VILLAGE AT RANCHO SOLANO ASSISTED LIVING, THE

Official classification

Type B

Official code

1569.699(a)(7)(A)

Regulation authority

HSC

What the official deficiency says

1569.699 (a)(7) (A) A sign shall be provided on the door located above and within 12 inches (305mm) of the panic bar or other door-latching hardware reading: KEEP PUSHING. THIS DOOR WILL OPEN IN ___ SECONDS. ALARM WILL SOUND. This requirement not met as evidenced by: Based upon observation, one (1) of eight (8) delayed egress doors in Memory Care did not have signage per Title 22 regulations which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Deficiency cleared during visit.

Deadline recorded: Jul 23, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

1569.269(a)(6)

Regulation authority

HSC

What the official deficiency says

§1569.269 Enumerated rights... a)Residents...shall have all of the following rights:(6) To care, supervision, and services that meet their individual needs... This requirement not met by licensee as evidenced by: Based on LPA review of facility's Response Time Alert, between 3/29/26 and 4/11/26 9 instances of call alarms went unanswered for 1+hours which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Licensee to submit plan identifying the how the facility will correct the delays in call button/pendant response time as well as ensure that alert system is in good repair and staff is sufficient to timely answer pendant/call button by Plan of Correction due date of 5/15/2026 by 5:00PM.

Deadline recorded: May 15, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87224(d)

Regulation authority

CCR

What the official deficiency says

87224(d)The licensee shall set forth in the notice to quit the reasons relied upon for the eviction with specific facts to permit determination of the date, place, witnesses, and circumstances concerning those reasons. This requirement not met by licensee as evidenced by: Resident (R1) was given an eviction notice that did not provided detailed information as specified in the regulation cited as for the reason for eviction which poses/posed a potential health, safety or personal rights risk to persons in care

Official plan of correction

Licensee to reissue eviction notice following cited regulation to R1 and provide a copy to Community Care Licensing by Plan of Correction due date of 4/03/2026 by 5:00PM. 30-day time period will not start until notice is reissued.

Deadline recorded: Apr 3, 2026. 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

87465(a)(2) The licensee shall provide assistance in meeting necessary medical and dental needs... This requirement not met by licensee as evidenced by: Resident (R1) did not receive adequate body checks that resulted in partial amputation of their big toe from an ulcer which poses/posed an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

Licensee will submit self-certification regarding adherence to the regulation cited as well as in-service training for staff on completing, documenting, and escalating resident body checks when required by Plan of Correction due date of 3/13/2026 by 5:00pm.

Deadline recorded: Mar 13, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87629(b)(1)

Regulation authority

CCR

What the official deficiency says

87629 Injections (b)... licensees who admit or retain residents who require injections...(1) Ensuring that injections are administered by an appropriately skilled professional should the resident require assistance. This requirement not met as evidence by: Five out of Nine staff interviewed indicated non-skilled staff did not receive proper training on injections which poses/posed an immediate health and safety or personal rights risk to residents in care.

Official plan of correction

Assistant Executive Director and Health and Wellness Director shall submit self-certifications of their understanding that non-skilled staff shall not administer injections by Plan of Correction due date of 2/24/2026 by 5:00PM to Community Care Licensing.

Deadline recorded: Feb 24, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87555(b)(8)

Regulation authority

CCR

What the official deficiency says

(8) All food shall be of good quality. Commercial foods shall be approved by appropriate federal, state and local authorities. Food in damaged containers shall not be accepted, used or retained. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above in two (2) counts of spoiled food which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/19/2026 Plan of Correction Licensee shall submit plan on ensuring food quality is maintainted by Plan of Correction due date of 3/19/2026 by 5:00PM.

Official classification

Type B

Official code

87307(3)(f)

Regulation authority

CCR

What the official deficiency says

87307(3) Equipment and supplies necessary for personal care and maintenance of adequate hygiene practice shall be readily available to each resident…(F) Basic laundry service (washing, drying, and ironing of personal clothing). This requirement not met by Licensee as evidenced by: Based on documentation and interviews, R1 was not provided laundering services as outlined in resident agreement for more then one (1) month.

Official plan of correction

Regional Director of Operations stated in-service training would be conducted on ensuring resident basic laundry needs are being met.

Deadline recorded: Mar 3, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

1569.657(a)

Regulation authority

HSC

What the official deficiency says

1569.657(a) For any rate increase due to a change in the level of care... licensee shall provide… written notice of the rate increases… The notice shall include a detailed explanation of the additional services to be provided... and an accompanying itemization of the charges. This requirement not met by Licensee as evidenced by: Based on documentation and interviews, R1 was charged a rate increase without being provided proper notice as outlined in Title 22 regulation 87307(3)(f).

Official plan of correction

Regional Director of Operations stated they would submit a self-certification that residents and/or their responsible parties would received detailed and itemized letters of notice regarding rate increases for higher levels of care by 5:00PM on Plan of Correction due date of 3/3/2026.

Deadline recorded: Mar 3, 2026. 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 87411(a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs… This requirement not met by Licensee as evidenced by: R1 alarm pendant was activated and rang for more than 1 hour as " invalid zone " before R1 was discovered.

Official plan of correction

Deficiency cleared at time of visit, civil penalty assessed in the amount of $500.

Deadline recorded: Feb 4, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87466

Regulation authority

CCR

What the official deficiency says

87466 The licensee shall ensure that residents are regularly observed for changes in physical, mental, emotional and social functioning and that appropriate assistance is provided when such observation reveals unmet needs… This requirement not met by Licensee as evidenced by: Facility staff were not informed of additional checks to completed for R1 following hospital discharge.

Official plan of correction

Deficiency cleared at time of visit,

Deadline recorded: Feb 4, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

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 not met by licensee as evidenced by: Resident (R1) was injected with Humalog intended for resident (R2) which poses/posed an immediate health and safety or personal rights risk to residents in care.

