A1 DEL MONTE STOCKTON

Official classification

Type A

Official code

87203

Regulation authority

CCR

What the official deficiency says

All facilities shall be maintained in conformity with the regulations Adopted by the State Fire Marshall for the protection of life and property against fire and panic. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation the licensee did not comply with the section cited above due to not having immediate access to the fire extinguisher as the door had been painted shut. Which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/11/2026 Plan of Correction Administrator will make sure all fire extinguishers are accessible.

Official classification

Type A

Official code

87305(a)

Regulation authority

CCR

What the official deficiency says

87305 Alterations to Existing Building or New Facilities (a) Prior to construction or alterations, all facilities shall obtain a building permit. This requirements is not met as evidenced by The facility has moved the memory care door back approximately 10 feet to expose additional rooms to be used for none memory care residents. This is an immediate saftey risk to residents in care.

Official plan of correction

The Licensee will contact building permits or code enforcement to determine if the altercations to the buliding require a permit and if the work completed meets code. The information will be submitted to the department by the close POC date. If addtional time is needed please request the additional time by submitting a request in writting or email LPA

Deadline recorded: Apr 3, 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

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: Based on record reviews and interviews, Licensee is addressing the situation with a routine bed bug treatment service after an initial bed bug occurrence.

Official plan of correction

The facility is actively working with a local exterminator to remedy the incidents and to prevent reoccurrence.

Deadline recorded: Jun 14, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87307(a)(2)(c)

Regulation authority

CCR

What the official deficiency says

87307 Personal Accommodations and Services (a) Living accommodations and grounds shall be related to the facility's function. The facility shall be large enough to provide comfortable living accommodations and privacy for the residents, staff, and others who may reside in the facility. The following provisions shall apply: (C) No bedroom of a resident shall be used as a passageway to another room, bath or toilet. This requirement was not met as evidenced by based on touring the facility and interviews with the staff. R1's room was an access point for the shower and the bathroom.

Official plan of correction

The facility has addressed the room access point and has established an alternative enrty into the shower /bathroom area. POC cleared.

Deadline recorded: May 15, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87468.1

Regulation authority

CCR

What the official deficiency says

87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (1) To be accorded dignity in their personal relationships with staff, residents, and other persons. (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This requirement was not met as evidenced by the actions of S1 opening the door to the kitchen without regard causing an injury to R1. This is an immediate safety risk for residents in care.

Official plan of correction

Licensee is to ensure that all inservice trainings are documented and residents' personal rights are upheld at all times. Please submit a letter of understanding and a copy of the completed in-service training to include date and signatures of trainer and attendees by POC due date.

Deadline recorded: Jan 25, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87468.2(a)(4)

Regulation authority

CCR

What the official deficiency says

(a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (4) To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs. This requirement is not met as evidenced by R1 sustaining an injury.

Official plan of correction

The facility has completed the in service training fro Personal rights. The plan of correction was completed on 1/25/2024.

Deadline recorded: Mar 6, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87208(a)(9)

Regulation authority

CCR

What the official deficiency says

Plan of Operation. (a) Each facility shall have and maintain a current, written definitive plan of operation… Any significant changes in the plan of operation which would affect the services to residents shall be submitted to the licensing agency for approval…(9) A statement whether or not the applicant will handle residents' money and/or valuables. If money or valuables will be handled, the method for safeguarding…This requirement is not met as evidenced by: Based on record reviews and interviews, licensee did not ensure the practice and method of maintaining and using resident debit card for purposes of obtaining monthly rent be explained in the facility’s plan of operation which resulted in a potential health, safety, and resident rights risk to residents in care.

Official plan of correction

Licensee will ensure an updated plan of operation be submitted to LPA by POC due date to include, but not be limited to: Policies on safeguarding resident properties including debit cards and how such cards are stored and utilized.

Deadline recorded: Dec 15, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87405(d)(2)

Regulation authority

CCR

What the official deficiency says

Administrator - Qualifications and Duties. (d) The administrator shall have the qualifications specified in Sections 87405(d)(1) through (7)… (2) Knowledge of and ability to conform to the applicable laws, rules and regulations. This requirement was not met as evidenced by: Based on record review, Administrator did not exercise the practice of initiating a necessary change in plan of operation and submit to the Department. This resulted in a potential health, safety, and resident rights risk to residents in care.

