MONTEVERDE MANOR

Official classification

Type A

Official code

87405(a)

Regulation authority

CCR

What the official deficiency says

87405 Administrator - Qualifications and Duties (a) All facilities shall have a qualified and currently certified administrator...this requirement is not met as evidenced by the administrator's certificate has expired which poses an immediate health and safety risks to residents in care.

Official plan of correction

The administrator/ licensee will develop a plan to ensure that the administrator completes the re-certification process in a timely fashion. In addition, the licensee will appoint an acting administrator for the facility while the administrator is working on the renewal process. The administrator will provide a copy of the plan of correction to CCL by 4/30/2026. The administrator will provide documents to CCL by 5/8/2026 to proof that the renewal process is completed.

Deadline recorded: Apr 30, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87303(e)(2)

Regulation authority

CCR

What the official deficiency says

(2) 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 degrees C) and not more than 120 degree F (49 degrees C). 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 hot water temperature in the kitchen and bathroom was measured at 125- 138 degrees Fahrenheit. which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/23/2026 Plan of Correction The administrator will develop a plan of correction to ensure hot water temperature is within 105-120 and will provide a copy of the plan of correction to CCL by 4/23/26.

Official classification

Type A

Official code

87457(c)

Regulation authority

CCR

What the official deficiency says

(c) Prior to admission a determination of the prospective resident's suitability for admission shall be completed and shall include an appraisal of their individual service needs in comparison with the admission criteria specified in Section 87455, Acceptance and Retention Limitations. 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, R2 and R3 pre-admission appraisals were incomplete which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/23/2026 Plan of Correction The administrator will develop a plan of correction to ensure pre-admission appraisal are completed accordingly and will provide a copy of the plan of correction to CCL by 4/23/26. The administrator will ensure the pre-admission appraisals are completed for R1, R2 and R3 by 4/27/2026.

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 LPA observed the faucets in the kitchen and bathroom in room number 3 were loose which poses/posed a potential health, safety or personal rights risk to persons in car.

Official plan of correction

POC Due Date: 04/27/2026 Plan of Correction The administrator will provide proof to CCL that the faucets are repaired by 4/27/2026.

Official classification

Type B

Official code

87303(e)(5)

Regulation authority

CCR

What the official deficiency says

(5) Slip-resistant mats, strips, or flooring shall be used in all bathtub and shower floors. 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 the shower/bathroom in room number 6 did not have a slip- resistant mat which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/27/2026 Plan of Correction The administrator will provide proof to CCL that the bathroom in room #4 has a non-skid mat by 4/27/2026.

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 R4 and R5's reappraisals were incomplete which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/27/2026 Plan of Correction The administrator will develop a plan to ensure reappraisals are completed in a timely fashion and will provide a copy of the plan of correction and a copy of the completed reappraisals for R4 and R5 to CCL by 4/27/2026.

Official classification

Type A

Official code

87303(e)(2)

Regulation authority

CCR

What the official deficiency says

(e) Water supplies and plumbing fixtures shall be maintained as follows: (2) 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 degrees C) and not more than 120 degree F (49 degrees C). 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 he water temperature for the faucets used by residents were measured at 130- 160 degrees F which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/17/2025 Plan of Correction The administrator will develop a plan to ensure the water temperature is within 105-120 and will provide a copy of the plan to CCL by 4/17/2025. In addition, the administrator will take daily temperatures for 7 days and provide a copy of the results to CCL by 4/24/2025.

Official classification

Type A

Official code

87457(c)

Regulation authority

CCR

What the official deficiency says

(c) Prior to admission a determination of the prospective resident's suitability for admission shall be completed and shall include an appraisal of their individual service needs in comparison with the admission criteria specified in Section 87455, Acceptance and Retention Limitations. 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, R2 and R4 did not have pre-admission appraisals which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/17/2025 Plan of Correction The administrator will develop a plan to ensure all pre-admission appraisals are completed prior to admission and will provide a copy of the plan to CCL by 4/17/2025.

