MAGNOLIA COURT

Official classification

Type A

Official code

87411(a)

Regulation authority

CCR

What the official deficiency says

Personnel Requirements – General 87411(a) –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 interviews and file review, facility did not provide supervision to R1 resulting in an elopement. The absence/lack of supervision is an immediate risk to the Health, Safety and Rights of residents in care.

Official plan of correction

A $500 immediate civil penalty was assessed, and a $500 penalty for a repeat violation (7/17/2025). Licensee/Administrator to submit in-service retraining to all staff on elopement protocols.

Deadline recorded: Jun 30, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(a)(5)(A)

Regulation authority

CCR

What the official deficiency says

87465(a)(5)Incidental Medical and Dental Care: A plan for incidental medical and dental care...The plan shall encourage routine medical and dental care and provide for assistance...with the following:The licensee shall assist residents...(A) Medications usually prescribed for self-administration which have been authorized by the person's physician. This requirement was not met as evidenced by: Based on review of R1's medication administration record (MAR) there was a missed dose on 2/18/26 which is an immediate health, safety and personal rights risk to residents in care.

Official plan of correction

Executive Director will submit a plan by 6/4/2026 to ensure that all medication technicians review the rules for proper procedures in medication administration and will go through a re-training regarding accurate documentation in the MAR, including the reporting process to CCL for missed medications. Training to be completed by 6/15/2026 and reported to LPA upon completion.

Deadline recorded: Jun 2, 2026. 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

87211Reporting Requirements(a)Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: (1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below. This report shall include the resident's name, age, sex and date of admission; date and nature of event; attending physician's name, findings, and treatment, if any; and disposition of the case.This requirement was not met as evidenced by: Based on review of the Incident Report of 10/27/2024 the report was not provided to responsible parties as required per regulation.

Official plan of correction

Licensee to submit copy of Incident Report of 10/27/2024 to responsible parties of R1 within 5 days of receipt.

Deadline recorded: Jun 2, 2026. 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: A plan for incidental medical and dental care...The plan shall encourage routine medical and dental care and provide for assistance...with the following:The licensee shall assist residents with self-administered medications as needed. This requirement was not met as evidenced by: Based on self-reported incident reports and interview with Executive Director, S1 gave the wrong medication to resident R1 and R2. This is an immediate health, safety and personal rights risk to residents in care.

Official plan of correction

Executive Director will submit a plan by 3/30/2026 to ensure that all medication technicians review the rules for proper procedures in medication administration and will go through a re-training including shadowing assessment with facility's nurse prior to administering medications independently.

Deadline recorded: Mar 27, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

1569.657(a)

Regulation authority

HSC

What the official deficiency says

Health and Safety Code1569.657provides:(a)For any rate increase due to change in the level of care......detailed explanation. This regulation was not met as evidenced by: Based on LPA's observations and review of records, the Licensee failed to provide the additional services that the new level of care and accompanying charges. This serves as an immediate health & safety and personal rights risk to residents in care.

Official plan of correction

LIcensee agrees to have staff review the care plan with resident R1's representative and provide a detailed explanation of the additional services to be provided to R1. A date of the care plan meeting to be provided to LPA by 10/27/25.A copy of the Care Plan signed by R1's representative will be submitted to LPA by 11/01/2025.

Deadline recorded: Oct 24, 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 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 evidence by: Based on incident report and interview, facility failed to provide supervision to R1 resulting in an elopement. The absence of supervision is an immediate risk to the Health, Safety and Rights of resident in care.

Official plan of correction

Administrator submitted proof of training conducted with Memory Care staff on 7/7/25 to CCL on 7/17/25 re: conducting ongoing in-service training about elopement procedures, and will self-certify that all alarms, delayed egress, and sensors in memory Care are functioning by submitting a check-off list for PM Med. Tech. to complete each evening to ensure lights, sensors and alarms are 100% operational. ****A civil penalty is being assessed for $500.00.

Deadline recorded: Jul 17, 2025. 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 Additional Personal Rights of Residents in Privately Operated Facilities (a) ... Personal Rights of Residents... following personal rights: (4) To care, supervision, and services that meet... need delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs.This requirement was not met as evidenced by: :Based on interviews conducted and LPA’s observations of residents being unsupervised during feeding the Licensee failed to ensure that residents were assisted with feeding. This serves as an immediate health & safety and personal rights risk to residents in care.

Official plan of correction

Administrator to provide CCL with an update LIC-500 showing adequate staffing for all shifts by 11/14/2024 and Administrator to provide in-service training for all caregiving staff to review care and feeding of residents in Dementia Care. Administrator to submit scheduled training date to CCLD by POC date 11/14/2024 and submit completed signed training log to CCLD by POC date 11/21/2024.

