LA SALLE CARE HOME INC.

Official classification

Type A

Official code

87468.2(a)(4)

Regulation authority

CCR

What the official deficiency says

87468.2(a)(4) Additional Personal Rights of Residents in Privately Operated Facilities. Residents shall have all of the following personal rights ...care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs. This requirement was not met as evidenced by: Based on investigation interviews with Witness 1 and administrator, the licensee did not comply with the section cited above, as resident was not properly supervised which led to three elopements, which posed an immediate safety, and personal rights risk to residents in care.

Official plan of correction

Administrator will review facilities Plan of Operation that discusses elopement and dementia processes. Licensee will provide a written statement to CCL by 6/20/25 stating how they will prevent future incidents from reoccurring.

Deadline recorded: Jun 20, 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)(1)A written report shall be submitted to the licensing agency…within seven days of the occurrence of any of the events specified…(D) Any incident which threatens the welfare, safety or health of any resident, such as… unexplained absence of any resident. This requirement is not met as evidenced by:Based on interview and record review, facility failed to provide report of elopement incidents to Licensing as required which posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Licensee will review 87211 reporting requirements and provide CCL with a written statement of understanding. Licensee agrees to complete a Unusual Incident Report for each elopement and submit them to licensing by 06/30/2025.

Deadline recorded: Jun 30, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87465(a)(4)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care (a)A plan for incidental medical…care shall be developed…plan shall encourage routine medical…care and provide for assistance in obtaining such care...(4)The licensee shall assist residents with self-administered medications as needed. This requirement is not met as evidenced by: Based on interview and record review, Resident 1(R1) did not received medication ordered by physician which posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Administrator agrees to submit a written statement of understanding of CCR 87465 in its entirety. As well as review Medication guidance from the Technical Support Program.

Deadline recorded: Jun 30, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87412(f)

Regulation authority

CCR

What the official deficiency says

(f) All personnel records shall be available to the licensing agency to inspect, audit, and copy upon demand during normal business hours. This requirement is not met as evidenced by: Deficient Practice Statement Based on an interview, the licensee did not comply with the section cited, as licensee was unalbe to provide any peronnel records which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/20/2024 Plan of Correction Provide CCL with all required documents from personnel file: 1st Aid/CPR, Personnel Records/Application, Health screening with TB results, and education requirements.

Official classification

Type A

Official code

87355(e)(1)

Regulation authority

CCR

What the official deficiency says

(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department. This requirement is not met as evidenced by: Deficient Practice Statement Based on interview, the licensee did not comply with this section when family member performed work and did not have criminal record clearance which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/14/2024 Plan of Correction LPA observed Licensee excuse worker from her duties and Licensee agreed to not have anyone perform work without being fingerprinted.

Official classification

Type A

Official code

87309(a)

Regulation authority

CCR

What the official deficiency says

(a) Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients. 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 bleach was left unattended in bathroom, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/14/2024 Plan of Correction Administrator agreed to submit a statement of understanding that all cleaning solutions and disinfectants must be inaccesible. Administrator also agreed to repair lock on cabinet under kitchen sink.

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 Disregard--- unalbe to delete- Merla Ventura 1st aid expires 9/21/25 Roger Ventura 1st aid expires 9/25/25

Official plan of correction

POC Due Date: Plan of Correction

Official classification

Type B

Official code

87412(d)

Regulation authority

CCR

What the official deficiency says

(d) The licensee shall maintain documentation that an administrator has met the certification requirements specified in Section 87406, Administrator Certification Requirements or the recertification requirements in Section 87407, Administrator Recertification Requirements. This requirement is not met as evidenced by: Deficient Practice Statement Based on interview and record review, the licensee did not comply with the section cited as there is no active administrtor certificate on file, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/20/2024 Plan of Correction Administrator agrees to complete certification process by POC.

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 the licensee did not comply with the section cited above as an Appraisal Needs and Services form was not included in resdient file, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/20/2024 Plan of Correction Administrator will create an Appraisal Needs and Services Plan for all residents in care by POC.

Official classification

Type B

Official code

87705(c)(6)

Regulation authority

CCR

What the official deficiency says

(c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following: (6) Appraisals are conducted on an ongoing basis pursuant to Section 87463, Reappraisals. This requirement is not met as evidenced by: Deficient Practice Statement Based on a record review, the licensee did not comply with the section cited above in resdient records did not inlcude current appraisal which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/20/2024 Plan of Correction Administrator agrees to submit updated appraisals by POC.

Official classification

Type B

Official code

87224(d)

Regulation authority

CCR

What the official deficiency says

87224(d) Eviction Procedures. The licensee shall set forth in the notice to quit the reasons relied upon for the eviction with specific facts to permit determination of the date, place, witnesses, and circumstances concerning those reasons. This requirement was not met as evidenced by: Based on observations, interview and record review, the licensee did not comply with the section cited above when they issued an invalid eviction notice to R1, which posed a potential personal rights risk to residents in care.

Official plan of correction

In LPA’s presence, Administrator informed R1 the eviction notice was invalid and was rescinded. Administrator agreed to submit a signed statement of understanding of regulation 87224 Eviction Procedures.

Deadline recorded: Sep 20, 2024. A deadline is not proof that correction was completed.