PARKSIDE MANOR

Official classification

Type A

Official code

1569.269(a)(1)

Regulation authority

HSC

What the official deficiency says

Type A: §1569.269 Enumerated rights; severability (a) Residents of residential care facilities for the elderly shall have all of the following rights: (1) To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement has not been met as evidence by: Based on LPA’s/Administrator’s observations and interviews with residents in care, S1 did not ensure that residents’ personal rights were not violated by raising their voice to residents in care, which poses an immediate risk to the health and safety of residents in care.

Official plan of correction

The administrator agrees to contact the Ombudsman or outside agency to schedule personal rights training for all staff including S1. The administrator will ensure residents’ rights are not violated, then submit proof of enrollment to a personal rights training provider to clear the citation by POC due date 6/4/2026.

Deadline recorded: Jun 4, 2026. A deadline is not proof that correction was completed.

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 & record review, the licensee did not comply with the section cited above in that two (2) of five (5) staff files (for staff members S4 & S5) were observed not to have a medical assessment and proof of a negative tuberculosis test in their personal files which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/10/2026 Plan of Correction Licensee or Administrator will submit a valid medical assessment and proof of a negative tuberculosis test for staff members S4 & S5 to Community Care Licensing by POC due date of 3/10/2026

Official classification

Type B

Official code

1569.625(b)(2)

Regulation authority

HSC

What the official deficiency says

(2) In addition to paragraph (1), training requirements shall also include an additional 20 hours annually, eight hours of which shall be dementia care training, as required by subdivision (a) of Section 1569.626, and four hours of which shall be specific to postural supports, restricted health conditions, and hospice care, as required by subdivision (a) of Section 1569.696. This training shall be administered on the job, or in a classroom setting, or both, and may include online training. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation & record review, the licensee did not comply with the section cited above in that five (5) of five (5) staff files (for staff members S1 through S5) were observed not to contain proof of annual training for 2025 which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/10/2026 Plan of Correction Licensee or Administrator to provide proof that staff members S1, S2, S3, S4 and S5 have completed their annual training for 2025 to Community Care Licensing (CCL) by POC due date of 3/10/2026.

Official classification

Type B

Official code

87411(c)(1)

Regulation authority

CCR

What the official deficiency says

(1) Staff providing care shall receive appropriate training in first aid from persons qualified by such agencies as the American Red Cross. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation & record review, the licensee did not comply with the section cited above in that two (2) of five (5) staff files (for staff members S1 & S3) were observed to have expired First Aid certification. which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/10/2026 Plan of Correction licensee or Administrator to submit proof that staff members S1 & S3 have been certified in First Aid Training to CCL by POC due date of 3/10/2026.

Official classification

Type B

Official code

87555(b)(23)

Regulation authority

CCR

What the official deficiency says

(23) All readily perishable foods or beverages capable of supporting rapid and progressive growth of micro-organisms which can cause food infections or food intoxications shall be stored in covered containers at appropriate temperatures. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation & interview, the licensee did not comply with the section cited above in that In the kitchen LPA observed two (2) large containers of eggs that were not refrigerated. Facility staff stated they were not refrigerated for the past 24 hours. which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/10/2026 Plan of Correction Licensee or Administrator will submit proof of Food Service Training for all staff members to Community Care Licensing (CCL) by POC due date of 3/10/2026.

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 & record review, the licensee did not comply with the section cited above in that four (4) of five (5) resident files (for residents R1, R2, R3 & R4) were observed not to have current appraisals. which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/10/2026 Plan of Correction Licensee or Administrator to submit to CCL completed and signed Appraisals for residents R1, R2, R3 & R4 to CCL by POC due date of 3/10/2026.

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 & record review, the licensee did not comply with the section cited above in that the facility is only conducting Emergency Disaster Drills bi-annually which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/10/2026 Plan of Correction Licensee or Administrator to submit an LIC 9098 self certification that in the future Emergency Disaster Drills will be held quarterly to Community Care Licensing by POC due date of 3/10/2026.

Official classification

Type A

Official code

87411(a)

Regulation authority

CCR

What the official deficiency says

87411 Personnel Requirements General (a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. This requirement has not been met as evidenced by: Based on record review and interviews conducted the facility failed to ensure adequate staffing to meet clients needs resulting in R1 AWOL the facility without staff knowledge, which poses an immediate health and safety risk to clients in care.