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

Official classification

Type B

Official code

87468.2(a)(1)

Regulation authority

CCR

What the official deficiency says

87468.2 Additional Personal Rights of Residents in Privately Operated Facilities (a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (1) To have a reasonable level of personal privacy in accommodations...telephone... use of the Internet, and meetings of resident and family groups. This is evidenced by: Based on LPAs observations of photo including resident posted on internet without consent. This poses a potential health & safety and personal rights risk to residents in care.

Official plan of correction

Administrator to provide in-service training for all staff to review resident rights and protocols for using residents’ images on social media. Administrator to submit scheduled training date to CCLD by POC date 11/13/2024 and submit completed signed training log to CCLD by POC date 11/20/2024.

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

Official classification

Type A

Official code

87468.1(a)(11)

Regulation authority

CCR

What the official deficiency says

87468.1(a)(11) 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: (11) To have their visitors, including ombudspersons and advocacy representatives, permitted to visit privately during reasonable hours and without prior notice, provided that the rights of other residents are not infringed upon. Based on record review and interview, the licensee did not comply with the section cited above when they stopped visitation at the direction of the resident’s responsible party which poses an immediate personal rights risk to persons in care.

Official plan of correction

Licensee will ensure that residents rights are maintained. Licensee will submit a self-certification (LIC9098) that all staff had been notified about regulation by POC due date of 09/30/2024.

Deadline recorded: Sep 27, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87303(d)(6)

Regulation authority

CCR

What the official deficiency says

87307(d)(6) Personal Accommodations and Services. All outdoor and indoor passageways and stairways shall be kept free of obstruction. This requirements is not met as evidenced by: Based upon interviews, multiple staff (S1, S2, S3 & S4) stated that they have observed memory care unit doors being blocked by furniture, which poses an immediate health and safety risk to resident in care.

Official plan of correction

Facility agrees to ensure all exits are free from obstruction and submit a written statement on how facility will remain in compliance by POC date 7/10/2024. In addition, facility is to hold an in-service meeting with all caregiving staff to discuss compliance concerns of blocked passageways. Signed meeting attendance to be submitted to CCLD by POC date 7/23/2024.

Deadline recorded: Jul 10, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87464(f)

Regulation authority

CCR

What the official deficiency says

87464(f) - Basic services shall at a minimum include care and supervision as described in Health and Safety Code section 1569.2(c). These requirements were not met as evidenced by: Based upon LPA observation, resident (R1) was found left in soiled clothing (photos taken) In addition, interviews with staff (S3 & S4) stated observing residents being left in soiled clothing and not properly changed.

Official plan of correction

Facility agrees to submit a written statement on how facility will remain in compliance by POC date 7/10/2024.

Deadline recorded: Jul 10, 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(b)(2) Care of Persons with Dementia: Safety measures to address behaviors such as wandering, aggressive behavior and ingestion of toxic materials. Not met as evidence by** Based on a review of facility incident reports and resident records it was found that resident (R1) had eloped from the facility without supervision. R1 is diagnosed with dementia and based upon appraisal, requires special supervision for confusion and wander risk. This is an immediate health & safety risk to resident in care.

Official plan of correction

Facility agrees to conduct staff training regarding elopements & updated R1's Physician's Report to better indicate their capabilities matching the level of care needed. Facility is to submit training date to CCLD by POC date 7/10/2024 and completed training by 7/23/2024. In addition, facility is to submit updated physician's report for R1 by POC date 7/23/2024.

Deadline recorded: Jul 10, 2024. 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) Facility personnel shall at all times be sufficient in numbers & competent to provide the services necessary to meet resident needs…This requirement has not been met as evidence by:** Based on records review of alarm response system and interivews with multiple staff Administrator did not ensure that staff on duty responded in a timely manner to call system to assist residents (R2 & R3) in care. Call bell response times were between 1-3 hours, which poses an immediate risk to the health and safety of residents in care.

Official plan of correction

Licensee failed to ensure staff responded appropriately to call bell system and meet resident care needs in a timely manner. Licensee shall conduct staff training on how call bells will be responded to and provide a 7 day alarm response log to Licensing along with training verification by POC due date 7/11/2024. In addition, Licensee to submit written statement on how future compliance will be met by POC date 6/21/2024.

Deadline recorded: Jun 21, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

1569.625(b)(1)

Regulation authority

HSC

What the official deficiency says

1569.625(b)(1) A staff member shall complete 20 hours, including six hours specific to dementia care, as required by subdivision (a) of Section 1569.626 and four hours specific to postural supports, restricted health conditions, and hospice care, as required by subdivision (a) of Section 1569.696, before working independently with residents. This was not met as evidence by:** Based upon review of staff records it was found that 12 caregiving staff had received hoyer lift training on 6/13/2024, after resident (R1) had already been residing in the facility for several months requiring hoyer lift assistance. This serves as a potential health & safety risk

Official plan of correction

Facility failed to ensure staff had properly completed training requirements for dementia care and hoyer lift prior to staff providing direct care. Licensee agrees to ensure ALL staff that provide caregiving duties have received hoyer lift training. Training to be submitted to CCLD by POC date 6/27/2024. Lastly, faciltiy is to ensure all required training for caregiving staff both initial or annual are on fille.

