RM UGALE CARE HOME

Official classification

Type B

Official code

87705(c)(5)

Regulation authority

CCR

What the official deficiency says

(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: Deficient Practice Statement Based on observation and record review, the licensee did not comply with the section cited above by not ensure that 2 out 2 resident files reviewed had a current physicians report on file. This poses an potential health, safety, and personal rights risks to persons in care.

Official plan of correction

POC Due Date: 12/20/2024 Plan of Correction Licensee shall provide a statement of correction and acknowledgement to the LPA by the POC date. In addition, Licensee shall conduct provide copies of annual medical assessments for 2 out 2 residents by the POC date.

Official classification

Type B

Official code

87705(c)(6)

Regulation authority

CCR

What the official deficiency says

(6) Appraisals are conducted on an ongoing basis pursuant to Section 87463, Reappraisals. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and record review, the licensee did not comply with the section above in by not ensure that 2 out 2 resident files did not have a current reappraisal which poses a potential health, safety, and personal rights risks to persons in care.

Official plan of correction

POC Due Date: 12/20/2024 Plan of Correction Licensee shall provide a statement of correction and acknowledgement. Licensee shall conduct reappraisals for all residents and provide a copy to the LPA by POC date.

Official classification

Type A

Official code

87411(c)(1)

Regulation authority

CCR

What the official deficiency says

(1) Staff providing care shall receive appropriate training in first aid from persons qualified by such agencies as the American Red Cross. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and record review, the licensee did not comply with the section cited above by not ensuring that 2 out 2 staff members do not have a current First Aid and/or CPR on file. This poses an immediate, health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/20/2024 Plan of Correction Licensee shall provide a statement of correction and acknowledgement to this LPA by POC date. First aid and/or CPR must be sent to the LPA by POC date.

Official classification

Type A

Official code

87707(a)(2)

Regulation authority

CCR

What the official deficiency says

(a) Licensees who advertise, promote, or otherwise hold themselves out as providing special care, programming, and/or environments for residents with dementia or related disorders shall ensure that all direct care staff, described in Section 87706(a)(1), who provide care to residents with dementia, meet the following training requirements: This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and record review, the licensee did not comply with the section cited above in by not ensuring that 2 out 2 staff members did not have dementia related training. This poses an immediate health, safety and personal rights risks to persons in care.

Official plan of correction

POC Due Date: 11/20/2024 Plan of Correction Licensee shall provide a statement of correction and acknowledgement to the LPA by POC date. A copy of all staff training must be sent to the LPA by 12/20/2024.

Official classification

Type A

Official code

87355(e)(3)

Regulation authority

CCR

What the official deficiency says

(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (3) Request a transfer of a criminal record clearance as specified in Section 87355(c) or This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above by not ensuring that S1 was associated to the facility. This poses an immediate health, safety, and personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/17/2023 Plan of Correction Licensee shall provide a statement of acknowlegement stating that they have read and understood Section 87355(e)(3). Licensee stated that S1 will be associated by the POC date. An immediate civil penalty of $500 is being assessed.

Official classification

Type A

Official code

87411(c)(1)

Regulation authority

CCR

What the official deficiency says

(1) Staff providing care shall receive appropriate training in first aid from persons qualified by such agencies as the American Red Cross. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and record review, the licensee did not comply with the section cited above by ensuring that 3 out 3 staff members did not have a current First Aid Certificate. This poses an immediate health, safety or personal rights risks to persons in care.

Official plan of correction

POC Due Date: 10/17/2023 Plan of Correction Licensee shall conduct first aid training for all staff members who do not have a current certificate by the POC date. Copies of first aid training shall be submitted to the LPAs email.

Official classification

Type B

Official code

87456(a)(2)

Regulation authority

CCR

What the official deficiency says

(a) Prior to accepting a resident for care and in order to evaluate his/her suitability, the facility shall, as specified in this article 8: (2) Perform a pre-admission appraisal. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and record review, the licensee did not comply with the section cited above by not ensuring that 3 out 3 residents did not have a pre-admission appraisal. This poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/30/2023 Plan of Correction Licensee shall provide a statement of acknowledgement that they have read and understanding the section cited above by the POC date.

