NANTUCKET RESIDENCE, THE

Official classification

Type B

Official code

1569.185(a)(1)

Regulation authority

HSC

What the official deficiency says

An application fee adjusted by facility and capacity shall be charged by the department for the issuance of a license to operate a residential care facility for the elderly. After initial licensure, a fee shall be charged by the department annually on each anniversary of the effective date of the license. Annual Fee was not paid as of this date.

Official plan of correction

Licensee will pay annual license fee and submit proof of payment to CCL by 10/22/25.

Deadline recorded: Oct 22, 2025. 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

(2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degree C) and not more than 120 degree F (49 degree C). This requirements is not met as evidenced by Hot water temperature was measured at 130 degrees Fahrenheit in resident's bathroom sink. This is an immediate health and safety risk to residents in care.

Official plan of correction

Test hot water in the bathroom to meet Title 22 regulations. Send 3 days hot water temperature to LPA.

Deadline recorded: Apr 5, 2024. 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

(a) Persons who require health services for or have a health condition including, but not limited to, those specified below shall not be admitted or retained in a residential care facility for the elderly: (4) Staphylococcus aureus ( " staph " ) infection or other serious infection. this requirement is not met as evidenced by discharge papers. R1 has a diagnosis of carrier or suspected carrier of Methicillin resistant Staphylococcus

Official plan of correction

Proof of correction to be sent to CCLD by POC date.

Deadline recorded: Apr 5, 2024. A deadline is not proof that correction was completed.

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 review and interview, R1 sustained a fall with injury due to lack of appropriate required supervision as stated in R1's plan of care. This posed an immediate health, safety and resident rights risk to residents in care.

Official plan of correction

Licensee to develop and submit an updated plan of care for R1 outlining needs for care and supervision. Plan to be integrated with hospice care plan. Plan to be submitted to LPA by POC due dates.

Deadline recorded: Aug 3, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(g)

Regulation authority

CCR

What the official deficiency says

Incidental Medical and Dental Care. (g) 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 was not met as evidenced by: Based on interview and record review, Licensee did not ensure an immediate call to 9-1-1 following the discovery of a R1's fall and pain on 7-8-23. This posed an immediate health and safety risk to residents in care.

Official plan of correction

Licensee will read regulation 87465(g) and submit a signed decalration of understanding to LPA by POC due date. Licensee will ensure completed staff training on regulation 87465(g). Training date to be submitted to LPA by POC due date with proof of completed training to be submitted to LPA no later than 2 weeks from date of citation issuance.

Deadline recorded: Aug 3, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87405(d)

Regulation authority

CCR

What the official deficiency says

Administrator Qualifications and Duties. (d) The administrator shall have the qualifications...(1) Knowledge of the requirements for providing care and supervision appropriate to the residents. This requirement was not met as evidenced by: Based on interview and record review, Administrator did not ensure a care and supervision level for R1 consistent with R1's written plan of care resulting in a fall with injury. This posed and immediate health and safety risk to residents in care.

Official plan of correction

Licensee to review regulations regarding care and supervision and regulatory definition of care and supervision, and submit a signed declaration of understanding to LPA by POC due date. Sections referenced: H & S Code 1569.312(a) and H & S Code Section 1569.2.

Deadline recorded: Aug 3, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87309(a)

Regulation authority

CCR

What the official deficiency says

(a) Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation the licensee did not comply with the section cited above. LPA observed various toxins stored in unlocked shed in backyard which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/04/2023 Plan of Correction Licensee secured shed with lock during LPA's visit. Licensee to provide staff training on regulation 87309(a) and submit proof of completed training to LPA by POC due date

Official classification

Type B

Official code

87303(c)

Regulation authority

CCR

What the official deficiency says

(c) All window screens shall be clean and maintained in good repair. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation the licensee did not comply with the section cited above. LPA observed window screen on side of facility detached and unsecured which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/15/2023 Plan of Correction Licensee will repair or replace window screen and send photo proof of completion to LPA by POC due date.

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 4 out of 4 staffing charts reviewed. Staffing charts did not contain evidence of regulatory required staff training which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/15/2023 Plan of Correction Licensee will ensure the completion of the 20 hours of required staff training and send proof of completed training to LPA by POC due date.

