FAMILY SENIOR CARE HOME I

Official classification

Type B

Official code

87608(a)(5)(B)

Regulation authority

CCR

What the official deficiency says

87608 Postural Supports (a)(5)(B) Bed rails that extend the entire length of the bed are prohibited except for residents who are currently receiving hospice care... This requirement is not met as evidenced by: Based on record review and observation, R2 has a bed rail that extended the entire length of the bed and R2 is not receiving hospice care at this time which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Administrator stated to submit a written plan of action of understanding regulation and remove the full bed rail and ask for written physician’s order for half-bed rail and place a half-bed rail on R2’s bed by POC due date.

Deadline recorded: Jan 31, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87608(a)(3)

Regulation authority

CCR

What the official deficiency says

87608 Postural Supports (a)(3)A written order from a physician indicating the need for the postural support shall be maintained in the resident’s record.... This requirement is not met as evidenced by: Based on observation and record review, 3 out of 5 residents used a half bed rail and did not have a written order from a physician on file which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Adminstrator stated to submit a written plan of action of understanding reglulation and obtain a written order from resident's physician for half-bed rail to be used for mobility by POC due date.

Deadline recorded: Jan 31, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87465(h)(2)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care (h) (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 record review, 3 medication bottles were not kept in a safe and locked place which is not accessible to persons other than employees which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Administrator stated to submit a written plan of action of understanding regulation and provide staff training to ensure centrally stored medications are kept in a safe and locked place inaccessible to residents by POC due date.

Deadline recorded: Jan 31, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87463(h)

Regulation authority

CCR

What the official deficiency says

87463 Reappraisals (h) The licensee shall request that all residents receive an annual routine visit with a licensed medical professional once every twelve months, either in person or by video appointment. This requirement is not met as evidenced by: Based on record review, R5's file contained a medical assessment completed on 6/13/2023 and there was no other documentation of R5 receiving an annual routine visit with R5's physician which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Administrator stated to submit a written plan of action of understanding regulation and schedule an appointment with R5's physician to complete an updated medical assessment by POC due date.

Deadline recorded: Jan 31, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87463(f)

Regulation authority

CCR

What the official deficiency says

87463 Reappraisals (f) The licensee shall ...communicate with the resident and,... the resident's representative, about any significant change in condition and the recommendation... Documentation of such communication shall be added to the resident’s record. This requirement is met as evidenced by: Based on record review of R5's Appraisal/Needs and Services Plan was not signed by R5's responsible party which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Administrator stated to submit a written plan of action understanding regulation and to follow up with R5's responsible party to sign the Appraisal/Needs and Services Plan by POC due date.

Deadline recorded: Jan 31, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87355(e)(3)

Regulation authority

CCR

What the official deficiency says

87355 Criminal Record Clearance (e) All individuals subject to a criminal record review ... prior to working, residing or volunteering in a licensed facility:(3)Request and be approved for a transfer of a criminal record exemption. This requirement is not met as evidenced by: Based on interview and record review, S3 did not have an approved transfer of a criminal record exemption. S3 provides care and supervision to the residents at the facility which poses/posed an immediate Health, Safety, or Personal Rights risk to persons in care.

Official plan of correction

ADM completed the LIC 9188 while LPA was in the facility and ADM stated that as soon as exemption transfer approval is received ADM will email or fax proof to LPA. ADM will fax the proof of application by POC due date.

Deadline recorded: Jun 8, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87405(d)(2)

Regulation authority

CCR

What the official deficiency says

87405 - Administrator Qualification (d) The administrator shall have the qualification as specified in Section 87405(d)(1) through (7). (2) Knowledge of and the ability to conform to the applicable laws, rules and regulations. This requirement is not met as evidenced by. Based on interview, ADM did not exhibit understanding of the applicable laws, rules and regulations by assuming that the exemption transfer approval from the old license automatically transfer to the new license.