Official plan of correction

Licenses stated they will submit step by step plan on ensuring medications are dispensed properly as well as in-service training log by Plan of Correction due date of 12/5/2025 by 5:00PM.

Deadline recorded: Dec 5, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.2(a)(4)

Regulation authority

CCR

What the official deficiency says

87468.2(a)(4) Additional Personal Rights of Residents in Privately Operated Facilities. (4) To care, supervision, and services that meet their individual needs... This requirement not met by licensee as evidenced by: Based on a review of Response Time Report for Pendant Alarms/Bath E-Calls showed 39 instances of Pendant Alarms/Bath E-Calls going unanswered for 30 minutes to 2 plus hours which posed/poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Administrator stated they would provide in-service training logs regarding answering alarms in a timely manner by Plan of Correction due date of 12/19/2025. Additional alarm phones have also been ordered.

Deadline recorded: Dec 19, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87307(a)(3)(D)

Regulation authority

CCR

What the official deficiency says

Personal Accommodations and Services 87307(a)(3)(D) Hygiene items of general use such as soap and toilet paper. This requirement not met as evidenced by: Licensee did not ensure resident was supplied with basic hygeine items as outlined in Title 22 regulations

Official plan of correction

Administrator stated they would discuss with house keeping and implement soap dispensation immediately. Administrator would submit statement of implementation by Plan of Correction due date of 11/28/2025.

Deadline recorded: Nov 28, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.1(a)(9)

Regulation authority

CCR

What the official deficiency says

Personal Rights of Residents in All Facilities 87468.1(a)(9) To have communications to the licensee from their representatives answered promptly and appropriately. This requirement not met as evidenced by: Licensee did not ensure representative communications were answered promptly as representative was made to wait twelve (12) days to receive a call back regarding resident health and safety.

Official plan of correction

Administrator stated they would conduct an -inservice communication and reporting requirements training with reception and leadership team and will submit proof by Plan of Correction due date of 11/28/2025.

Deadline recorded: Nov 28, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87466

Regulation authority

CCR

What the official deficiency says

Observation of the Resident 87466 The licensee shall ensure that residents are regularly observed for changes in physical, mental, emotional and social functioning ... This requirement not met by licensee as evidenced by: 3 instances of missed status check over the course of a 10 day fall intervention plan, including 1 instance of 22 hours and 40 minutes elapsing between checks which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Administrator shall review methods of documenting resident notes before submitting plan on how facility will ensure resident checks are completed and documented by COB on Plan of Correction due date of 11/7/2025.

Deadline recorded: Nov 7, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

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 not met by licensee as evidenced by: Based on review of MAR, R1 was administered higher dosages then prescribed by physician on five (5) occasion which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

Licensee to submit plan on training memory care staff on medication management as well as self-certification that regulation 87465 has been read and understood.

Deadline recorded: Sep 26, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

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 not met by licensee as evidenced by: Based on interviews and review of MAR, R1 was not administered fourteen (14) doses of prescribed medication over the course of thirty-one (31) days which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

Licensee to submit plan on how facility will ensure resident prescription medication is available as prescribed by physician.

Deadline recorded: Sep 26, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

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 not met by licensee as evidenced by: Based on interviews and facility's incident report of medication error of not discontinuing one of R1’s, 2 anti-seizure medications as indicated by Dr., which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

Licensee submitted certification of medication training along with additional 8 hrs of medication training. Citation cleared at time of visit.

Deadline recorded: Jul 11, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

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 not met by licensee as evidenced by: Based on facility's submitted incident report reporting medication error, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

Licensee submitted certification of medication training along with additional 8 hrs of medication training. Citation cleared at time of visit.

Deadline recorded: May 30, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87468.1(a)(3)

Regulation authority

CCR

What the official deficiency says

87468.1(a)(3) Personal Rights of...Residents…all residents…shall have personal rights to be free from …interfering with daily living functions such as…sleeping… *** Based on statements and videos, this requirement has not been met as evidenced by: Resident R2 has repeatedly ventured into Resident R1’s space and handled R1’s belongings and is seen on video taken on 2/21/25 entering R1’s bed while an apparent sleeping R1 is occupying the bed. This posed an immediate violation of R1’s personal rights.

Official plan of correction

Administration will provide a written plan to CCL by POc date that outlines how the facility will protect R1 from further personal rights violations.

Deadline recorded: Mar 20, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87412(g)(1)

Regulation authority

CCR

What the official deficiency says

87412 Personnel Records (g) All personnel records shall be maintained at the facility & shall be available to the licensing agency for review. (1) The licensee shall be permitted to retain such records in a central administrative location provided that they are readily available to the licensing agency at the facility as specified in Section 87412(f). This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview and record review, the licensee did not comply with the section cited above not having records available for Licensing to review during visit including updated personnel records which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 03/13/2025 Plan of Correction Licensee agrees to submit self certification that all resident/staff files are accessible for review and contain all required documents by POC due date.

Official classification

Type A

Official code

87705

Regulation authority

CCR

What the official deficiency says

87705 Care of Persons with Dementia: (b) In addition to the requirements as specified in Section 87208... plan of operation shall address... residents with dementia, including: (2) Safety measures to address behaviors such as wandering.. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, Licensee did not comply with the section cited above. Resident 1 eloped from facility. R1's Physician Reports state they are unable to leave without assistance and has a diagnosis of dementia. This poses an immediate health and safety risk to residents in care.

Official plan of correction

POC Due Date: 03/06/2025 Plan of Correction Licensee submitted proof of all staff training conducted on 3/4/2025 & 3/6/2025. Coyp of staff suspension provided. Deficiency cleared during visit, and Plan of Corrections Letter provided.

Official classification

Type A

Official code

87465(a)(1)

Regulation authority

CCR

What the official deficiency says

87465(a)(1) Incidental Medical and Dental Care. The licensee shall arrange, or assist in arranging, for medical and dental care appropriate to the conditions and needs of residents. ***Based upon records reviewed and statements taken, this requirement has not been met as evidenced by: Medical tests ordered for R1 on 1/24/2025 were not made until 2/4/2025. This posed an immediate risk to the health of R1.

