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

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 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

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

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

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

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 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 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.