Official plan of correction

Administrator will read regulation 87405(d)(2) and reference regulation 87208(a). Administrator will submit a signed declaration of understanding these regulations to LPA by POC due date.

Deadline recorded: Dec 15, 2023. 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 as evidenced by: Based on interviews and record reviews, the facility maintained a presence of bed bugs between 8-24-23 and 8-30-23 with treatment for bed bugs initiated on 8-30-23. This posed a potential health, safety, and resident rights risk to residents in care.

Official plan of correction

Licensee designee has provided pest control service records to LPA indicating completed service. Licensee shall provide an updated plan of procedures for processes involving treatment of bed bugs and other pests in the event of reoccurrence. Update shall include evidence of a routine pest control service specifically targeting bed bugs in addition to general service. Plan to be submitted to LPA by POC due date.

Deadline recorded: Sep 20, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87203

Regulation authority

CCR

What the official deficiency says

Fire Safety. All facilities shall be maintained in conformity with the regulations adopted by the State Fire Marshal for the protection of life and property against fire and panic. This requirement was not met as evidenced by: Based on observation and interview, Memory care door alarm was not functioning in that bar door was unable to move forward, which poses an immediate health, safety, and resident rights risk to residents in care.

Official plan of correction

Door was repaired during LPAs visit and LPAs observed alarm to be functioning properly. Licensee will read regulation 87203 and submit a signed declaration of understanding to LPA by POC due date.

Deadline recorded: Jul 13, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87202(a)

Regulation authority

CCR

What the official deficiency says

Fire Clearance. (a) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department, or district providing fire protection services, or the State Fire Marshal...This requirement was not met as evidenced by: Based on interview and record review, Licensee initiated a relocation of memory care door without securing an updated fire clearance. This poses an immediate health and safety risk to residents in care.

Official plan of correction

Licensee will update LIC 200 and submit to LPA by POC due date as process for updating fire clearance. Licensee will read regulation 87202 (a) and submit a signed declaration of understanding to LPA by POC due date. *Civil Penalty assessed for Fire Safety*

Deadline recorded: Jul 13, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87305(a)

Regulation authority

CCR

What the official deficiency says

Alterations to existing buildings and new facilities. (a) Prior to construction or alterations, all facilities shall obtain a building permit. This requirement was not met as evidenced by: Based on interview and record review, licensee did not secure a buidling permit for an alteration regarding memory door relocation. This poses an immediate health and safety risk to residents in care.

Official plan of correction

Licensee will submit proof of application for building permit to LPA by POC due date. Licensee will read regulation 87305(a) and submit a signed declaration of understanding to LPA by POC due date.

Deadline recorded: Jul 13, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87405(h)(5)

Regulation authority

CCR

What the official deficiency says

Administrator Qualifications-Duties. (h) The administrator shall have the responsibility to:(5) Provide or ensure the provision of services to the residents with appropriate regard for the residents' physical and mental well-being and needs...This requirement was not met as evidenced by: Based on interview and record review, Licensee did not ensure a provision of safety for residents in that a plan to ensure resident rights and safety was not submitted in regards to a building alteration. This posed an immediate health and safety risk to residents in care.

Official plan of correction

Licensee will read regulation 87405(h)(5) and submit a signed declaration of understanding to LPA by POC due date.

Deadline recorded: Jul 13, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

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 5 out of 11 staffing files reviews. Health screening forms were completed more than 7 days after employee hire and facility licensure which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/20/2023 Plan of Correction Licensee will read regulation 87411(f) and submit a signed declaration of understanding to LPA by POC due date. Licensee will conduct staff file audit to bring any necessary health screening reports up to date. Results of audit to be sent to LPA by POC due date.

Official classification

Type B

Official code

87224(f)

Regulation authority

CCR

What the official deficiency says

Eviction Procedures. (f) A written report of any eviction shall be sent to the licensing agency within five (5) days. This requirement was not met as evidenced by: Based on record review and interview, licensee did not ensure an eviction notice issued to R1 on 4-17-23 was sent to licensing department within regulatory time frame as noted above.

Official plan of correction

Licensee will rescind previous written eviction notice and so inform R1. Licensee will send proof of rescinded notice to LPA by POC due date.