Official plan of correction

Administration to submit written plan which addresses how facility will ensure compliance with 87465(a)(1) going forward. To be submitted to CCL by POC date in order to clear the deficiency.

Deadline recorded: Mar 7, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468(c)

Regulation authority

CCR

What the official deficiency says

87468© Personal Rights. Licensees shall prominently post personal rights, nondiscrimination notice, and complaint information in areas accessible to residents, representatives, and the public. ***Based on statements and observation, this requirement not met as evidenced by: Inspection on 12/10/24 found complaint sign posting was not required size and no residents’ rights posted. This posed a potential denial of residents’ personal rights. POC: Cleared at time of visit. Required postings are currently in place.

Official plan of correction

POC: Cleared at time of visit. Required postings are currently in place.

Deadline recorded: Mar 4, 2025. 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

. Facility personnel shall be sufficient in numbers, and competent to provide the services necessary to meet resident needs. *** Based upon interviews and records reviewed, this requirement not met as evidenced by: On 10/13/2024 R1 left facility without staff’s knowledge and remained away therefrom between 7:30pm and 9pm when R1 was returned by Law Enforcement. R1’s has dementia cannot leave facility unassisted. This posed an immediate risk to the safety of R1.

Official plan of correction

Facility to submit written plan to ensure the prevention of elopements from facility going forward. Plan to be submitted to CCL by POC date in order to clear the deficiency. ***Civil Penalty issued in the amount of $500.00 for Zero Tolerance of Absence of Supervision.****

Deadline recorded: Feb 25, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

1569.657(a)

Regulation authority

HSC

What the official deficiency says

CA H & S 1569.657(a)For any rate increase (for) change in level of care …the Licensee shall provide…written notice..within two business days. *** Based on statements and documents, this requirement not met as evidenced by: R1’s Representative was provided written notice of increase effective 10/04/24 on 10/09/24 and effective 10/21/24 on 10/25/24. This posed a potential risk to the personal rights of the Resident.

Official plan of correction

Administration will review 1569.657 and submit written plan that outlines how facility will comply going forward. Plan to be submitted to CCL by POC date in order to clear the deficiency.

Deadline recorded: Feb 28, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87211(a)

Regulation authority

CCR

What the official deficiency says

87211(a)(1) Reporting Requirements. A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of…Any incident which threatens the welfare, safety or health of any resident….***Based on statements and documents reviewed, this requirement has not been met as evidenced by: Responsible Person for R1 was not provided copies of Reports for R1’s elopements from facility on 10/13 and 11/12 until 01/22/2025. This posed a potential risk to the personal rights and safety of R1.

Official plan of correction

Administration will submit a written plan outlining how facility will comply with 87211 going forward. Plan to be submitted to CCL by POC date in order to clear the deficiency.

Deadline recorded: Feb 28, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87303(e)(2)

Regulation authority

CCR

What the official deficiency says

87303(e)(2) Maintenance and Operation- Water supplies and plumbing fixtures shall be maintained as follows: 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 degree C) and not more than 120 degree F (49 degree C). This requirement is not met as evidenced by: This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above in 7 out of 11 (4 in memory care) faucets accessible to residents in care ranged from 120.2 to 125.2 degrees F which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/21/2025 Plan of Correction Licensee/Administrator to ensure the hot water is monitored and under 120.degrees Fahrenheit, and not to be under 105. degrees Fahrenheit. Monitor the hot water for a period of one week (7 days). Submit a copy of the hot water log, and a plan on how the facility will ensure the hot water is maintained in compliance with regulation. Submit plan of correction by 2/21/2025, and follow up with copy of hot water log and maintenance plan by 2/28/25.

Official classification

Type B

Official code

87705(f)(2)

Regulation authority

CCR

What the official deficiency says

87705 Care of Persons with Dementia:(f) The following shall be stored inaccessible to residents with dementia:(2) Over-the-counter medication... alcohol... and toxic substances... This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, Licensee did not comply with the section cited above. During tour of memory care LPAs and Administrator observed laundry room unlocked with cleaning chemicals on shelves. This is a potential health and safety risk to residents in care.

Official plan of correction

POC Due Date: 02/27/2025 Plan of Correction Licensee to submit self certification that training for Regulation 87705(f)(2) will be conducted for all staff by POC due date of 02/27/2025. Training to review items that are inaccessible to residents in care. Licensee to conduct Inservice Training and submit a sign in sheet to CCL that includes the following: Date, Training Topic, Name/Job Role, and Signatures by POC due date of 02/27/2025.

Official classification

Type A

Official code

87468.1(a)(1)

Regulation authority

CCR

What the official deficiency says

Personal Rights of Residents. Residents in all residential care facilities for the elderly shall have all of the following personal rights: (1) To be accorded dignity in their personal relationships with staff, residents, and other persons. ***Based upon statements and observations, this requirement not met as evidenced by: Cameras placed in the common areas of facility had the audio function activated. This posed an immediate violation of the residents' personal rights.

Official plan of correction

Cleared at time of visit. Administrator has de-activated the audio function of the cameras on 01/11/2025 and states that cameras will be utilized for video only going forward.

Deadline recorded: Jan 13, 2025. 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(a) 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 has not been met as evidenced by: Based on records reviewed and interviews conducted, facility staff were unable to respond to call buttons in a timely manner. Records reviewed indicated that multiple call buttons had response times of 20 minutes or more. This poses an immediate risk to the health and safety of residents in care.

Official plan of correction

Licensee to submit a self-certification statement that a plan of action will be written regarding facility staffing and call light system by POC due date of 11/20/24. Plan of action to detail how facility will ensure there is sufficient staff available to respond to resident care needs in a timely manner. In addition, broken pull cord to be repaired. Plan to be submitted to CCL by POC date of 11/22/2024.

