VILLA ANTONIO

Official classification

Type B

Official code

87463(a)

Regulation authority

CCR

What the official deficiency says

(a) The pre-admission appraisal, as specified in Section 87457, Pre-Admission Appraisal, shall be updated, in writing as frequently as necessary or once every 12 months, whichever occurs first, to note significant changes in condition, as defined in Section 87101, Definitions, and to keep the appraisal accurate. For the purposes of this section, the updated pre-admission appraisal shall be referred to as the reappraisal. This requirement is not met as evidenced by: Deficient Practice Statement Based on interview and record review, the licensee did not comply with the section cited above. R1-R3's Needs and services plans are not updated and are over 12 months old. ADM stated he has not updated R1-R3's Needs and services plans. This poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/10/2025 Plan of Correction ADM stated he would send LPA a copy of residents R1-R3's updated Needs and Services Plans. ADM stated he would also send a letter of understanding regarding the regulation. ADM stated he will send the plan of corrections to LPA by POC date, September 10, 2025.

Official classification

Type B

Official code

87465(h)(3)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care (h) (3) Each container shall carry all of the information specified in (6)(A) through (E) below plus expiration date and number of refills. 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. While reviewing resident R2's medications, LPA's observed medication #1's bottle did not contain the prescription label. This poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/22/2024 Plan of Correction ADM stated he will send a letter of understanding regarding the regulation. ADM stated he will send the plan of correction to LPA by POC date, August 22, 2024.

Official classification

Type A

Official code

87202(a)

Regulation authority

CCR

What the official deficiency says

87202(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. ... This requirement was not met as evidenced by Based on observation & interview, the ADM did not comply with the section cited above. LPA observed S2 leaving the storage unit with his/her spouse. S2 admitted that he/she was resting in the storage area. This poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

ADM stated he will send plan of action on how he/she will ensure the facility is adhering to their fire clearence and ensure the facility storage units are not being used as a sleeping/rest area. This is a repeat citation, issued on 10/24/2023.

Deadline recorded: Dec 20, 2023. 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

(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: (1) Obtain a California clearance or a criminal record exemption ... This requirement is not met as evidenced by: Based on interviews, record review and observation the ADM did not ensure S2's spouse received a fingerprint clearance from the Department pior to S2 residing at the facility, which poses an immediate health, safety, and personal rights risk to persons in care

Official plan of correction

ADM will review section 87355 and submit a statement of understanding to LPA by POC due date, December 12, 2023.

Deadline recorded: Dec 20, 2023. A deadline is not proof that correction was completed.

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 Facilites (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 evidence reviewed and interviews with conducted, 2 Out of 3 staff admitted that S1 verbally abused resident R1. The facility staff did not acccord dignity to residents in care. This poses an immideate threat to health, saftey and personal rights risk to person in care.

Official plan of correction

ADM stated he will send a plan of action on how the facility will ensure staff accord residents with dignity. ADM will send the plan of action by POC date, 12/20/2023.

Deadline recorded: Dec 20, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

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, such as psychological abuse of a resident by staff or other residents, or unexplained absence of any resident. This requirement was not met as evidenced by Based on evidence reviewed & interviews with conducted, 2 Out of 3 staff admitted that S1 verbally abused resident R1. 2 Out of 3 staff acknowledge the verbal abuse occured a month ago & they did not report it. This poses an immideate threat to health, saftey & personal rights risk to persons in care.

Official plan of correction

ADM stated he will send a plan of action on how facility staff will meet reporting requirments. ADM will send plan of action to LPA by POC date, 12/20/2023.

Deadline recorded: Dec 20, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

1569.50(a)(3)

Regulation authority

HSC

What the official deficiency says

1569.50 Denial, suspension or revocation of license; ...exclusion from licensee without right to petition for reinstatement (a)(3) Conduct that is inimical to the health, morals, welfare, or safety ... from the facility or the people of the State of California. This requirement was not met as evidenced by; Based on interviews conducted, and evidenced reviewed, the facility staff verbally abused a resident in care. 2 Out of 3 staff admitted a staff member verbally abused a resident. This poses an immediate threat to residents health, safety and personal rights.

Official plan of correction

ADM stated that S1 will be terminated and removed effective today. ADM stated S1 will move from the facility and will be relocated at Licensee's home.

Deadline recorded: Dec 20, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

1569.625(b)(1)

Regulation authority

HSC

What the official deficiency says

1569.625 Staff training; legislative findings; contents (b)(1)The department shall adopt regulations to require staff members of residential care facilities for the elderly ...This training shall consist of 40 hours of training.... This requirement was not met as evidenced by; Based on staff training records review & interviews, Staff did not receive training on mandated reporting/elder abuse & filling out SOC341. ADM also acknowledged he/she did not provide training on mandated reporting of elder abuse. This poses an immediate threat to residents health, safety & personal rights

Official plan of correction

ADM stated he/she will provide training for staff. ADM stated he will send documentation to LPA by POC date, 12/26/2023.

Deadline recorded: Dec 26, 2023. 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

(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. This requirement is not met as evidenced by: Deficient Practice Statement LPA observed a can of WD-40 lubricant and can of paint next to the storage units in the facility's backyard. ADM stated the residents have access to the backyard. ADM stated he/she has dementia residents. This poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/25/2023 Plan of Correction ADM will send a plan of action on how the facility will ensure disinfectants, cleaning solutions, poisons and other items that could pose a danger to residents are properly stored, inaccessible to residents in care. ADM will send by POC date, 10/25/2023.

Official classification

Type A

Official code

87705(f)(1)

Regulation authority

CCR

What the official deficiency says

(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 is not met as evidenced by: Deficient Practice Statement LPA observed several knives and a tool bag containing things such as scissors next to the storage unit in the backyard. ADM stated the residents have access to the backyard. ADM stated he has residents with dementia. This poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/25/2023 Plan of Correction ADM will send plan of action on how the facility will secure knives and tools in the facility to ensure they are not accessible to residents in care. ADM stated he will send to LPA by POC date, 10/25/2023.

Official classification

Type B

Official code

87202(a)

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: This requirement is not met as evidenced by: Deficient Practice Statement Based on observation & interview, the ADM did not comply with the section cited above. LPA observed a mattress in the storage unit. ADM stated the storage unit is being used as a rest area. S1 admitted that he/she sleeps in the storage room with his/her 6-year-old child until his/her spouse picks them up. This poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/31/2023 Plan of Correction ADM will photo documentation showing the storage area is no longer being used as a sleeping area. ADM stated he will also send a letter of understanding stating no staff or any individual is allowed to sleep in the following areas without building permit and fire clearance such as but not limited storage room, living room, and garage.

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 & record review, the ADM did not comply with the section cited above. ADM stated the facility has not done a fire drill in the past year. This poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/31/2023 Plan of Correction ADM stated he will conduct a fire drill and send documentation to LPA by 10/31/2023.