Deadline recorded: May 15, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

1569.312(d)

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: (d) Being aware of the resident's general whereabouts… This requirement was not met as evidenced by: Based on interview and record review, Licensee did not ensure facility’s knowledge of R1’s whereabouts on 2-28-23 leading to an absence of supervision. This posed an immediate health, safety, and resident rights risk to resident in care.

Official plan of correction

Licensee to conducted staff training on elopement policy and procedures. Training date to be submitted to LPA by POC due date. Training to be completed and proof of completed training sent to LPA no later than 2 weeks from citation issued date. Licensee will submit a plan outlining procedures for maintaining knowledge of residents whereabouts at all times. Plan to be submitted to LPA by POC due date.

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

Official classification

Type B

Official code

87625(b)(3)

Regulation authority

CCR

What the official deficiency says

87625(b)(3). Managed Incontinence. (b) ...the licensee shall be responsible for the following: (3) Ensuring that...facility remains free of odors from incontinence. This requirement was not as evidenced by: Based on observation, licensee did not comply with this regulation in that LPA observed a strong urine odor in and around room 107 on 3-24-23. This poses a potential health and safety risk to residents in care.

Official plan of correction

Licensee will submit a plan to ensure incontinent residents are kept clean and dry, and rooms, along with surrounding areas are kept odor free. Plan to be submitted to LPA by POC due date.

Deadline recorded: Apr 4, 2023. 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...This requirement was not met as evidenced by: Based on observation, licensee did not comply with this regulation in that LPA observed a used adult diaper on the floor of room 107 near the foot of R1's bed. This posed a potential health and safety risk to residents in care.

Official plan of correction

Licensee will submit a plan to ensure rooms, common areas, and other areas used by residents remain clean and sanitary. Plan to be submitted to LPA by POC due date.

Deadline recorded: Apr 4, 2023. 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...This requirement was not met as evidenced by: Based on observation and interview, window seal in room 107 contained damage for 2-3 weeks after occurrance. This poses a potential health and safety risk to residents in care.

Official plan of correction

Licensee has repaired damage to window seal and send photo proof of repair to LPA. Licensee will submit a plan outlining how future repair items will be addressed timely. Plan to submitted to LPA by POC due date.

Deadline recorded: Apr 4, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.2(a)(2)

Regulation authority

CCR

What the official deficiency says

Additionial Personal rights...(a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities...(2) To have their records and personal information remain confidential and to approve their release, except as authorized by law. This requirement was not met as evidenced by: Based on record review and interview, Licensee did not ensure confidential medical information for R2 in that a photograph of medication information was sent to the wrong receipient. This posed a potential health, safety and resident rights risk to residents in care.

Official plan of correction

Licensee will read regulation 87468.2(a)(2) and submit a signed declaration of understanding to LPA by POC due date. Licensee will submit plan outlining procedures for safely and effectively communicating private information to the appropriate parties. Plan to be submitted to LPA by POC due date.

Deadline recorded: Apr 4, 2023. 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

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 as evidenced by: Licensee did not ensure a proper medication order was followed for R3 in that R3 was given 80mg of Lasix instead of the physician ordered 40mg of Lasix on 12-27-22. This posed a potential health and safety risk to resident in care.

Official plan of correction

Licensee and facility nurse have provided additional staff inservice on medication administration and will provide proof of completed inservice to LPA by POC due date. Licensee will read regulation 87465(a)(4) and submit a signed declaration of understanding to LPA by POC due date.

Deadline recorded: Feb 10, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

1569.312(d)

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: (d) Being aware of the resident's general whereabouts… This requirement was not met as evidenced by: Based on interview and record review, Licensee did not ensure facility’s knowledge of R1’s whereabouts on 8-19-22 leading to an elopement episode and absence of supervision. This posed an immediate health, safety, and resident rights risk to resident in care. An immeidate civil penalty in the amount of $500 is being issued on today's visit due to the violation of absence of supervision Additional civil penalty may be assessed upon further department review.

Official plan of correction

Licensee wil submit a plan to ensure residents whereabout are accounted for by staff. Plan to be submitted to LPA by POC due date. Licensee to conducted staff training on elopement policy and procedures. Training date to be submitted to LPA by POC due date. Training to be completed and proof of completed training sent to LPA no later than 2 weeks from citation issued date of 8-19-22.

