ARAVILLE RESIDENTIAL CARE HOME II

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 [(observation) (interview) (record review)], the licensee did not comply with the section cited above as LPA observed R1 has bed rail by the head of the bed without a physician's order. which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/30/2026 Plan of Correction The Licensee will submit a plan of correction to ensure compliance and will submit a copy of the plan to CCL by 7/30/2026.

Official classification

Type A

Official code

87608(a)(5)(B)

Regulation authority

CCR

What the official deficiency says

(B) Bed rails that extend the entire length of the bed are prohibited except for residents who are currently receiving hospice care and have a hospice care plan that specifies the need for full bed rails. This requirement is not met as evidenced by: Deficient Practice Statement Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above as LPA observed R2 and R3 who are not on hospice care have bed rails on the upper and lower side of their beds. which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/30/2026 Plan of Correction The Licensee will submit a plan of correction to ensure compliance and will submit a copy of the plan to CCL by 7/30/2026.

Official classification

Type A

Official code

87618(b)(5)

Regulation authority

CCR

What the official deficiency says

(5) Ensuring that facility staff have knowledge of, and ability in the operation of the oxygen equipment. This requirement is not met as evidenced by: Deficient Practice Statement Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above The facility did not have training records to proof that facility staff, S1 and S2 have knowledge of, and ability in operation of the oxygen/concentrator equipment.which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/30/2026 Plan of Correction The licensee will submit a plan of correction to ensure facility staff have knowledge of, and ability in operation of the oxygen/concentrator equipment. The licensee will submit a copy of the plan of correction to CCL by 7/30/2026.

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

(a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by: Deficient Practice Statement Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above as During the facility tour, LPA observed room 2 and the bathroom next to room 2 had a very strong urine smell. This observation was shared with the administrator and the caregiver. which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/07/2026 Plan of Correction The licensee will submit a plan of correction to ensure this is corrected and maintained. The licensee will submit a copy of the plan of correction to CCL by 8/7/2026.

Official classification

Type B

Official code

87618(b)(3)(A)

Regulation authority

CCR

What the official deficiency says

(3) Ensuring that the use of oxygen equipment meets the following requirements: (A) A report shall be made in writing to the local fire jurisdiction that oxygen is in use at the facility. This requirement is not met as evidenced by: Deficient Practice Statement Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above as the facility stated that they did not provide written notification to the local fire jurisdiction that R5 is on oxygen which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/07/2026 Plan of Correction The licensee will submit a plan of correction to ensure this is corrected. The licensee will submit a copy of the plan of correction to CCL by 8/7/2026.

Official classification

Type A

Official code

87412(a)(11)

Regulation authority

CCR

What the official deficiency says

(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: (11) A health screening as specified in Section 87411, Personnel Requirements - General. This requirement is not met as evidenced by: Deficient Practice Statement Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above as LPA observed S2 did not have a health screen record which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/02/2025 Plan of Correction The administrator will submit a plan to ensure compliance and the plan shall indicate the date that S2 will complete the health screen process and it shall be no later than 7/8/2025. The administrator will submit a copy of the plan of correction to CCL by 7/2/2025.

Official classification

Type A

Official code

87456(a)(2)

Regulation authority

CCR

What the official deficiency says

(a) Prior to accepting a resident for care and in order to evaluate his/her suitability, the facility shall, as specified in this article 8: (2) Perform a pre-admission appraisal. This requirement is not met as evidenced by: Deficient Practice Statement Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above LPA observed R1 and R2 were admitted in June 2025 without a pre-admission appraisal which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/02/2025 Plan of Correction The manager will complete the pre-admission appraisals for R1 and R2 and submitted by 7/2/2025. The manager will develop a plan to ensure compliance and submit it to CCL by 7/2/2025.

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 [(observation) (interview) (record review)], the licensee did not comply with the section cited above as R1 was admitted in June 2025 without a recent medical assessment. which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/02/2025 Plan of Correction The manager will complete medical assessment and submitted by 7/2/2025. The manager will develop a plan to ensure compliance and submit it to CCL by 7/2/2025.

Official classification

Type A

Official code

87458(c)(1)(A)

Regulation authority

CCR

What the official deficiency says

(c) The medical assessment shall include, but not be limited to: (1) A physical examination of the resident indicating the licensed medical professional's diagnosis or diagnoses and results of an examination for all of the following: (A) Communicable tuberculosis. This requirement is not met as evidenced by: Deficient Practice Statement Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above as R1 was admitted in June 2025 without a TB status which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/02/2025 Plan of Correction The manager will complete medical assessment and submitted by 7/2/2025. The manager will develop a plan to ensure compliance and submit it to CCL by 7/2/2025.

