MARINER'S GREEN RESIDENTIAL CARE

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 reviewed, resident 2 (R2) in Room 2 was observed to be bedridden per physician's report, however according to the facility license, facility does not have a fire clearance for bedridden residents which poses an immediate health, safety or personal rights risk to persons in care. An immediate $500.00 civil penalty is being issued during the visit.

Official plan of correction

POC Due Date: 03/25/2026 Plan of Correction Licensee/administrator shall reach out to the fire department by 3/25/26 and notify them of R2 being bedridden. Licensee/administrator shall submit a new LIC200 with a new floor plan indicating what rooms to be used as bedridden so CCL can submit to fire deparment for a new clearance. Licensee/administrator shall reach out to R2's physician to clarify ambulation status as caregivers indicated R2 is ambulatory.

Official classification

Type A

Official code

87608(a)(3)

Regulation authority

CCR

What the official deficiency says

(a) Based on the individual's preadmission appraisal, and subsequent changes to that appraisal, the facility shall provide assistance and care for the resident in those activities of daily living which the resident is unable to do for himself/herself. Postural supports may be used under the following conditions: (3) A written order from a physician indicating the need for the postural support shall be maintained in the resident's record. The licensing agency shall be authorized to require other additional documentation if needed to verify the order. This requirement is not met as evidenced by: Deficient Practice Statement Based on observations and records reviewed, Resident rooms #1, #2, and #4 had beds equipped with half bed rails and room #5 to be equipped with a full bed rail. The residents in the specified with bed rails did not have a physician's order for it which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/25/2026 Plan of Correction Licensee/administrator shall remove half bed rail until residents in rooms #1, #2 and #4 have a written order from their physicians indicating the need for a postural support.

Official classification

Type A

Official code

87608(a)(5)(A)

Regulation authority

CCR

What the official deficiency says

(A) A bed rail that extends from the head half the length of the bed and used only for assistance with mobility shall be allowed. This requirement is not met as evidenced by: Deficient Practice Statement Based on observations and record review, resident 5 (R5) in room #5 had a bed with a full bed rail, however is not on hospice which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/25/2026 Plan of Correction Licensee/administrator shall remove the full bed rails from R5's bed and consult with R5's family and physician to discuss other options for R5.

Official classification

Type B

Official code

87305(a)

Regulation authority

CCR

What the official deficiency says

Prior to construction or alterations, all facilities shall obtain a building permit. This requirement is not met as evidenced by: Deficient Practice Statement Based on observations, LPA toured the garage and observed storage cabinets built which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/20/2024 Plan of Correction Licensee/Administrator to contact the Redwood City Building Department regarding built storage cabinets. Licensee/Administrator will notify CCL of what Building Department indicate and submit a plan of correction in writing.

Official classification

Type A

Official code

87303(e)(3)

Regulation authority

CCR

What the official deficiency says

(e) Water supplies and plumbing fixtures shall be maintained as follows: (3) Taps delivering water at 125 degree F (52 degrees C) or above shall be prominently identified by warning signs. 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 water temperature throughout the facility bathrooms measured between 144.8- 152.9 degrees F and water temperature in the kitchen measured at 124.7 degrees F which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/04/2023 Plan of Correction Facility administrator adjusted water temperature. Water temperature measured between 111 degrees F to 118 degrees F. Deficiency is corrected and cleared during the visit.

Official classification

Type B

Official code

87555(b)(8)

Regulation authority

CCR

What the official deficiency says

(b) The following food service requirements shall apply: (8) All food shall be of good quality. Commercial foods shall be approved by appropriate federal, state and local authorities. Food in damaged containers shall not be accepted, used or retained. This requirement is not met as evidenced by: Deficient Practice Statement Based on observations, the licensee did not comply with the section cited above as LPA observed an expired gallon of milk in the fridge which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/03/2023 Plan of Correction Caregiver immediately threw away the gallon of milk in LPAs presence. Deficiency is corrected and cleared during the visit.

Official classification

Type B

Official code

87555(b)(7)

Regulation authority

CCR

What the official deficiency says

(b) The following food service requirements shall apply: (7) Modified diets prescribed by a resident's physician as a medical necessity shall be provided. 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 LPA observed a resident to be allergic to dairy based on physician's report, however facility provided resident with milk for breakfast which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/10/2023 Plan of Correction Facility administrator to contact responsible party/DPOA or resident's physician to confirm if resident has a dairy allergy and request for a new physician's report to ensure that staff preparing food. Administrator to provide facility cook training to ensure residents with special diets are being provided with food to meet their dietary needs.

Official classification

Type B

Official code

87465(e)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care: (e) For every prescription and nonprescription PRN medication for which the licensee provides assistance there shall be a signed, dated written order from a physician, on a prescription blank, maintained in the residents file... Violation of this regulation is not met as evidenced by: Based on the interviews conducted, the Administrator admitted to administering R1 fluids without a consent from R1's responsible party which poses a potential health and safety risks to residents in care.

Official plan of correction

Facility to consult with all resident's physician ensuring residents are able to take the liquid drink as a supplement without any complications. Facility will obtain a written order from all physicians and maintain it in resident files.

Deadline recorded: Jul 25, 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

87468.1 Personal Rights of Residents in All Facilities: (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (8) To have their representatives regularly informed by the licensee of activities related to care or services, including ongoing evaluations, as appropriate to their needs. Violation of this regulation is not met as evidenced by: Based on the interviews conducted, the Administrator admitted to not asking or receiving consent from a resident's (R1's) responsible party prior to administering a liquid drink to take as a supplement. consent from R1's responsible party which poses a potential health and safety risks to residents in care.

Official plan of correction

Facility will request both written and verbal consent from resident's responsible party to all facility to administer the liquid drink to resident and put it in resident's files.

Deadline recorded: Jul 25, 2022. A deadline is not proof that correction was completed.