Deadline recorded: Aug 29, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.1(a)(1)

Regulation authority

CCR

What the official deficiency says

Personal Rights of Residents in All Facilities 87468.1(a)(1) residents in all residential care facilities for the elderly shall have all of the following personal rights: to be accorded dignity in their personal relationships with staff...This requirement was not met as evidence by: Based on observation: staff 1 and staff 2 did not provide R1 with dignity. This posed a potential health and safety risk to resident 1 (R1).

Official plan of correction

Facility staff agrees to conduct a training on personal rights for the administrator and all staff by POC date 08/24/2022. Facility will email LPA Martinez copies of training sign in sheet and training materials by POC date 08/24/2022.

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

Official classification

Type B

Official code

87405(d)(5)

Regulation authority

CCR

What the official deficiency says

Administrator - Qualifications and Duties 87405(d)(5) The administrator shall have the qualifications specified in Sections 87405...Good character and a continuing reputation of personal integrity. This requirement was not met as evidence by: Based on observation facility administrator did not implement personal integrity. this posed a potential health and safety risk to R1.

Official plan of correction

Administrator agrees to complete a training on personal rights and integrity by POC date 08/24/2022. Facility will email LPA Martinez copies of training sign in sheet and training materials by POC date 08/24/2022.

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

Official classification

Type B

Official code

87468.1(a)(11)

Regulation authority

CCR

What the official deficiency says

87468.1 (a)(11)Personal Rights of Residents in All Facilities: Residents in all residential care facilities for the elderly shall have all of the following personal rights: To have their visitors, including ombudspersons and advocacy representatives, permitted to visit privately during reasonable hours. This requirement was not met as evidence by:Based on interviews it was learned resident's visitors were not granted entry during reasonable hours. This posed a potential health and safety risk to residents in care.

Official plan of correction

The facility agrees to conduct Covid-19 and visitation training for all staff by POC Date 08/24/2022. Facility staff will email training documentation and sign in sheet to LPA Martinez by POC date 08/24/2022.

Deadline recorded: Aug 24, 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

87303 (a) Maintenance and Operation: 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 as evidence by: based on observation and interview review, LPA Martinez observed R1 and R2 bedroom were unsanitary and not in good repair. This posed a potential health and safety risk to residents in care.

Official plan of correction

Facility staff agrees to conduct a housekeeping and facility maintenance and operation training for all housekeeping staff by POC date 08/24/2022. Facility will email LPA Martinez copies of training sign in sheet and training materials by POC date 08/24/2022. Facility has installed bug zappers in the facility.

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

Official classification

Type B

Official code

87211(a)(2)

Regulation authority

CCR

What the official deficiency says

Reporting Requirements. (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...which threaten the welfare, safety or health of residents...shall be reported within 24 hours...to the licensing agency and to the local health officer... This requirement is not met as evidenced by: Based on record review and interviews: A suspected outbreak of flu occurred on 6-5-22 involving multiple residents, resulting in the threat to welfare, safety, and health of residents in care. This poses a potential health and safety risk to residents in care.

Official plan of correction

Licensee will conduct staff training on regulation 87211(a)(2) and submit proof of completed training to LPA by POC due date. Licensee will submit a signed declaration of understanding of regulation 87211(a)(2) to LPA by POC due date.

Deadline recorded: Jun 20, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(e)

Regulation authority

CCR

What the official deficiency says

Incidental Medical and Dental Care. (e) For every prescription…medication for which the licensee provides assistance there shall be a signed, dated written order from a physician…This requirement is not met as evidenced by: Based on record reviews and interviews licensee did not ensure physician’s order for blood pressure medication was followed appropriately. Medication for R1 was held by facility staff and not given to R1 without a physician’s approved order to hold or stop medication. This poses an immediate health and safety risk to residents in care.

Official plan of correction

Licensee will ensure staff complete medication training on assisting residents with medication and following physician orders. Training date to be submitted to LPA by POC due date. Proof of training to be submitted to LPA by POC due date.

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

Official classification

Type A

Official code

87465(a)(1)

Regulation authority

CCR

What the official deficiency says

Incidental Medical and Dental Care.A plan for incidental medical and dental care shall be developed by each facility (1)The licensee shall arrange, or assist in arranging, for medical and dental care appropriate to the conditions and needs of residents. This requirement is not met as evidenced by: Based on record reviews and interviews, licensee did not ensure physician was efficiently notified for medication order clarification for R1. This poses an immediate health and safety risk to residents in care.

