KINGDOM HEARTS CARE HOME

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 the licensee did not comply with the section cited above. LPA observed inside bedroom #6, a medication container accessible to residents in care. LPA noted the door to bedroom 5 (staff room)was not locked, and a note written tape, in the inside of the door, which states " don't lock. " LPA observed a multivitamin container, accessible to residents in care. This poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/01/2026 Plan of Correction ADM stated she will send a written plan of action on how she will ensure dangerous items such as medications are stored in a locked area, inaccessible to residents in care. ADM stated she will send the written plan of action to LPA by POC due date, August 1, 2026.

Official classification

Type B

Official code

87465(h)(5)

Regulation authority

CCR

What the official deficiency says

(h) The following requirements shall apply to medications which are centrally stored: (5) Each resident's medication shall be stored in its originally received container. No medications shall be transferred between containers. 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. LPA observed the locked medication storage area. LPA noted that the facility is pre-pouring resident R1-R4's medications. (Photographs taken.) ADM stated they pre-pour so the dosages are completed a week in advanced. This poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/07/2026 Plan of Correction ADM stated she will send a written plan of action on how she will ensure Each resident's medication shall be stored in its originally received container and No medications shall be transferred between containers. ADM stated her plan of action will explain how medications will be administered while ensuring she is not pre-pouring. ADM stated she will send Plan of action to the Department by POC due date.

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)(2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This Requirement was not met as evidenced by: Based on interviews and observation, Resident R1's bedroom sliding door was blocked with a couch and a stick. ADM, S1 and S2 stated this was done to prevent R1 from exiting his/her bedroom. This poses/posed an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

ADM stated she will send LPA a plan of action on how she will ensure she is providing a safe and healthful accommodations for R1. ADM stated she will send the plan of correction by POC date, July 24, 2024.

Deadline recorded: Jul 24, 2024. 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

87307 Personal Accommodations and Services (d)(6) All outdoor and indoor passageways and stairways shall be kept free of obstruction. This Requirement was not met as evidenced by; Based on interviews and observation, Resident R1's bedroom had a couch obstructing the exit outside. ADM, S1 and S2 admitted they obstructed R1's sliding screen door and the front door of the facility due to R1's exit seeking behaviors.

Official plan of correction

ADM stated she will send a plan of action on how she will ensure All outdoor and indoor passageways and stairways shall be kept free of obstruction. ADM stated she will send the plan of correction by POC date, July 24, 2024.

Deadline recorded: Jul 24, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87705(j)

Regulation authority

CCR

What the official deficiency says

87705 Care of Persons with Dementia (j) The licensee shall have an auditory device or other staff alert feature to monitor exits, if exiting presents a hazard to any resident. This Requirement was not met as evidenced by; Based on observation, Resident bedrooms 2-5's sliding doors alarms were turned off. Based on record review, resident R1 cannot leave the facility unassisted and he/she has exit seeking behavior. This poses/posed an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

ADM stated she will send a plan of action on how she will ensure all exits have an auditory device, turned on, to protect the health and safety of residents with exit seeking behaviors ADM stated she will send the plan of action by POC date, July 24, 2024.

Deadline recorded: Jul 24, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87705(k)(7)

Regulation authority

CCR

What the official deficiency says

87705 Care of Persons with Dementia (k)(7) For each incident in which a resident wanders away from the facility unsupervised...The report shall be made by telephone no later than the next working day and in writing within seven calendar days. This Requirement was not met as evidenced by; Based on interview with ADM, the ADM admitted that she did not contact community care licensing to make a report the next working day. ADM stated she did not know she had to call in to make a report. This poses/posed an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

ADM stated she will send a letter of understanding regarding the regulation. ADM stated she will send the letter by POC date, July 24, 2024.

Deadline recorded: Jul 24, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87405(d)(2)

Regulation authority

CCR

What the official deficiency says

87405 Administrator - Qualifications and Duties (d)(2) Knowledge of and ability to conform to the applicable laws, rules and regulations. This Requirement was not met as evidenced by; Based on records reviewed and interviews conducted, Administrator did not exhibit the knowledge of applicable laws, rules and regulations resulting in serious violations involving a resident who eloped from facility which poses an immediate health safety and personal rights risk to persons in care.

