RILLERA'S GUEST HOME 2

Official classification

Type B

Official code

87465(h)(6)(A)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care (h) The following requirements shall apply to medications which are centrally stored: (6) The licensee shall be responsible for assuring that a record of centrally stored prescription medications for each resident is maintained for at least one year and includes: (A) The name of the resident for whom prescribed. (B) The name of the prescribing physician. (C) The drug name, strength and quantity. (D) The date filled. (E) The prescription number and the name of the issuing pharmacy. (F) Instructions, if any, regarding control and custody of the medication. This requirement was not met as evidenced by: Licensee did not ensure that resident R1 did not have three medications missing from the Centrally Stored Medication and Destruction Record, which poses a potential health risk to residents in care.

Official plan of correction

Licensee agrees to audit all resident centrally stored medication and destruction records and submit a statement of understanding of the regulation 87465(h)(6)(A)-(F) to CCL by POC date.

Deadline recorded: Jul 17, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87465(h)(6)(A)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care (h) The following requirements shall apply to medications which are centrally stored: (6) The licensee shall be responsible for assuring that a record of centrally stored prescription medications for each resident is maintained for at least one year and includes: (A) The name of the resident for whom prescribed. (B) The name of the prescribing physician. (C) The drug name, strength and quantity. (D) The date filled. (E) The prescription number and the name of the issuing pharmacy. (F) Instructions, if any, regarding control and custody of the medication. This requirement is not met as evidenced by: Deficient Practice Statement Based on records review, the licensee did not ensure that residents R1 and R2 did not have prescription medications missing from their centrally stored medication and destruction records, which poses a potential safety risk to residents in care. **A civil penalty of $250 was issued due to a repeated deficiency**

Official plan of correction

POC Due Date: 07/09/2025 Plan of Correction Licensee agrees to audit all resident centrally stored medication and destruction records and submit a statement of understanding of the regulation 87465(h)(6)(A)-(F) to CCL by POC date.

Official classification

Type B

Official code

87411(c)(1)

Regulation authority

CCR

What the official deficiency says

(c) All RCFE staff who assist residents with personal activities of daily living shall receive initial and annual training as specified in Health and Safety Code sections 1569.625 and 1569.69 (1) Staff providing care shall receive appropriate training in first aid from persons qualified by such agencies as the American Red Cross. This requirement is not met as evidenced by: Deficient Practice Statement Based on records review, the licensee did not ensure that staff S1 had a current first aid certification, which poses a potential safety risk to residents in care.

Official plan of correction

POC Due Date: 07/09/2025 Plan of Correction Licensee agrees to submit a copy of S1’s first aid certification to the department by Plan of Correction due date.

Official classification

Type B

Official code

87412(a)(11)

Regulation authority

CCR

What the official deficiency says

Personnel Records (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 records review, the licensee did not ensure that staff S2’s personnel record contained a health screening form, which poses a potential health risk to residents in care.

Official plan of correction

POC Due Date: 07/09/2025 Plan of Correction Licensee agrees to submit a copy of S2’s health screening form to the department by Plan of Correction due date.

Official classification

Type B

Official code

87705(c)(5)

Regulation authority

CCR

What the official deficiency says

87705 Care of Persons with Dementia (c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following: (5) Each resident with dementia shall have an annual medical assessment as specified in Section 87458, Medical Assessment, and a reappraisal done at least annually, both of which shall include a reassessment of the resident’s dementia care needs. This requirement was not met as evidenced by: Licensee did not ensure that residents with dementia R4-R6 had an annual medical assessment, which poses a potential health risk to residents in care.

Official plan of correction

Licensee agrees to arrange for an annual medical assessment for residents R4-R6 and submit updated copies of their Physician's Reports to CCL by POC date.

Deadline recorded: Aug 2, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87506(b)(16)

Regulation authority

CCR

What the official deficiency says

87506 Resident Records (b) Each resident’s record shall contain at least the following information: (16) Records of resident's cash resources as specified in Section 87217, Safeguards for Resident Cash, Personal Property, and Valuables. This requirement was not met as evidenced by: Licensee did not ensure that residents R4 and R6 had a Safeguard for Property and Valuables form on file in their resident records, which poses a potential safety risk to residents in care.

Official plan of correction

Licensee agrees to submit completed copies of the Safeguard of Property and Valuables form for residents R4 and R6 by POC date.

Deadline recorded: Aug 2, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87465(h)(6)(A)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care (h) The following requirements shall apply to medications which are centrally stored: (6) The licensee shall be responsible for assuring that a record of centrally stored prescription medications for each resident is maintained for at least one year and includes: (A) The name of the resident for whom prescribed. (B) The name of the prescribing physician. (C) The drug name, strength and quantity. (D) The date filled. (E) The prescription number and the name of the issuing pharmacy. (F) Instructions, if any, regarding control and custody of the medication. This requirement was not met as evidenced by: Licensee did not ensure that R2-R4 and R6 have medications missing from their centrally stored medication and destruction records, which poses a potential safety risk to residents in care.

Official plan of correction

Licensee agrees to audit all resident centrally stored medication and destruction records and submit a statement of understanding of the regulation 87465(h)(6)(A)-(F) to CCL by POC date.

Deadline recorded: Aug 2, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87211(a)(1)(A)

Regulation authority

CCR

What the official deficiency says

87211(a)(1)(A) Reporting Requirements: (a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following:(1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below. This report shall include the resident's name, age, sex and date of admission; date and nature of event; attending physician's name, findings, and treatment, if any; and disposition of the case. (A) Death of any resident from any cause regardless of where the death occurred, including but not limited to a day program, a hospital, en route to or from a hospital, or visiting away from the facility. This requirement was not met as evidenced by: Licensee did not report a resident death to licensing that occurred at a hospital sometime between 07/07-10/2022, which poses a potential safety risk to residents in care.

Official plan of correction

Licensee agrees to retrain staff on reporting deaths of residents to the Department, including deaths that occur outside of the facility. The training records must be submitted to CCL by POC date and the records must include names of staff trained, dates of training, and name and qualifications of trainer.

Deadline recorded: Sep 16, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87211(a)(2)

Regulation authority

CCR

What the official deficiency says

87211(a)(2) Reporting Requirements: a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: (2) Occurrences, such as epidemic outbreaks, poisonings, catastrophes or major accidents which threaten the welfare, safety or health of residents, personnel or visitors, shall be reported within 24 hours either by telephone or facsimile to the licensing agency and to the local health officer when appropriate. This requirement was not met as evidenced by: Licensee did not report COVID cases of 4 residents and 2 staff to CCL, which poses a potential safety risk to residents in care

Official plan of correction

Licensee agrees to retrain staff on reporting COVID cases and any epidemic outbreak to the Department. The training records must be submitted to CCL by POC date and the records must include names of staff trained, dates of training, and name and qualifications of trainer.

Deadline recorded: Sep 16, 2022. A deadline is not proof that correction was completed.