Official classification

Type B

Official code

87705(c)(3)

Regulation authority

CCR

What the official deficiency says

(c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following: (3) In addition to the on-the-job training requirements in Section 87411(d), staff who provide direct care to residents with dementia shall receive the following training as appropriate for the job assigned and as evidenced by safe and effective job performance: This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and record review, the licensee did not comply with the section above by ensuring that all staff did not have current Dementia training. This poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/30/2023 Plan of Correction Licensee shall ensure that on-the-job training shall be provided to all staff on an annual basis. Licensee shall conduct training by POC date. A copy of training, along with information discussed, trainer, names of trainees shall be sent to the LPA by the POC date.

Official classification

Type B

Official code

87705(c)(6)

Regulation authority

CCR

What the official deficiency says

(c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following: (6) Appraisals are conducted on an ongoing basis pursuant to Section 87463, Reappraisals. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above by ensuring that 3 out 3 residents have a current appraisals conducted. This poses an potential health, safety, and personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/30/2023 Plan of Correction Licensee shall provide a statement of acknowledgement and a plan of correction to ensure that appraisals are conducted on an ongoing basis by the POC date.

Official classification

Type B

Official code

80019(e)(2)

Regulation authority

CCR

What the official deficiency says

80019 Criminal Record Clearance (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1522 shall prior to working, residing or volunteering in a licensed facility: (2) Request a transfer of a criminal record clearance as specified in Section 80019(f) or This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and record review, the Licensee did not comply with the section cited above by not associating S1 and S2 to RM Ugale Care Home prior to working at the facility. This poses a potential health, safety, or personal rights risk to the persons in care.

Official plan of correction

POC Due Date: 10/24/2022 Plan of Correction Licensee will submit all required documentation to the Department in order to associate S1 to RM Ugale Care Home. The licensee shall maintain verification that it was submitted on file. The licensee shall follow-up with LPA via email to ensure that S2 is associated by POC Date 10/24/2022.

Official classification

Type B

Official code

80075(6)(D)

Regulation authority

CCR

What the official deficiency says

80075 Health Related Services (D) For every prescription and nonprescription PRN medication for which the licensee provides assistance, there shall be a signed, dated written order from a physician on a prescription blank, maintained in the client's file, and a label on the medication. Both the physician's order and the label shall contain at least all of the following information. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and record review the Licensee did not obtain a written order and maintain in the clients file from the physician for R1's Vitamin C medication. This poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/24/2022 Plan of Correction Licensee will obtain phsyician's written order and maintain a copy in the clients file. Licensee will provide a copy of the physicans order to the LPA's email by POC date 10/24/2022.

Official classification

Type A

Official code

87458(a)

Regulation authority

CCR

What the official deficiency says

87458 Medical Assessment (a) Prior to a person's acceptance as a resident, the licensee shall obtain and keep on file, documentation of a medical assessment, signed by a physician, made within the last year. The licensee shall be permitted to use the form LIC 602 (Rev. 9/89), Physician's Report, to obtain the medical assessment. This regulation was not met as evidence by, licensee did not ensure to obntain an 602 or physcians reportt prior to accepting the resident. This poses an immediate risk to resident in care.

Official plan of correction

Licesnee will write a letter acknowleding understanding of regulation and submit to LPA by POC date.

Deadline recorded: Dec 21, 2021. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87507(a)

Regulation authority

CCR

What the official deficiency says

87507 Admission Agreements (a) The licensee shall complete an individual written admission agreement, as defined in Section 87101(a), with each resident or the resident's representative, if any. This regulation was not met as evidence by, licensee did not ensure to obntain an addmission agreement prior to accepting the resident. This poses an potential risk to resident in care.

Official plan of correction

Licesnee will write a letter acknowleding understanding of regulation and submit to LPA by POC date.

