BONNEVIE RESIDENCE AND CARE

Official classification

Type A

Official code

87468.1(a)(1)

Regulation authority

CCR

What the official deficiency says

87468.1 Personal Rights of Residents in All Facilities (a)(1) To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement was not met as evidenced by: Based on interviews conducted and observation, a metal latch was observed in the door exiting the living room. Staff interviewed stated they did this because a resident would try to exit. This poses an immediate health, safety, personal rights risks to residents in care.

Official plan of correction

ADM stated he will conduct a personal rights training, and the importance of keeping passageways cleared. ADM stated he will submit documentation showing the training occurred, who attended, who gave the training, and how long the training was. ADM stated he will submit by POC date, August 14, 2025.

Deadline recorded: Aug 14, 2025. A deadline is not proof that correction was completed.

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 observation and interview, the licensee did not comply with the section cited above. LPA noted there was " hook & eye " , metal latch outside the living room door, leading towards the outside. S1 stated the latch was put there because there used to be a resident who wanted to go outside a lot. This poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/09/2025 Plan of Correction ADM removed the metal latch during todays visit on 08/08/2025. ADM stated he will send a letter of understanding regarding the regulation, and the importance of keeping all passageways clear of any obstructions, by POC date, August 9, 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 record review, the licensee did not comply with the section cited above. The facility conducted drills on the following dates: June 15, 2024, September 21, 2024, April 13, 2025, and July 10, 2025. This poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/15/2025 Plan of Correction ADM stated he will send a written plan of action on how he will ensure drills are conducted quarterly, with different scenarios, taking into account different emergency scenarios. ADM stated 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. ADM stated he will send LPA the written plan by POC date, August 15, 2025.

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 records reviewed, the licensee did not comply with the section cited above. LPA reviewed 3 resident medications and centrally stored medication records. Residents R1, R2 and R3 did not have multiple medications listed on the centrally stored medication record. Resident R1, R2 and R3's centrally stored medication record did not have any medications listed with a fill date of 2025. This poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/15/2025 Plan of Correction ADM stated he will send a written plan of action on how he will ensure residents centrally stored medication records will be complete with the following information: Name of resident, name of the prescribing physician, drug name, strength and quantity.The date filled, prescription number and the name of the issuing pharmacy, Instructions, and start date. ADM stated he will send LPA a copy of R1-R4's completed centrally stored medication record and the plan of action by 8/15/25.

Official classification

Type A

Official code

87303(a)(2)

Regulation authority

CCR

What the official deficiency says

This requirement is not met as evidenced by: (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). Deficient Practice Statement Based on inspection LPA measured the water temperature with a digital thermometer at 145.7 degrees F in bathroom #1, 130.1 in bathroom #2 and 141.1 in bathroom #3 (2nd Floor)

Official plan of correction

POC Due Date: 11/01/2024 Plan of Correction Administrator stated they will do a weekly check to maintain required level of measurement ranging from 105 to 120 degrees F. Administrator will submit a written plan of action by POC date 11/01/2024

Official classification

Type A

Official code

87309(a)(1)

Regulation authority

CCR

What the official deficiency says

This requirement is not met as evidenced by: (a)(1) Storage areas for poisons, and firearms and other dangerous weapons shall be locked. Deficient Practice Statement Based on observation the licensee did not comply with the section cited above. LPA observed the followiing toxic materials accessible to residents in care the following areas: #1. Car Wax and Curaid ointment unlocked hallway closet accross common area. #2. Comet, and cleaning supplies found in bathroom #3, #3 lighter fluid and bucket of laundry detergent was found in unlocked basement. #4 a garden potting soil/fertilizer was found outside the facility accesible.

Official plan of correction

POC Due Date: 11/01/2024 Plan of Correction Administrator willl submit a written plan of action that will deligate to staff to make sure toxics are properly stored to the department by the POC date 11/01/2024,

Official classification

Type A

Official code

87457(c)(1)

Regulation authority

CCR

What the official deficiency says

This requirement is not met as evidenced by: (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. (1) The appraisal shall include, at a minimum, an evaluation of the prospective resident's functional capabilities, mental condition and an evaluation of social factors as specified in Sections 87459, Functional Capabilities and 87462 Social Factors. Deficient Practice Statement Based on record review the licensee did not comply with the section cited above. LPA randomly reviewed resident file (R1,R2,R3,R4 R5). All 5 residents did not have appraisals needs and services plan in there files.

Official plan of correction

POC Due Date: 11/01/2024 Plan of Correction Administrator will develop and submit a appraissal needs and services for each resident by the POC date 11/01/2024

Official classification

Type B

Official code

87465(h)

Regulation authority

CCR

What the official deficiency says

(h) The following requirements shall apply to medications which are centrally stored: (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. This requirement is not met as evidenced by: Deficient Practice Statement Based on medication audit LPA observed R1,R2,and R3's Centrallly Stored Medicatiion Log (LIC622), all 3 residents medication refilled in September 2024 were not documented on log.

