SOUTHLAND HOME

Official classification

Type B

Official code

1569.626(a)(2)

Regulation authority

HSC

What the official deficiency says

(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: (2) Eight hours of in-service training per year on the subject of serving residents with dementia. This training shall be developed in consultation with individuals or organizations with specific expertise in dementia care or by an outside source with expertise in dementia care. In formulating and providing this training, reference may be made to written materials and literature on dementia and the care and treatment of persons with dementia. This training requirement may be satisfied in one day or over a period of time. This training requirement may be provided at the facility or offsite and may include a combination of observation and practical application. This requirement is not met as evidenced by: Deficient Practice Statement Based on interview, and record review, the licensee did not comply with the section cited above in five out of five staff records reviewed did not have the 8 hours of dementia training and a technical violation was given last year, which poses a potential health, safety risk to persons in care.

Official plan of correction

POC Due Date: 06/11/2026 Plan of Correction Administrator will provide LPA with copies of all staff training transcripts by 6/11/26.

Official classification

Type B

Official code

1569.69(b)

Regulation authority

HSC

What the official deficiency says

(b) Each employee who received training and passed the examination required in paragraph (5) of subdivision (a), and who continues to assist with the self-administration of medicines, shall also complete eight hours of in-service training on medication-related issues in each succeeding 12-month period. This requirement is not met as evidenced by: Deficient Practice Statement Based on interview, and record review, the licensee did not comply with the section cited above in two out of two staff who assist with medication have not had training since 2024 which poses a potential health, safety risk to persons in care.

Official plan of correction

POC Due Date: 05/29/2026 Plan of Correction Administrator will provide LPA with copies of medication training sign in sheets by 5/29/26.

Official classification

Type B

Official code

87555(a)

Regulation authority

CCR

What the official deficiency says

87555 General Food Service Requirements (a) The total daily diet shall be of the quality... necessary to meet the needs of the residents... All food shall be selected, stored, prepared, and served in a safe and healthful manner. This requirement is not met as evidenced by: Based on interviews, and observation, the licensee did not comply in the section cited above as spoiled/expired food was found which poses a health and safety risk to residents in care.

Official plan of correction

Licensee agrees to provide training. Facility will provide document with staff signatures of those who attended. Additionally, Administrator agrees to conduct weekly food check to ensure food management is being upheld. Documentation will be submitted to LPA via email no later than 10/18/2024.

Deadline recorded: Oct 18, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87555

Regulation authority

CCR

What the official deficiency says

Type B 87555 (a) The total daily diet shall be of the quality... necessary to meet the needs of the residents... All food shall be selected, stored, prepared and served in a safe and healthful manner. This requirement is not met as evidenced by: Based on interviews, and observation, the licensee did not comply in the section cited above as spoiled/expired food was found which poses a health and safety risk to residents in care.

Official plan of correction

Licensee agrees to provide a written statement to CCLD acknowledging regulation 87555 and how the facility will regulate food compliance going forward. Plan will be submitted to LPA via email no later than 7/8/2024.

Deadline recorded: Jul 8, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87202(a)(2)

Regulation authority

CCR

What the official deficiency says

(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: (2) Bedridden persons 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 as the Licensee does not have an updated fire clearance for a bedriddent resident, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/25/2024 Plan of Correction Administrator agreed to notify fire deparment of bedriden resident, confirm notification to CCL, send CCL copy of LIC 200, LIC 9054, and facility sketch by POC due date.

Official classification

Type B

Official code

80026(h)(1)

Regulation authority

CCR

What the official deficiency says

(h)...(1) Records of clients' cash resources maintained as a drawing account, which shall include a current ledger accounting, with columns for income, disbursements and balance, for each client. Supporting receipts for purchases shall be filed in chronological order. This requirement was not met as evidenced by: Based on record review and audit of P & I funds the licensee did not comply with the regulation above supporting receipts were not provided for all transactions listed on the LIC 405, handwritten ledger, or the RFMS statement which poses a potential personal rights risk to residents in care.

Official plan of correction

Administrator agreed to work with business office to provide the facility with all the receipts for the residents P & I Cash and Account funds debits/credit transactions. All staff that handled P & I funds must be trained, read, review, and abide by regulation 80026 provide a copy of staff signatures that participated to CCL.

Deadline recorded: Mar 6, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

80070(d)

Regulation authority

CCR

What the official deficiency says

(d) All client records shall be available to the licensing agency to inspect, audit, and copy upon demand during normal business hours. Records may be removed if necessary for copying. Removal of records shall be subject to the following requirements: This requirement was not met as evidenced by: Based on record review the licensee did not comply with the above regulation the facility was unable to provide all the records requested by the LPA on 02/01/2023 visit which poses a potential personal rights risk to residents in care.

Official plan of correction

Administrator with work with corporation so the facility can provide CCL with requested documents on demand during normal business hours. Train all staff, read, review, and abide by regulation 80070 and provide copy of staff signatures to CCL.

Deadline recorded: Mar 6, 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

(a)...(1)... (D)Any incident which threatens the welfare, safety or health of any resident,...This requirement was not met as evidenced by: Based on record review the licensee did not comply with the above regulation Staff did not report two ER visits to CCL which possess a potential Health and Safety risk to residents in care.

Official plan of correction

Licensee with train all staff on Regulation 87211 reporting requirements and send in an up to date LIC 500 and all staff signatures for training completed to CCL.

