C.A.L.L. - VALDEZ HOUSE

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 3/4 staff did not have records on file at the facility which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/25/2025 Plan of Correction Administrator agreed to get a staff files up to date and send in the health screeening with TB results for the staff missing in files.

Official classification

Type B

Official code

1569.618(c)(3)

Regulation authority

HSC

What the official deficiency says

(c)The facility shall employ, and the administrator shall schedule, a sufficient number of staff members to do all of the following: (3) Ensure that at least one staff member who has cardiopulmonary resuscitation (CPR) training and first aid training is on duty and on the premises at all times. This paragraph shall not be construed to require staff to provide CPR. 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 3/5 staff did not have CPR card on file at the facility which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/18/2025 Plan of Correction The facility is required to have a staff on each shift with CPR. Administrator agreed to get files up to date and CPR cards on file for 3/5 staff at the facility.

Official classification

Type B

Official code

87412(a)

Regulation authority

CCR

What the official deficiency says

(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: 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 3/5 files were not complete at the facility for staff and administrator which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/25/2025 Plan of Correction Administrator agreed to get all staff records up to date and on file at the facility. Take a video of each file with contents and send to LPA.

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 3/5 files reviewed did not have the required trianing in the files which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/25/2025 Plan of Correction Administrator agreed to get all files at the facility and updated with all required records/forms/trianing, take video of each file with contents and send to LPA.

Official classification

Type B

Official code

87555(b)(23)

Regulation authority

CCR

What the official deficiency says

(b) The following food service requirements shall apply: (23) All readily perishable foods or beverages capable of supporting rapid and progressive growth of micro-organisms which can cause food infections or food intoxications shall be stored in covered containers at appropriate temperatures. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA observation, the licensee did not comply with the section cited above in food was stored without wrapping or covers in the refrigerator which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/25/2025 Plan of Correction Administrartor agreed to go through refrigerator and throw out any food not covered or marked accorndingly. Send LPA a photo of refrigerator cleaned out and everything stored properly.

Official classification

Type B

Official code

87506(b)(15)

Regulation authority

CCR

What the official deficiency says

(b) Each resident's record shall contain at least the following information: (15) The admission agreement and pre-admission appraisal, specified in Sections 87507, Admission Agreements and 87457, Pre-admission Appraisal. 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 2/4 were missing signed admission agreement, pre placement appraisal or reapprisals were not present in the files which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/25/2025 Plan of Correction Administrator agreed to get all 4 files completed with all required forms and send LPA a video of all for 4 files with all forms present.

Official classification

Type B

Official code

87457(c)

Regulation authority

CCR

What the official deficiency says

(c) Prior to admission a determination of the prospective resident's suitability for admission shall be completed and shall include an appraisal of their individual service needs in comparison with the admission criteria specified in Section 87455, Acceptance and Retention Limitations. 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 files did not have preplacment appriosals and functional capabilites asseseements to determin adequate placements were done which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/25/2025 Plan of Correction Admiistrator agreed to find all preplacment apprisal and functional capabitlies assessments and put in files at the faciltiy, send photograph of each file with these forms.

Official classification

Type B

Official code

87457(c)(1)(A)

Regulation authority

CCR

What the official deficiency says

(c) Prior to admission a determination of the prospective resident's suitability for admission shall be completed and shall include an appraisal of their individual service needs in comparison with the admission criteria specified in Section 87455, Acceptance and Retention Limitations. (1) The appraisal shall document, at a minimum: (A) An evaluation of the prospective resident's functional capabilities, mental condition, and social factors as specified in Sections 87459, Functional Capabilities and 87462, Social Factors. 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 4/4 files did not have funcational capabilties assessments which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/25/2025 Plan of Correction Administrator agreed to do functional capabilites assesments on 4 residents and put forms in the files send picture to LPA.

Official classification

Type B

Official code

87463(a)

Regulation authority

CCR

What the official deficiency says

(a) The pre-admission appraisal, as specified in Section 87457, Pre-Admission Appraisal, shall be updated, in writing as frequently as necessary or once every 12 months, whichever occurs first, to note significant changes in condition, as defined in Section 87101, Definitions, and to keep the appraisal accurate. For the purposes of this section, the updated pre-admission appraisal shall be referred to as the reappraisal. 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 1/4 residents did not have an update ANS or ISP on file at the facility which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/25/2025 Plan of Correction Administrator agreed to send resident updated ISP/ANS to LPA and put in resident file.

Official classification

Type B

Official code

87463(h)

Regulation authority

CCR

What the official deficiency says

(h) The licensee shall request that all residents receive an annual routine visit with a licensed medical professional once every twelve months, either in person or by video appointment. 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 medical visits and recoes were not updated every 12 months which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/25/2025 Plan of Correction Administrator agreed to get update medical records in resident files for 2025. Take photograph and send to LPA.

