Requirements. Administrator will submit a written plan ensuring that incidents are reported to the CCL office as required according to the Regulation. Signatures of all Staff from the training must be submitted to CCL after training is complete. The plan is due by the POC date of 12/03/22.

Deadline recorded: Dec 3, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87465(g)

Regulation authority

CCR

What the official deficiency says

87465(g)Incidental Medical and Dental. The licensee shall immediately telephone 9-1-1 if an injury or other circumstance has resulted in an imminent threat to a resident’s health ... This requirement is not met as evidenced by: Based on observation, interview and record review, the licensee did not call 911 as required by requlations.

Official plan of correction

Licensee will provide staff training on 911 policy and provide proof of training to LPA by POC date.

Deadline recorded: Oct 26, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87465(a)(4)

Regulation authority

CCR

What the official deficiency says

87465(a)(4)Incidental Medical and Dental Care …The plan shall encourage routine medical and dental care … (4) The licensee shall assist residents with self-administered medications .... This requirement is not met as evidenced by Based on observation, interview and record review, medication was missed on 08/15/22 and given incorrectly on 07/17/22 and 08/20/22 which poses a potential Health, Safety or Personal Rights risk to persons in care.

Official plan of correction

Licensee will require that med-techs undergo training on following medication orders. Licensee will provide proof of training by POC date.

Deadline recorded: Oct 24, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

Not listed

Regulation authority

Not listed

What the official deficiency says

(g) All personnel records shall be maintained at the facility and shall be available to the licensing agency for review. This regulation was not followed as observed in the lack of sighed Employee RIghts forms in Personnel Files. Based on record review, licensee did not comply with section cited above in 87412(g). LPA observed 5 of 5 staff files did not have employee rights on file which poses as a potential health and safety risks to residents in care.

Deadline recorded: Jul 19, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

Not listed

Regulation authority

Not listed

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: (2) Request a transfer of a criminal record clearance. This requirement was not met as evidence by:

Deadline recorded: Jul 6, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

Not listed

Regulation authority

Not listed

What the official deficiency says

Based on record review, licensee did not comply with section cited above in 87355 (e)(2). LPA observed S1 is not associated to the facility which poses as an immediate health and safety risks to residents in care.

Deadline recorded: Jul 6, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(c)(2)

Regulation authority

CCR

What the official deficiency says

87465(c)(2): Incidental Medical and Dental Care:(c) ...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 was not met as evidence by: Based on documentation, Facility did not comply with the section cited in 87465(c)(2). Based on documentation, there was a medication error with R1, resulting in R1 receiving medication twice. This poses an immediate health and safety risks to clients in care.

Official plan of correction

Facility agreed to conduct in-service training regarding medication order with all staff and submit proof to CCLD by POC date. Deficiency cleared during inspection.

Deadline recorded: Jun 7, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87465(c)(2)

Regulation authority

CCR

What the official deficiency says

87465(c)(2): Incidental Medical and Dental Care:(c) ...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 was not met as evidence by: Based on documentation, Facility did not comply with the section cited in 87465(c)(2). Based on documentation, there was a medication error with R1, resulting in R1 receiving medication twice. This poses a potential health and safety risks to clients in care.

Official plan of correction

ED agreed to conduct in-service training regarding medication order with all staff and submit proof to CCLD by POC date.

Deadline recorded: Feb 24, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87211(a)(1)

Regulation authority

CCR

What the official deficiency says

(a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: (1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below. This report shall include the resident's name, age, sex and date of admission; date and nature of event; attending physician's name, findings, and treatment, if any; and disposition of the case. This requirement was not met as evidence by based on observation facility did not comply with the section cited above in 87211(a)(1). LPA observed facility did not inform CCLD within 7 days of incident occurrence which poses a potential health and safety risk to residents in care.

Official plan of correction

Executive Director agreed to review regulations on reporting requirements. Executive Director also agreed to conduct in-service training with management and submit proof to CCL by POC date.

Deadline recorded: Feb 1, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87211(a)(2)

Regulation authority

CCR

What the official deficiency says

(a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following (2)Occurrences, such as epidemic outbreaks... shall be reported within 24 hours either by telephone or facsimile to the licensing agency... This requirement is not met as evidence by. Based on LPA observation, facility did not comply with section cited above on 87211(a)(2). LPA observed facility did not inform CCLD of COVID positive resident within 24 hours which poses as an immediate health and safety risks to residents in care.

Official plan of correction

Executive Director agreed to review regulations on reporting requirements. Executive Director also agreed to conduct in-service training with management and submit proof to CCL by POC date.

Deadline recorded: Oct 4, 2021. A deadline is not proof that correction was completed.