Official plan of correction

ADM stated she will send a letter of understanding regrading the regulation. ADM stated she will send the letter by POC date, July 24, 2024.

Deadline recorded: Jul 24, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87463(a)

Regulation authority

CCR

What the official deficiency says

87463 Reappraisals (a) The pre-admission appraisal shall be updated, in writing as frequently as necessary...shall document changes in the resident's physical, medical, mental, and social condition... This requirement was not met as evidenced by; Based on document review and investigation, R1's needs and services plan was not updated after R1 had eloped from the facility. The facility did not update the care plan for R1 to meet his/her needs. This poses an immediate risk to the health of the resident.

Official plan of correction

ADM stated she will send a plan of action on how she will ensure residents needs and services plans are updated in writing as frequently as necessary to note significant changes and to keep the appraisal accurate. ADM stated she will send LPA a copy of R1's updated Needs and Services plan. ADM stated she will send the written plan of action to LPA by POC date, July 24, 2024.

Deadline recorded: Jul 24, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87468.2(a)(4)

Regulation authority

CCR

What the official deficiency says

87468.2 Additional Personal Rights of Residents in Privately Operated Facilities (a)(4) To care, supervision, and services that meet their individual needs ... by staff that are sufficient in numbers, qualifications, and competency to meet their needs. This requirement was not met as evidenced by; Based on interviews conducted, resident R1 had elopped from the facility on July 19, 2024 and staff did not provide R1 with Care and Supervision to met his/her needs. This poses an immideate threat to health, safety or personal rights risk to persons in care.

Official plan of correction

ADM stated she will conduct training for her staff regarding wandering residents and elopement. ADM stated she will send documentation of training to LPA by POC date, August 2, 2024.

Deadline recorded: Aug 2, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87412(f)

Regulation authority

CCR

What the official deficiency says

87412 (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... This requirement was not met as evidenced by; Based on interview conducted, LPA requested to review staff dementia training records. ADM stated the records were at her home and unavailable for LPA to inspect. This poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

ADM stated she will send a letter of understanding regarding the regulation. ADM stated she will send the letter by POC date, July 26, 2024. ADM stated she will send staff dementia training records for 2023 & 2024, to LPA by POC date.

Deadline recorded: Aug 2, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(a)(4)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care (a)(4) The licensee shall assist residents with self administered medications as needed. This requirement was not met as evidence by: Based on record review and interviews conducted, R1’s medications had an excess of 55 pills. ADM acknowledged that there have been instances where 1 pill was given instead of 3 pills. This poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

ADM stated she will be conducting a medication training for her staff. ADM stated she will document the staff who attend the training and send the documentation to LPA by POC date. ADM stated she will send the plan of correction by POC date June 8, 2024.

Deadline recorded: Jun 8, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87211(a)(1)(D)

Regulation authority

CCR

What the official deficiency says

87211 Reporting Requirements (a)(1)(D) Any incident which threatens the welfare, safety or health of any resident..., or unexplained absence of any resident. This requirement was not met as evidenced by; Based on interview and records reviewed, R1 had sustained a fall in March 26, 2024. ADM stated she did not send an incident report for this fall. This poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

ADM stated she will send a written plan of action on how she will ensure any incident which threatens the welfare, safety or health of any resident is reported to CCL. ADM stated she will send the plan of action by POC date, May 2, 2024.

Deadline recorded: May 2, 2024. A deadline is not proof that correction was completed.

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 and interview, the ADM did not comply with the section cited above. Facility records state the last drill conducted was on 03/30/2023. ADM stated the facility was due for a drill. This poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/23/2023 Plan of Correction ADM stated she will conduct a fire drill by plan of correction date, 09/23/2023. ADM stated she will send documentation to LPA, showing a drill has been conducted. ADM agreed and understood.