Deadline recorded: Nov 19, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

87303(a) Maintenance and Operation. The facility shall be clean, safe, sanitary and in good repair at all times. ***Based upon photographs and statements, this requirement not met as evidenced by: 10/25/24 photographs of R1’s shower depict mold on the floor and wall. This poses an immediate risk to the health of R1.

Official plan of correction

Administration will submit a written plan that addresses how shower maintenance will be achieved going forward and will provide retraining to maintenance staff. Plan to be submitted to CCL by POC date in order to clear the citation

Deadline recorded: Nov 12, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(a)(4)

Regulation authority

CCR

What the official deficiency says

87465(a)(4) Incidental Medical and Dental Care. …The licensee shall assist residents with self-administered medications as needed… Based on records and statements, this requirement not met as evidenced by: On 10/14/24 R1 was administered a medication not ordered and the wrong dose of a medication that was ordered. The ordered medication dosage was incorrectly listed in the Medication Administration Record. This posed an immediate risk to the health of R1.

Official plan of correction

Cleared at time of visit. Staff involved in the medication error has been retrained in the requirements of 874665.

Deadline recorded: Oct 29, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87224(a)

Regulation authority

CCR

What the official deficiency says

Eviction Procedures. The licensee may evict a resident for one or more of the reasons listed in Section 87224(a)(1) through (5). Thirty (30) days written notice to the resident is required except as otherwise specified in paragraph (5) ***Based on statements and documents, this requirement not met as evidenced by: R1 was not allowed to return to facility from hospitalization due to a medical condition that is not a prohibited condition. This posed an immediate violation of R1’s personal rights.

Official plan of correction

Facility management agree to review the regulations governing prohibited and restricted conditions and to consult with CCL in the event there is a situation where resident’s medical condition is in doubt. Management to submit a declaration confirming the review by POC date in order to clear the deficiency.

Deadline recorded: Oct 15, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87464(f)(4)

Regulation authority

CCR

What the official deficiency says

87464. Basic Services. Basic services shall at a minimum include:...Personal assistance and care...such as dressing, eating, bathing..***Based on documents, this requirement not met as evidenced by: Care report for 8/2024 indicate R1 was not showered 8/16 thru 8/31/2024. This posed an immediate risk to the health and personal rights of R1.

Official plan of correction

Cleared at time of visit. Administration has provided proof of refresher training to staff on the subject of showers provided in August and September, 2024.

Deadline recorded: Oct 1, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

1569.6557

Regulation authority

HSC

What the official deficiency says

H & S code section 1569.657 For any rate increase due to a change in level of care..licensee shall provide ..resident and resident representative..written…detailed explanation of additional services provided and itemization of charges. ****Based on documents and statements, this requirement not met as evidenced by: Facility did not provide R1 detailed explanation of services and charges for changes in level of care. This posed an immediate violation of personal rights. POC: Facility

Official plan of correction

Facility shall refund additional charges for services but may rebill for the additional services provided the services are outlined in the Admission Agreement and itemized as required by H & S 1569.657. Facility to provide proof of refund and written plan to correctly bill future charges in order to clear the deficiency. Due by POC date

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

Official classification

Type B

Official code

87555(b)(7)

Regulation authority

CCR

What the official deficiency says

87555(b)(7) General Food Service Requirements. Modified diets prescribed by a resident's physician as a medical necessity shall be provided. ***Based on documents and statements, this requirement has not been met as evidenced by: Kitchen staff were reminded by Administration on two occasions to follow diet prescribed by R1’s physician in the assessment of 1/7/2023. This posed a potential risk to R1's health

Official plan of correction

Administration shall provide a written plan that outlines how facility will ensure that special diets are served to residents when ordered by the physician. Plan due by POC date in order to clear the deficiency.

Deadline recorded: Oct 15, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87211(a)(1)

Regulation authority

CCR

What the official deficiency says

87211(a)(1) Reporting Requirements. A written report shall be submitted to the licensing agency and to the person responsible for the resident …***Based upon statements, this requirement has not been met as evidenced by: Administrator has stated that written incident reports have not been provided to R1’s Responsible Person. This posed a potential risk to the personal rights and health of Residents in Care.

Official plan of correction

Cleared at time of visit. Facility now provides written incident reports to the residents’ Responsible Persons.

Deadline recorded: Oct 15, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87555(B)

Regulation authority

CCR

What the official deficiency says

General Food Service Requirements. Sufficient food service personnel shall be employed, trained and their working hours scheduled to meet the needs of residents. ****Based on statements, this requirement has not been mete as evidenced by: Residents have waited up to 2 hours for food service in the dining rood. This posed an immediate violation of residents' rights.

Official plan of correction

Administration will provide a written report of current and future steps to be taken to insure that the residents are served meals timely and that sufficient staff are on duty to serve the residents. Report due to CCL by POC date in order to clear the deficiency

Deadline recorded: Sep 20, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87466

Regulation authority

CCR

What the official deficiency says

87466 Observation of the Resident. The licensee shall ensure that residents are regularly observed for changes in physical, mental, emotional and social functioning and that appropriate assistance is provided when such observation reveals unmet needs. Based on statements and documents, this requirement was not met as evidenced by; On 4/22/2024, Staff did not note that R1 was feverish and required medical attention for UTI. This posed an immediate risk to the health of R1.

Official plan of correction

Administration will provide refresher training to staff on the requirements of 87455 and provide an agenda to CCL by POC date, with follow-up confirmation of training, in order to clear the deficiency.

Deadline recorded: Sep 9, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(c)(2)

Regulation authority

CCR

What the official deficiency says

87465(c)(2) Incidental Medical and Dental Care. Once ordered by the physician the medication is given according to the physician's directions. ***Based on documents and statements, this requirement has not been met as evidenced by: On July 23 and July 24 R1 and R2 were not administered injections ordered by the physician. this posed an immediate risk to the health of the residents.

Official plan of correction

Cleared at time of visit. 17 staff who provide medication administration have been retrained on administration of medications.