Official classification

Type B

Official code

1569.69(a)(2)

Regulation authority

HSC

What the official deficiency says

(a) Each residential care facility for the elderly licensed under this chapter shall ensure that each employee of the facility who assists residents with the self-administration of medications meets all of the following training requirements: (2) In facilities licensed to provide care for 15 or fewer persons, the employee shall complete 10 hours of initial training. This training shall consist of 6 hours of hands-on shadowing training, which shall be completed prior to assisting with the self-administration of medications, and 4 hours of other training or instruction, as described in subdivision (f), which shall be completed within the first two weeks of employment. 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 4 out of 4 staffing charts reviewed. Licensee did not ensure completed medication training for staff who handle medication until 3/25/23 and licensee began operation on 5-3-22, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/15/2023 Plan of Correction Licensee will read regulation 1569.69(a)(2) and submit a signed declaration of understanding to LPA by POC due date .

Official classification

Type A

Official code

87468.1(a)(2)

Regulation authority

CCR

What the official deficiency says

87468.1(a)(2). 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: (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This requirement was not met as evidenced by: Based on interview and observation, licensee did not ensure a properly stored isolation cart outside of R1’s room during a scabies outbreak to promote safety. This posed an immediate health and safety risk to residents in care.

Official plan of correction

Licensee will read regulation 87468.1(a)(2) and submit a signed declaration of understanding to LPA by POC due date. Licensee and staff will complete training on infection control practices. Training date to be submitted to LPA by POC due date. Proof of completed training to be submitted to LPA no later than 2 weeks after date of citation issuance.

Deadline recorded: Mar 24, 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

87405(h)(5). Administrator Qualification 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 was not met as evidenced by: Based on interview, licensee did not ensure a service of safety for R1 in that a responsible person was allowed to handle and cut medication for R1 without appropriate staff intervention occurring. This posed an immediate health and safety risk to residents in care.

Official plan of correction

Licensee and staff will ensure completed training on safe medication handling procedures and physician orders. Training date to be submitted to LPA by POC due date. Proof of completed training to be submitted to LPA no later than 2 weeks from date of citation issuance. Licensee will read regulation 87405(h)(5) and submit a signed declaration of understanding to LPA by POC due date.

Deadline recorded: Mar 24, 2023. 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

87211(a)(1)(D). Reporting requirements. (a) Each licensee shall furnish to the licensing agency such reports…(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…(D) Any incident which threatens the welfare, safety or health of any resident… This requirement was not met as evidenced by: Based in interview and record review, licensee did not ensure the timely reporting of R1 contracting scabies. This posed a potential health and safety risk to residents in care.

Official plan of correction

Licensee will read regulation 87211(a)(1)(D) and submit a signed declaration of understanding to LPA by POC due date.

Deadline recorded: Apr 3, 2023. 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

87463(a) 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 was not met as evidenced by: Based on interview and record review, licensee did not ensure the appropriate and required updates to R1’s needs and service plan. This posed a potential health and safety risk to residents in care.

Official plan of correction

Licensee will read regulation 87463(a) and submit a signed declaration of understanding to LPA by POC due date.

Deadline recorded: Apr 3, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87468.1(a)(2)

Regulation authority

CCR

What the official deficiency says

Personal Rights of Residents in all facilities. (a)Residents in call residential care facilities for the elderly shall have all other following personal rights: (2) To be accorded safe, healthful, and comfortable accommodations. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, S1 was not wearing a mask while in the presence of resident in care. This poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/03/2022 Plan of Correction Licensee will read regulation 87468.1(a)(2) and submit a signed declaration of understanding to LPA by POC due date. Declaration to include understanding of mask requirement and signed by all staff.

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...(2)Occurences...which threaten the welfare, safety, or health of residents, personnel or visitors...within 24 hours either by telephone or facsimile to the licensing agency...This requirement is not met as evidenced by: Deficient Practice Statement Based on interview the licensee did not comply with the section cited above in that S2 contracted COVID-19 on 7/22/22 and not reported by licensee to licensing agency. This posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/05/2022 Plan of Correction Licensee will ensure reporting of all COVID cases of staff and residents to licensing agency per regulatory requirements by POC due date. Licensee will read regulation 87211 and submit a signed declaration of understanding to LPA by POC due date.