IVY PARK AT GLEN COVE

Official classification

Type B

Official code

87463(a)

Regulation authority

CCR

What the official deficiency says

(a) The pre-admission appraisal, as specified in Section 87457, Pre-Admission Appraisal, shall be updated, in writing as frequently as necessary or once every 12 months, whichever occurs first, to note significant changes in condition, as defined in Section 87101, Definitions, and to keep the appraisal accurate. For the purposes of this section, the updated pre-admission appraisal shall be referred to as the reappraisal. 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 4 of 15 resident records. Reappraisals were not updated within the last 12 months, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/19/2025 Plan of Correction Licensee agrees to review resident care plans and make updates as needed. Licensee shall submit Self Certification that resident reappraisals have been completed. Self Certification shall be subitted to CCLD by 12/19/2025.

Official classification

Type B

Official code

87211(a)(1)(A)

Regulation authority

CCR

What the official deficiency says

87211(a)(1)(A)Reporting 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 name.............; attending physician's name, findings, and treatment, if any; and disposition of the case. (A) Death of any resident from any cause regardless of where the death occurred, including but not limited to a day program, a hospital, en route to or from a hospital, or visiting away from the facility. This requirement was not met as evidenced by: The facility failed to report several incidents and the Death report in November 2023 for resident R1. This is a potential risk to the health & safety of residents in care

Official plan of correction

Facility to submit missing incident reports. Death report was provided during todays visit. Facility to send in written plan on how facility will ensure care coordinator/facility staff will send in required reports timely. New administrator to provide proof all staff have been trained in reporting requirements. Written Plan of correction due 5/15/24 & staff training due 5/17/2024

Deadline recorded: May 17, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87705(f)(2)

Regulation authority

CCR

What the official deficiency says

87705(f)(2)Care of Persons with Dementia(f) The following shall be stored inaccessible to residents with dementia:(2) Over-the-counter medication, nutritional supplements or vitamins, alcohol, cigarettes, and toxic substances such as certain plants, gardening supplies, cleaning supplies and disinfectants. This requirement was not met as evidenced by: During the inspection of 2/2/2024 LPA found, cleaning solution, hammer, knife and cup of vitamins accessible to resident R1 and R2. This is an immediate risk to the health and safety of residents in care.

Official plan of correction

Facility to send in written statement on how they will stay in compliance. POC due date 3/5/2024 to LPA A Canela

Deadline recorded: Mar 4, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87355(e)(b)

Regulation authority

CCR

What the official deficiency says

87355(e)(b) Criminal Record Clearance(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility:(2) Request a transfer of a criminal record clearance as specified in Section 87355(c) This requirement was not met as evidenced by: during the inspection of 2/2/2024, LPA discovered staff S1 who was working, had been fingerprinted, but previous Administrator forgot to properly associate S1 to this facility. This is a potential risk to the health and safety of residents in care.

Official plan of correction

Facility immediately processed paperwork to associate S1. Facility to send in written statement on how they will stay in compliance and ensure all new staff and current staff are fingerprint cleared and properly associated to this facility prior to working or volunteering. POC due date 3/5/2024 to LPA A Canela

Deadline recorded: Mar 5, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87463(a)

Regulation authority

CCR

What the official deficiency says

87463(a) REAPPRAISALS. The pre-admission appraisal shall be updated, in writing as frequently as necessary to note significant changes and to keep the appraisal accurate…*** Based on statements and documents, this requirement has not been met as evidenced by: RI’s condition significantly changed since 5/2/2023 appraisal and now requires substantial bed rest due to pressure injury. No update to R1’s appraisal has been made. This poses a potential risk to R1’s health and safety.

Official plan of correction

Administration agrees to produce an updated care plan for R1. Administration to provide a copy of the updated plan to CCL by POC date in order to clear the deficiency.

Deadline recorded: Aug 17, 2023. 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 on self reported incident and interview with Administrator the facility failed to ensure R2's medication was given as prescribed by doctor. Staff found R2 had 2 Fentanyl patches at one time, staff failed to remove one of the patches before applying another one, which poses an immediate health and safety risk to resident in care.

Official plan of correction

Administrator had already conducted medication training and provided proof to LPA to clear citation repeated CITATION $250.00

Deadline recorded: Jun 6, 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-Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. Based on review of incident report and interview with Administrator, this requirement has not been met as evidenced by: Resident R1 left the facility on two occasions, one being at 9pm at night, without the facility knowing or R1 signing out. This is an immediate risk to the health and safety of residents in care. This requirement is not met

Official plan of correction

Facility to ensure R1 plan of care is updated to reflect an AWOL alert POC date 6/6/2023. Caregiver staff to be trained in AWOL protocols/procedures by 6/15/2023- in addition facility to obtain a new medical assessment LIC602 for resident R1 and send in to CCL LPA A Canela when received .

Deadline recorded: Jun 6, 2023. 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 on record review, and interview with Administrator the facility failed to ensure R1's medication was given as prescribed by doctor when S1 accidentaly gave R1 medication for a resident with the same name (R2) which poses an immediate health and safety risk to resident in care.

Official plan of correction

Facility administrator incorporated the use of the medication cart, will submit proof of in service medication training POC due date,7/20/2022 To LPA A. Canela

Deadline recorded: Jul 20, 2022. A deadline is not proof that correction was completed.