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

Official classification

Type B

Official code

87411(c)(1)

Regulation authority

CCR

What the official deficiency says

(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 record review the licensee did not comply with the section cited above in 3 out of 5 staff records review did not have first aid training which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/23/2024 Plan of Correction The facility will provide first aid training and ensure that all first aid training remains up to date for all care staff. The facility will email the LPA proof that the facility is 100% compliant with first aid training for direct care staff.

Official classification

Type A

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

Maintenance and Operation. The facility shall be clean, safe, sanitary and in good repair at all times. ***Based upon statements and photographs, this requirement not met as evidenced by: Extension and assorted electrical cords were noted across the bed and pillows of R1 and R2 in December of 2022; loose medication belonging to R1 was noted on the floor and furniture of R1’s room in December 2022. This posed and immediate risk to health and safety of residents. Civil penalty for $250.00 Issued for repeat violation within 12 months.

Official plan of correction

Administration to submit written plan, which will include additional staff training, which addresses how facility will avoid the reoccurrence of safety issues effecting residents in care. Plan to be submitted to CCL by POC date in order to clear the deficiency.

Deadline recorded: Aug 29, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87303(i)(1)(2)

Regulation authority

CCR

What the official deficiency says

Maintenance and Operation. Facilities licensed for 16 or more…shall have a signal system which meets specified requirements. ***Based on statements and written log reports, this requirement not met as evidenced by: Of 14 calls for assistance to room of R1 and R2 for 3 days in May 2023, 8 were over 20 minutes and 1 over an hour and 1 over 3 hours. This posed an immediate risk to health and safety of residents.

Official plan of correction

Administration to submit a written plan that addresses how facility will ensure that calls for assistance are answered timely going forward. Plan to be submitted to CCL by POC date in order to clear the deficiency.

Deadline recorded: Aug 29, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87307(d)(6)

Regulation authority

CCR

What the official deficiency says

Personal Accommodations and Services. All outdoor and indoor passageways and stairways shall be kept free of obstruction. *** Based upon statements and photographs, this requirement not met as evidenced by: In February of 2023 and other occasions, furniture was observed to be blocking outdoor passageways in the Memory Care Unit of the facility. This posed an immediate risk to safety of residents. Immediate Civil Penalty issued in amount of $500.00 for Zero Tolerance violation.

Official plan of correction

Administration will provide additional training to staff regarding the importance of complying with the requirements of 87307. Proof of training to be submitted to CCL by POC date in order to clear the deficiency.

Deadline recorded: Aug 29, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87705(b)(2)

Regulation authority

CCR

What the official deficiency says

87705 Care of Persons with Dementia - (b) (2)Safety measures to address behaviors such as wandering. This requirement is not met as evidenced by: Based on incident report dated for March 24, 2023, Resident R1 eloped from facility without staff knowledge on March 20, 2023. Staff found resident and resident was escorted back into the community. Current medical assessment for resident states resident is not able to leave facility unassisted.

Official plan of correction

Licensee/Administrator will submit a Plan of Correction on how future compliance will be met. Furthermore, in-service training was already conducted. Plan of Correction due on April 5, 2023.

Deadline recorded: Apr 5, 2023. 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(a) Personnel Requirements – General: Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs… This requirement was not met as evidenced by: Based on records reviewed and interviews conducted, facility staff were unable to respond to resident care needs and call buttons in a timely manner from January 20 through January 23, 2023. Records reviewed indicated that multiple call buttons had response times of 20 minutes or longer. In addition, December 2022 Call Pendants were not available for viewing. This poses an immediate risk to the health and safety of residents in care.

Official plan of correction

Licensee to submit a self-certification along with staff training regarding facility call pendants by POC due date of 02/20/2023. In addition, facility shall also submit a statement on how future compliance will be met.

Deadline recorded: Feb 14, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87707(a)(1)

Regulation authority

CCR

What the official deficiency says

87707(a)(1) & 87707((a)(2) Training Requirements If Advertising Dementia Special Care, Programming And/Or Environments: (a) Licensees who advertise, promote, or otherwise hold themselves out as providing special care, programming, and/or environments for residents with dementia or related disorders shall ensure that all direct care staff, described in Section 87706(a)(1), who provide care to residents with dementia, meet the following training requirements: (1) Direct care staff shall complete six hours of orientation specific to the care of residents with dementia within the first four weeks of working in the facility. (2) Direct care staff shall complete at least eight hours of in-service training on the subject of serving residents with dementia within 12 months of working in the facility and in each succeeding 12-month period. Direct care staff hired as of July 3, 2004 shall complete the eight hours of in-service training within 12 months of that date and in each succeeding 12-month period. This requirement was not met as evidenced by: Based off of facility records review on February 6, 2023 with the Regional Vice President, LPA and Regional Vice President identified 10 staff members including the former Administrator who did not have the sufficient number of hours as outlined in Title 22 regulation. This poses a potential Health, Safety and Personal Rights risk to the residents in care.

Official plan of correction

Licensee/Regional Vice President shall ensure that ALL staff are trained in accordance with Title 22 regulations. In addition, a written statement on how future compliance and training shall be submitted on February 20, 2023. All staff trainings shall be conducted, and proof of those trainings shall be furnished to the Department by February 20, 2023.

Deadline recorded: Feb 20, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87468.1(a)(9)

Regulation authority

CCR

What the official deficiency says

87468.1(a)(9) Personal Rights of Residents in All Facilities: (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (9) To have communications to the licensee from their representatives answered promptly and appropriately. Based off of facility records review which included the After-Hours phone history on February 6, 2023 with the Regional Vice President, LPA and Regional Vice President identified on January 20, 2023 and January 24, 2023 phone calls were missed and not returned back in a timely fashion. This poses an immediate Health, Safety and Personal Rights risk to the residents in care.

Official plan of correction

Licensee/Regional Vice President shall ensure that ALL telephones owned by the facility shall be responded to and answered in a timely manner. In addition, a written statement on how future compliance and training shall be submitted on February 20, 2023.