Official classification

Type A

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 [(observation) (interview) (record review)], the licensee did not comply with the section cited above as LPA observed the emergency drills were not conducted accordingly which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/02/2025 Plan of Correction The house manager and Licensee will develop a plan to ensure compliance and will provide a copy of the plan to CCL by 7/2/2025.

Official classification

Type A

Official code

87608(a)(1)

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: (1) Postural supports shall be limited to appliances or devices such as braces, spring release trays, or soft ties, used to achieve proper body position and balance, to improve a resident's mobility and independent functioning, or to position rather than restrict movement including, but not limited to, preventing a resident from falling out of bed, a chair, etc. This requirement is not met as evidenced by: Deficient Practice Statement Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above as R1 has bed rails by the head and foot of the bed which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/02/2025 Plan of Correction The house manager and the licensee will develop a plan to ensure compliance and will provide a copy of the plan and written order to CCL by 7/2/2025.

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 [(observation) (interview) (record review)], the licensee did not comply with the section cited above as R1 has postural support without a written order which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/02/2025 Plan of Correction The house manager and the licensee will develop a plan to ensure compliance and will provide a copy of the plan and written order to CCL by 7/2/2025.

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

(a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by: Deficient Practice Statement Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above LPA observed the bathroom next to R5 has a very strong urine odor which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/08/2025 Plan of Correction The house manager and the licensee will develop a plan to ensure compliance and will provide a copy of the plan CCL by 7/8/2025.

Official classification

Type B

Official code

1569.319(a)

Regulation authority

HSC

What the official deficiency says

(a) A licensee of a facility that has internet service shall provide at least one internet access device, such as a computer, smart phone, tablet, or other device, that can support real-time interactive applications, is equipped with videoconferencing technology, including microphone and camera functions, and is dedicated for resident use. This requirement is not met as evidenced by: Deficient Practice Statement Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above as LPA did not observe any internet access device at the facility which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/08/2025 Plan of Correction The house manager and the licensee will develop a plan to ensure compliance and will provide a copy of the plan to CCL by 7/8/2025.

Official classification

Type B

Official code

87463(a)

Regulation authority

CCR

What the official deficiency says

(a) The pre-admission appraisal, as specified in Section 87457, Pre-Admission Appraisal, shall be updated, in writing as frequently as necessary or once every 12 months, whichever occurs first, to note significant changes in condition, as defined in Section 87101, Definitions, and to keep the appraisal accurate. For the purposes of this section, the updated pre-admission appraisal shall be referred to as the reappraisal. This requirement is not met as evidenced by: Deficient Practice Statement Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above as LPA observed R3, R4 and R5's reappraisals were not updated accordingly which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/08/2025 Plan of Correction The house manager and the licensee will develop a plan to ensure compliance and will provide a copy of the plan and the updated reappraisals to CCL by 7/8/2025.

Official classification

Type B

Official code

87307(a)

Regulation authority

CCR

What the official deficiency says

87307 Personal Accommodations and Services (a) 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: LPA observed a bed and personal belongings in the garage and according to the administrator and staff, the bed is for a male caregiver to rest and he sleeps in the living room. Deficient Practice Statement Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above as LPA observed a bed and personal belongings in the garage for a male caregiver which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/08/2025 Plan of Correction The administrator will develop a plan to ensure that the facility provides a comfortable living space for staff and will provide a copy of the plan to CCL by 7/8/2025 along with photos to proof that all the personal items and bed were removed from the garage.

Official classification

Type B

Official code

1569.652(c)

Regulation authority

HSC

What the official deficiency says

Health and Safety Code section 1569.652 provides in part:..(c) A refund of any fees paid in advance covering.. within 15 days after the personal property is removed. This requirement is not met as evicenced by based on interivew, R1 passed away on 12/25/24 and the refund has yet been issued which poses a potential health and safety risk with residents in care.

Official plan of correction

The administrator/licensee shall review the regulation and provide a statement in writing acknowledging the review and provide a copy of proof that the refund was issued. The administrator/licensee will provide a copy of the proof and the written statement to CCL by 3/25/2025.

Deadline recorded: Mar 24, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87202(a)(1)

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: (1) Nonambulatory persons. This requirement is not met as evidenced by: Deficient Practice Statement Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above based on the LIC 602, 4 out of 4 residents are non-ambulatory and the facility is approved for 2 non-ambulatory residents which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/18/2024 Plan of Correction The administrator and the assistant administrator will contact the physicians and obtain an updated LIC 602 for both residents. If the status of both residents remain as non-ambulatory, the facility will work with CCL to obtain fire clearance. The facility will provide either an updated physician order for both residents or a plan of correction to CCL by 7/18/2024.