Official plan of correction

Licensee will submit a plan which ensures physician’s are efficiently and effectively notified for any resident care needs. Plan to be submitted to LPA by POC due date.

Deadline recorded: Apr 11, 2022. 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. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following: (4)The licensee shall assist residents with self-administered medications as needed. This requirement is not met as evidenced by: Based on interviews and record reviews, Licensee did not ensure R1 receive a prescribed blood pressure medication for a period of more than 3 weeks. This poses an immediate health and safety risk to residents in care.

Official plan of correction

Licensee will submit a plan to ensure residents are receiving medications as ordered. Plan to be submitted to LPA by POC due date Licensee will ensure staff training on medication regarding physician’s orders and working with pharmacies is completed. Proof of training to be sent to LPA by POC due date.

Deadline recorded: Mar 17, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87405(h)(5)

Regulation authority

CCR

What the official deficiency says

Administrator-Qualifications and Duties. (h) The administrator shall have the responsibility to: (5) Provide or ensure the provision of services to the residents with appropriate regard for the residents' physical and mental well-being and needs…This requirement is not met as evidenced by: Based on interviews and record reviews, Licensee did not ensure Administrator communicate effectively with designee, other staff, and outside entities to resolve a medication order discrepancy for R1’s blood pressure medication resulting in R1 not receiving medication for a period longer than 3 weeks. This poses an immediate health and safety risk to residents in care.

Official plan of correction

Licensee will submit a plan to ensure Administrator staff effectively communicate to meet residents’ needs.

Deadline recorded: Mar 17, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87705(b)(2)

Regulation authority

CCR

What the official deficiency says

Care of Persons with Dementia. (b) In addition to the requirements as specified in Section 87208, Plan of Operation, the plan of operation shall address the needs of residents with dementia, including (2) Safety measures to address behaviors such as wandering, aggressive behavior and ingestion of toxic materials. This requirement is not met as evidenced by: Based on interviews and record reviews, Licensee did not ensure the staff present appropriately coordinate to address R1s wandering behavior resulting in R1 exiting facility unattended on 3-12-22. This poses an immediate health and safety risk to residents in care.

Official plan of correction

Licensee will develop a plan to ensure wandering and exit seeking behaviors are addressed to prevent any future attempted elopements. Plan to be submitted to LPA by POC due date. Licensee to assess current alarm system and submit a tested audit of alarm system functionality to determine appropriate resident safety.

Deadline recorded: Mar 15, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87303(i)(A)(B)(C)

Regulation authority

CCR

What the official deficiency says

Maintenance and Operation (i) Facilities shall have signal systems which shall...(1)All facilities licensed for 16 or more...shall:(A)Operate from each resident's living unit.(B)Transmit a visual and/or auditory signal to a central staffed location or produce an auditory signal at the living unit loud enough to summon staff. (C) Identify the specific resident living unit. This requirement is not met as evidenced by: Based on observation and interview, it was determined that facility's signal system did not function properly per regulatory requirements in 8 out of 8 resident rooms. This poses an immediate health, safety, and resident rights risk to residents in care.

Official plan of correction

Licensee will submit plan to ensure resident needs are met with alternative signal system until current system is repaired or replaced. Plan to be submitted to LPA by POC due date. Licensee has provided hand held bells for residents in care as of 3-8-22. Licensee will repair or replace current signal system to meet regulatory requirements. A time frame for repair or replacement to be submitted to LPA by POC due date.

Deadline recorded: Mar 9, 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

Reporting Requirements. (a) Each licensee shall furnish to the licensing agency such reports...:(1) A written report shall be submitted to the licensing agency…within seven days of the occurrence of any of the events specified…(D) Any incident which threatens the welfare, safety or health of any resident… This requirement is not met as evidenced by: Based on interviews and record reviews, R1 did not receive prescribed blood pressure medications for approximately 3 weeks and incident was not reported to licensing agency. This poses a potential health and safety risk to residents in care.

Official plan of correction

Licensee will read regulation 87211 and submit a signed declaration of understanding to LPA by POC due date Licensee will conduct staff training on regulation 87211 and submit proof of completed training to LPA by POC due date. Training from an outside vendor to be utilized.