Deadline recorded: Feb 14, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA observation, the licensee did not comply with the section cited above in 3 out of 3 elevators that were last inspected on August 9, 2019 with an expiration of August 9, 2020 which poses a potential health, safety or personal rights risk to persons in care. In addition, this regulation poses a potential risk to visitors and staff members.

Official plan of correction

POC Due Date: 01/04/2023 Plan of Correction Plan of Correction (POC) shall include a written statement on how future compliance will be met. In addition, provide proof that the 3 out of 3 elevators will be inspected by the POC due date. Administrator requested an Extention for the POC due to the holidays.

Official classification

Type A

Official code

87202(a)

Regulation authority

CCR

What the official deficiency says

87202 Fire Clearance (a) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department, or district providing fire protection services, or the State Fire Marshal. Prior to accepting or retaining any of the following types of persons, the applicant or licensee shall notify the licensing agency and obtain an appropriate fire clearance approved by the city, county, or city and county fire department, or district providing fire protection services, or the State Fire Marshal. (1) Nonambulatory persons. (2) Bedridden persons This requirement was not met as evidenced by: Based on observation of the STD 850, the fire clearance was not approved due to the Fire Alarm system being inoperable during the inspection with the Fairfield Fire Department. In addition, during the tour, LPA and Fire Inspector observed 16-24 residents in the Memory Care Unit on the 2nd floor that was not Fire Clearance approved.

Official plan of correction

Plan of Correction shall include: In Depth Descriptive Fire Watch indicating who will be additional staff and education on the fire watch. In addition, Descriptive Fire Watch plan will be due to the State of California-Department of Social Services-Community Care Licensing and Fairfield Fire Department by December 1, 2022.

Deadline recorded: Dec 1, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(a)(5)

Regulation authority

CCR

What the official deficiency says

87465(a)(5): Incidental Medical and Dental Care Services. The licensee shall assist residents with self-administered medications when needed. This requirement is not met as evidenced by: Based off an incident report and an interview with the Administrator, the nurse over-medicated the resident on insulin. This is an immiedate health, safety and personal rights risk to residents in care.

Official plan of correction

Plan of Correction (POC) shall include a self-certification of the regulation and training of ALL staff that administer medication. In addition, Licensee shall write a written statement on how future compliance will be met. Administrator requested an extension due to holidays. November 28, 2022 will be the POC due date.

Deadline recorded: Nov 28, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

87303(a) Maintenance and Operation : (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement was not met as evidenced by: Based on interviews and observations, LPA confirmed that the metal plate was present on November 7, 2022 and during the incident on the alleged date. This is a potential health, safety and personal rights risk to the residents in care.

Official plan of correction

POC cleared during the tour of the facility on November 18, 2022. LPA observed NO metal plate and the floor being aligned with one another.

Deadline recorded: Nov 25, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

87303(a) Maintenance and Operation. The facility shall be clean, safe, sanitary and in good repair at all times. ***This requirement not met as evidenced by: Based on photo’s and statements, R1’s room was observed to be dirty from feces, including floor and bedding. This posed an immediate risk to health of resident.

Official plan of correction

Administration to submit to CCL by POC date a written plan to addresses how facility will provide sufficient maintenance of residents’ rooms going forward in order to clear this deficiency.

Deadline recorded: Oct 28, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87507(f)

Regulation authority

CCR

What the official deficiency says

87507(f) Admission Agreements. The licensee shall comply with all applicable terms and conditions set forth in the admission agreement…This requirement not met as evidenced by: Based on statements and documents, facility failed to provide notice of fee increased to R1 as specified in the Admission agreement. This posed a potential risk to the personal rights of R1.

Official plan of correction

Administration will review the requirements of 87507 and submit to CCL a signed, dated declaration addressing how facility will comply with 87507 going forward. Declaration to be submitted by POC date in order to clear the deficiency.

Deadline recorded: Nov 8, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87307(3)

Regulation authority

CCR

What the official deficiency says

87307(3)(C) Personal Accommodations and Services. (Licensee shall provide) Clean linen, including blankets, bedspreads… ***This requirement has not been met as evidenced by: Based on statements and photos, R1 has not been provided adequate clean linens. This posed a potential risk to the health of R1.

Official plan of correction

Administration shall provide a written plan addressing how facility will comply with 87307 going forward. Plan to be submitted to CCL by POC date in order to clear the deficiency.

Deadline recorded: Nov 8, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87355

Regulation authority

CCR

What the official deficiency says

87355 Criminal Record Clearance.This requirement isnt met as evidenced by: Based on records reviewed facility didn't comply w/section above on 1 out of 3 staff fingerprint clearance & staff association before providing care to residents which poses an immediate health, safety, & personal rights risk to residents in care.CCLD reviewedtimecards provided by facility & learned that staff S3 isnt associated to facility.Staff S3 worked 2 days between 2/13 & 2/17/22.

Official plan of correction

Facility to ensure that all facility & agency staff and volunteers are fingerprint cleared and associated to facility before working, residing, and/or voluntering at facility. Facility to provide & submit CCLD with self certification that they understand this regulation and that all staff and volunteer at facility are and will be fingerprint cleared and associated to the facility by 9/17/22. (see Civil Penalty)

Deadline recorded: Sep 17, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87412

Regulation authority

CCR

What the official deficiency says

87412 Personnel Records:This requirement is not met as evidenced by: Based on records reviewed & interview facility didn't comply w/section above on 3 out of 3 staff files which poses a potential safety risk to residents in care. During visit on 8/11/22 LPA requested to review 2 staff files S1, S2, S3 based on timecards provide by facility. Facility staff files for S1 & S2 only contained resume & training. S3 had no file available.

Official plan of correction

Facility to ensure that all staff documentation required on Title 22 Regulation # 87412 is on file and available for the Department to review when requested. Facility to review staff files and submit to CCLD Self certification that all staff files have required documentatioin available for the Department to review when requested by POC date of 9/29/22 in order to clear this citation.

