EBADAT RESIDENTIAL CARE HOME # 5

Official classification

Type B

Official code

80072(a)(8)(C)

Regulation authority

CCR

What the official deficiency says

Personal Rights (a)(8)(C):Except for children’s residential facilities, each client shall have personal rights which include, but are not limited to...(8)Not to be placed in any restraining device.Postural supports may be used under the following conditions:(C) Postural supports shall be fastened or tied in a manner which permits quick release by the client. This requirement is not met as evidenced by: Based on inspection and observation, (See continuation on next column, under Plan of Correction) Food Services(13)(14): All persons engaged in food preparation and service shall observe personal hygiene and food services sanitation practices which protect the food from contamination. (14)All foods or beverages capable of supporting rapid and progressive growth of micro-organisms which can cause food infections or food intoxications shall be stored in covered containers at 45 degrees F (7.2 degrees C) or less. This requirement is not met as evidenced by the observation of a package of raw meat left to

Official plan of correction

Continuation: R1 was observed seated in wheelchair tied with a gait belt and staff also stated they use gait belt for R2 which poses an immediate Health, Safety or Personal Rights risk to residents in care. ADM stated that he will provide a written plan of action by POC date 4/24/2025. Continuation: defrost on the main dining table since the prior day, which poses an immediate Health, Safety or Personal Rights risk to residents in care. ADM stated that he will provide food service training for food preparation and storage by POC date 4/24/2025.

Deadline recorded: Apr 24, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

80075(k)(1)

Regulation authority

CCR

What the official deficiency says

Health Related Services(k)(1):The following requirements shall apply to medications which are centrally stored(1)Medication shall be kept in a safe and locked place that isnot accessible to persons other than employees responsible for the supervision of the centrally stored medication. This requirement is not met as evidenced by: Based on observation, medications are found accessible in a brown observed on top of an office table (against the wall on the left facing the street) in the main dining room which belongs. (See continuation on next column, under Plan of Correction)

Official plan of correction

Continuation: to R1 to R4, which poses an immediate Health, Safety or Personal Rights risk to residents in care. ADM stated that he will conduct a staff in service training on medication such as but not limited to storage and recording/logging in the centrally stored medicaiton log by POC date 4/24/25.

Deadline recorded: Apr 24, 2025. 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 is not met as evidenced by: Deficient Practice Statement Based on interview and observation, the licensee did not comply with the section cited above in wherein the hot water temperature in the bathroom was measured at 158 degrees F which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/17/2024 Plan of Correction Licensee corrected the deficiency during visit by turning down the hot water temperature. Hot water temperature measured at 112.1 degrees F.

Official classification

Type A

Official code

87608(a)(5)(B)

Regulation authority

CCR

What the official deficiency says

(a) Based on the individual's preadmission appraisal, and subsequent changes to that appraisal, the facility shall provide assistance and care for the resident in those activities of daily living which the resident is unable to do for himself/herself. Postural supports may be used under the following conditions. (5) Under no circumstances shall postural supports include tying, depriving, or limiting the use of a resident's hands or feet. (B) Bed rails that extend the entire length of the bed are prohibited except for residents who are currently receiving hospice care and have a hospice care plan that specifies the need for full bed rails. This requirement is not met as evidenced by: Deficient Practice Statement Based on interview, record review and observation the licensee did not comply with the section cited wherein 2 resident beds contains full length bed rails without a physician's order for the full length beds and approval from the Department which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/17/2024 Plan of Correction Licensee will submit a written plan to ensure compliance of the section cited regarding the postural supports to LPA Yanez via email by POC due date of 10/17/2024.

Official classification

Type B

Official code

87463(a)

Regulation authority

CCR

What the official deficiency says

(a) The pre-admission appraisal shall be updated, in writing as frequently as necessary to note significant changes and to keep the appraisal accurate. The reappraisals shall document changes in the resident's physical, medical, mental, and social condition. Significant changes shall include but not be limited to: This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview, and record review the licensee did not comply with the section cited above in wherein 2 residents appraisal/needs and serices plan did not include the need for full length bed rails which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/23/2024 Plan of Correction Licensee will update the appraisal/needs and services plan to include the use of the postural supports via email to LPA Yanez by POC due date of 10/23/2024.

Official classification

Type A

Official code

80019(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 1522 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 or This requirement is not met as evidenced by: Based on interview, record review and observation the licensee did not ensure staff (S1) obtained a fingerprint clearance from the Department 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 plans to request another live scan for S1. Licensee will submit a written plan when verifying new staff's personnel records to include their fingerprint clearance, to LPA Dolores via email by POC due date.