Official classification

Type A

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 [(observation) (interview) (record review)], the licensee did not comply with the section cited above as the facility was not able to provide documents to proof that emergency drills were conducted after Oct 31, 2023 which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/18/2024 Plan of Correction The administrator and the assistant administrator will develop a plan to ensure compliance and will submit a copy of the plan to CCL by 7/18/2024.

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 [(observation) (interview) (record review)], the licensee did not comply with the section cited above as 3 out of 4 residents observed to have half bed rails without a physician's order which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/18/2024 Plan of Correction The administrator and the assistant administrator will provide a plan/physician order to ensure compliance and submit a copy of the plan to CCL by 7/18/2024.

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 [(observation) (interview) (record review)], the licensee did not comply with the section cited above as 1 resident with diagnosis dementia did not have an updated medical assessment which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/24/2024 Plan of Correction The administrator and the assistant administrator will provide a plan to ensure compliance and submit a copy of the plan to CCL by 7/24/2024.

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 the record review, the licensee did not comply with the section cited above in [1] out of [6] residents was deemed to be bedridden at this time but this facility does not have an approved bedridden fire clearance which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/19/2023 Plan of Correction The facility representative stated that a bedridden fire clearance will be requested by this facility and an addendum to this facility's program will be completed and submitted into CCL for review by the assigned LPA. A statement of correction, along with all required forms and documents, will be completed and submitted into CCL by the due date.

Official classification

Type A

Official code

87458(b)(1)

Regulation authority

CCR

What the official deficiency says

(b) The medical assessment shall include, but not be limited to: (1) A physical examination of the resident indicating the physician's primary diagnosis and secondary diagnosis, if any and results of an examination for communicable tuberculosis, other contagious/infectious or contagious diseases or other medical conditions which would preclude care of the person by the facility. This requirement is not met as evidenced by: Deficient Practice Statement Based on the record review, the licensee did not comply with the section cited above in [1] out of [6] residents did not have a proper TB clearance on their medical assessment which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/19/2023 Plan of Correction The facility representative stated that an updated medical assessment will be completed for the resident to reflect proper TB clearance. A statement of correction, along with the updated medical assessment, will be completed and submitted into CCL by the due date.

Official classification

Type A

Official code

87463(c)

Regulation authority

CCR

What the official deficiency says

(c) The licensee shall arrange a meeting with the resident, the resident's representative, if any, appropriate facility staff, and a representative of the resident's home health agency, if any, when there is significant change in the resident's condition, or once every 12 months, whichever occurs first, as specified in Section 87467, Resident Participation in Decision Making. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and record review, the licensee did not comply with the section cited above in [4] out of [6] residents did not have an updated annual appraisal performed to address any changes in residents' care and supervision needs which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/25/2023 Plan of Correction The facility representative stated that re-appraisals will be requested by this facility unto the resident's attending physician and an updated assessment will be completed and submitted into CCL for review by the assigned LPA. A statement of correction, along with all required forms and documents, will be completed and submitted into CCL by the due date.

Official classification

Type A

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 observation, the licensee did not comply with the section cited above since there was not a sufficient supply of nonperishable food items to meet the required 7-day requirement at all times which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/19/2023 Plan of Correction The facility representative stated that additional food items will be purchased in order to satisfy the required 7-day nonperishable food supply at all times. A statement of correction, along with proof of food purchase receipts, will be completed and submitted into CCL by the due date.

Official classification

Type A

Official code

87628(a)

Regulation authority

CCR

What the official deficiency says

(a) The licensee shall be permitted to accept or retain a resident who has diabetes if the resident is able to perform his/her own glucose testing with blood or urine specimens, and is able to administer his/her own medication including medication administered orally or through injection, or has it administered by an appropriately skilled professional. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and record review, the licensee did not comply with the section cited above in that a resident diagnosed with diabetes was unable to conduct their own glucose testing and insulin injections at this time and were solely reliant on the facility staff to perform them which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/19/2023 Plan of Correction The facility representative stated that a reappraisal of this diabetic resident will be conducted and this facility will be required to acquire the necessary health care needs in order to meet the continuing care needs of this resident. A statement of correction, along with all required forms and documents, will be completed and submitted into CCL by the due date.

Official classification

Type A

Official code

87705(c)(5)(A)

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. (A) When any medical assessment, appraisal, or observation indicates that the resident's dementia care needs have changed, corresponding changes shall be made in the care and supervision provided to that resident. 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 in [1] out of [6] residents did not have an updated annual medical assessment which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/25/2023 Plan of Correction The facility representative stated that an updated medical assessment will be completed and submitted into CCL for review by the assigned LPA. A statement of correction, along with the updated annual medical assessment, will be completed and submitted into CCL by the due date.