LAKEVIEW LODGE

Official classification

Type B

Official code

87309(a)

Regulation authority

CCR

What the official deficiency says

(a) Except as specified in subsection (b), the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances, knives, matches, tools, sharp objects, and other similar items which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and interview, the licensee did not ensure that sharp objects which could pose a danger to residents are in locked storage, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/17/2025 Plan of Correction Licensee will have the lock fixed. Deficiency cleared during visit.

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 ensure that staff received eights hour dementia care training and four hours of training specific to postural supports, restricted health condition, and hospice care, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/24/2025 Plan of Correction Licensee will conduct a training and send proof of correction to the Department by the POC due date.

Official classification

Type A

Official code

87608(a)(3)

Regulation authority

CCR

What the official deficiency says

87608(a)(3) Postural Supports: (a) Postural supports may be used under the following conditions...A written order from a physician indicating the need for the postural support shall be maintained in the resident’s record. This requirement is not met as evidenced by: Based on observation and record review, facility does not have written orders from a physician indicating the need for half bed rails in the rooms of R1, which is an immediate health, safety, or personal rights risk to persons in care.

Official plan of correction

Licensee removed bed rail in presence of LPA. Deficiency cleared during visit.

Deadline recorded: Jul 18, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(c)(2)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care (c) If the resident's physician has stated…facility staff designated… (2) Once ordered by the physician the medication is given according to the physician's directions. This requirement was not met as evidenced by: Based on observation, interview, and record review, the Administrator did not ensure one medication Lorazepam was administered correctly to resident (R1), which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

The Administrator will submit the plan for POC to CCLD by 07/03/2025.

Deadline recorded: Jul 3, 2025. 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 is not met as evidenced by: Based on observations, LPA observed prescription medications unlocked and accessible on the desk in the lobby area and no staff present. In addition, LPA observed the med-cart keys on the side of the med-cart accessible.

Official plan of correction

Licensee/administrator shall conduct an in-service training with med-techs to ensure all medications are locked and inaccessible to residents in care. In addition, to ensure med-cart keys are not left in the med cart where it's accessible to residents in care.

Deadline recorded: Jul 2, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87208(a)

Regulation authority

CCR

What the official deficiency says

87208 Plan of Operation (a)The licensee shall have and maintain....The licensee shall operate the facility in accordance with the terms specified in the plan of operation and may be cited for not doing so ...This requirement is not met as evidenced by Based on record review, the facility did not follow their plan of operation. The facility's program description states “Residents determined to have their physician diagnosis of mental disorder, unrelated to dementia shall not be accepted or retained. R1s primary diagnosis

Official plan of correction

The Licensee will submit a written plan of action on how they will ensure they are following their plan of operation. (con't) was schizophrenia, dementia, confusion, aggressive behavior and harm to self and will require supervision, which pose/poses an immediate health, safety and personal rights risk to residents in care.

Deadline recorded: Jun 27, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87207

Regulation authority

CCR

What the official deficiency says

87207 False Claims No licensee, officer or employee of a licensee shall make…any false or misleading statement regarding the facility…This requirement is not met as evidenced by: Based on interview, S2 stated he/she checked R1 at 4:00am and later admitted that he/she lied. S1 was interviewed & stated CPR was administered prior to 911 call, however, S1 stated to SMCSO deputies he/she did not perform CPR. Administrator denied knowledge and witnessing that staff ties the door shut. On 5/14/25 ADM 2 was interviewed and admitted he has remote

Official plan of correction

The Licensee will submit a plan of action on how false statements are not made regarding care that is being provided at the facility. (con't) access to facility cameras to redirect staff. However during investigation, ADM2 denied having knowledge of staff's actions at night. which pose/poses an immediate health, safety and personal rights risk to persons in care.

Deadline recorded: Jun 27, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87405(d)(2)

Regulation authority

CCR

What the official deficiency says

87405(d)(2) Administrator - Qualifications and Duties... The administrator shall have the qualifications..(2) Knowledge of and ability to conform to the applicable laws, rules and regulations. This requrement is not met as evidenced by: Based on interview, ADM denied having knowledge that staff are locking resident door. for over 12 hours and denied seeing the tie before. ADM stated that he/she did not know if S2 was interviewed and did not speak to S2 about the incident. S2 was written up/cited by law enforcement. ADM did not know what S2

Official plan of correction

The Licensee will ensure that all residents will have a POLST on file. Licensee shall submit a plan to the Department stating how they will ensure this deficiency does not occur again in the future. (Continued) was doing majority of the night. Based on document review 4 staff’s CPR/first aid was expired on 3/2024. Which pose/poses an immediate health, safety and personal rights risk to persons in care.

