VILA MONTE

Official classification

Type B

Official code

87467(a)

Regulation authority

CCR

What the official deficiency says

(a) Prior to, or within two weeks of the resident’s admission, the licensee shall arrange a meeting with the resident, the resident’s representative, if any, appropriate facility staff, and a representative of the resident’s home health agency, if any, and any other appropriate parties, to prepare a written record of the care the resident will receive in the facility, and the resident’s preferences regarding the services provided at the facility. This requirement is not met as evidenced by: Based on interview, record review and observation the licensee did not comply with the section cited above wherein 3 residents reppraisals were not completed to indicate the individual care the resident will receive which poses a potential health, safety and personal rights risk to persons in care.

Official plan of correction

Administrator states they will meet with each resident to go over the reaprraisals. Administrator states to submit the 3 residents reappraisals to LPA Kabariti via email by POC due date of 08/26/2025.

Deadline recorded: Aug 26, 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

(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 THIS DEFICIENCY WAS INADVERTENTLY AMENDED. Based on observation, interview, and record review, the licensee did not comply with the section cited above wherein the licensee did not ensure 1 resident was provided their routine medication from 04/08/25 - 04/23/25 which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/01/2025 Plan of Correction Licensee will submit a written plan regarding how the facility will ensure resident's medications refills are followed-up with timely before a resident's medication runs out. Licensee will submit the POC to LPA Kabariti via email by POC due date.

Official classification

Type B

Official code

87506(a)

Regulation authority

CCR

What the official deficiency says

(a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff This requirement is not met as evidenced by: Deficient Practice Statement THIS DEFICIENCY WAS INADVERTENTLY AMENDED. Based on observation, interview, and record review, the licensee did not comply with the section cited above wherein the licensee did not ensure the centrally stored medication records contained a start date which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/01/2025 Plan of Correction Licensee states they will implement start dates on the record and medication. Licensee will submit a written plan to LPA Kabariti via email by POC due date

Official classification

Type B

Official code

80087(a)(1)

Regulation authority

CCR

What the official deficiency says

80087(a)(1) (a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors. (1) The licensee shall take measures to keep the facility free of flies and other insects. This is not met as evidenced by: The licensee did not ensure that the facility was free of pests such as bed bugs. It was learned that upon admission the resident room obtained bed bugs and was treated upon notice. This poses a potential health, safety and personal rights risks to persons in care.

Official plan of correction

Licensee has obtained pest control services. POC has been cleared as of this date.

Deadline recorded: Nov 9, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87411(a)

Regulation authority

CCR

What the official deficiency says

(a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs... This requirement is not met as evidenced by: Based on interview, record review, and observation staff (S1) was not competent in providing proper supervision during dinner time by having his/her back turned towards the residents and initially ignoring the resident the first time when R1 began to choke, which poses an immediate health, safety, and personal rights risk to persons in care.

Official plan of correction

Licensee will provide staff training with emphasis in supervision. Licensee will submit the training document via email to LPA Dolores by POC due date.

Deadline recorded: May 14, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87208(a)(12)

Regulation authority

CCR

What the official deficiency says

(a) Each facility shall have and maintain a current, written definitive plan of operation. The plan and related materials shall be on file in the facility and shall be submitted to the licensing agency with the license application. Any significant changes in the plan of operation which would affect the services to residents shall be submitted to the licensing agency for approval. The plan and related materials shall contain the following: (12) The Infection Control Plan pursuant to Section 87470. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview and record review the licensee did not comply with the section cited above by not having the infection control plan available for review during LPAs visit which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/25/2024 Plan of Correction Licensee will submit a current infection control plan to the Department. Licensee will ensure the infection control plan is maintained in the facility. Licensee will submit a statement of understanding to LPA Dolores via email by POC due date.

