MADERA VILLA RESIDENTIAL CARE

Official classification

Type B

Official code

87608(a)(3)

Regulation authority

CCR

What the official deficiency says

POSTURAL SUPPORTS 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 there are half bed rails on all but one bed, but there are no MD orders maintained. Licensee failed to ensure that MD orders are maintained for those who use half bed rails. This poses a potential health, safety or personal rights risk to clients in care.

Official plan of correction

MD orders shall be obtained and copies of MD orders to be sent to CCLD BY DUE DATE for clients #1 - #5, referenced on LIC858. MD orders to be maintained and available for review for all other residents.

Deadline recorded: Aug 12, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87465(e)

Regulation authority

CCR

What the official deficiency says

INCIDENTAL MEDICAL CARE For every RX and non RX 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. This requirement is not met, as there is no MD order maintained for OTC tumeric/curcumin 1950 mg & Vit K2/D3 125 mcg/90 mcg for client #1. Licensee failed to ensure that MD orders are maintained for OTC meds, which poses a potential health, safety or personal rights risk to clients in care.

Official plan of correction

Written MD orders for OTC supplements for client #1 will be sent to CCLD BY DUE DATE.

Deadline recorded: Aug 12, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87555(b)(26)

Regulation authority

CCR

What the official deficiency says

FOOD SUPPLY Supplies of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days shall be maintained on the premises. This requirement is not met, as there is an insufficient 7-day supply of canned fruits and vegetables maintained. Licensee failed to ensure that there is a 7 day nonperishable supply of fruits and vegetables maintained, which poses a potential health and safety risk to clients in care.

Official plan of correction

Receipt for purchase of at least 7-day supploy of canned fruits and vegetables will be sent to CCLD BY DUE DATE

Deadline recorded: Aug 12, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87506(b)(17)(A)

Regulation authority

CCR

What the official deficiency says

(b) Each resident's record shall contain at least the following information: (17) Documents and information required by the following: (A) Section 87457, Pre-Admission Appraisal; This requirement is not met as evidenced by: Deficient Practice Statement Based on record review and interview, the Administrator did not ensure that 3 of 5 residents (R3-R5) have Pre-Admission Appraisal done, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/14/2025 Plan of Correction The Administrator will submit a plan of correction to CCLD by 07/14/2025.

Official classification

Type B

Official code

87506(b)(17)(B)

Regulation authority

CCR

What the official deficiency says

(b) Each resident's record shall contain at least the following information: (17) Documents and information required by the following: (B) Section 87459, Functional Capabilities; This requirement is not met as evidenced by: Deficient Practice Statement Based on record review and interview, the Administrator did not ensure that 5 of 5 residents (R1-R5) have Functional Capabilities assessment done, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/14/2025 Plan of Correction The Administrator will submit a plan of correction to CCLD by 07/14/2025.

Official classification

Type B

Official code

87467(a)(3)

Regulation authority

CCR

What the official deficiency says

(a) Prior to, or within two weeks of the resident's admission, 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, and any other appropriate parties, to prepare a written record of the care the resident will receive in the facility, and the resident's preferences regarding the services provided at the facility. (3) The licensee shall arrange a meeting with the resident and appropriate individuals identified in Section 87467(a)(1) to review and revise the written record as specified, when there is a significant change in the resident's condition, or once every 12 months, whichever occurs first. Significant changes shall include, but not be limited to occurrences specified in Section 87463, Reappraisals. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review and interview, the Administrator did not ensure that 4 of 5 residents (R2-R5) have current Appraisal Needs and Service Plan, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/14/2025 Plan of Correction The Administrator will submit a plan of correction to CCLD by 07/14/2025.

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 interview and record review, the Administrator did not ensure that the Emergency Disaster Drills logs are available for review and hence LPA was not able to verify if the drills are conducted quarterly at the facility, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/14/2025 Plan of Correction The Administrator will submit a plan of correction to CCLD by 07/14/2025.

Official classification

Type B

Official code

87465(e)(2)

Regulation authority

CCR

What the official deficiency says

(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 resident's file, and a label on the medication. Both the physician's order and the label shall contain at least all of the following information. (2) The exact dosage. 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 6 residents' centrally stored medication forms were not updated and were not matched with medications which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/25/2024 Plan of Correction Administrator stated to send a plan of correction by the POC due date and to provide staff training for documentation for medications. ADM stated to send the staff training log to CCL office.

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 record review, the licensee did not comply with the section cited above in that 1 out of 6 resident does not have valid appraisal/needs service plan in the resident file which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/25/2024 Plan of Correction Administrator stated to submit a plan of correction to CCL office to maintain a valid appraisal needs and service plan for residents.