CORNERSTONE ASSISTED LIVING

Official classification

Type B

Official code

87303(i)(1)(B)

Regulation authority

CCR

What the official deficiency says

(i) Facilities shall have signal systems which shall meet the following criteria: (1) All facilities licensed for 16 or more and all residential facilities having separate floors or buildings shall have a signal system which shall: (B) Transmit a visual and/or auditory signal to a central staffed location or produce an auditory signal at the living unit loud enough to summon staff. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA and admin observation , the licensee did not comply with the section cited above in that auditory signal system alarm was not loud enough to summon staff. In additon, door signal system in first floor heading toward back parking lot exit next to restrooms was not turned on which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/24/2025 Plan of Correction Licensee turned on signal system during inspection visit. Submit LIC9098 self certifying that door alarm system will continue to be kept on at all times 24/7 by Plan of Correction due date 11/24/25. In addition, LIC9098 self certifying that batteries will/did get replaced for system to be loud enough to summon staff.

Official classification

Type A

Official code

87465(a)

Regulation authority

CCR

What the official deficiency says

Incidental Medical and Dental Care 87465(a)4 The licensee shall assist residents with self-administered medications as needed. This requirement is not met as evidenced by: Based on interviews and records review, facility did not dispense R1's medications as prescribed. This poses an immediate health, safety, and/or personal rights risk to residents in care.

Official plan of correction

Administrator to submit scheduled training date with a self-certification to CCLD by POC date 07/16/2025.

Deadline recorded: Jul 16, 2025. 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). 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 has not been met as evidenced by A/C was observed non-functional resulting in increased temperatures within parts of facility. This poses a potential health and safety risk to residents in care.

Official plan of correction

Licensee to submit plan on how they will ensure resident safety from heat in areas affected by non-functional A/C by POC due date of 7/3/2025. Additionally, Licensee shall submit self-certification to CCL of functional A/C when new unit has been installed.

Deadline recorded: Jul 3, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87465(h)

Regulation authority

CCR

What the official deficiency says

(h) The following requirements shall apply to medications which are centrally stored: This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and record review, the licensee did not comply with the section cited above in ensuring that residents' centrally stored medication records are maintained in compliance with regulation which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/17/2025 Plan of Correction Licensee to submit proof of medication training completed by all facility medication technicians addressing regulatory compliant record keeping of the centrally stored medication records which accurately reflect the prescription labels on each medication to CCL by POC due date 2/17/2025.

Official classification

Type A

Official code

87465(a)(4)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care (a) …. (4) The licensee shall assist residents with self-administered medications as needed. This requirement was not met as evidenced by: Based on observation, interviews, and record review, the Licensee did not ensure R2 received the correct medication as prescribed which poses an immediate health, safety, and/or personal rights risk to residents in care.

Official plan of correction

Licensee has already conducted medication training on ensuring the correct medication and dosages are given to residents in care per the physician's order. Additionally, Licensee counselled the staff member who made the medication error. LPA cleared POC during today's visit.

Deadline recorded: Oct 23, 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) A written report shall be submitted to the licensing agency...within seven days of the occurrence of…. (D) Any incident which threatens the welfare, safety or health of any resident….This requirement was not met as evidenced by: Based on observation, interviews, and record review, the Licensee did not ensure CCL received Unusual Incident/Injury reports for two falls R4 experienced which poses a potential health, safety, and/or personal rights risk to residents in care.

Official plan of correction

Licensee will conduct in-service training with all care staff on the proper reporting requirements as outlined in CCR 87211. Licensee will submit a signed training log with names of attendees, date, time, location and subject of the training, and who conducted the training to CCL by POC due date 11/22/2024.

Deadline recorded: Nov 22, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87468.2(a)(4)

Regulation authority

CCR

What the official deficiency says

87468.2(a) … [R]esidents ... shall have […] the following personal rights: (4) To...supervision...that meet their individual needs.... This requirement was not met as evidenced by: Based on review of facility submitted UIR, resident record review, and interviews with facility staff, facility did not provide adequate supervision for R1, which resulted in R1's elopement from the facility. This poses an immediate health, safety, and personal rights risk to residents in care.

Official plan of correction

Administrator to provide in-service training for all staff to be alert and aware of residents wandering and/or exiting the facility and review of the facility's protocols in these situations. Administrator to submit scheduled training date to CCLD by POC date 10/23/2024 and submit completed signed training log to CCLD by POC due date 11/8/2024 EOB.

Deadline recorded: Oct 23, 2024. 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)In addition to the requirements as specified in Section 87208..., the plan of operation shall address the needs of residents with dementia, including:Safety measures to address behaviors and ingestion of toxic materials. This requirement is not met as evidenced by: Based on record review, self-incident report dated 05/01/2024, and interviews with Administrator, R1 eloped without staff knowledge on 4/24/2024. The facility did not comply with section above,when R1 eloped from facility, which poses an immediate Health, Safety risk to residents in care.

Official plan of correction

Administrator to ensure all exits have working auditory alarms that staff can hear or receive a signal when doors are opened. In addition Administrator to provide proof of scheduling of elopement training for staff (by EOB 5/10/2024). Administrator to reassess R1 for change in condition.

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

Official classification

Type B

Official code

87405(d)(1)

Regulation authority

CCR

What the official deficiency says

87405(d)(1) Administrator - Qualifications and Duties (d) The administrator shall have the qualifications specified in Sections 87405(d)(1) through (7). If the licensee is also the administrator, all requirements for an administrator shall apply.(1)Knowledge of the requirements for providing care and supervision appropriate to the residents. This requirement was not met. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above, facility staff failed to ensure staff S1 wears face mask coverings, while providing care to residents which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/03/2022 Plan of Correction Facility to send in written plan, that all staff have knowledge of the requirements of Covid-19 precautions, CCL and CDC.