RETIREMENT PLUS OF SAN CARLOS

Official classification

Type B

Official code

1569.696(a)(1)

Regulation authority

HSC

What the official deficiency says

HSC 1569.696(a)(1) Other Provisions: (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: (1)Four hours of training on the care, supervision, and special needs of those residents, prior to providing direct care to residents. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, the Licensee did not ensure that their staff had been provided training within the last year including four hours on the subjects of postural supports, restricted health conditions, and hospice care which is a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/30/2026 Plan of Correction Licensee will conduct training and send list of atendees, subjects of trainings and dates to the Department by the POC due date.

Official classification

Type B

Official code

1569.695(e)(2)

Regulation authority

HSC

What the official deficiency says

HSC 1569.695(e)(2): Other Provisions: e) A facility shall have all of the following information readily available to facility staff during an emergency: (2) An appraisal of resident needs and services plan for each resident. This requirement is not met as evidenced by: Deficient Practice Statement Based on document review, Licensee did not ensure that an appraisal of resident needs and services plan had been created for R1 and R2 which is a potential health, safety, or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/30/2026 Plan of Correction Licensee will create an appraisal of resident needs and services plan for R1 and R2 and submit them to the Department by the POC due date.

Official classification

Type A

Official code

87303(e)(2)

Regulation authority

CCR

What the official deficiency says

87303(e)(2): Maintenance and Operations: 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 degree C) and not more than 120 degree F (49 degree C). This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, Licensee did not ensure hot water temperature was maintained between 105-120 degrees as evidenced by temperature reading of 164 degrees during the inspection, which is an immediate health, safety, or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/17/2026 Plan of Correction Licensee will turn down water temperature and send proof of correction by the POC due date.

Official classification

Type A

Official code

1569.618(c)(3)

Regulation authority

HSC

What the official deficiency says

(c)The facility shall employ, and the administrator shall schedule, a sufficient number of staff members to do all of the following: (3) Ensure that at least one staff member who has cardiopulmonary resuscitation (CPR) training and first aid training is on duty and on the premises at all times. This paragraph shall not be construed to require staff to provide CPR. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, no staff have active CPR and first aid training, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/28/2024 Plan of Correction Administrator to arrange for CPR and first aid training for staff and submit proof that training is scheduled and proof of completion to CCLD

Official classification

Type B

Official code

87411(f)

Regulation authority

CCR

What the official deficiency says

(f) All personnel, including the licensee and administrator, shall be in good health, and physically and mentally capable of performing assigned tasks. Good physical health shall be verified by a health screening, including a chest x-ray or an intradermal test, performed by a physician not more than six (6) months prior to or seven (7) days after employment or licensure. A report shall be made of each screening, signed by the examining physician. The report shall indicate whether the person is physically qualified to perform the duties to be assigned, and whether he/she has any health condition that would create a hazard to him/herself, other staff members or residents. A signed statement shall be obtained from each volunteer affirming that he/she is in good health.Personnel with evidence of physical illness or emotional instability that poses a significant threat to the well-being of residents shall be relieved of their duties. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review of personnel records, S1 started in March 2020 and per the Health Screening Report, S1's TB results were in 2014, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/17/2025 Plan of Correction Administrator to have S1 schedule a TB exam and submit updated Health Screening Report or Chest X-ray results to CCLD by the POC due date.

Official classification

Type B

Official code

87411(c)(6)

Regulation authority

CCR

What the official deficiency says

(6) The licensee shall maintain documentation pertaining to staff training in the personnel records, as specified in Section 87412(c)(2). For on-the-job training, documentation shall consist of a statement or notation, made by the trainer, of the content covered in the training. Each item of documentation shall include a notation that indicates which of the criteria of Section 87411(c)(3) is met by the trainer. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review and interview of Administrator, no training records were available to be reviewed by the LPA for S1, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/17/2025 Plan of Correction Administrator to submit documentation pertaining to staff training, including topics of training, dates of trainings, and logs showing which employees attended trainings as well as information such as qualification of the trainer and contact information for the trainer by the POC 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 record review, S1 has not received training on postural supports, restricted conditions, and hospice care which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/17/2025 Plan of Correction Administrator to submit proof that S1 has received training on postural supports, restricted conditions by the POC due date.

Official classification

Type B

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 record review and interview of the Administrator, the facility has not conducted quarterly emergency drills, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/17/2025 Plan of Correction Administrator to submit proof that trainings have been completed to the Department by the Plan of Correction due date.

Official classification

Type B

Official code

1569.695(e)(2)

Regulation authority

HSC

What the official deficiency says

(e) A facility shall have all of the following information readily available to facility staff during an emergency: (2) An appraisal of resident needs and services plan for each resident. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, R1 did not have an Appraisal of resident needs and services plan, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/10/2025 Plan of Correction Administrator to submit an updated appraisal of resident needs and services plan for R1 by the POC due date.

Official classification

Type A

Official code

Not listed

Regulation authority

Not listed

What the official deficiency says

87705 Care of Persons with Dementia: (f) The following shall be stored inaccessible to residents with dementia: (1) Knives, matches, firearms, tools and other items that could constitute a danger to the resident(s). Violation of this regulation is not met as evidence by: Based on LPA's observation, during facility inspection LPA found that knives are stored in an area of the kitchen that is not secured under lock and key.

Deadline recorded: Mar 29, 2022. A deadline is not proof that correction was completed.