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

Official classification

Type A

Official code

87465(h)(2)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care (h) The following requirements shall apply to medications which are centrally stored: (2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. This regulation was not met as evidence by based on the interviews conducted, the licensee did not ensure that resident did not have access to medication. Resident had medication in their purse and attempted to take the medication. This poses an immediate health and safety risks to resident in care.

Official plan of correction

Licesnee will conduct a training with staff on process when accepting a new resident to ensure all belongings are accounted for and medications are locked. Licesnee will write a letter acknowleding understanding of regulation and submit to LPA by POC date.

Deadline recorded: Dec 21, 2021. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87224(b)

Regulation authority

CCR

What the official deficiency says

87224 Eviction Procedures (b) The licensee may, upon obtaining prior written approval from the licensing agency, evict the resident upon three (3) days written notice to quit. The licensing agency may grant approval for the eviction upon a finding of good cause. Good cause exists if the resident is engaging in behavior which is a threat to the mental and/or physical health or safety of himself or to the mental and/or physical health or safety of others in the facility. This regulation was not met as evidence by based on the interviews conducted, the licensee did not ensure proper procedures and approval was recieved prior to not accepting the resident back into care. This poses a potential risks to resident in care.

Official plan of correction

Licesnee will write a letter acknowleding understanding of regulation and submit to LPA by POC date.

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

Official classification

Type B

Official code

Not listed

Regulation authority

Not listed

What the official deficiency says

(a) Prior to accepting a resident for care and in order to evaluate his/her suitability, the facility shall, as specified in this article 8: (1) Conduct an interview with the applicant and his responsible person. This requirement is not met as evidenced by: Based on record review, the licensee did not comply with the section cited above there were no pre-admission assessments or interviews which poses/posed a potential health, safety or personal rights risk to persons in care.

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

Official classification

Type B

Official code

Not listed

Regulation authority

Not listed

What the official deficiency says

(a) Prior to accepting a resident for care and in order to evaluate his/her suitability, the facility shall, as specified in this article 8: (2) Perform a pre-admission appraisal. This requirement is not met as evidenced by: Based on record review, the licensee did not comply with the section cited above there were no pre-admission assessments or interviews which poses/posed a potential health, safety or personal rights risk to persons in care.

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

Official classification

Type B

Official code

Not listed

Regulation authority

Not listed

What the official deficiency says

87506 Resident Records (b) Each resident’s record shall contain at least the following information: (8) Names, address, and telephone numbers of the resident’s representative, as defined in Section 87101(r), to be notified in case of accident, death, or other emergency. This requirement is not met as evidenced by: Based on record review, the licensee did not comply with the section cited above there were no updated emergency contact information for each resident or information was missing which poses/posed a potential health, safety or personal rights risk to persons in care.

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

Official classification

Type B

Official code

Not listed

Regulation authority

Not listed

What the official deficiency says

87705 (I)(8) Care of Persons with Dementia. 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. This requirement was not met as evidenced by records reviewed, facility did not have record of fire Drill log. Caregiver. Licensee had no record to provide to LPA. LPA was unable to determine when the last disaster drill was conducted as required. This poses a potential safety risk to the residents in care.

Deadline recorded: Sep 20, 2021. 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

87618 (b)(3)(B) Oxygen Administration - Gas and Liquid - Oxygen in Use signs shall be posted in appropriate areas. (As identified in 87101: (E) Maintenance of house rules for the protection of residents) This regulation was not met by evidence by: Based on observation, AD did not ensure posting of oxygen in use signs of the resident(s) rooms that had oxygen. This poses an immediate threat to the residents in care.

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

Official classification

Type B

Official code

Not listed

Regulation authority

Not listed

What the official deficiency says

87464 (f) Basic services shall at a minimum include: (1) Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). This regulation was not met by evidence by: A sign-in policy and PPE supplies available upon entry was not enacted with all visitors to ensure compliance with central entry point for symptom screening and to record contact information (for reporting requirements to public health officer and contact tracing).

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