SAINT MICHAEL RESIDENTIAL HOME

Official classification

Type A

Official code

87202(a)(2)

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: (2) Bedridden persons . This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and record review, the licensee did not comply with the section cited above by not obtaining an appropriate fire clearance approved by city and county fire department providing fire protection services by accepting 2 bedridden residents. ADM stated R2 & R5 are bedridden. Based on document review the facility is approved for 1 bedridden person in bedroom #5 which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/09/2025 Plan of Correction LIC/ADM stated that a request will be submitted to CCLD to increase the amount of bedridden that the facility can accommodate. ADM will submit a memorandum of understanding of CCR Title 22 87202(a)(2).

Official classification

Type A

Official code

87355(e)(2)

Regulation authority

CCR

What the official deficiency says

87355 Criminal Record Clearance (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) Obtain a California clearance or a criminal record exemption as required by the Department. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, the licensee/administartor did not comply with the section cited above by not ensuring S2 has a valid criminal background clearance after prior to working and after separating S2 from the facility on 10/4/2019, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/09/2025 Plan of Correction ADM/LIC stated that S2 will be livescanned today and will email proof of livescan by POC due date. LIC/ADM will submit a memorandum of understanding regarding 87355(e)(2) that all direct staff should have a current and valid criminal background check.

Official classification

Type A

Official code

87705(f)(1)

Regulation authority

CCR

What the official deficiency says

87705 Care of Persons with Dementia (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 was not met as evidenced by: Based on interview and observation, LPA Rai observed the cabinet containing knives was unlocked and accessible to residents with dementia which poses/posed an immediate Health, Safety, or Personal Rights risk to persons in care.

Official plan of correction

Administrator stated to submit a written plan of action understanding regulation and will ensure in-service is conducted to train staff by POC due date. Licensee/Administrator agreed and understood. Staff S1 locked the cabinet during today's visit

Deadline recorded: Apr 16, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87705(f)(2)

Regulation authority

CCR

What the official deficiency says

87705 (f) (2) Over-the-counter medication, nutritional supplements or vitamins, alcohol, cigarettes, and toxic substances such as certain plants, gardening supplies, cleaning supplies and disinfectants. This requirement was not met as evidenced by: Based on interview and observation, LPA Rai observed the cabinet containing laundry detergent was unlocked and accessible to residents with dementia which poses/posed an immediate Health, Safety, or Personal Rights risk to persons in care.

Official plan of correction

Administrator stated to submit a written plan of action understanding regulation and will ensure in-service is conducted to train staff by POC due date. Administrator agreed and understood. Staff S1 locked the cabinet during today's visit.

Deadline recorded: Apr 16, 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) The following space and safety provisions shall apply to all facilities: (6) All outdoor and indoor passageways and stairways shall be kept free of obstruction. This requirement was not met as evidenced by: Based on interview and observation, LPA Rai observed the area infront of the exit door for a bedridden resident on Hospice services was obstructed by a recliner chair which poses/posed an immediate Health, Safety, or Personal Rights risk to persons in care.

Official plan of correction

Administrator stated to submit a written plan of action understanding regulation and will ensure in-service is conducted to train staff by POC due date. Licensee/Administrator agreed and understood.

Deadline recorded: Apr 16, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(h)(2)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care (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 was not met as evidenced by: Based on interview and observation, LPA Rai observed the medication cabinet containing the centrally stored medication was unlocked and accessible to persons other than employees and residents which poses/posed an immediate Health, Safety, or Personal Rights risk to persons in care.

Official plan of correction

Administrator stated to submit a written plan of action understanding regulation and will ensure in-service is conducted to train staff by POC due date. Licensee/Administrator agreed and understood. Administrator locked the cabinet during today's visit

Deadline recorded: Apr 16, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

85075.4

Regulation authority

CCR

What the official deficiency says

85075.4 Observation of the Client(a) The licensee shall regularly observe each client for changes in physical, mental, emotional and social functioning. (c) The licensee shall bring observed changes, including but not limited to unusual weight gains or losses, or deterioration of health condition, to the attention of the client's physician and authorized representative, if any. This requirement is not met as evidenced by: 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 in 3 out of 3 residents' file record review. The current staff are not able to find the weight records for the resident, which poses/posed a potential health, safety or personal rights risk to persons in care. S2 tried to call ADM but was not successful.

Official plan of correction

POC Due Date: 04/05/2024 Plan of Correction S1 and S2 stated they will reach out to the administrator who is currently out of the country and ask where the weight records of residents are kept. S1 and S2 or ADM will email proof of correction on or before the POC due date of 4/5/2024.