MASONIC GUEST HOME II

Official classification

Type B

Official code

87411(f)

Regulation authority

CCR

What the official deficiency says

(f) All personnel, including the licensee and administrator, shall be in good health, and physically and mentally capable of performing assigned tasks. Good physical health shall be verified by a health screening, including a chest x-ray or an intradermal test, performed by a physician not more than six (6) months prior to or seven (7) days after employment or licensure. A report shall be made of each screening, signed by the examining physician. The report shall indicate whether the person is physically qualified to perform the duties to be assigned, and whether he/she has any health condition that would create a hazard to him/herself, other staff members or residents. A signed statement shall be obtained from each volunteer affirming that he/she is in good health.Personnel with evidence of physical illness or emotional instability that poses a significant threat to the well-being of residents shall be relieved of their duties. 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 that Staff member S1's file was observed to be missing the LIC 503 Medical assessment and Tuberculosis (TB) test which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/15/2025 Plan of Correction Licensee or Administrator will submit to Community Care Licensing a valid LIC 503 Medical Assessment and TB test for S1 by the POC due date of 5/15/2025.

Official classification

Type B

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 observation and record review, the licensee did not comply with the section cited above in Staff member S1's file was observed to be missing current 1st Aid and CPR certification which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/15/2025 Plan of Correction Licensee or Administrator will submit to Community Care Licensing valid CPR and 1st Aid certification for S1 by the POC due date of 5/15/2025.

Official classification

Type B

Official code

87468(b)(1)(A)

Regulation authority

CCR

What the official deficiency says

(b) At the time the admission agreement is signed, a resident and the resident's representative shall be personally advised of and given a copy of: (1) The personal rights of residents specified in Sections 87468.1, Personal Rights of Residents in All Facilities and 87468.2, Additional Personal Rights of Residents in Privately Operated Facilities, as applicable to the facility. (A) The licensee shall have each resident and the resident's representative sign a copy of these rights, and the signed copy shall be included in the resident's record. 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 that the resident files for R1 and R2 did not contain signed Personal Rights documentation which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/15/2025 Plan of Correction Licensee or Administrator will submit to Community Care Licensing Signed Personal Rights documentation for R1 and R2 by POC due date of 5/15/2025.

Official classification

Type B

Official code

87456(a)(2)

Regulation authority

CCR

What the official deficiency says

(a) Prior to accepting a resident for care and in order to evaluate his/her suitability, the facility shall, as specified in this article 8: (2) Perform a pre-admission appraisal. 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 that R1's file did not have a Pre-Placement Appraisal which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/15/2025 Plan of Correction Licensee or Administrator will self certify that a Pre-Placement Appraisal will be completed for all new residents going forward by POC due date of 5/15/2025.

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 observation and record review, the licensee did not comply with the section cited above in that R4 did not have annual reappraisals done for 2021, 2022 and 2023 which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/15/2025 Plan of Correction Licensee or Administrator will self certify that Reappraisals will be completed as frequently as necessary or once every 12 months, whichever occurs first, to note significant changes in condition for all residents going forward by POC due date of 5/15/2025.

Official classification

Type B

Official code

87463(h)

Regulation authority

CCR

What the official deficiency says

(h) The licensee shall request that all residents receive an annual routine visit with a licensed medical professional once every twelve months, either in person or by video appointment. 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 that R2 and R3 did not receive an annual routine visit with a licensed medical professional once every twelve months, either in person or by video appointment have which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/26/2025 Plan of Correction Licensee or Administrator will provide updated Medical Assessments for R2 and R3 and will self certify that they understand that all residents must receive an annual routine visit with a licensed medical professional once every twelve months, either in person or by video appointment. These are to be provided to Community Care Licensing by the POC due date of 5/26/2025

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 observation and record review, the licensee did not comply with the section cited above in that emergency drills are not being completed quarterly which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/15/2025 Plan of Correction Licensee or Administrator will submit to Community Care Licensing proof that an emergency drill has been completed by POC due date of 5/15/2025. Licensee or Administrator will also self certify that Emergency drills will completed quarterly going forward.

Official classification

Type B

Official code

87211(a)(D)

Regulation authority

CCR

What the official deficiency says

87211(a)(D)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:(D) Any incident which threatens the welfare, safety or health of any resident, such as psychological abuse of a resident by staff or other residents, or unexplained absence of any resident. This requirment was not met as evidenced by: during todays inspection, it was disclosed resident R1 walked out of the facility to a neighbor, was upset and yelling and asked they call the police. Facility failed to report to CCL and notify R1s physician. This is a potential risk to the health and safety of residents in care.

Official plan of correction

Facility to send in written plan of correction on how they will ensure they stay in compliance and submit incident report to LPA Canela POC due date 1/24/2024

Deadline recorded: Jan 24, 2024. A deadline is not proof that correction was completed.