J AND V FAMILY CARE HOME

Official classification

Type A

Official code

87303(e)(2)

Regulation authority

CCR

What the official deficiency says

MAINTENANCE AND OPERATION Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degree C) and not more than 120 degree F (49 degree C). This regulation has not been met as evidenced by: Based on observations made, the licensee did not comply with the section cited above, as hot water temperature in clients' bathroom tested at 130 degrees F, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

Facility shall develop a plan to ensure that the hot water temperature will be lowered and maintained between 105 and 120 degrees. Proof of correction to be sent to CCLD BY DUE DATE.

Deadline recorded: Apr 23, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

1569.695(c)

Regulation authority

HSC

What the official deficiency says

§1569.695 (c) Emergency Plans - 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 health and safety code has not been met as evicenced by: Based on facility records reviewed, and discussion with administrator, the facility does not have a record of the last emergency drill conducted. This poses a potential health and safety risk to residents in care.

Official plan of correction

The facilty shall develop a plan to conduct drills quarterly. This plan and updated disaster drill log is to be maintained at all times. Proof of correction to be sent to CCLD BY DUE DATE.

Deadline recorded: Apr 29, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87506(a)

Regulation authority

CCR

What the official deficiency says

87506(a) Resident Records. A separate, complete, and current record shall be maintained for each resident in the facility, readily available to facility staff and to licensing agency staff and shall contained specified information. This regulation has not been met as evidenced by: Based on resident files reviewed, resident #5 and #6 do not have current physicians reports. Both residents reports are over 1 year old with no updated assessments or reports on file. This poses a potential health and safety risk for residents in care.

Official plan of correction

Facility shall ensure that all residents with dementia have either a current physicians report or other assessment showing the resident has no change from last physician's report. Proof of correction to be sent to CCLD BY DUE DATE.

Deadline recorded: Apr 29, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87465(h)(5)

Regulation authority

CCR

What the official deficiency says

(h) The following requirements shall apply to medications which are centrally stored: (5) Each resident's medication shall be stored in its originally received container. No medications shall be transferred between containers. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation of medications in kitchen cabinet, the licensee did not comply with the section cited above, as 2 out of 5 residents' medications are prepared 7 days in advance. Pills are observed in 7-day plastic pill dispenser. This poses a potential health, safety or personal rights risk to persons in care. Medicatiions for clients #1 and #3 are prepared 7 days in advance.

Official plan of correction

POC Due Date: 04/29/2024 Plan of Correction This practice must stop immediately. Plan/proof of correction to be submitted to CCLD BY DUE DATE.

Official classification

Type B

Official code

87307(a)

Regulation authority

CCR

What the official deficiency says

PERSONAL ACCOMMODATIONS AND SERVICES Living accommodations and grounds shall be related to the facility's function. The facility shall be large enough to provide comfortable living accommodations and privacy for the residents, staff, and others who may reside in the facility. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above, as staff are sleeping in garage. There is a makeshift bed in garage and personal items of staff. This poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/29/2024 Plan of Correction Garage cannot be used as sleeping quarters. Plan/proof of correction to be sent to CCLD BY DUE DATE.

Official classification

Type A

Official code

87303(e)(2)

Regulation authority

CCR

What the official deficiency says

MAINTENANCE AND OPERATION Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degree C) and not more than 120 degree F (49 degree C). This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above, as hot water temperature in clients' bathroom tested at 129 degrees F, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/23/2024 Plan of Correction Hot water temperature will be lowered and maintained between 105 and 120 degrees. Proof of correction to be sent to CCLD BY DUE DATE.

Official classification

Type A

Official code

87468.1

Regulation authority

CCR

What the official deficiency says

PERSONAL RIGHTS This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above, as both wood gates that lead from backyard to street are locked. This poses an immediate health, safety or personal rights risk to persons in care. One gate is secured with a padlock. The other has 2 nails driven into the wood post so gate cannot be opened. Per staff, gates were secured to prevent a resident from wandering out of facility. in [count] out of [total count] [(objects) (persons)] [identifiers] which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/23/2024 Plan of Correction Padlock hardware was removed from one gate nails were removed from the other gate. Administrator to ensure that gates remain accessible. Plan of correction to be submitted to CCLD BY DUE DATE.

Official classification

Type A

Official code

87411(a)

Regulation authority

CCR

What the official deficiency says

PERSONNEL REQUIREMENTS - GENERAL Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. This requirement was not met, as staff referenced on LIC812 failed to provide EMTs with acccurate client information on 6/21/22 during medical emergency of R5. Licensee failed to ensure that staff were competent to meet resident's needs, which posed an immediate health, safety and personal rights risk to clients in care. Because this error may have contributed to R5 death, LIC421M issued to assess immediate $500 civil penalty.

Official plan of correction

Staff to receive training specific to emergency responses from CCLD approved vendor . Proof of training to be submitted to CCLD within 7 days of training.

Deadline recorded: Oct 24, 2022. A deadline is not proof that correction was completed.