WEST VALLEY CARE HOME

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 (a) (4)To 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 was not met as evidenced by: Based on interview and record review, the licensee did not comply with the section cited above. Resident R1 eloped from the facility on 3/29/2025. R1 is unable to leave the facility unassisted which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

Licensee states he will submit a plan to address R1's elopement behavior to CCLD by POC due date by 12/27/2025.

Deadline recorded: Dec 27, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87202(a)

Regulation authority

CCR

What the official deficiency says

(a) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, or the State Fire Marshal. Prior to accepting or retaining any of the following types of persons, the applicant or licensee shall notify the licensing agency and obtain an appropriate fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, or the State Fire Marshal: This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, LPAs observed two 'office rooms' being use a resident rooms, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/10/2025 Plan of Correction Licensee states he will submit an updated facility sketch to request an updated fire inspection to CCLD by POC due date 10/10/2025.

Official classification

Type A

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, LPAs observed spiderwebs around residents windows, dirt on residents interior windows, ripped and torn couch in living room, brown stains on walls through the facility which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/10/2025 Plan of Correction Licensee states he clean the areas mentioned, and ensure the faciliyt is clean, safe and sanitary for all residents. Licensee states he will submit the POC to CCLD by POC due date 10/10/2025.

Official classification

Type A

Official code

87307(d)(6)

Regulation authority

CCR

What the official deficiency says

(6) All outdoor and indoor passageways and stairways shall be kept free of obstruction. This requirement is not met as evidenced by: Deficient Practice Statement Based on observations, LPAs observed a gate with a lock on the side of the facility, which poses an immediate health, safety or personal rights risk to persons in care. Licensee removed lock during inspection visit.

Official plan of correction

POC Due Date: 10/10/2025 Plan of Correction Licensee removed the lock from gate on the side of the facility. Licensee will submit a statement of understanding of the regulation cited.

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 observation, LPAs observed medications on a dresser in R2s bedroom which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/10/2025 Plan of Correction Licensee states he will ensure that residents do not keep medications in their room.

Official classification

Type A

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 record review, 1 Out of 2 staff (S2) did not have training for 2025, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/10/2025 Plan of Correction Licensee states he will submit a plan of action stating how S2 will complete required 20 hours of training. Licensee stated he will submit documentation of S2's completion of training to CCLD. Licensee will submit POC by POC due date 10/10/2025.

Official classification

Type B

Official code

87506(b)(16)

Regulation authority

CCR

What the official deficiency says

(b) Each resident's record shall contain at least the following information: (16) Records of resident's cash resources as specified in Section 87217, Safeguards for Resident Cash, Personal Property, and Valuables. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, 3 Out of 3 resident records did not contain personal property log which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/16/2025 Plan of Correction Licensee states he will have residents completed the Safeguard for Resident Cash, Personal Property and Valuables and place in their file. Licensee will submit POC to CCLD by POC due date of 10/16/2025.

Official classification

Type B

Official code

87456(a)(3)

Regulation authority

CCR

What the official deficiency says

(a) Prior to accepting a resident for care and in order to evaluate his/her suitability, the facility shall, as specified in this article 8: (3) Obtain and evaluate a recent medical assessment. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, 3 Out of 3 resident records did not contain an updated medical assessment/physicians report which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/16/2025 Plan of Correction Licensee states he will call each resident's responsible parties to obtain an updated physician's report. Licensee will submit POC to CCLD by POC due date 10/16/2025.

Official classification

Type A

Official code

87468.1(a)(2)

Regulation authority

CCR

What the official deficiency says

87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (2)To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. 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 above. Resident R1 eloped from the facility on 3/29/2025. R1 is unable to leave the facility unassisted which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/10/2025 Plan of Correction Licensee states he will submit a plan to address R1's elopement behavior to CCLD by POC due date by 10/10/2025.

Official classification

Type A

Official code

87405(d)(2)

Regulation authority

CCR

What the official deficiency says

87405 Administrator - Qualifications and Duties (d) The administrator shall have the qualifications specified in Sections 87405(d)(1) through (7). If the licensee is also the administrator, all requirements for an administrator shall apply. (2) Knowledge of and ability to conform to the applicable laws, rules and regulations. This requirement is not met as evidenced by: Deficient Practice Statement Based on the totality of today's visit, Licensee did not confirm to rules and regulations by ensuring R1 did not elope, R1's care plan was not updated, resident medication was accessible. This poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/10/2025 Plan of Correction Licensee states he will send a letter that he understand his duties and responsibilities of Administrator, and that he will be in compliance moving forward. Licensee will submit POC to CCLD by POC due date of 10/10/2025.

Official classification

Type A

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 and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following: (4) The licensee shall assist residents with self-administered medications as needed This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and interview the licensee did not comply with the section cited above. LPAs observed medication bottles in a box in the 'family room' of the facility, accessible to residents which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/10/2025 Plan of Correction Licensee states he will dispose of the medication by taking it to the pharmacy for destruction. Licensee states he will submit the POC to CCLD by POC due date of 10/10/2025

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. LPA observed medication and sharps in two separate unlocked drawers in the kitchen which are easily accessible to residents in care, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/31/2024 Plan of Correction Licensee states the facility will lock all medications and sharps to ensure they are not accessible to residents in care. Licensee will submit a statement of understanding of the regulation cited. Licensee will submit POC to LPA Tarin by POC due date 10/31/2024.

Official classification

Type A

Official code

87705(c)(5)

Regulation authority

CCR

What the official deficiency says

(c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following: (5) Each resident with dementia shall have an annual medical assessment as specified in Section 87458, Medical Assessment, and a reappraisal done at least annually, both of which shall include a reassessment of the resident's dementia care needs. 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. Resident (R3) record did not contain an updated physician's report. Resident R3 physician's report was not updated within the year. R3 has neurocognitive disorder which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/31/2024 Plan of Correction Licensee states the facility will call R3 family to request and updated physician report. Licensee will submit a statement of understanding of the regulation cited. Licensee will submit POC to LPA Tarin by POC due 10/31/2024.

Official classification

Type A

Official code

87705(f)(1)

Regulation authority

CCR

What the official deficiency says

(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 medication in an unlocked dresser drawer in R3's bedroom,(R3 has neurocognitive disorder and shares a bedroom with R2). Medication is accesible to residents in care, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/31/2024 Plan of Correction Licensee stated the medication will be removed from the room and locked, and inaccessible to residents in care. Licensee will submit POC to LPA Tarin by POC due date 10/31/2024.

Official classification

Type A

Official code

87464(f)(1)

Regulation authority

CCR

What the official deficiency says

87464 Basic Services (f) Basic services shall... include: (1) Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). This requirement was not met as evidenced by: Based on interviews and records review, Staff (S1) did not ensure resident (R1) who can’t leave facility unassisted was supervised while leaving the facility. This posed an immediate health and safety risk to residents in care.

Official plan of correction

Licensee increased night shift monitoring of residents. Door alarms were implemented. LPA observed documentation of daily resident checks and alarm door checks. POC observed to be completed on site.

Deadline recorded: Mar 21, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

Not listed

Regulation authority

Not listed

What the official deficiency says

87705 - Care for Persons with Dementia - (f) The following shall be stored inaccessible to residents with dementia: (2)...cleaning supplies and disinfectants. This requirement was not met as evidences by: Based on LPA observation, cleaning supplies were accessible to residents with dementia in facility bathroom and in unlocked facility garage. This posed a potential risk to the health and safety of residents in care.

Official plan of correction

Licensee to provide proof of correction by POC due date.

Deadline recorded: Oct 20, 2022. A deadline is not proof that correction was completed.