Deadline recorded: Oct 21, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.1(a)(8)

Regulation authority

CCR

What the official deficiency says

(a)...(8)To have their representatives regularly informed by the licensee of activities related to care...This requirement was not met as evidenced by: Based on interviews and record review the licensee did not comply with the regulation above R1’s POA W1 was not notified prior to W2 and W1 was not notified of a new medication which possess a potential Personal Rights risk to residents in care.

Official plan of correction

Licensee agreed to train all staff in Personal Rights of Residents regulation 87468, 87468.1 and 87468.2, send up to date LIC 500 and all staff signatures for training to CCL.

Deadline recorded: Oct 21, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87608(a)(3)

Regulation authority

CCR

What the official deficiency says

(a)...(3)A written order from a physician indicating the need for the postural support shall be maintained in the resident’s record...This requirement was not met as evidenced by: Based on interviews and record review the licensee did not comply with the regulation above R1 did not have any doctors orders for the postural supports and the postural supports were being used by staff to limit R1’s abilities which poses an immediate health, safety and personal rights risk to residents in care.

Official plan of correction

Licensee/Administrator agreed to review all residents’ records and update any records for current LIC 602’s, Doctor’s orders and complete an exception request for each resident to the department if needed. Review and train all staff on regulation 87608. Send proof of record review, training and all staff signatures to CCL.

Deadline recorded: Jul 18, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87506(a)

Regulation authority

CCR

What the official deficiency says

(a)The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility...readily available to facility staff and to licensing agency staff. This requirement was not met as evidenced by: Based on observation and record review the licensee did not comply with the above regulation. Resident files were not complete and current which poses a immediate health and safety risk to residents in care.

Official plan of correction

Licensee/Administrator agree to review all resident files and make sure they have all required forms/documents, review regulation 87506 and have all staff trained, provide proof of training and all staff signatures to CCL.

Deadline recorded: Jul 18, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87707(a)(2)(A)(1-6)

Regulation authority

CCR

What the official deficiency says

(a)...(2)...(A)...training topics shall be covered annually, and all topics shall be covered within a three-year period (1-6)...: This requirement was not met as evidenced by: Based on interviews and record review the licensee did not comply with the above regulation as staff did not have dementia training which poses an immediate health,Personal rights risk to residents in care

Official plan of correction

Licensee/Administrator agree to review regulation 87707 and provide required dementia training on all topics that have not been covered in the past 3 years to all staff as required by regulation, proof of training and all staff signatures required to clear POC.

Deadline recorded: Jul 18, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

1569.618(a)

Regulation authority

HSC

What the official deficiency says

(a) The administrator designated by the licensee pursuant to paragraph (11) of subdivision (a) of Section 1569.15 shall be present at the facility during normal working hours. A facility manager designated by the licensee with notice to the department, shall be responsible for the operation of the facility when the administrator is temporarily absent from the facility. 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 the facility does not have a valid administrator or manager present at the facility which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/27/2022 Plan of Correction Licensee agreed to appoint a valid administrator to be present at the facility during normal business hours and designate a manager to fill behind when an administrator is not present. Send the following forms to CCL LIC 500, LIC 501, LIC 308, Valid Administrator Certificate, and a Board Resolution appoitnting new administrator with an additional LIC 308 for a manager to be present when Administrator is absent.

Official classification

Type B

Official code

1569.695(d)

Regulation authority

HSC

What the official deficiency says

(d) A facility shall review the plan annually and make updates as necessary, including changes in floor plans and the population served. The licensee or administrator shall sign and date documentation to indicate that the plan has been reviewed and updated as necessary. 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 the emergency plan LIC 610E (10/030 signed and dated 10/01/2015 is no longer valid and requires to be updated which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/23/2022 Plan of Correction Licensee agreed to update and submit a new LIC 610 Emergnecy Disaster Plan to CCL and post in the facility.

Official classification

Type B

Official code

87468.2.(a)(1)

Regulation authority

CCR

What the official deficiency says

87468.2 (a)(1)...personal privacy in accommodations,... and assistance, visits, communications, telephone conversations,... This requirement was not met as evidenced by: Based on observation the license did not comply with the above as R1 had baby monitors in their bedroom which poses a potential personal rights risk to residents in care.

Official plan of correction

Administrator agreed to read and review regulation 87468.2, train staff and sign documentation, baby monitors have been removed from facility. If the facility is going to provide any type of device for the resident it will met regulation requirements. Send documentation to CCL by 04/12/22

Deadline recorded: Apr 12, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87608(a)(2)

Regulation authority

CCR

What the official deficiency says

(a)...resident is unable to do for himself/herself...may be used under the following...(2)...shall...in a manner that permits quick release by the resident. This requirement was met as evidenced by: Based on documentation the licensee did not comply with the above as R1 is not able to release/takeoff the postural supports and an exception has not been approved by CCL which poses a potential safety and personal rights risk to the resident in care.

Official plan of correction

Administrator agreed to immediately send documentation to CCL for an exception request for R1’s bi-lateral arm splints.

Deadline recorded: Apr 11, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87615(a)(5)

Regulation authority

CCR

What the official deficiency says

(a)...(5)Residents who depend on others to perform all activities of daily living for them as set forth in Section 87459, Functional Capabilities. This requirement was not met as evidenced by: Based on documentation the license did not comply with the above as R1 had a physician report dated 11/30/2021 stating R1 was total care and no exception approval on file for R1 with CCL which poses a potential Health, Safety and Personal rights risk to residents in care.

Official plan of correction

Administrator agreed to immediately send documentation to CCL for an exception request for R1’s total care.

Deadline recorded: Apr 11, 2022. A deadline is not proof that correction was completed.