ATRIA SUNNYVALE

Official classification

Type A

Official code

87465(a)(4)

Regulation authority

CCR

What the official deficiency says

(4) The licensee shall assist residents with self-administered medications as needed. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview, and record review, the licensee did not ensure 3 medications were correctly administered to 1 of 5 residents (R1), which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/06/2025 Plan of Correction The licensee will submit the POC to CCLD by 06/06/2025.

Official classification

Type B

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 degrees C) and not more than 120 degree F (49 degrees C). This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not ensure the hot water in is the range of 105°F-120°F. The hot water temperature was measured above 120°F in 8 of 10 random rooms, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/12/2025 Plan of Correction The licensee will submit the POC to CCLD by 06/12/2025.

Official classification

Type B

Official code

87465(b)

Regulation authority

CCR

What the official deficiency says

(b) If the resident's physician has stated in writing that the resident is able to determine and communicate his/her need for a prescription or nonprescription PRN medication, facility staff shall be permitted to assist the resident with self-administration of his/her PRN medication. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview, and record review, the licensee did not ensure R2's physician has stated in writing that the resident is able to determine and communicate his/her need for medication. A pillbox containing medication was observed in R2's room, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/12/2025 Plan of Correction The licensee will submit the POC to CCLD by 06/12/2025.

Official classification

Type A

Official code

87465(c)(2)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care (c)(2) Once ordered by the physician the medication is given according to the physician's directions. This was not met as evidence by: Based on observation, interviews, and records review the licensee did not ensure R1 was given the right medication and dosage on 12/23/2024 morning. R2 was not given medication on 12/23/2024 morning and MAR shows R2 was given the medication.

Official plan of correction

The Executive Director will develop a plan to ensure correct medications ordered by physician are always given to the residents. Executive Director will provide a copy of the plan to CCLD by 01/03/2025.

Deadline recorded: Jan 3, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87464(f)(1)

Regulation authority

CCR

What the official deficiency says

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 was not met as evidenced by: Licensee did not ensure that resident R1, who cannot leave the facility unassisted, was provided the necessary assistance to ensure R1 did not leave the facility unassisted, which poses an immediate risk to the health and safety to the resident in care.

Official plan of correction

Licensee agrees to submit a plan to train staff regarding providing care, supervision, and assistance to residents who cannot leave the facility unassisted by POC date. Once training is completed, Licensee agrees to send copies of staff training rosters with dates, signatures, training topic, and name and qualifications of trainer to CCLD.

Deadline recorded: Jun 11, 2022. A deadline is not proof that correction was completed.