DOVER VALLEY RESIDENTIAL CARE HOME

Official classification

Type B

Official code

87555(b)(9)

Regulation authority

CCR

What the official deficiency says

(b) The following food service requirements shall apply: (9) Procedures which protect the safety, acceptability and nutritive values of food shall be observed in food storage, preparation and service. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and interview, the licensee did not comply with the section cited above in three (3) out of three (3) instances of food storage which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/26/2026 Plan of Correction Licensee to ensure that all left over meats are fully enclosed and labeled with the date they are removed from commercial bags, as well as ensuring all sauces/condiments that need to be refridgerator are stored properaly. In addition, licensee to show proof that all employees on the current LIC500 Personnel Report have received an inservice on the GENERAL food storage regulations in CCR 87555.

Official classification

Type B

Official code

87606(c)

Regulation authority

CCR

What the official deficiency says

(c) To accept or retain a person who is bedridden, other than for a temporary illness or recovery from surgery, a licensee shall obtain and maintain an appropriate fire clearance as specified in Section 87202, Fire Clearance. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, and interview, the licensee did not comply with the section cited above in one (1) count out of six (6) residents which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/26/2026 Plan of Correction Licensee to submit a complete and new LIC602 or similar Physican Report indicating whether R1 who is seen up out of bed in a wheelchair in the living room and dinning room is truly " Bedridden " for fire clearance purposes or simply " non-ambulatory " . Licensee also asked to self-certify they have read GENERAL regulations of CCR 87606 (fire clearance and bedridden status)

Official classification

Type B

Official code

87465(a)(4)

Regulation authority

CCR

What the official deficiency says

Incidental Medical and Dental Care: 87465(a)(4) The licensee shall assist residents with self administered medications as needed. This requirement is not met as evidenced by: Based on interviews conducted and documents obtained for R1, the facility staff did not ensure that R1 took their medications as directed by their doctor which poses/posed a potetnial health, safety, and/or personal rights violation to persons in care.

Official plan of correction

Licensee to submit proof of retraining with all staff on administration of medications in accordance with regulation and the facility's policy. Additionally, this training shall include a review of the required notification procedures when a resident... ...refuses medications, including an update to the facility's policy which accurately reflects regulatory reporting requirements to CCL by POC due date of 07/18/2025.

Deadline recorded: Jul 18, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(a)(2)

Regulation authority

CCR

What the official deficiency says

Incidental Medical and Dental Care 87465(a)(2) The licensee shall provide assistance in meeting necessary medical and dental needs…. This requirement is not met as evidenced by: Based on facility not ensuring R1 was sent out for timely medical evaluation of observed changes to R1's condition, resulting R1's family seeking medical attention and diagnosis of a stage 2 pressure injury, which posed an immediate health, safety, and personal rights risk to persons in care.

Official plan of correction

Licensee to submit self-certification that regulations 87465 Incidental Medical and Dental Care and 87466 Observation of a Resident have been reviewed with facility staff and are understood to CCL by POC due date 06/12/2025.

Deadline recorded: Jun 12, 2025. A deadline is not proof that correction was completed.