COMMONS AT UNION RANCH, THE

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 their individual service needs in comparison with the admission criteria specified in Section 87455, Acceptance and Retention Limitations. (1) The appraisal shall document, at a minimum: This requirement is not met as evidenced by: Deficient Practice Statement Based on 4/5 AL resident files reviewed the preplacement appraisal was incomplete. This poses a potential risk to clients in care.

Official plan of correction

POC Due Date: 07/18/2026 Plan of Correction The facility will do an internal audit of the preplacement appraisal documents within 30 days

Official classification

Type A

Official code

87465(a)(1)

Regulation authority

CCR

What the official deficiency says

This requirement is not met as evidenced by: Deficient Practice Statement (a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following: (1) The licensee shall arrange, or assist in arranging, for medical and dental care appropriate to the conditions and needs of residents. Based on review of MARS and interview with staff, when a resident runs out of medication it is documented on the MAR as " Medication not available " , sometimes for several weeks. This poses an immediate threat to the H & S of residents in care.

Official plan of correction

POC Due Date: 06/18/2026 Plan of Correction DHS will Provide documentation of training to all Med Techs of facilities regarding practice for ordering medications when they have not been filled by the RP or resident. This alert should be signed by the MT and copies email to Melina.Oropeza@dss.ca.gov by 5:00pm on June 18, 2026.

Official classification

Type A

Official code

87309(b)

Regulation authority

CCR

What the official deficiency says

This requirement is not met as evidenced by: Deficient Practice Statement (b) Residents may have access to items specified in subsection (a) for personal use unless there is documentation, as specified in Section 87457, Pre-Admission Appraisal or Section 87463, Reappraisals, that indicates the resident's or other residents’ safety would be at risk if allowed access. Based on tour of the facility, photographs taken and interview with staff 2of5 MC resident rooms contained personal care supplies accessible to those in care although the residents LIC602 documented that the resident would be at risk if allowed access. This poses an immediate H & S concern for those in care.

Official plan of correction

POC Due Date: 06/17/2026 Plan of Correction Items removed during visit no POC needed. hOWEVER, Facility should provide an in-service to all caregivers regarding this regulation and best practices in the community.

Official classification

Type B

Official code

87468(a)

Regulation authority

CCR

What the official deficiency says

87468 Personal Rights (a) Residents in residential care facilities for the elderly shall have personal rights which include, but are not limited to, those listed in Sections 87468.1, Personal Rights of Residents in All Facilities, and 87468.2, Additional Personal Rights of Residents in Privately Operated Facilities, as applicable to the facility. Based on incident report received from the facility and interview with administrator there is no dispute that R1 was struck by R2 which caused an injury to R1. This poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Facility has already completed staff training during an all staff meeting and covered behaviors, re-direction and how to maintain safety. No POC is due at this time.

Deadline recorded: May 7, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87411(a)

Regulation authority

CCR

What the official deficiency says

87411(a)- Personnel Requirements - General-Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs.This requirement is not met by records review. R-1 AWOL'd from the facility. The LIC 602 states the resident was not allowed to leave the facility unassisted. This presents an immediate health and safety risk to the resident in care.

Official plan of correction

The facility shall conduct an in-service training with staff to go over what and how staff shall ensure that residents do not AWOL. Executive Director shall send the in-service training materials, plan on how staff will ensure residents do not AWOL and a signature sheet of all staff who attended. Executive Director shall email the date of the in-service training to LPA by COB on POC date 04/03/26.

Deadline recorded: Apr 2, 2026. 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

(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 that the kitchen cabinet drawers were in need of repair and a broken chair was set out in the memory care courtyard which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/14/2025 Plan of Correction The facility designated Administrator stated that the kitchen cabinet will be repaired and the broken chair will be removed as soon as possible. A statement of correction, along with proof of correction, will be completed and submitted into CCL by the due date. Proof of correction will involve photos of the repaired/replaced kitchen cabinets and removal of the broken chair.

Official classification

Type B

Official code

1569.625(b)(2)

Regulation authority

HSC

What the official deficiency says

(2) In addition to paragraph (1), training requirements shall also include an additional 20 hours annually, eight hours of which shall be dementia care training, as required by subdivision (a) of Section 1569.626, and four hours of which shall be specific to postural supports, restricted health conditions, and hospice care, as required by subdivision (a) of Section 1569.696. This training shall be administered on the job, or in a classroom setting, or both, and may include online training. 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 [2] out of [7] facility personnel files did not contain initial/annual training hours which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/14/2025 Plan of Correction The facility designated Administrator stated that the staff training hours will be conducted and completed at the designated due date. A statement of correction, along with proof of correction, will be completed and submitted into CCL by the due date. Proof of correction will involve name of instructor, topics of training with related hour(s), and list of facility staff attendees.

Official classification

Type A

Official code

87411(f)

Regulation authority

CCR

What the official deficiency says

(f) All personnel, including the licensee and administrator, shall be in good health, and physically and mentally capable of performing assigned tasks. Good physical health shall be verified by a health screening, including a chest x-ray or an intradermal test, performed by a physician not more than six (6) months prior to or seven (7) days after employment or licensure. A report shall be made of each screening, signed by the examining physician. The report shall indicate whether the person is physically qualified to perform the duties to be assigned, and whether he/she has any health condition that would create a hazard to him/herself, other staff members or residents. A signed statement shall be obtained from each volunteer affirming that he/she is in good health.Personnel with evidence of physical illness or emotional instability that poses a significant threat to the well-being of residents shall be relieved of their duties. 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 [1] out of [8] facility personnel records was not properly cleared for TB by a licensed medical professional which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/18/2024 Plan of Correction The facility designated Administrator stated that all facility personnel records will be reviewed to make sure that all of them are properly cleared, with documentation from a licensed medical professional, for TB at all times. A statement of correction, along with copies of all updated and completed TB clearances, will be completed and submitted into CCL by the due date of 07/18/2024.

Official classification

Type B

Official code

87506(b)

Regulation authority

CCR

What the official deficiency says

(b) Each resident's record shall contain at least the following information: 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 [7] out of [8] facility resident files were incomplete missing required forms and documents which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/24/2024 Plan of Correction The facility designated Administrator stated that all resident records will be reviewed to make sure that all of them are properly updated to include the required forms and documents at all times. A statement of correction, along with copies of all updated and completed forms, will be completed and submitted into CCL by the due date of 07/24/2024.

Official classification

Type A

Official code

87705(c)(5)

Regulation authority

CCR

What the official deficiency says

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, the licensee did not comply with the section cited above in [1] out of [8] facility resident records did not have an updated annual medical assessment to address care of persons diagnosed with dementia which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/18/2024 Plan of Correction The facility designated Administrator stated that all residents diagnosed with dementia will be reviewed to make sure that their annual medical assessments have been updated with complete records in their respective files. A statement of correction, along with copies of updated medical assessments addressing care needs for dementia, will be completed and submitted into CCL by the due date of 07/18/2024.