PRINCESS LODGE

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 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 was not met as evidenced by: Based on observation, Laundry Room #2 was not locked with accessible laundry detergents, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

Violation has since been corrected when the investigation started.

Deadline recorded: May 19, 2025. 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

(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 the licensee did not comply with the section cited above. Based on the totality of today's visit, LPAs observed a leaks in the facility, drywall missing in the facility bathroom, fridge's ice buildup perpenicular to room 6, wall above the kitchen facuet, screen doors obsevred not attached, backyard fence being propped by stick, LPAs noted other issues on report. This poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/20/2025 Plan of Correction AD stated that she will provide POC by the due date with detailed information in a document regarding the work plans for each individual issues found in today's visit. AD stated she will send photographs when they resolve these issues.

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 record review, the licensee did not comply with the section cited above. LPAs requested to review R1 to R4's Care Plans/Needs & Services Plan. AD stated the form was not completed. This poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/20/2025 Plan of Correction AD stated that she will provide all Care Plans for R1 to R4 and send LPA a copy. ADM will send by POC date.

Official classification

Type A

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 observations the licensee did not comply with the section cited above. LPAs observed laudnry detergent accessible in bedroom #10. LPAs observed tools accesible to residents in the backyard. LPAs observed storage shed window open with toxics and tools accesible via window. LPAs observed tools and detergent in second story staff area accesible to resident in care. This poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/14/2025 Plan of Correction Staff removed toxics/detergents during visits. AD will send a Letter of Understanding regarding the regulation and the importance of ensuring 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.

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, the licensee did not comply with the section cited above. 3 out 4 staff health screeening forms were not signed by the phsyican. This poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/20/2025 Plan of Correction AD will submit a copy of all the 3, signed by the phsycian, staff health screening forms by POC due date.

Official classification

Type A

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

87303 (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 the licensee did not comply with the section cited above. LPA observed accumulated grease and grime on the vent hood and used paper towel that was stuck in between the vent hood and the cabinet, and a paper towel left on the left corner of the griddle, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/23/2024 Plan of Correction Licensee stated that they will send a plan of correction (POC) by the due date and will have the vent hood cleaned and maintained and remind staff to report to administrator any maintenance concerns as soon as possible to ensure the health and safety of residents in care.

Official classification

Type A

Official code

80087(d)

Regulation authority

CCR

What the official deficiency says

80087(d) Buildings and Grounds- All outdoor and indoor passageways, stairways, inclines, ramps, open porches and other areas of potential hazard shall be kept free of obstruction. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation the licensee did not comply with the section cited above. LPA observed large items obstructing a designated emergency exit door in the conference room behind the accordion door, a large recliner seat by the exit doorway, large dumpster bin that was obstructing the gate and walkway designated for emergency exit and a wheel burrow containing asphalt, which poses an immediate health, safety or personal rights risk to persons in care

Official plan of correction

POC Due Date: 02/23/2024 Plan of Correction LIcensee stated that a plan of correction (POC) will be submitted to address obstruction from designated exits and walkways. Licensee stated they willl move the dumpster bin and make room in another area of the facility to store items that is currently blocking the emergency exit door in the conference room.

Official classification

Type A

Official code

87705(f)(1)

Regulation authority

CCR

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). This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above. LPA observed tools and paint sprays in the open inside the gazebo left unattended, which poses an immediate health, safety or personal rights risk to persons in care

Official plan of correction

POC Due Date: 02/23/2024 Plan of Correction Licensee stated that a plan of correction (POC) will be submitted on the due date and will remove the tools in the gazebo. Licensee stated that he/she will remind the maintenance person not to leave tools in the open unattended and when tools are not in use to keep it in a locked and inaccessible.

Official classification

Type A

Official code

87411(c)(D)

Regulation authority

CCR

What the official deficiency says

87411 Personnel Requirements - General (c) All RCFE staff who assist residents with personal activities of daily living shall receive initial and annual training as specified in Health and Safety Code sections 1569.625 and 1569.69 (D)Policies and procedures regarding medications, including the knowledge in Section 87411(d)(4). Any on-the-job training provided for the requirements in Section 87411(d)(4) may also count towards the requirement in this subsection. 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. Licensee did not discard and maintain record of expired medication R1 and R3 has a medication that was not prescribed in their centrally stored medication bin, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/23/2024 Plan of Correction Licensee stated he/she will send a plan of correction (POC) by due date. Licensee will conduct medication training to med techs to ensure proper documentation of medications received and needs to be discarded.

Official classification

Type A

Official code

87303(e)(2)

Regulation authority

CCR

What the official deficiency says

87303 - Maintenance and Operation - (e)(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 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, the licensee did not comply with the section cited above due to sink in resident bathroom reaching a temperatue of 150.2 *F which posed an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/10/2023 Plan of Correction Licensee to adjust the water heater to the correct temperature and provide video documentation of sink outputting water at the correct temperature. If adjusting the water heater does not output water at acceptable levels, Licencee to provide proof of enlisted plumping services by POC due date.