Deadline recorded: Sep 29, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

1569.625

Regulation authority

HSC

What the official deficiency says

§1569.625 Staff training; legislative findings…This requirement isn't met as evidenced by:Based on records review & interviews,licensee didn't comply w/section cited above in 3 out of 3 staff training which poses a potential health, safety, & personal risk to residents in care.During visit on 8/11 & email follow up, facility wasn't able to provide sufficient initial & on going proof of training for staff S1 & S2 and no proof of training for S3.

Official plan of correction

Facility to ensure that all facility & agency staff have initial training required as well as on going training. Facility to provide CCLD with a plan on how facility will ensure that all staff have required training on file as well as how it will maintain the on going training and self certification that staff has all training required to be reviewed by the Department by POC date of 9/29/22 in order to clear this citation.

Deadline recorded: Sep 29, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

1569.618(b)(3)

Regulation authority

HSC

What the official deficiency says

1569.618 (b)(3)Ensure that at least 1 staff member who has cardiopulmonary resuscitation (CPR) training & first aid training is on duty & on the premises at all times.This requirement isn't met as evidenced by: Based on staff file review & interviews 3 out of3 staff file had no proof of 1st Aid and on 2/17/22 there were no staff w/ CPR on premises as per 8/11/22 visit and records requested on email which poses a potential health, safety, & personal rights risk to residents in care.

Official plan of correction

Facility to provide CCLD w/ proof of 1st aid for staff S1, S2, S3, and self certification that facility will have at all times/ every shift at least 1 facility staff that carries an active CPR certification by POC date of 9/29/22.

Deadline recorded: Sep 29, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87463(c)

Regulation authority

CCR

What the official deficiency says

87463(c) Reappraisals...once every 12 months...as specified in Section 87467.This requirement is not met as evidenced by: Based on observation,interview, and record review, facility did not comply with the section cited above in 4 out of 4 residents' reappraisals which poses a potential health,safety or personal rights risk to persons in care.Dept learned that residents R1,2,3,4 have no reappraisal or they are over 12 months.(see copies)

Official plan of correction

Facility to ensure that reappraisals are conducted at least every 12 months and/or any time there is a change of condition. Facility review residents careplans and provide Department with a self certification as proof that all careplans/reappraisals have been updated, reviewed & resident and/or responsible party by POC due date of 9/29/2022 in order to clear citation and avoid civil penalties.

Deadline recorded: Sep 29, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(a)(5)

Regulation authority

CCR

What the official deficiency says

87465(a)(5)-Incidental Medical and Dental Care:The licensee shall assist residents with self-administered medications as needed. This requirement was not met as evidenced by: Based on Self report made by facility, a staff member administered the wrong medication to R1. This is an immediate Health and Safety risk to the resident(s) in care. A civil penalty of $250 is being issued for this Repeated violation within in a 12 month period.

Official plan of correction

Licensee shall submit a Plan of Correction that will include plan for future compliance and to ensure that ALL Med Techs are re-trained on Medication management, dispensing and counting medications. Licensee shall include a sign-in sheet. Plan to be submitted to CCL by POC date of 09/09/2022.

Deadline recorded: Sep 5, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

Maintenance and Operation. The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. ***Based on LPA observations and statements, this requirement has not been met as evidenced by: Main entrance door to MC facility has not been functioning properly for at least 4 months. This poses a potential risk to the safety of the residents.

Official plan of correction

Administration shall repair or replace non functioning door and provide proof of compliance to CCL by POC date in order to clear the deficiency.

Deadline recorded: Aug 23, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(a)(5)

Regulation authority

CCR

What the official deficiency says

87465(a)(5)-Incidental Medical and Dental Care The licensee shall assist residents with self-administered medications as needed. This requirement was not met as evidenced by: Based on an interview with the Administrator, a review of the discharge paperwork, Medication List and the Medication Assessment Record (MAR) for July 12, 2022, staff member administered the wrong dosage to R1. This is an immediate Health and Safety risk to the resident(s) in care.

Official plan of correction

Licensee shall submit a Plan of Correction that will include plan for future compliance and to ensure that ALL Med Techs are trained on Medication management, dispensing and counting medications. Licensee shall include a sign-in sheet. Plan of Correction due August 10, 2022.

Deadline recorded: Aug 3, 2022. 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 has not been met based on document review showing that a resident who was unable to leave facility unassisted eloped the facility. This poses an immediate health and safety risk to residents.

Official plan of correction

Administrator agrees to provide planned inservice date for all caregivers regarding observing a resident for physical and mental changes to ensure that residents are adequately supervised by POC date of 4/7/2022.

Deadline recorded: Apr 7, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

97465(g)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care (g) The licensee shall immediately telephone 9-1-1 if an injury or other circumstance has resulted in an imminent threat to a resident’s health including, but not limited to, an apparent life-threatening medical crisis except as specified in Sections 87469(c)(2), (c)(3), or (c) (4). This requirement has not been met as evidenced by interview and record review showing that 911 was not called for resident despite complaints of pain and inability to walk. This is an immediate risk to the health and safety of residents in care.

Official plan of correction

Facility has changed their policy to ensure 911 is called per regulation. Executive Director to conduct an inservice on regulation 87469- Advanced Directives and Requests Regarding Resuscitative Measures no later than March 25, 2022. Executive Director agrees to submit planned training date(s) to CCL by POC due date, 3/18/2022.

Deadline recorded: Mar 17, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87506(e)

Regulation authority

CCR

What the official deficiency says

Original records or photographic reproductions shall be retained for a minimum of three (3) years following termination of service to the resident. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, Facility did not have the available record when requested by CCL. This poses a potential health and safety risk to residents in care.

Official plan of correction

POC Due Date: 03/01/2022 Plan of Correction Facility agrees to contact outside agency as soon as possible and will provide update to CCL no later than POC date of Tuesday, March 1, 2022. Facility will attempt to find missing file and if unable to will recreate file as much as they can.