Official classification

Type B

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 observation, interview, and record review the licensee did not comply with the section cited above in by not providing at least 20 hours of annual training to staff regarding this section which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/25/2024 Plan of Correction Licensee will submit a statement of understanding of the section cited above to LPA Dolores by 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 observation, interview, and record review the licensee did not comply with the section cited above by not completing the emergency drills quarterly which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/25/2024 Plan of Correction Licensee will complete the quarterly emergency drill for each shift. Licensee will submit the quarterly drill and statement of understanding of the section cited above to LPA Dolores by POC due date.

Official classification

Type B

Official code

87458(a)

Regulation authority

CCR

What the official deficiency says

(a) Prior to a person's acceptance as a resident, the licensee shall obtain and keep on file, documentation of a medical assessment, signed by a physician, made within the last year. The licensee shall be permitted to use the form LIC 602 (Rev. 9/89), Physician's Report, to obtain the medical assessment. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview, and record review, the licensee did not comply with the section cited above by 1 out of 6 counts for a resident who did not have a physician's report on file which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/25/2024 Plan of Correction Licensee will submit a statement of understanding regarding the section cited above to LPA Dolores by POC due date.

Official classification

Type A

Official code

87466

Regulation authority

CCR

What the official deficiency says

The licensee shall ensure that residents are regularly observed for changes in physical, mental, emotional and social functioning and that appropriate assistance is provided when such observation reveals unmet needs. When changes such as unusual weight gains or losses or deterioration of mental ability or a physical health condition are observed, the licensee shall ensure that such changes are documented and brought to the attention of the resident's physician and the resident's responsible person, if any. This requirement is not met as evidenced by: Based on interview, record review and observation the licensee did not ensure to document the observation of resident (R1)’s throat condition resulting in R1’s death after choking on food which poses/posed an immediate health, safety, and personal rights risk to persons in care.

Official plan of correction

Licensee will provide an in-service training to all the staff regarding observations of the residents and proper documentation regarding any changes in condition. Licensee will submit the in-service training to LPA by POC due date of 01/17/2024.

Deadline recorded: Jan 17, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87555(b)(10)

Regulation authority

CCR

What the official deficiency says

(b) The following food service requirements shall apply: (10) Where indicated, food shall be cut, chopped or ground to meet individual needs. This requirement is not met as evidenced by: Based on interview, record review, and observation the licensee did not ensure to cut R1’s foods into small portions as indicated on his/her medical discharge summary which poses/posed an immediate health, safety, and personal rights risk to persons in care.

Official plan of correction

Licensee will provide an in-service training with all the staff on portion sizes and reviewing physician's orders / discharge summaries relating to residents special diets. Licensee will submit the in-service training to LPA by POC due date of 01/17/2024.

Deadline recorded: Jan 17, 2024. A deadline is not proof that correction was completed.

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: Based on interview, record review, and observation the licensee did not ensure the facility was clean, sanitary and in good repair which poses/posed an immediate health, safety, and personal rights risk to persons in care.

Official plan of correction

Licensee will purchase new light fixtures for the facility by 11/03/23. Licensee will go over in-service training with staff regarding proper cleaning. Licensee will submit the completed in-service training document and light fixture receipt to LPA Dolores by POC due date.

Deadline recorded: Nov 3, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87211(a)(1)(A)

Regulation authority

CCR

What the official deficiency says

(a) Each licensee shall furnish to the licensing agency such reports as the Department may require, … : (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 of any of the events specified in (A) through (D) below. … (A) Death of any resident from any cause regardless of where the death occurred, including but not limited to a day program, a hospital, en route to or from a hospital, or visiting away from the facility.This requirement is not met as evidenced by: Based on interview, record review, and observation the licensee did not ensure to inform the Department of a death of a resident within 7 days of the occurrence which poses/posed an immediate health, safety, and personal rights risk to persons in care.

Official plan of correction

Licensee will submit a plan in writing to ensure incident reports and death reports will be sent to the Department within the reporting requirement, to LPA Dolores by POC due date.

