HACIENDA DEL MAR CARE HOME

Official classification

Type A

Official code

87309(a)

Regulation authority

CCR

What the official deficiency says

(a) Except as specified in subsection (b), the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances, knives, matches, tools, sharp objects, and other similar items which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage. 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 that tKnife drawer did not have lock. Chemicals under sink observed to be unlocked, Lysol spray and disinfectant wipes observed to be in living room accessble to residents. Gallon bottle of Clorax Bleach and gallon bottle of Multi-Purpose Cleaner Solution on floor in walkway of backyard which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/13/2025 Plan of Correction Licensee to submit LIC9098 self certifying that all chemicals must be kept locked and inaccessible to residents by Plan of Correction due date 8/13/2025 to CCL.

Official classification

Type A

Official code

1569.618(c)(3)

Regulation authority

HSC

What the official deficiency says

(c)The facility shall employ, and the administrator shall schedule, a sufficient number of staff members to do all of the following: (3) Ensure that at least one staff member who has cardiopulmonary resuscitation (CPR) training and first aid training is on duty and on the premises at all times. This paragraph shall not be construed to require staff to provide CPR. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA and admin record review, the licensee did not comply with the section cited above in that S2 and S3 does not have First Aid Certification which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/13/2025 Plan of Correction Licensee to submit self certification that staff are signed up to take First Aid Cerification Course by Plan of Correction Due date 8/13/2025. Licensee to submit First Aid/CPR Certification for S2 and S3 by 8/29/2025 to CCL.

Official classification

Type B

Official code

87412(a)

Regulation authority

CCR

What the official deficiency says

(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA observation and record review the licensee did not comply with the section cited above in that there is No LIC503, LIC501 and TB Clearance for S1 and S2 which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/01/2025 Plan of Correction Licensee to submit LIC503,LIC501 and TB Clearance for S1 and S2 to CCL by Plan of Correction due date 9/01/2025.

Official classification

Type B

Official code

1569.695(c)

Regulation authority

HSC

What the official deficiency says

(c) A facility shall conduct a drill at least quarterly for each shift. The type of emergency covered in a drill shall vary from quarter to quarter, taking into account different emergency scenarios. An actual evacuation of residents is not required during a drill. While a facility may provide an opportunity for residents to participate in a drill, it shall not require any resident participation. Documentation of the drills shall include the date, the type of emergency covered by the drill, and the names of staff participating in the drill. This requirement is not met as evidenced by: Deficient Practice Statement Based onLPA observation and record review, the licensee did not comply with the section cited above in that disaster drills are not being conducted quarterly which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/01/2025 Plan of Correction Administrator will conduct a disaster drill and will send a self-certification form (LIC9098) to CCL ensuring that the facility is within compliance by Plan of Correction due date 9/01/2025

Official classification

Type B

Official code

1569.695(c)

Regulation authority

HSC

What the official deficiency says

(c) A facility shall conduct a drill at least quarterly for each shift. The type of emergency covered in a drill shall vary from quarter to quarter, taking into account different emergency scenarios. An actual evacuation of residents is not required during a drill. While a facility may provide an opportunity for residents to participate in a drill, it shall not require any resident participation. Documentation of the drills shall include the date, the type of emergency covered by the drill, and the names of staff participating in the drill. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA's/Administreator observation, interview and record review, the licensee did not comply with the section cited above in having a disaster drill conducted within the last quarter, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/23/2024 Plan of Correction Administrator will conduct a disaster drill and will send a self-certification form (LIC9098) to CCL ensuring that the facility is within compliance by POC due date (8/23/24) to clear the citation.

Official classification

Type B

Official code

87465(h)(6)

Regulation authority

CCR

What the official deficiency says

The licensee shall be responsible for assuring that a record of centrally stored prescription medications for each resident is maintained for at least one year and includes: 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 3 resident records. Facility failed to properly input prescription medicaiton information on the Centrally Stored Medication Records which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/15/2023 Plan of Correction Licensee agrees to reconsile all prescription medication to be properly input on the Centrally Stored Medicaiton Records for 3 out of 3 residents. Copies of the Centrally Stored Medicaiton Records of residents' current medicaitons are to be submitted to CCLD by POC date 9/15/2023.

Official classification

Type B

Official code

87464(f)(3)

Regulation authority

CCR

What the official deficiency says

87464(f)Basic services shall at a minimum include: (3) Three nutritionally well-balanced meals and snacks made available daily, including low salt or other modified diets prescribed by a doctor as a medical necessity, as specified in Section 87555, General Food Service Requirements. This requirement has not been met as evidenced by LPA observation and receipt review and interviews showing that facility is not providing meals that meet Recommended Dietary Allowances. This is a potential risk to residents in care.

Official plan of correction

Facility agrees to submit a planned menu that meets the Recommended Dietary Allowances of the Food and Nutrition Board of the National Research Council by POC due date, 4/18/2023

Deadline recorded: Apr 18, 2023. A deadline is not proof that correction was completed.