Deadline recorded: Jun 25, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87463(i)

Regulation authority

CCR

What the official deficiency says

87463(i) Reappraisals: When there is significant change in condition... Definitions, or once every 12 months.., the licensee shall arrange an in-person or virtual meeting or conference call to share the reappraisal with the resident, the resident's representative... This requirement is not met as evidenced by: Based on document review, R2 had a reappraisal mentioning wandering, but it was not discussed with resident's responsible party, which is an immediate health, safety and personal rights risk to persons in care.

Official plan of correction

The Licensee shall notify responsible parties regarding all reappraisals going forward and document all interactions. Licensee will submit a plan to the Department stating how they will ensure this deficiency does not occur again in the future.

Deadline recorded: Jun 25, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87468.1(a)(6)

Regulation authority

CCR

What the official deficiency says

87468.1(a)(6) Personal Rights of Residents in All Facilities: Residents in all residential care facilities for the elderly shall have all of the following personal rights: To leave or depart the facility at any time... This requirement is not met as evidenced by: Based on interviews and observations, the Licensee did not ensure that R2 and R3 had the right to leave their room at night by locking them in their rooms by tying the door knob to the hand rail, which is an immediate health, safety and personal rights risk to persons in care.

Official plan of correction

Licensee conducted a training on May 20, 2025 regarding personal rights. Licensee shall submit a roster of staff who attended the training, information on the trainer, and content of the training.

Deadline recorded: Jun 25, 2025. A deadline is not proof that correction was completed.

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 and interview of Administrator, Zach Pilkerton, S1's TB results/Health Screening Report were not present at the facility and could not be reviewed, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/30/2024 Plan of Correction Licensee/Administrator to submit a copy of S1's TB results/Health Screening Report by the Plan of Correction due date. Administrator will also ensure that S1's file is always on site and available for review.

Official classification

Type B

Official code

87415(a)

Regulation authority

CCR

What the official deficiency says

(a) The following persons providing night supervision from 10:00 p.m. to 6:00 a.m. shall be familiar with the facility's planned emergency procedures, shall be trained in first aid as required in Section 87465, Incidental Medical and Dental Care Services, and shall be available as indicated below to assist in caring for residents in the event of an emergency: This requirement is not met as evidenced by: Deficient Practice Statement Based on record review and interview of the Administrator, staff providing night supervision are familiar with the facility's planned emergency procedures, however no documentation of said training was available for review by the LPA, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/03/2025 Plan of Correction Licensee/Administrator to work with someone to develop a training plan that will show topics covered, dates, and list of attendees by the Plan of Correction due date.

Official classification

Type B

Official code

1569.695(c)

Regulation authority

HSC

What the official deficiency says

(c) A facility shall conduct a drill at least quarterly for each shift. The type of emergency covered in a drill shall vary from quarter to quarter, taking into account different emergency scenarios. An actual evacuation of residents is not required during a drill. While a facility may provide an opportunity for residents to participate in a drill, it shall not require any resident participation. Documentation of the drills shall include the date, the type of emergency covered by the drill, and the names of staff participating in the drill. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review and interview with Administrator, the facility has conducted quarterly emergency drill trainings but does not have documentation of them, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/03/2025 Plan of Correction Licensee/Administrator to conduct a quarterly emergency drill and send the following information to CCLD: date of training, list of attendees, and content covered by the Plan of Correction due date.

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 record review, the facility's LIC 610E(Emergency and Disaster Plan) was last updated on 12/9/2022, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/03/2025 Plan of Correction Licensee/Administrator to submit updated LIC 610E form to CCLD by the Plan of Correction due date. Administrator to add to his calendar a date that he will update the LIC 610E.

Official classification

Type B

Official code

87303(e)(6)

Regulation authority

CCR

What the official deficiency says

(e) Water supplies and plumbing fixtures shall be maintained as follows: (6) Toilet, handwashing and bathing facilities shall be maintained in operating condition. Additional equipment shall be provided in facilities accommodating physically handicapped and/or nonambulatory residents, based on the residents' needs. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, a faucet in residents room did not supply hot water, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/27/2024 Plan of Correction Licensee shall have faucet fixed and submit proof of fixture to the Regional Office by POC due date along with a plan on how the facility will prevent this issue from occurring in the future.