Official classification

Type A

Official code

1569.269(a)(6)

Regulation authority

HSC

What the official deficiency says

§1569.269 Enumerated rights; severability (a) Residents of residential care facilities for the elderly shall have all of the following rights: (6) To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs. This requirement was not met based on interviews and documents that show that facility did not seek timely medical care for resident, R1. This is an immediate risk to health and safety of residents in care.

Official plan of correction

Facility agrees to have an in-service for all caregivers and Medication Technicians regarding protocol on reporting changes of condition no later than 3/72022. Acting Administrator agrees to submit planned training date(s) and what subjects will be trained no later than POC due date, 2/26/2022 An immediate civil penalty is being assessed today in the amount of $500 for a violation that resulted in the sickness or injury of a resident in care. Additional Civil Penalty pending review per H & S Code Section 1548(d).

Deadline recorded: Feb 26, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87466

Regulation authority

CCR

What the official deficiency says

87466 Observation of the Resident. Licensee shall ensure that residents are...observed for changes in physical,mental,emotional & social functioning & that appropriate assistance is provided when such observation reveals unmet needs. When changes...or deterioration of mental ability or a physical health condition are observed, licensee shall ensure that such changes are documented & brought to the attention of the resident's physician & responsible person, if any. Requirement wasn't met based on interviews & documents that show that some staff didn't observe bruising or pressure injury on R1 despite assisting with care & some observed injuries but didn't report. This is an immediate risk.

Official plan of correction

Facility agrees to have an in-service for all caregivers and Medication Technicians regarding how to observe residents for changes in condition no later than 3/72022. Acting Administrator agrees to submit planned training date(s) and what subjects will be trained no later that POC due date, 2/26/2022

Deadline recorded: Feb 26, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87208(a)(2)

Regulation authority

CCR

What the official deficiency says

87208(a)(2) PLAN OF OPERATION. Each facility shall have and maintain a current, written definitive plan of operation. (2) A copy of the Admission Agreement, containing basic and optional services. ***This requirement is not met as evidence by: Based on a review of records and interviews, , Licensee did not follow program plan as shown by call button logs. This poses an immediate Health and safety risk for residents in care. **Civil penalty issued in the amount of $250.00 for repeat violation within 12 months.

Official plan of correction

Licensee to ensure resident assistance is provided in a timely manner. Licensee to draft a policy regarding calls for assistance by residents and ensure all staff are trained on the policy. Licensee to submit the policy to CCL by POC date. Licensee to submit signed staff training logs to verify staff training to CCL in order to clear the deficiency by 10/04/2021.

Deadline recorded: Sep 27, 2021. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87211(a)(1)(B)

Regulation authority

CCR

What the official deficiency says

87211(a)(1)(B) REPORTING REQUIREMENTS. ..Licensee shall report to the Department…within 7 days..Any serious injury as determined by the attending physician and occurring while the resident is under facility supervision. ***Based upon documents reviewed, statements, and photographs, this requirement not met as evidenced by: Facility did not report timely R1’s fall which resulted in injury and bruising. This posed an immediate risk to health and safety of resident.

Official plan of correction

Facility will train all staff on the reporting requirements of 87211. Outline of proposed training due by POC with training completion proof to follow in order to clear the deficiency.

Deadline recorded: Oct 4, 2021. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87555(b)(27)

Regulation authority

CCR

What the official deficiency says

87555(b)(27) General Food Service Requirements. All kitchen areas shall be kept clean and free of litter, rodents, vermin and insects. ***Based upon observations, this requirement has not been met as evidenced by: LPA observed kitchen floor; food storage areas and carts in a dirty state. This posed an immediate risk to the health of the residents in care.

Official plan of correction

Cleared at time of visit. Subsequent visits show that kitchen has been cleaned and areas previously noted met regulation.

Deadline recorded: Aug 23, 2021. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87555(b)(9)

Regulation authority

CCR

What the official deficiency says

87555(b)(9) General Food Service Requirements… Procedures which protect the safety, acceptability and nutritive values of food shall be observed in food storage, preparation and service.***Based upon observations, this requirement not met as evidenced by: opened food observed stored without labels or dates. This posed an immediate risk to the health of the residents in care.

Official plan of correction

Administration to train all staff handling food in the requirements of 87555 and will provide proof of training by POC date in order to clear the deficiency.

Deadline recorded: Sep 6, 2021. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87303(e)(2)

Regulation authority

CCR

What the official deficiency says

87303e(2) Maintenance and Operation. 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 degree C) and not more than 120 degree F (49 degree C). ***Based upon statements and reviewed documents, this requirement has not been met as evidenced by: Hot water not available to residents for periods during the months of May and June, 2021. This posed an immediate risk to health and welfare of residents.

Official plan of correction

Administration will test hot water daily for 7 days and submit results to CCL along with a written plan on how the facility will insure adequate hot water for residents going forward. Log and plan to be submitted to CCL by POC date in order to clear the deficiency.

Deadline recorded: Sep 6, 2021. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

1569.269

Regulation authority

HSC

What the official deficiency says

1569.269 H & S (a)(6) Residents of residential care facility for the elderly shall have all of the following rights: (6) to care, supervision, and services that meet their individual needs..delivered by staff ..in sufficient numbers, qualifications, and competency to meet their needs. ***Based upon statements and reviewed records, this requirement has not been met as evidenced by: Front desk staff did not respond to R1’s call for help in a timely way following a fall. This posed an immediate risk to safety and health of resident in care.

Official plan of correction

Disciplinary action has been taken with the staff involved. Administration will submit a written plan that outlines protocols put in place that will prevent the future occurrence of front desk failure to respond to residents calls in a timely manner. Plan to be submitted to CCL by POC date in order to clear the deficiency.

Deadline recorded: May 7, 2021. A deadline is not proof that correction was completed.