Official plan of correction

ADM stated he/she will reference Title 22 at all times to ensure that ADM is complying with the regularions as applicable to the program. ADM will email LPA of the plan of correction by due date.

Deadline recorded: Jun 8, 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 ... 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 observation, interview and record review, staff S2 did not have a California Criminal Record Clearance and S2 was providing care and supervision to the residents at the facility which poses/posed an immediate Health, Safety, or Personal Rights risk to persons in care.

Official plan of correction

Administrator stated staff S2 will be removed from the facility and will return after obtaining a Claifornia criminal record clearance. Administrator stated to submit a written plan of action and understanding regulations by POC dute date. Administrator agreed and understood.

Deadline recorded: May 25, 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

87355 Criminal Record Clearance (e) All individuals subject to a criminal record review ... prior to working, residing or volunteering in a licensed facility: (2) Request a transfer of a criminal record clearance. This requirement is not met as evidenced by: Based on observation, interview and record review, staff S1 and S3 did have a California Criminal Record Clearance but was not assosicated to the facility, which poses/posed an immediate Health, Safety or Personal Rights risk to persons in care.

Official plan of correction

Administrator stated she will ensure staff S1 and S3 will ensure the California criminal record clearance is transferred and associated to the facility. Administrator stated to submit a written plan of action and understanding regulations by POC dute date. Administrator agreed and understood.

Deadline recorded: May 25, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87411(a)

Regulation authority

CCR

What the official deficiency says

87411 Personnel Requirements - General (a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. This requirement is not met as evidenced by: Based on record review, interview and observation R1's 2 out of 13 meds not administered to R1 as prescribed by the R1's physician which poses an immediate Health, Safety, or Personal Rights risk to persons in care.

Official plan of correction

Administrator stated to submit a written plan on understanding regulations and schedule in-service training to staff by POC due date. Administrator agreed and understood.

Deadline recorded: Jan 31, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87207

Regulation authority

CCR

What the official deficiency says

87207 False Claims No licensee, officer or employee of a licensee shall make or disseminate any false or misleading statement regarding the facility or any of the services provided by the facility. This requirement is not met as evidenced by: Based on record review, interview and observation, R1's MARs noted medications were given to R1 but medication was not administered based on medications counted in bottle which poses an immediate Health, Safety, or Personal Rights risk to persons in care.

Official plan of correction

Administrator stated to submit a written plan on understanding regulations and schedule in-service training to staff by POC due date. Administrator agreed and understood.

Deadline recorded: Jan 31, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(e)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care (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 residents file, and a label on the medication. Both the physician's order and the label shall contain at least all of the following information. 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 in 1 out of 4 resident records contained a medication list which not was signed by a physician, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/12/2023 Plan of Correction Licensee will submit a signed medication list for resident (R3) by POC date. Licensee will provide medication training to staff and provide the training log to LPA Rai by POC date.

Official classification

Type A

Official code

87411(f)

Regulation authority

CCR

What the official deficiency says

87411 Personnel Requirements - General (f) All personnel, including the licensee and administrator, shall be in good health, and physically and mentally capable of performing assigned tasks. Good physical health shall be verified by a health screening, including a chest x-ray or an intradermal test, performed by a physician not more than six (6) months prior to or seven (7) days after employment or licensure. A report shall be made of each screening, signed by the examining physician. The report shall indicate whether the person is physically qualified to perform the duties to be assigned, and whether he/she has any health condition that would create a hazard to him/herself, other staff members or residents. A signed statement shall be obtained from each volunteer affirming that he/she is in good health. Personnel with evidence of physical illness or emotional instability that poses a significant threat to the well-being of residents shall be relieved of their duties. 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 in 2 out of 2 staff did not have chest x-ray or an intradermal test not more than 6 months prior or 7 days after employment which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/12/2023 Plan of Correction Licensee will obtain chest X-Ray or an intradermal test for S1 and S2 and submit the results to LPA Rai by POC date.