ARLYN'S GUEST HOME

Official classification

Type A

Official code

80075(k)(3)

Regulation authority

CCR

What the official deficiency says

This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA record review, the licensee did not comply with the section cited above in facility conducted last fire drill on 7/8/2023 which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/09/2024 Plan of Correction LIcensee agrees to submit a plan showing that fire drills and log will be conducted every three months as required by licensing. Plan of correction is to be submitted to LPA by 1/9/2024. This is a repeat deficiency within a twelve month period, last cited on (1/10/2023); therefore there is a civil penalty which will be given on today's date. ruth.wallace@dss.ca.gov

Official classification

Type A

Official code

87202

Regulation authority

CCR

What the official deficiency says

87202 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. Prior to accepting or retaining any of the following types of persons, the applicant or licensee shall notify the licensing agency and obtain an appropriate 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 testing two detector not working in the main hallway. This is an immediate safety risk.

Official plan of correction

Administrator shall replace battery in smoke detector by POC date and submit a statement of compliance via email to CCL.

Deadline recorded: Jun 24, 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

Storage Space (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 regulations was not met as evidenced by: lpm observed medications that were accessible in the staff room, cleaning supplies were unlocked under the sink and in unlocked cabinets in the unlocked garage

Official plan of correction

The licensee will provide proof of locks repaired or relpaced on areas that store medications and chemicals to Albert.Johnson@dss.ca.gov.

Deadline recorded: Jun 22, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87705(C)(4)(a)

Regulation authority

CCR

What the official deficiency says

Care of Persons with Dementia (A) In addition to requirements a facility with fewer than 16 residents shall have at least one night staff person awake and on duty ... This regulation was not met as evidenced by: According to staff interview there is one CG present in the facilily from 430 pm to 6am whom sleeps during sleeping hours.

Official plan of correction

The licessee will submit a Plan of correction by 06/22/23 to Albert.Johnson@dss.ca.gov.

Deadline recorded: Jun 22, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.1(a)(3)

Regulation authority

HSC

What the official deficiency says

Personal Rights: ..(a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: .(3) To be free from...interfering with daily living functions such as eating, sleeping, or elimination. This was not met as evidenced by: The LPM observed a chain and lock on the refridgerator.

Official plan of correction

The lock was removed during the visit. The licensee will provide a statement to the LPA Albert.Johnson@dss.ca.gov that this regulation has been read, understood by themself and the staff.

Deadline recorded: Jun 22, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87411(g)(2)

Regulation authority

CCR

What the official deficiency says

Personnel Requirements: (g) Prior to employment or initial presence in the facility, all employees and volunteers subject to a criminal record review shall: (2) Request a transfer of a criminal record clearance as specified in Section 87355(c) This was not met as evidenced by: LPM reviewed the facility roster at time of visit and CG1 had a criminal record clearance, however the staff was not associated to the facility and a transfer request had not been submitted.

Official plan of correction

The licensee will submit to CCL Albert.Johnson@dss.ca.gov a transfer request on 06/22/23.

Deadline recorded: Jun 22, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

80075(k)(3)

Regulation authority

CCR

What the official deficiency says

(3) Fire and earthquake drills shall be conducted at least once every three months on each shift and shall include, at a minimum, all direct care staff. The facility conducted a fire drill on 2/5/2022. This does not met the requirement for this regulation while caring for a resident with Dementia.

Official plan of correction

The licensee shall conduct a drill by the POC date odf 1/10/23. The facility will document this drill and keep a copy in the facility file for review.

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

Official classification

Type B

Official code

87705(c)(5)

Regulation authority

CCR

What the official deficiency says

(c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following: (5) 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: Based on observation, interview, and record review, the licensee did not comply with the section cited above in (2) out of (2) residents diagnosed with dementia which poses/posed a potential health and safety risk to persons in care.

Official plan of correction

Licensee agrees to submit a plan of correction to LPA by 1/14/2022 on how R1 and R2's annual appraisal will be completed.

Deadline recorded: Jan 14, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87463(c)

Regulation authority

CCR

What the official deficiency says

The licensee shall arrange a meeting with the resident, the resident’s representative, if any, appropriate facility staff, and a representative of the resident’s home health agency, if any, when there is significant change in the resident’s condition, or once every 12 months, LPA observed Needs and Services Plan is outdated for R1 thru R3.

Official plan of correction

The facility shall obtain a current Needs and Services Plan for R1 thru R3. Written certification stating administrator has read regulation 87463 along with copies of current Needs and Services Plan to be sent to CCLD by POC date

Deadline recorded: Jan 14, 2022. A deadline is not proof that correction was completed.