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 the facility did not have any documentation to proof that drills were conducted accordingly which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/17/2025 Plan of Correction The administrator will develop a plan to ensure compliance and will provide a copy of the plan to CCL by 4/16/2025.

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 R1 and R3 have bed rail without a written order from a physician which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/17/2025 Plan of Correction The administrator will provide a plan to ensure compliance and will provide a copy of the plan of correction to CCL by 4/17/2025. The administrator will provide a copy of the written order to CCL by 4/24/2025.

Official classification

Type B

Official code

1569.625(b)(2)

Regulation authority

HSC

What the official deficiency says

(2) In addition to paragraph (1), training requirements shall also include an additional 20 hours annually, eight hours of which shall be dementia care training, as required by subdivision (a) of Section 1569.626, and four hours of which shall be specific to postural supports, restricted health conditions, and hospice care, as required by subdivision (a) of Section 1569.696. This training shall be administered on the job, or in a classroom setting, or both, and may include online training. 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 S2 did not complete the required annual training which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/24/2025 Plan of Correction The administrator will develop a plan to ensure compliance and will provide a copy of the plan of correction and a copy of the training records for S2 to CCL by 4/24/2025.

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 R1 and R4 were admitted in 2023 and there was no reappraisals in their records which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/24/2025 Plan of Correction The administrator will develop a plan to ensure compliance and will provide a copy of the plan of correction and a copy of the reappraisals for R1 and R4 to CCL by 4/24/2025.

Official classification

Type B

Official code

87633(a)(1)

Regulation authority

CCR

What the official deficiency says

(a) The licensee shall be permitted to accept or retain residents who have been diagnosed as terminally ill by his or her physician and surgeon and who may or may not have restrictive and/or prohibited health conditions, to reside in the facility and receive hospice services from a hospice agency in the facility, when all of the following conditions are met: (1) The licensee has received a hospice care waiver from the department. 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 is approved for 1 hospice and is currently caring for 2 which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/24/2025 Plan of Correction The administrator will provide a copy of the required documents to increase the number of hospice residents by 4/24/2025.

Official classification

Type A

Official code

Not listed

Regulation authority

Not listed

What the official deficiency says

87305 Alterations to Existing Building or New Facilities..(a) Prior to construction or alterations, all facilities shall obtain a building permit. This requirement is not met as evidenced by: Based on observation and interview, LPA observed a staff was sleeping in the garage which poses an immediate health and safety risks to residents in care

Official plan of correction

The administrator will develop a plan to ensure garage is not a living space for facility staff and submit a copy of the plan to CCL by 4/25/2024.

Deadline recorded: Apr 25, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

Not listed

Regulation authority

Not listed

What the official deficiency says

§1569.695 (c)Emergency Plans..c) A facility shall conduct a drill at least quarterly for each shift. This requirement is not met as evidenced by: Based on observation, interview and record review, the facility was not able to provide documents to proof that emergency drills were completed which poses an immediate health and safety risks to residents in care.

Deadline recorded: Apr 25, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87506(c)(1)

Regulation authority

CCR

What the official deficiency says

87506 Resident Records: (c) All information and records obtained from or regarding residents shall be confidential.(1) The licensee shall be responsible for storing active and inactive records... The licensee... shall reveal or make available confidential information only upon the resident's written consent or that of his designated representative. Violation of this regulation is not met as evidence by: Based on information collection and interviews conducted, it was indicated that the due to the pandemic and personal issues, the administrator has not had a chance to provide the responsible party with Resident's (R1's) documents.

Official plan of correction

Administrator will provide resident's responsible party with a copy of resident's file. In addition, Administrator will submit a copy of email, fax cover sheet, or copy of receipt to CCLD as proof or correction.

Deadline recorded: May 3, 2022. A deadline is not proof that correction was completed.