Deadline recorded: Oct 27, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87355(e)(2)

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: (2) Request a transfer of a criminal record clearance as specified in Section 87355(c) or ... This requirement is not met as evidenced by: Based on record review, interview, and observation the Licensee did not comply with the section cited above for staff (S1) working in the facility without association which poses an immediate health, safety, and personal rights risk to persons in care.

Official plan of correction

Licensee will submit the LIC9182 or LIC9188 to the Department, ASAP. Licensee will submit a plan to ensure all staff are fingerprint cleared and associated to the facility prior to starting work to LPA Dolores via email by POC due date.

Deadline recorded: May 11, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87211(a)(1)(A)

Regulation authority

CCR

What the official deficiency says

(a) Each licensee shall furnish to the licensing agency such reports as the Department may require, … : (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 of any of the events specified in (A) through (D) below. … (A) Death of any resident from any cause regardless of where the death occurred, including but not limited to a day program, a hospital, en route to or from a hospital, or visiting away from the facility. Based on record review, interview and observation the licensee did not ensure to submit an incident report and death report for a resident (R1) who was sent to the hospital for medical treatment and who later passed away which poses an immediate health, safety, and personal rights risk to persons in care.

Official plan of correction

Licensee will submit the death report and incident report to LPA Dolores via email by POC due date. Licensee will also send a written plan to ensure complaince to LPA Dolores by POC due date.

Deadline recorded: May 11, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87458(b)(1)

Regulation authority

CCR

What the official deficiency says

(b) The medical assessment shall include, but not be limited to: (1) A physical examination of the resident indicating the physician's primary diagnosis and secondary diagnosis, if any and results of an examination for communicable tuberculosis, other contagious/infectious or contagious diseases or other medical conditions which would preclude care of the person by the facility. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, record review, and interview resident (R1)'s medical assessment did not include a TB result which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/11/2023 Plan of Correction Licensee will submit a plan to ensure resident (R1)'s obtains a TB test to LPA Dolores by POC due date.

Official classification

Type B

Official code

87412(a)

Regulation authority

CCR

What the official deficiency says

(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview, and record review licensee did not ensure personnel records were maintained at the facility for review which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/17/2023 Plan of Correction Licensee will submit a written plan to ensure that all personnel records will be maintained at the facility at all times to LPA Dolores by POC due date.

Official classification

Type B

Official code

87506(a)

Regulation authority

CCR

What the official deficiency says

(a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview, and record review licensee did not ensure all needs and services plans were signed and that residents did not obtain an updated physician's report which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/17/2023 Plan of Correction Licensee will submit a written plan to ensure all resident records will be complete and current to LPA Dolores via email by POC due.

Official classification

Type B

Official code

87219(a)

Regulation authority

CCR

What the official deficiency says

(a) Residents shall be encouraged to maintain and develop their fullest potential for independent living through participation in planned activities. The activities made available shall include: This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview, and record review licensee did not ensure residents were provided activties which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/17/2023 Plan of Correction Licensee will create an activities list and submit a written plan to ensure residents are provided activtiies. Licensee will submit a plan to LPA Dolores by POC due date.

Official classification

Type A

Official code

80087(a)(1)

Regulation authority

CCR

What the official deficiency says

(a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors. (1) The licensee shall take measures to keep the facility free of flies and other insects. This requirement was not met as evidenced by: Based on interview and observation, the licensee did not ensure to keep the facility free from pests such as the insect, bed bugs, which poses an immediate health, safety, and personal rights risk to persons in care.

Official plan of correction

Licensee and Administrator will continue weekly treatment for bed bugs and utilize aerosol foggers to treat bed bug infested rooms. Licensee and Administrator will seek professional help if the issue cannot be contained. Licensee will send the plan of correction in writing by POC due date.

Deadline recorded: Oct 21, 2022. A deadline is not proof that correction was completed.