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

Official classification

Type B

Official code

1569.655(a)

Regulation authority

HSC

What the official deficiency says

Increase in fee rates for elderly residents...60 days' written notice..(a)If a licensee of a residential care facility for the elderly increases the rates of fees for residents...the licensee shall provide no less than 60 days' prior written notice to the residents or the residents' representatives setting forth the amount of the increase, the reason for the increase, and a general description of the additional costs. This requirement is not met as evidenced by: Based on record review and interviews Licensee did not ensure proper 60-day notification was given to R1 for a rate increase. This poses a potential resident rights risks to residents in care.

Official plan of correction

Licensee has re-issued a revised 60-day notice with proper contents to R1 on 2-18-22 to reflect the new rate change on 5-1-22. Licensee will read health and safety code 1569.655 and provide a signed certification of understanding to LPA by POC due date.

Deadline recorded: Feb 28, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87211(c)

Regulation authority

CCR

What the official deficiency says

c) Any suspected physical abuse that does not result in serious bodily injury of an elder or dependent adult shall be reported to the local ombudsman, the corresponding licensing agency, and the local law enforcement agency within twenty-four (24) hours as required by Welfare and Institutions Code Section 15630(b)(1). This requirement is not met as evidenced by: Based on interviews conducted an incident of suspected abuse occurred on 1-4-22 and was not reported timely to local law enforcement and ombudsman. This poses a potential health and safety risk to residents in care.

Official plan of correction

Licensee will report the incident to local law enforcement and ombudsman by POC due date and submt proof of completed reporting to LPA by POC due date. Licensee will schedule training on Elder Abuse reporting and submit scheduled training date to LPA by POC due date.

Deadline recorded: Feb 10, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

80069(a)

Regulation authority

CCR

What the official deficiency says

Client Medical Assessment. Except for licensees of ARFs, prior to or within 30 calendar days following the acceptance of a client, the licensee shall obtain a written medical assessment of the client…The requirement is not met as evidenced by: Based on record review and interview, physician’s report from R1’s chart was absent and not obtained. This poses a potential health and safety risk to residents in care.

Official plan of correction

Licensee will complete physician’s report for R1 and submit copy to LPA by POC due date. Licensee will develop and submit a plan ensuring all residents will have current and updated physician reports in charts as appropriate. Plan to be submitted to LPA by POC due date.

Deadline recorded: Dec 20, 2021. 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

Ammended from original report dated 12-9-21: 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 as evidenced by: Based on record reviews, interviews, and observation, R1 sustained a fall with injury...Licensee did not ensure R1 received appropriate care and supervision due to inadequate staff coverage. This poses an immediate health, safety, and resident rights risk to residents in care.

Official plan of correction

Licensee will submit staffing schedule to indicate appropriate levels of coverage necessary to meet residents’ needs. Schedule to be submitted to LPA by POC due date. Licensee will conduct staff training on fall precautions and submit a scheduled training date to LPA by POC due date. Licensee will submit plan on providing adequate coverage to meet residents’ needs in the event of staff shortages. Plan to be submitted to LPA by POC due date.

Deadline recorded: Dec 10, 2021. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87211(a)(1)(B)

Regulation authority

CCR

What the official deficiency says

Reporting Requirements (a) Each licensee shall furnish….reports as the Department may require…(1) A written report shall be submitted…to the person responsible for the resident within seven days of the occurrence…(B) Any serious injury….occurring while the resident is under facility supervision. This requirement is not met as evidenced by: Based on interviews and record review, responsible person for R1 was not notified in writing of fall that occurred on 10-27-21 at 5:00am within seven days of occurrence. This poses a potential health, safety, and resident rights risk to residents in care.

Official plan of correction

Licensee will read regulation 87211(a)(1) and submit a signed statement of understanding and agreeance to follow regulation. Licensee will submit a plan to ensure responsible parties are notified appropriately following incidents as noted in regulation 87211(a)(1)

Deadline recorded: Dec 20, 2021. 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. (a) The pre-admission appraisal shall be updated in writing…as frequently as necessary to note significant changes and to keep the appraisal accurate. This requirement is not met as evidenced by: Based on records review and interviews, facility did not update an appraisal form for R1 to address fall precautions and a fall event of R1 which occurred on 10-27-21 at 5:00am. This poses a potential health and safety risk to residents in care.

