MILLBRAE FAMILY CARE HOME

Official classification

Type B

Official code

1569.695(c)

Regulation authority

HSC

What the official deficiency says

§1569.695 Emergency Plans(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 notrequired 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 evidenced by: Based on documentation reviewed, LPA observed that there is no disaster drill log present. Per interviews with staff, a disaster drill has not been conducted in about a year. This poses an immediate health and safety risk to residents and staff in the facility.

Official plan of correction

Facility shall conduct a drill and send evidence of it taking place along with the name of attendees and topic of the drill.

Deadline recorded: Aug 1, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87606(c)

Regulation authority

CCR

What the official deficiency says

(c) To accept or retain a bedridden person, other than for a temporary illness or recovery from surgery, a facility shall obtain and maintain an appropriate fire clearance as specified in Section 87202(a). 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 one out of 6 residents is bedridden, per MD report, which poses an immediate health, safety or personal rights risk to persons in care. Client #6 is bedridden, per MD report dated 8/2022. Facility maintains fire clearance for 6 Non-ambulatory residents.

Official plan of correction

POC Due Date: 11/22/2023 Plan of Correction Plan of correction to be submitted to CCLD BY DUE DATE

Official classification

Type B

Official code

1569.696(a)

Regulation authority

HSC

What the official deficiency says

(a) All residential care facilities for the elderly shall provide training to direct care staff on postural supports, restricted conditions or health services, and hospice care as a component of the training requirements specified in Section 1569.625. The training shall include all of the following: This requirement is not met as evidenced by: Deficient Practice Statement Based on staff record review, the licensee did not comply with the section cited above, as 3 out of 3 staff have not received required 4 hours of training on postural supports, restricted health conditions, and hospice care, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/12/2023 Plan of Correction Proof that 3 staff have received 4 hours of training on postural supports, restricted health conditions, and hospice care till be sent to CCLD BY DUE DATE.

Official classification

Type B

Official code

87705(c)(5)

Regulation authority

CCR

What the official deficiency says

(c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following: (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 client records review, the licensee did not comply with the section cited above, as 4 out of 4 clients diagnosed with dementia have MD reports that are more than 1 year old and 3 out of 4 clients diagnosed with dementia have appraisals that are more than 1 year old, which poses a potential health, safety or personal rights risk to persons in care. Clients #1, #2, #3, #5 are diagnosed with dementia, but MD reports are over one year old and appraisals for clients #1, #3, #5 are over one year old.

Official plan of correction

POC Due Date: 12/12/2023 Plan of Correction Updated MD reports and appraisals will be submitted to CCLD BY DUE DATE for above referenced residents who are diagnosed with dementia

Official classification

Type B

Official code

87465(h)(6)

Regulation authority

CCR

What the official deficiency says

INCIDENTAL MEDICAL CARE A record of centrally stored prescription medications for each resident shall be maintained and include names of the resident for whom prescribed, prescribing physician and pharmacist, drug name, strength and quantity, dates filled, started & expiration, prescription number and instructions: This requirement is not met as evidenced by: Deficient Practice Statement Based on review of client records and centrally stored medications, the licensee did not comply with the section cited above. All medications for at least 2 residents are not logged on CSMR (LIC622), which poses a potential health, safety or personal rights risk to persons in care. Six RX medications filled in November 2023 and 1 med filled in October 2023 for client #4 are not logged and meds for client #3 and client #5 are not logged since 8/23 and 9/23, respectively.

Official plan of correction

POC Due Date: 12/12/2023 Plan of Correction Plan/proof of corrections to be submitted to CCLD BY DUE DATE, to acknowledge and ensure that medications are logged in CSMR promptly upon receipt.

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

MAINTENANCE AND OPERATION The facility shall be clean, safe, sanitary and in good repair at all times. 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 wood fence boards, chairs, commodes, building equipment, dresser, are stored in back and side yards. This poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/26/2023 Plan of Correction Back and side yards will be cleared of wood and furnishings. Proof of correction to be submitted to CCLD BY DUE DATE.

Official classification

Type B

Official code

87411(C)(1)

Regulation authority

CCR

What the official deficiency says

PERSONNEL REQUIREMENTS - GENERAL 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 review of staff records, the licensee did not comply with the section cited above , as 3 out of 7 staff do not have proof of current first-aid training, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/26/2023 Plan of Correction Proof of current first-aid training for staff #3, #5, #6 will be sent to CCLD BY DUE DATE