FOUNTAIN SQUARE OF LOMPOC

Official classification

Type B

Official code

87405(a)

Regulation authority

CCR

What the official deficiency says

87405Administrator - Qualifications and Duties (a)All facilities shall have a qualified and currently certified administrator. The licensee and the administrator may be one and the same person. The administrator shall have sufficient freedom from other administration of the facility as responsibilities and shall be on the premises a sufficient number of hours to permit adequate attention to the management and administration of the facility as specified in this section. When the administrator is not in the facility, there shall be coverage by a designated specifiedsection.

Official plan of correction

substitute who shall have qualifications adequate to be responsible and accountable for management and in this The Department may require that the administrator devote additional hours in the facility ... This requirment is not met be evidence of the lack of assigned Administrator and posess a potential risk to residents in care. BOM agrees to contact Parent Company (Tharon Lompoc, LLC) and provied weekly updates to the LPA as to the assingment of new Administrator, and cordinate all open Plan of Corrections with parent company untill all POC are cleared.

Deadline recorded: Sep 3, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

This requirement is not met as evidenced by: Deficient Practice Statement Based on observation of facility kitchen door that leads to resident hallway and disrepair of fountain in in-closed courtyard with rocks on pathway, the licensee did not comply with the section cited above in 2 out of 2 observations of disrepair, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/20/2025 Plan of Correction Community Relations Director agrees to repair kitchen door leading to resident hallway and midigate the disrepair of the fountain and immidated fountian area by 11/20/2025. CRD will provide photographic and/or video evidence to LPA by cell phone no later than 11/20/2025.

Official classification

Type B

Official code

87303(e)(2)

Regulation authority

CCR

What the official deficiency says

This requirement is not met as evidenced by: Deficient Practice Statement Based on observation the licensee did not comply with the section cited above in that the water temperature in residetn room exceeded 120*(f), which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/20/2025 Plan of Correction During inpsection facility Maintenance Director made temperture adjustments to hot water heaters and conducted additional water test througout the facility. CRD will email LPA updates on 11/13/2025 and 11/20/2025 of regulated water temperture checks that show complaince of maininting a facility water temperature of 105*(f) -120*(f).

Official classification

Type B

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 [(observation) (interview) (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.

Official plan of correction

POC Due Date: Plan of Correction

Official classification

Type A

Official code

87309(a)

Regulation authority

CCR

What the official deficiency says

87309 Storage Space and Access (a) Except as specified in subsection (b), the licensee shall ensure that ... 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 was not met by evidence of: The licensee did not follow the section cited above when S1 brought a loaded gun into the facility and left it accessible, which posed an immediate health and safety risk to residents in care.

Official plan of correction

Administrator agrees to conduct an all staff meeting to review employee handbook section that specificity address weapons at work. Administrator agreed to the all staff meeting that is taking place on 07/22/2025, and Administrator will send All Staff agenda signatures of staff in attendance to LPA.

Deadline recorded: Jul 22, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(h)(2)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care (h) The following requirements shall apply to medications which are centrally stored: (2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. This requirement was not met by observation of LPA discovering open and unsecured medication room with no staff present. This poses an eminent danger to residents in care.

Official plan of correction

Administrator agrees to reevalute and update medication securty policy and send update to LPA by 07/11/2025.

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

Official classification

Type B

Official code

87211(a)(2)

Regulation authority

CCR

What the official deficiency says

87211 Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following:(1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence ...This report shall include...attending physician's name, findings, and treatment, if any; and disposition of the case. This requirement was not met was not met in 18 of 105 and 7 of 105 SIRs submitted in March through June of 2025, which poses a potential risk to Residents.

Official plan of correction

Administrator agrees to contact hospital (ER) administrator and clarifiy discharge requiorments when a resieent is released back to the facility from the ER. Aministrator will request email of outcome and forward that email to LPA by 07/24/2025.

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

Official classification

Type B

Official code

87211(a)(1)(D)

Regulation authority

CCR

What the official deficiency says

87211 Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports as the Department may require…(1) A written report submitted to licensing agency…within seven days...(D) Any incident that threatens welfare, safety or health of any resident This requirement was not met based on interviews and record review; licensee did not comply with section cited above when Licensing Department did not receive incident reports regarding a resident fall and physical altercation which posed a potential health and safety risk to residents in care.

Official plan of correction

Licensee agrees to submit Incident Reports to the Licensing Agency regarding any incident that threatens the welfare, safety, or health of any resident. The licensee will submit a plan describing how the facility will ensure reporting requirements are followed.

Deadline recorded: Dec 5, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87211(a)(1)(A)

Regulation authority

CCR

What the official deficiency says

87211a(1)(A),(B) Reporting Reqs. Licensee shall furnish to licensing agency...including...(1) Written report to licensing agency…within 7 days…(A) Death of resident...regardless where death occurred...(B) Any serious injury determined by attending physician..occurring to resident under facility supervision This requirement is not met as evidenced by: Based on interviews and records review, licensee did not comply with the section cited above. Licensee did not submit incident reports for R1's hospitalizations or death report for R1, which posed a potential health and safety risk to residents in care.

Official plan of correction

The licensee will submit a plan describing how the facility will ensure reporting requirements are followed. Submit proof to Community Care Licensing Division (CCLD) by 08/08/2024

Deadline recorded: Aug 8, 2024. A deadline is not proof that correction was completed.