FIVE STAR CARE HOME

Official classification

Type A

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 observations, LPA observed the medications, sharps and chemicals unlocked and accessible to residents in care which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/19/2025 Plan of Correction Administrator shall purchase new locks and provide LPA a copy of receipt. In addition, administrator shall submit photos of the new locks places on the cabinets/drawers.

Official classification

Type A

Official code

87555(b)(25)

Regulation authority

CCR

What the official deficiency says

(b) The following food service requirements shall apply: (25) Soaps, detergents, cleaning compounds or similar substances shall be stored in areas separate from food supplies. This requirement is not met as evidenced by: Deficient Practice Statement Based on observations, LPA observed chemicals in a cabinet with food in the garage which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/19/2025 Plan of Correction Administrator shall remove all the chemicals and place them in a cabinet away from food and food supplies and send LPA a photo of the cabinet.

Official classification

Type A

Official code

87458(a)

Regulation authority

CCR

What the official deficiency says

(a) Prior to a person's acceptance as a resident, the licensee shall obtain documentation of a medical assessment, signed by a licensed medical professional acting within the scope of their practice and made within the last year, to be kept in the resident's record. This requirement is not met as evidenced by: Deficient Practice Statement Based on residents file reviewed, LPA observed one resident (R1) to not have a physician's report in the file which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/19/2025 Plan of Correction Administrator shall submit documentation to LPA showing that the facility reached out to R1's physician to obtain a copy of a physician's report for R1 or schedule an appointment for R1 to get a new physician's report.

Official classification

Type B

Official code

87555(b)(26)

Regulation authority

CCR

What the official deficiency says

(b) The following food service requirements shall apply: (26) Supplies of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days shall be maintained on the premises. This requirement is not met as evidenced by: Deficient Practice Statement Based on observations, facility does not have a two day supply of perishables which poses/posed 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 to submit a plan to LPA on how to ensure the facility has a supply of 2-days perishables and 7-days non-perishable at all times. Plan should include shopping more often if needed.

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 5/5 resident record reviewed,, 5/5 resident files reviewed did not have signed pre-admissions appraisal which poses/posed 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 shall also have all residents and responsible parties sign the pre-admissions appraisal and send LPA copies of all signed and completed documents by 7/18/25

Official classification

Type B

Official code

87506(a)

Regulation authority

CCR

What the official deficiency says

87506 Resident Records : (a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff. This requirement is not met as evidenced by: Deficient Practice Statement Based on 5/5 resident records reviewed, the service plans were not completed and were not signed by residents/resident's responsible party which poses/posed 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 shall complete all service plans and have residents or their responsible parties sign and date them. Administrator to send LPA copies of all signed and completed documents by 7/18/25

Official classification

Type B

Official code

87506(a)

Regulation authority

CCR

What the official deficiency says

87506 Resident Records:(a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff. This regulation has not been met as evidenced by: Based on resident records reveiwed, 3 resident files are not current. Needs and appraisal plans are not completed as well as other items such as current physician reports as several are from when the resident was admitted to the facility. This can pose a potential health and safety risk to residents in care.

Official plan of correction

The licensee shall develop a plan in writing on how she will correct this citation to maintain current records for all residents at all times. POC due by 06/24/2024

Deadline recorded: Jun 24, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

80075(f)

Regulation authority

CCR

What the official deficiency says

80075(f) Health Related Services (f) Staff responsible for providing direct care and supervision shall receive training in first aid from persons qualified by agencies including but not limited to the American Red Cross. This regulation has not been met as evidenced by: Based on faciltiy staff files reviewed, 3 of 3 staff files indicate that first aid cards expired on 05/2024. This can pose a potential health and safety risk for residents in care.

Official plan of correction

The licensee shall submit proof that all staff, including the licensee, will receive current first aid training and provide copies of first aid cards as part of the correction. POC due by 06/24/2024

Deadline recorded: Jun 24, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.1(a)(2)

Regulation authority

CCR

What the official deficiency says

(a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview and 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. The facility failed to provide documentation for the daily residents and staff members screening log; the facility failed to provide documentation for the visitor's screening log, facility failed to post COVID sign on front door.

Official plan of correction

POC Due Date: 08/08/2022 Plan of Correction The Administrator and/or designee will review the Department's Provider Information Notices (PINs) regarding the daily COVID-19 screening process for visitors, residents and staff members and start documenting the results of the screening outcomes on a log to indicate that it was done. The Administrator will in-service staff members on this procedure and the Administrator will provide a copy of the sign-in sheet and the required logs to the Department by 8/8/22. Administrator to send LPA picture of the front door with signs