Official classification

Type B

Official code

1569.885(c)

Regulation authority

HSC

What the official deficiency says

(c) The admission agreement shall inform a resident of the right to contact the State Department of Social Services, the long-term care ombudsman, or both, regarding grievances against the facility. 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 the admission agreements do not have this information in them which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/25/2025 Plan of Correction Administrator agreed to make sure admission agreements met all requirements of regualtion and have CCL and LTCO grievance and complaint information for an RCFE. Send LPA a copy of the new admission agreements.

Official classification

Type B

Official code

87507(d)

Regulation authority

CCR

What the official deficiency says

(d) The licensee shall retain in the resident's file the original signed and dated admission agreement and all subsequent signed and dated modifications. This does not apply to rate increases which have specific notification requirements as specified in Health and Safety Code section 1569.655. 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 1/4 residents did not have an admission agreements on file which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/25/2025 Plan of Correction Admiistratror agreed to do find or do a new admisison agremeent with residents and put in residents file and send copy of AA to LPA.

Official classification

Type B

Official code

87468.1(a)(1)

Regulation authority

CCR

What the official deficiency says

87468.1(a)(1) Personal Rights. 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, residents, and other persons. This requirement is not met as evidenced by: Based on interviews, the licensee did not comply with the section cited above when residents were not treated with dignity, which posed a potential personal rights risk to residents in care.

Official plan of correction

POC: Administrator agrees to hold personal rights training with a Community Care Licensing certified vendor, with all staff by 10/21/2024.

Deadline recorded: Oct 21, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

1569.311

Regulation authority

HSC

What the official deficiency says

Every residential care facility for the elderly shall have one or more carbon monoxide detectors in the facility that meet the standards established in Chapter 8 (commencing with Section 13260) of Part 2 of Division 12. The department shall account for the presence of these detectors during inspections. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above, the facility did not have a working carbon monxicde detector which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/27/2024 Plan of Correction Administrator agreed to install new carbon monoxide dectector and send LPA a photograph.

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 8/8 staff were not meeting the intial or annual trianing requirements which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/01/2024 Plan of Correction Administrator agreed to have all staff take the required initial or annual trianing and have all records at the facility for inspection. Provide an up to date LIC 500 and each staffs 40 intial or 20 annual trianing requirements completed and send proof to CCL.

Official classification

Type A

Official code

87705(b)(1-2)

Regulation authority

CCR

What the official deficiency says

(b) ...Plan of Operation, the plan of operation shall address the needs of residents with dementia, including:(1)Procedures for notifying...(2)Safety measures to address behaviors such as wandering, aggressive behavior and ingestion of toxic...This requirement has not been met as evidenced by: Based on record review the Licensee did not comply with the regulation above the facility does not have a plan of operation approved for dementia which poses an immediate risk to residents in care.

Official plan of correction

Licensee agreed to provide CCL with a addendum to the plan of operation adding a dementia program plan, if the program plan is not approved by CCL the facility will serve residents with Dementia a 60-day eviciton notice for relocation by TCRC.

Deadline recorded: May 23, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

1569.626(a)(1)

Regulation authority

HSC

What the official deficiency says

1569.626 Training requirements for direct care staff (a) All residential care facilities for the elderly shall meet the following training requirements, as described in Section 1569.625, for all direct care staff:(1) Twelve hours of dementia care training, six of which shall be completed before a staff member begins working independently with residents, … This requirement was not met by S1 being left alone and not properly trained, which poses an immediate danger to residents in care.

Official plan of correction

Facility shall provide a list of all facility personnel and their training records to LPA within 24 hours of this report. Then formulate a training schedule that will have all facility personnel properly trained by regulation standards within two weeks of this report.

Deadline recorded: Jan 29, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87411(a)

Regulation authority

CCR

What the official deficiency says

87411 Personnel Requirements – General (a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet residents’ needs. This requirement was not met by evidence of time sheets and interviews that on at least 5 to 15 occasions there was only one staff without basic regulated training was on shift during 7am to 10am which puts resident in immediate danger.

Official plan of correction

Facility will create a more robust staff recruitment campaign, outlining additional steps the facility will take to recut more numbers and qualified staff then the current recruitment tools the facility employes. this recruitment campaign will be emailed to LPA by 02/09/2024

Deadline recorded: Jan 29, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87303(a)(1)

Regulation authority

CCR

What the official deficiency says

87303 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.(1) Floor surfaces in bath, laundry and kitchen areas shall be maintained in a clean, sanitary, and odorless condition. This requirement was not met by evidence of black mold in the bathroom which poses an immediate danger to residents in care.

Official plan of correction

Mold mitigation was started on 11/02/2023, LPA confirmed with photographs that mold mitigation was started. LPA was sent photographs of KILLZ paint applied to vanity. LPA was told by Executive Director that vanity would eventually be replaced. This POC is cleared and new LPA will follow up.

Deadline recorded: Jan 29, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87465(a)(6)

Regulation authority

CCR

What the official deficiency says

(6) When requested by the prescribing physician or the Department, a record of dosages of medications which are centrally stored shall be maintained by the facility. This requirement is not met as evidenced by: Deficient Practice Statement Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in [count] out of [total count] [(objects) (persons)] [identifiers] which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: Plan of Correction