VILLAGE AT RANCHO SOLANO ASSISTED LIVING, THE

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

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 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 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 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

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

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

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 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 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 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.