Official plan of correction

Licensee will develop a plan to ensure all resident appraisals are updated as appropriate to meet the needs of residents in care. Plan to be submitted to LPA by POC due date.

Deadline recorded: Dec 20, 2021. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.1(a)(9)

Regulation authority

CCR

What the official deficiency says

Personal Rights of Residents in All Facilities. (a) Residents in all residential care facilities for the elderly shall have…the following rights: (9) To have communications to the licensee from their representatives answered promptly and appropriately. This requirement is not met as evidenced by: Based on interviews, Licensee did not ensure responsible person for R1 was answered promptly when requesting documents relating to a fall event for R1. Documents were requested on 11-1-21 and not received until 11-19-21. This poses a potential health, safety, and resident rights risk to residents in care.

Official plan of correction

Licensee will read regulation 87468.1(a)(9) and submit a signed understand of regulation indicating agreeance to follow the regulation. Licensee will conduct staff training to ensure communications from responsible persons of resident in care are answered timely. Proof of training to be submitted to LPA by POC due date.

Deadline recorded: Dec 20, 2021. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

80061(b)(1)(D)

Regulation authority

CCR

What the official deficiency says

Reporting requirements. (b) Upon the occurrence...of any of the events specified in (1)...a report shall be made to the licensing agency within the agency's next working day...a written report containing the information...shall be submitted to the licensing agency within seven days following the occurrence of such event. (1) Events reported shall include...(D)Any injury to any client which requires medical treatment. This requirement is not met as evidenced by: Based on record review licensee did not ensure timley reporting of incident in 6 of 14 incident reports reviewed. This poses a potential health and safety risk for resident in care. Civil penalty assessed due to repoeat violation.

Official plan of correction

Licensee will submit a plan to ensure timely reporting of incidents to licensing department. Plan shall include a procedure for designating an individual in charge of auditing and ensuring accurate and timely reporting. Licensee to submit plan to LPA by POC due date.

Deadline recorded: Nov 29, 2021. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87413(a)(1)

Regulation authority

CCR

What the official deficiency says

Section 87413 Personnel-Operations (a) In each facility (1) When regular staff members are absent, there shall be coverage by personnel with qualifications adequate to perform the assigned tasks. This requirement is not met as evidenced by: Based on interviews and record review, One staff member was attending to memory care unit and left unit unattended. Licensee did not ensure qualified personnel coverage in the memory care unit when staff member left memory care unit unattended which poses an immediate health, safety, and resident rights risk to residents in care.

Official plan of correction

Licensee will submit a staffing plan to ensure residents are not left unattended by staffing personnel. Licensee will submit a staffing schedule ensuring adequate coverage to prevent lack of supervision of residents. Licensee to submit above POCs by due date.

Deadline recorded: Sep 9, 2021. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

80078(a)

Regulation authority

CCR

What the official deficiency says

80078 Responsibility for Providing Care and Supervision (a) The Licensee shall provide care and supervision as necessary to meet the client’s needs. This requirement is not met as evidenced by: Based on interviews and record reviews licensee did not ensure R1 received appropriate repositioning and lifting by staff on duty for purposes of promoting fall prevention. This poses a potential health and safety risk to residents in care.

Official plan of correction

Licensee will conduct staff training on lifting and repositioning procedures and submit proof of training to LPA by POC due date. Licensee will conduct staff training on 9-1-1 emergency protocols with emphasis on when to call 9-1-1 versus performing care procedures necessary for fall prevention.

Deadline recorded: Sep 17, 2021. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

80061(b)(1)(D)

Regulation authority

CCR

What the official deficiency says

Reporting requirements. (b) Upon the occurrence...of any of the events specified in (1)...a report shall be made to the licensing agency within the agency's next working day...a written report containing the information...shall be submitted to the licensing agency within seven days following the occurrence of such event. (1) Events reported shall include...(D)Any injury to any client which requires medical treatment. This requirement is not met as evidenced by: Based on record review and interviews, Licensee did not furnish incident reports for R1's hospitalizations on 8/5/21 and 8/7/21 in a timely manner. This posses a potential health and safety risk to residents in care.

Official plan of correction

Licensee will conduct staff training on regulation 80061 and submit proof of completed training to LPA by POC due date Licensee will read and provide a signed statement of understanding of regulation 80061.

Deadline recorded: Sep 17, 2021. A deadline is not proof that correction was completed.