DRY CREEK GUEST HOME

Official classification

Type A

Official code

87411(c)(3)(D)

Regulation authority

CCR

What the official deficiency says

87355 Criminal Record Clearance (e) All individuals subject to a criminal record review 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) The requirement was not met as evidenced by: Base on interviews and record reviewed, staff S2 works for the facility for one and half months prior to associate with the facility. Licensee S2 worked for the facility before but does not associate with the facility at this time. That poses/posed a immediate health, safety risk to persons in care.

Official plan of correction

Licensee stated to provide a plan of correction by the POC due date to make sure all staff are associated with the facility prior to work for the facility.

Deadline recorded: Oct 19, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87355(e)(1)

Regulation authority

CCR

What the official deficiency says

87355 Criminal Record Clearance (e) All individuals subject to a criminal record review shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department This requirement is not met as evidenced by: Based on record review and interviews, S2 worked at the facility and the licensee's relatives live in the facility without fingerprint clearance which poses an immediate health, safety risk to a person in care.

Official plan of correction

Licensee stated to submit a plan of correction by the POC due date to ensure all the staff and all the people live in the facility to have criminal clearance and are associated with the facility.

Deadline recorded: Oct 19, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87309(a)(1)

Regulation authority

CCR

What the official deficiency says

(a) Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients. (1) Storage areas for poisons, and firearms and other dangerous weapons shall be locked. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above in that the knives closet was observed unlocked which poses an immediate health, safety risk to persons in care. ADM locked the knives closet immediately.

Official plan of correction

POC Due Date: 04/06/2024 Plan of Correction ADM stated to submit a plan of correction by the POC due date to lock the knives closet.

Official classification

Type B

Official code

87303(e)(2)

Regulation authority

CCR

What the official deficiency says

(e) Water supplies and plumbing fixtures shall be maintained as follows: (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 degrees C) and not more than 120 degree F (49 degrees C). This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above in that the water temperature was observed at 100 degree F which poses/posed a potential health, safety or personal rights risk to persons in care. ADM adjust the water temperature to be tested at 107 degree F before LPA left the facility.

Official plan of correction

POC Due Date: 04/12/2024 Plan of Correction ADM stated to submit a plan of correction by the POC due date to keep the water temperature between 105 and 120 degree F.

Official classification

Type B

Official code

87412(g)

Regulation authority

CCR

What the official deficiency says

(g) All personnel records shall be maintained at the facility. 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 that the staff files were observed incomplete which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/12/2024 Plan of Correction ADM stated to submit a plan of correction by the POC due date to make the staff files complete.

Official classification

Type B

Official code

87465(e)(2)

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 resident's file, and a label on the medication. Both the physician's order and the label shall contain at least all of the following information. (2) The exact dosage. 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 that the residents' centrally stored medication forms were observed inaccurate and not update to date which poses/posed a potential health, safety risk to persons in care.

Official plan of correction

POC Due Date: 04/12/2024 Plan of Correction ADM stated to submit a plan of correction by the POC due date to make residents' file accurate and up to date.

Official classification

Type B

Official code

87618(b)(3)(B)

Regulation authority

CCR

What the official deficiency says

(3) Ensuring that the use of oxygen equipment meets the following requirements: (B) “No Smoking-Oxygen in Use” signs shall be posted in the appropriate areas. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above in that one of the resident using Oxygen did not have " No Smoking-Oxygen in use " poster posted at the door of the bedroom which poses/posed a potential health, safety rights risk to persons in care. ADM posted the poster immediately.

Official plan of correction

POC Due Date: 04/12/2024 Plan of Correction ADM stated to submit a plan of correction by the POC due date to fix the issue.

Official classification

Type A

Official code

87309(a)

Regulation authority

CCR

What the official deficiency says

87309 Storage Space (a) Disinfectant, cleaning solutions, poisons, firearms, and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the knives closet and detergent closet in the kitchen were observed unlock, the licensee did not comply with the section cited above, which poses an immediate health, safety risk to persons in care.

Official plan of correction

POC Due Date: 04/15/2023 Plan of Correction Licensee/Administrator agreed to submit Plan of Correction by the POC due Date which provides the finished date of adding locks to knives closet and detergent closet in the kitchen to lock knives closet and detergent closet in the kitchen.

Official classification

Type B

Official code

87412(a)(11)

Regulation authority

CCR

What the official deficiency says

87412 Personnel Records (a) The licensee shall ensure that personnel records are maintained on the licnesee, administrator, and each employee. Each personnel record shall contain the following information: (11) A health screening as specified in Section 87411, Personnel Requirements - General. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, the personnel records for 3 out of 4 staff are missing health screening information, the licensee did not comply with the section cited above in 3 out of 4 staff which poses/posed a potential health rights risk to persons in care.

Official plan of correction

POC Due Date: 04/21/2023 Plan of Correction Licensee/Administrator agreed to submit Plan of Correction by the POC due date to complete staff health screening information.