CARLTON PLAZA OF SAN JOSE

Official classification

Type A

Official code

87464(F)(1)

Regulation authority

CCR

What the official deficiency says

87464 Basic Services(f) Basic services shall at a minimum include:(1) Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). This requirement is not met as evidenced by: Based on interview and record reviewed, The facility did not provide the necessary care and supervision to resident R1 and R2 to meet R1 and R2's care needs and leading to R1's multiple falls and sustained head injury which poses/posed an immediate Health, Safety risk to persons in care.

Official plan of correction

Executive Director (ED) stated to submit a plan of correction by the POC due date and provide staff training to prevent the similar incidents to happen again. ED agreed to send the staff training log to CCL office.

Deadline recorded: Aug 6, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87412(a)(11)

Regulation authority

CCR

What the official deficiency says

(a) The licensee shall ensure that personnel records are maintained on the licensee, 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 licensee did not comply with the section cited above in that 2 out of 5 staff files were observed without health screen form which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/19/2024 Plan of Correction Executive Director stated to submit a plan of correction by the POC due date to have staff with valid health screen form.

Official classification

Type B

Official code

87465(h)

Regulation authority

CCR

What the official deficiency says

(h) The following requirements shall apply to medications which are centrally stored: 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 1 out 5 resident files was observed the centrally stored medications form inaccurate and not maintained up to date which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/19/2024 Plan of Correction Executive Director stated to submit a plan of correction by the POC due date to maintain resident centrally stored medication form accurate and up to date.