Deadline recorded: Sep 12, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87613(a)(1)

Regulation authority

CCR

What the official deficiency says

(a) Prior to admission of a resident with a restricted health condition, the licensee shall: (1) Communicate with all other persons who provide care to that resident to ensure consistency of care for the condition. This requirement is not met as evidenced by: Based on interview, record review, and observation the licensee did not ensure to immediately communicate with the appropriate agencies responsible for R1’s care to ensure a restricted health condition care plan was in place upon being notified of R1's restricted health condition which poses an immediate health, safety and personal rights risk to persons in care.

Official plan of correction

Licensee plans to submit R1's restricted health condition care plan training to LPA by POC due date. Licensee will also submit a statement of understanding of the section cited. POC will be sent to LPA Dolores via email by POC due date .

Deadline recorded: May 18, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

1569.625(b)(2)

Regulation authority

HSC

What the official deficiency says

(2) In addition to paragraph (1), training requirements shall also include an additional 20 hours annually, eight hours of which shall be dementia care training, as required by subdivision (a) of Section 1569.626, and four hours of which shall be specific to postural supports, restricted health conditions, and hospice care, as required by subdivision (a) of Section 1569.696. This training shall be administered on the job, or in a classroom setting, or both, and may include online training. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview, and record review the licensee did not ensure staff were provided an additional 20 hours of annual training on the topics listed in this section which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/17/2023 Plan of Correction Licensee will enroll staff in training specific to the topics listed in this section. Licensee will submit a written plan to include the dates staff are enrolled and the instructor of the course to LPA Dolores via email by POC due date.

Official classification

Type B

Official code

87463(c)

Regulation authority

CCR

What the official deficiency says

(c) The licensee shall arrange a meeting with the resident, the resident's representative, if any, appropriate facility staff, and a representative of the resident's home health agency, if any, when there is significant change in the resident's condition, or once every 12 months, whichever occurs first, as specified in Section 87467, Resident Participation in Decision Making. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview and record review the licensee did not ensure resident's appraisal/needs and services plan and IPP was updated annually which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/24/2023 Plan of Correction Licensee will submit all residents updated appraisal/needs and services to include a date and signature to LPA Dolores via email by POC due date.

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 observation, interview, and record review the licensee did not ensure staff were provided a quarterly emergency drill which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/17/2023 Plan of Correction Licensee will submit the facility's emergency drill log to LPA Dolores via email by POC due date.

Official classification

Type A

Official code

87465(h)(2)

Regulation authority

CCR

What the official deficiency says

(h) The following requirements shall apply to medications which are centrally stored: (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 is not met as evidenced by: Based on observation and interview the licensee did not ensure the centrally stored medication cabinet was locked and inaccessible to residents in care 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 Title 22 Section 87465(h)(2) to LPA Dolores by POC due date.

Deadline recorded: Aug 24, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87608(a)(5)(B)

Regulation authority

CCR

What the official deficiency says

(5) Under no circumstances shall postural supports include tying, depriving, or limiting the use of a resident's hands or feet. (B) Bed rails that extend the entire length of the bed are prohibited except for residents who are currently receiving hospice care and have a hospice care plan that specifies the need for full bed rails. Based on observation, interview, and record review 3 out of 3 residents are utilizing full length bed rails during the night without prior approval from the Department and physician's orders on file which poses an immediate health, safety, and personal rights risk to persons in care.

Official plan of correction

During visit, Licensee contacted the home health agency regarding the physician's orders on the full length bed rails. Licensee will submit a statement of understanding of Title 22 Section 87608 and a written plan to LPA by POC due date.

Deadline recorded: Aug 24, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87307(a)

Regulation authority

CCR

What the official deficiency says

(a) Living accommodations and grounds shall be related to the facility's function. The facility shall be large enough to provide comfortable living accommodations and privacy for the residents, staff, and others who may reside in the facility. The following provisions shall apply: This requirement was not met as evidenced by: Based on interview, observation, and record review the garage is not approved to be a bedroom when LPA observed staff (S1) sleeping in the garage which poses an immediate health, safety, and personal rights risk to persons in care.

Official plan of correction

Licensee will advise the staff to sleep in another location and to remove all S1's personal belongings from the garage. Licensee will submit a statement of understanding to LPA Dolores via email by POC due date.

Deadline recorded: Jun 1, 2023. A deadline is not proof that correction was completed.