SANTO NINO RESIDENTIAL CARE HOME #1

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, record review the licensee did not comply with the section cited above 1 out of 2 staff files were not in facility premises which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/05/2026 Plan of Correction ADM stated she will provide a copy of the residents file via email. ADM will submit POC by 01/05/25

Official classification

Type A

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

87303 Maintenance and Operation (a) The facility shall be...in good repair at all times,...for the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by Based on observation the licensee did not ensure the facility was in good repair at all times. LPAs observed dust, cobwebs, a broken window screen exterior of Bedroom 4, uncovered waste basket in bedroom 1 with unknown brown residue on the wall next to the waste

Official plan of correction

Licensee states she schedule a general cleaning of the facility to ensure facility shall be in good repair at all time for the safety of residents, employees and visitors. Written plan of correction will be submitted to the Department by POC due date 3/14/2025. cont.--basket, which poses an immediate health, safety, or personal rights risk to 4 residents in care.

Deadline recorded: Mar 13, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87309(a)

Regulation authority

CCR

What the official deficiency says

Storage Space and Acess (a) .. the licensee shall ensure that disinfectants, cleaning solutions... 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 Based on observaton and the licensee did not ensure cleaning solutions were inaccessible to 4 residents in care. LPAs observed Comet cleaning product on top of a toilet in bathroom outside of bedroom #2, which poses an immediate health, safety, or personal rights risk to 4 residents in care.

Official plan of correction

Licensee removed Comet cleaning product during visit. Licensee states that all staff will be instructed to remove and lock cleaning products away. Licensee will submit a written statement of understanding of the regulation cited to the Department by POC due date 3/14/2025.

Deadline recorded: Mar 13, 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

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 the bathroom next to bedroom #2, had the sliding shower door which was stuck. ADM stated she doesn't know how long its been stuck. the bathroom closest to bedroom #3, LPA observed the sink was clogged. This poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/02/2025 Plan of Correction ADM stated she will send a written plan of action on how she will ensure the facility is in good repair at all times, and how she will address the shower door and clogged sink. ADM stated she will send the written plan of action by POC date, 01/02/2025.

Official classification

Type B

Official code

87303(c)

Regulation authority

CCR

What the official deficiency says

(c) All window screens shall be clean and maintained in good repair. 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 the screens in the bathroom windows between bedroom #3 and & 2 had dirt/grime on the screens. LPA observed the screen door, from the backyard, leading into bedroom #4 had dirt & grime. This poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/02/2025 Plan of Correction ADM stated she will send a written plan of action on how she will ensure All window screens shall be clean and maintained in good repair. ADM stated she will send photo documentation showing the screens are clean and in good repair. ADM stated she will send the written plan of action by POC date, 01/02/2025.

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. Records may be removed if necessary for copying. Removal of records shall be subject to the following requirements: This requirement is not met as evidenced by: Deficient Practice Statement Based on interview, the licensee did not comply with the section cited above. LPA requested to review ADM's documents. ADM stated she has the completed all the required documents but has them on her computer. ADM stated her printer does not work. ADM did not provide copies for LPA to audit. This poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/02/2025 Plan of Correction ADM stated she will send a written letter of understanding regarding the regulation. ADM stated she will send the plan of action to LPA by POC date, January 2, 2025.

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 interview, the licensee did not comply with the section cited above. LPA requested to review S1's training records and first aid training. ADM stated S1 has not completed his/her training for 2024 or his/her first aid training either. This poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/02/2025 Plan of Correction ADM stated she complete staff S1's training and send documentation showing his/her annual training has been completed. ADM stated she will also send documentation showing S1 has completed his/her first aid training as well. ADM stated she will send the plan of action to LPA by POC date, January 2, 2025.

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 record review, the licensee did not comply with the section cited above. Resident R1-R3 did not have the following forms in there file: LIC627C, LIC613. Residents R2-R3 did not have a LIC601 in there file. This poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/02/2025 Plan of Correction ADM stated she would complete the noted missing documents for the residents mentioned in the deficient practice statement. ADM stated she will send the plan of action to LPA by POC date, January 2, 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 interview the licensee did not comply with the section cited above. LPA requested to review R1-R3's Resident Personal Property & Valuables form, (LIC621). ADM stated she has not filled out this form for R1-R3. This poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/02/2025 Plan of Correction ADM stated she would fill out the LIC621 form for all residents. ADM stated she would send LPA a copy of the completed form by POC date. ADM stated she will also send a letter of understanding regarding the regulation. ADM stated she will send the plan of action to LPA by POC date, January 2, 2025.

Official classification

Type B

Official code

87457(c)

Regulation authority

CCR

What the official deficiency says

(c) Prior to admission a determination of the prospective resident's suitability for admission shall be completed and shall include an appraisal of his/her individual service needs in comparison with the admission criteria specified in Section 87455, Acceptance and Retention Limitations. This requirement is not met as evidenced by: Deficient Practice Statement Based on interview, the licensee did not comply with the section cited above. LPA requested to review R1-R3's preadmission appraisal. ADM was unable to provide LPA with a copy to review. ADM stated the form was not filled out. This poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/02/2025 Plan of Correction ADM stated she would fill out the forms and send LPA a copy. ADM stated she will also send a letter of understanding regarding the regulation. ADM stated she will send the plan of action to LPA by POC date, January 2, 2025.

Official classification

Type B

Official code

87463(a)

Regulation authority

CCR

What the official deficiency says

(a) The pre-admission appraisal shall be updated, in writing as frequently as necessary to note significant changes and to keep the appraisal accurate. The reappraisals shall document changes in the resident's physical, medical, mental, and social condition. Significant changes shall include but not be limited to: This requirement is not met as evidenced by: Deficient Practice Statement Based on interview, the licensee did not comply with the section cited above. LPA requested to review R3's needs and Services plan. ADM stated she has not completed R3's Needs and Services Plan. This poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/02/2025 Plan of Correction ADM stated she will complete R3's needs and services plan and send LPA a copy. ADM stated she will also send a letter of understanding regarding the regulation. ADM stated she will send the plan of action to LPA by POC date, January 2, 2025.

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 interview, the licensee did not comply with the section cited above. LPA requested to review the facility fire/earthquake/disaster drill log. ADM stated she does not have a log. This poses/posed a potential health, safety or personal rights risk to persons in care. ADM stated she will send the plan of action to LPA by POC date, January 2, 2025.

Official plan of correction

POC Due Date: 01/02/2025 Plan of Correction ADM stated she will create a fire/earthquake/disaster drill log. ADM stated she will conduct a drill and send LPA documentation showing a drill has taken place. ADM

Official classification

Type B

Official code

87465(h)(6)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care (h)(6) The licensee shall be responsible for assuring that a record of centrally stored prescription medications for each resident is maintained for at least one year and includes: 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. While reviewing R1's centrally stored medication log, LPA observed the log did not have start dates for 5 medications. While reviewing R3's Medications, LPA observed medication M1 was not listed on the Centrally stored medication log. This poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/02/2025 Plan of Correction ADM Added R3's medication to the Centrally stored log during visit. ADM stated she would audit R1's medications to put the start date for the 5 medications that are missing there start date. ADM stated she would also send a letter of understanding regarding the regulation. ADM stated she will send the plan of action to LPA by POC date, January 2, 2025.