Deadline recorded: Jun 27, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.1(a)(8)

Regulation authority

CCR

What the official deficiency says

87468.1 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: (8) To have their representatives regularly informed by the licensee of activities related to care or services, including ongoing evaluations, as appropriate to their needs. This requirement was not met as evidenced by: Based on an interview with the Administrator, staff did not adequately check on the resident and in turn provided inadequate information to the Responsible Party.

Official plan of correction

Plan of Correction shall include the Licensee filling out an LIC 9098. In addition, Licensee shall submit a Plan for Future compliance and conduct staff training as it relates to communicating with Responsible Parties. POC due date on November 27, 2023.

Deadline recorded: Nov 27, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87464(d)

Regulation authority

CCR

What the official deficiency says

87464 Basic Services (d) he facility shall be responsible for meeting the resident's needs as identified in the pre-admission appraisal specified in Section 87457, Pre-admission Appraisal and providing the other basic services specified below, either directly or through outside resources. Based on interviews, record review conducted, Faciltiy did not ensure the regulation above when they did not follow instructions from home health agency for R1 This is a potential health, safety and personal rights risk to residents in care.

Official plan of correction

Current Administrator developed communications logs with assignment sheet and care plans for staff to ensure that all staff are aware of changes in residents care needs. In addition Administrator developed a ledger for progress notes which allows progress notes to be audited POC corrected.

Deadline recorded: Dec 2, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

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: Records and interviews revealed that the facility delayed medical treatement for R1. This poses a pontential health and safety risk to residents in care.

Official plan of correction

Facility to submit poof of in-service, that they understand when to seek medical care for residents. Administrator to send proof of in-service by POC due date 10/11/22, to LPA Walters.

Deadline recorded: Oct 11, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87705(f)(1)

Regulation authority

CCR

What the official deficiency says

87705(f)(1)Care of Persons w/Dementia -The following shall be stored inaccessible to residents with dementia... This requirement is not met as evidenced by: Deficient Practice Statement Based on observation the licensee did not comply w/section cited above in 2 of 2 memory care resident which is an immediate safety risk to person in care. LPA observed Medicated Salve, scissors and mouthwash unlocked and accessible during tour.

Official plan of correction

POC Due Date: 04/11/2022 Plan of Correction Licensee to ensure that toxins, medications & other items that constitute danger to residents are locked & inaccessible at all time. Licensee to conduct an audit of all residents rooms, and inventory items for new residents. Once complete licensee to submit a self-certification that that all items that constitute danger to residents are locked by POC due date of 4/12/22.

Official classification

Type A

Official code

87465(c)(2)

Regulation authority

CCR

What the official deficiency says

Incidental Medical and Dental Care. Once ordered by the physician the medication is given according to the physician's directions. *** Based upon records and statements, this requirement has not been met as evidenced by: Facility reports several incidents where residents’ pain medications were replaced by other, non – narcotic over the counter medications. This posed an immediate risk to the health of the residents in care.

Official plan of correction

Administration shall submit a written plan to CCL by POC date in order to clear the deficiency. Plan shall address the steps to be taken by facility to insure medications are administered as ordered and in compliance with requirements of 87465.

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

Official classification

Type A

Official code

87465(c)(5)

Regulation authority

CCR

What the official deficiency says

Incidental Medical and Dental Care. Each resident's medication shall be stored in its originally received container. No medications shall be transferred between containers. **Based upon statements and records, this requirement has not been met as evidenced by: Facility reports several incidents where residents’ pain medications were replaced by other, non – narcotic over the counter medications. This posed an immediate risk to the health of the residents in care.

Official plan of correction

Administration shall submit a written plan to CCL by POC date in order to clear the deficiency. Plan shall address the steps to be taken by facility to insure medications are stored in original containers and in compliance with requirements of 87465.

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

Official classification

Type A

Official code

87464(f)(1)

Regulation authority

CCR

What the official deficiency says

87646 Basic Services. Basic services shall at a minimum include: (1) Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). Based upon records reviewed and statements made, this requirement has not been meet as evidenced by: On or about 08/22/2021, a resident eloped from the memory care unit unaccompanied by staff and remained away until returned by Vacaville Police 30 to 40 minutes later. This posed an immediate risk to safety of resident. $500 Civil Penalty issued for lack of supervision.

Official plan of correction

Administration to submit report to CCL addressing how the incident occurred and what steps will be put in place going forward to insure that memory care residents are provided adequate supervision in order to avoid potential elopements by residents in care. Submit by POC date in order to cure the deficiency.

Deadline recorded: Nov 1, 2021. A deadline is not proof that correction was completed.