Official plan of correction

POC Due Date: 11/05/2024 Plan of Correction

Official classification

Type B

Official code

87555(26)

Regulation authority

CCR

What the official deficiency says

(26)Supplies of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days shall be maintained on the premises. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and inspection during facility tour LPAs observed in pantry 20 cans of fruit and tomato soup and few vegetable and protein which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/05/2024 Plan of Correction Administrator will do a weekly check to maintain an adequate amount of perishable and non perishable food. Administrator will do a training for staff to make sure food is properly stored and labeled. Administrator will provide proof training and plan to the deparment by POC date 11/05/2024

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 inspection of the facility (inside and out), LPA observed the following: #1. Loose floorboard in the main dining area. #2. Residents bedroom had cob webs in window panel bedroom #1. #3.bedroom # 3 window screen had holes. #4. Kitchen stove and oven, microwave and refrigerator were observed to have grease,crumbs and food residue, oil spills and stains #5. Residents bedrooms carpets were unvaccumed and had stains, and residents furnitures were dusty.

Official plan of correction

POC Due Date: 11/01/2024 Plan of Correction Administrator will submit a written plan of action on how he/she will keep the facility in maintenance

Official classification

Type A

Official code

87465(i)

Regulation authority

CCR

What the official deficiency says

(i) Prescription medications which are not taken with the resident upon termination of services, not returned to the issuing pharmacy, nor retained in the facility as ordered by the resident’s physician and documented in the resident’s record nor disposed of according to the hospice’s established procedures or which are otherwise to be disposed of shall be destroyed in the facility by the facility administrator and one other adult who is not a resident... This requirement is not met as evidenced by: Deficient Practice Statement Based on observation medication was found in hallway closet accross from the common area curaid ointment which belonged to previous unknown resident R6 who was on hospice which were not distructed properly upon death or resident is no longer at facility which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/01/2024 Plan of Correction Administrator will submit a written plan of action how he/she will destruct medication for a hospice or non-hospice resident no longer at facility.

Official classification

Type A

Official code

87465(h)(2)

Regulation authority

CCR

What the official deficiency says

87465(h)(2)Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. This requirement is not met as evidenced by: Deficient Practice Statement Based on inspection and observation LPAs observed bottles of pain reliever, allergy pills, antacid, osteo vitamin, herbal supplement, first aid anitbiotic ointment and 1 prescription ointment, and tube of pain releving cream in R1 unlocked closet. These medications belongs to R1 who is not able to store or administer own prescription/ OTC and store medication. R1s flonase was also found in kitchen. This poses/posed and immediate risk to resident in care.

Official plan of correction

POC Due Date: 11/01/2024 Plan of Correction Administrator will submit a written plan of action to ensure medication (prescription or non prescription are stored properly.

Official classification

Type A

Official code

87465(e)

Regulation authority

CCR

What the official deficiency says

e) For every prescription and nonprescription PRN medication for which the licensee provides assistance there shall be a signed, dated written order from a physician, on a prescription blank, maintained in the residents file, and a label on the medication. Both the physician's order and the label shall contain at least all of the following information. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation LPAs observed in Residents unlocked closet OTC medication. R1 buys OTC medication on their own.

Official plan of correction

POC Due Date: 11/01/2024 Plan of Correction Administrator willl submit a written plan of action on how he/she will contact physcian to update if R1 is able to administer keep order or buy medication.

Official classification

Type A

Official code

87355(e)(1)

Regulation authority

CCR

What the official deficiency says

87355 Criminal Record(e)All individuals...pursuant to Health and Safety Code Section 1569.17(b)... prior to working, residing ...in a licensed facility: (1)Obtain a California clearance ...as required by the Department. This requirement is not met as evidenced by: *deficiency stmnt did not print

Official plan of correction

LIC directed S1 to obtain a clearance during LPAs visit on 9/13/2024. LIC provided LPAs a copy of the livescan receipt. LIC stated as soon as S1 received the clearance from CPMB, LIC will associate S1 to the facility.

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

Official classification

Type B

Official code

874111(c)

Regulation authority

CCR

What the official deficiency says

87411 Personnel Requirement General (c) All RCFE staff who assist residents ... shall receive initial and annual training as specified in Health and Safety Code sections 1569.625 and 1569.69. This requirement is not met as evidenced by Based on interview, LIC stated that S1 does not have training since residing in the facility 7/1/2024, and is current assisting with resident's with personal activties of daily living, which pose/poses a potential health, safety & personal rights risk to persons in care.

Official plan of correction

LIC stated that S1 will have an onboarding training and will not assist with resident's acitivities of daily living until fully trained. LIC stated that proof of training will be emailed to LPA by the end of the due date. *87355 Criminal Record: Based on interview licensee did not obtain California criminal background clearance for S1 prior to residing and providing care & supervision since 7/1/2024, which poses/poses an immediate health, safety & personal right risk to persons in care.

Deadline recorded: Sep 27, 2024. A deadline is not proof that correction was completed.