WILLOW GLEN SENIOR LIVING

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 interview & observation, the licensee did not comply with the section cited above. LPA noted the white box container that was holding all of R1's medications had 2 loose tablets on the bottom of the box. ADM stated staff attempted to administer the PRN at night & in the early in the morning, but R1 refused. ADM stated staff did not tape the tablets back in the bubble pack. which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/11/2026 Plan of Correction ADM stated she will send conduct a medication training for her staff. ADM stated she will send documentation showing the following: the staff who participated, the trainer, the subject covered, the time period the training lasted. ADM stated she will send plan of correction to LPA by POC due date, June 11, 2026.

Official classification

Type A

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times… for the safety and well-being of residents, employees and visitors. This requirement was not met as evidenced by; Based on observation, record review and interview the licensee did not ensure the facility was free of cockroaches. This poses an immediate health, safety and personal rights risk to residents in care.

Official plan of correction

ADM stated they will submit a written plan of action on how they will ensure the facility is free from cockroaches. Licensee/ADM will seek professional help if the issue cannot be addressed. ADM stated they will submit the written plan of action to the Department by POC due date April 25,2025.

Deadline recorded: Apr 25, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87555(b)(28)

Regulation authority

CCR

What the official deficiency says

87555 General Food Service Requirements (b)(28) All food shall be protected against contamination. Contaminated food shall be discarded immediately upon discovery. This requirement was not met as evidence by: Based on interview and observation, staff stored vegetables, fruits on top of a cardboard box of molding broccoli. This poses an immediate health, safety and personal rights risk to residents in care.

Official plan of correction

ADM stated to submit a Plan of Correction on how she will ensure all Contaminated food shall be discarded immediately upon discovery. ADM stated she will submit the plan of correction to LPA by POC date, 4/25/25.

Deadline recorded: Apr 25, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87464(a)

Regulation authority

CCR

What the official deficiency says

(a) The services provided by the facility shall be conducted so as to continue and promote, to the extent possible, independence and self-direction for all persons accepted for care. Such persons shall be encouraged to participate as fully as their conditions permit in daily living activities both in the facility and in the community. This requirement is not met as evidenced by: Based on interview, record, and observation the licensee did not ensure the facility staff provided basic services to include ADL care to resident (R1) which poses an immediate health, safety, and personal rights risk to persons in care.

Official plan of correction

Licensee has corrected their deficiency prior to visit by completing a sitter & companion role and responsibilities contract in collaboration with R1's family member.

Deadline recorded: Aug 15, 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

(a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following: (4) The licensee shall assist residents with self-administered medications as needed. This requirement is not met as evidenced by: Based on interview, the licensee did not ensure to assist R1 with self-administration of medication as R1’s private caregiver was administering R1’s medication which poses an immediate health, safety, and personal rights risk to persons in care.

Official plan of correction

Licensee has corrected their deficiency prior to visit by completing a sitter & companion role and responsibilities contract in collaboration with R1's family member.

Deadline recorded: Aug 15, 2024. A deadline is not proof that correction was completed.

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 was met as evidenced by: Based on interview, record review, and observation the licensee did not ensure the bathrooms were in good repair which poses an immediate health, safety and personal rights risk to persons in care.

Official plan of correction

Licensee has already corrected the deficiency prior to visit by repairing the bathroom shower in the hallway and items that were in disrepair near R1's bedroom.

Deadline recorded: Aug 15, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

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 degree C) and not more than 120 degree F (49 degree C). This requirement was met as evidenced by: Based on interview, record review and observation the licensee did not ensure the hot water temperature was not more than 120 degrees F measuring between 125 – 130 degrees F which poses an immediate health, safety, and personal rights risk to persons in care.

Official plan of correction

Licensee will submit a statement of understanding of the section cited to LPA Dolores via email by POC due date.

Deadline recorded: Aug 15, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87507(f)

Regulation authority

CCR

What the official deficiency says

(f) The licensee shall comply with all applicable terms and conditions set forth in the admission agreement, including all modifications and attachments. This requirement was not met as evidenced by: Based on interview, record review, and observation the licensee did not ensure to comply with all the applicable terms and conditions set forth in the admission agreement as R1’s private caregiver was providing R1 with basic services which poses an potential health, safety and personal rights risk to persons in care.

Official plan of correction

Licensee will submit a statement of understanding of the section cited above to LPA Dolores via email by POC due date.

Deadline recorded: Aug 21, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87355(e)(2)

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: (2) Request a transfer of a criminal record clearance as specified in Section 87355(c) ... This requirement is not met as evidenced by: Based on record review, interview and observation the licensee did not ensure staff (S1) was associated to the facility prior to working in the facility which poses an immediate health, safety, and personal rights risk to persons in care.

Official plan of correction

Licensee will associate S1 to the facility prior to S1 starting work at the facility.

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