Official plan of correction

Licensee agrees to submit a plan and updated LIC500 Personnel Report to ensure adequate staffing at the facility at all times. Submit plan to CCL by POC 8/22/2025. Facility to train all staff regarding Care and Supervision, AWOL procedures and staff training to be submitted to Community Care Licensing (CCL) by POC due date 8/22/2025

Deadline recorded: Aug 22, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87307(d)(6)

Regulation authority

CCR

What the official deficiency says

(6) All outdoor and indoor passageways and stairways shall be kept free of obstruction. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above because the back door was held closed with a small metal rod that was stuck into the door through the door frame on the bottom right side which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/15/2024 Plan of Correction It was removed during visit and Administrator stated she shall ensure the door is not held closed with something not approved by the fire department

Official classification

Type A

Official code

87309(a)

Regulation authority

CCR

What the official deficiency says

(a) Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above because LPA observed a gardening machete found on a bench in the backyard and two sheds with no locks on them that store paint and other items which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/15/2024 Plan of Correction Locks were found for the sheds and placed on the doors during visit and the gardening machete was placed in one of the sheds. Administrator stated she shall ensure the sheds are locked when not in use by the staff.

Official classification

Type A

Official code

87355(e)

Regulation authority

CCR

What the official deficiency says

87355(e)(1)Criminal Record Clearance (e)All individuals subject to a criminal record review pursuant to Health & Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department. This requirement was not met as evidenced by: LPA found staff S1 who was fingerprinted but has not received clearance. S1 was in the facility today. This is an immediate risk to the Health & Safety of residents in care.

Official plan of correction

Facility to send in a written plan that they understand regulation and how they will meet it. Facility understands S1 may not be inside the facility or around any residents until proper clearance is received. POC due date 1/4/2024 Facility was issued a $100.00 civil penalty for failure to have proper clearance prior to working, residing or volunteering in a facility.

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

Official classification

Type B

Official code

87458(c)

Regulation authority

CCR

What the official deficiency says

87458(c) Medical Assessment (c)The licensee shall obtain an updated medical assessment when required by the Department. This requirement was not met, As evidenced by: On 10/10/2023 LPA conducted a facility visit and requested facility to obtain a medical assessment, fully completed for R1 and as of today 1/3/2024 the facility failed to comply with needed request. This is a potential risk to the health & Safety of residents in care.

Official plan of correction

Facility agrees obtain a current and fully completed Medical assessment for resident R1. Facility to send in written plan on how facility will meet this requirement and stay in compliance. POC due date 1/22/2024 attention LPA A Canela.

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

Official classification

Type A

Official code

1569.269(a)(6)

Regulation authority

HSC

What the official deficiency says

1569.269(a)(6) Enumerated rights; severability (a) Residents of residential care facilities for the elderly shall have all the following rights: (6) To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs.This requirement was not met, as evidenced By: LPA Canela observed 3 residents sitting outside in the front area, with no staff present. Area is not gated, R1 has Dementia diagnoses and all 3 residents are not able to leave the facility unassisted. This is an immediate risk to the health and Safety of residents in Care

Official plan of correction

Facility to send in written plan/statement on how they will ensure they meet regulation along with staff training. Plan of Correction due 10/1/2022

Deadline recorded: Oct 1, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87303(i)

Regulation authority

CCR

What the official deficiency says

87303(i)(1)Maintenance and Operation (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: Alert staff During todays visit LPA observed and went over the requirement for facility to have workable signal system in all residents rooms. This is a potential risk to the health and safety of residents in care.

Official plan of correction

Facility to send in written plan/statement on how they will ensure they meet regulation. POC due date 10/7/2022 Attention LPA Canela

Deadline recorded: Oct 7, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87203

Regulation authority

CCR

What the official deficiency says

87203 Fire Safety All facilities shall be maintained in conformity with the regulations adopted by the State Fire Marshal for the protection of life and property against fire and panic. This requirement is not met as evidenced by: Based on LPA's observation & interviews, the Facility did not ensure the regulation above when they key locked front door and by locking 1 of 2 perimeter gates with tied string on latch. This is an immediate health, safety and personal rights risk to residents in care.

Official plan of correction

Licensee to send in written statement, they understand regulation, staff training and how facility will be in future compliance -as proof of correction and removing and/or fixing front door key lock and right perimeter gate. (POC) to Community Care Licensing attention LPA Araceli Canela by POC due date 2/12/2022 **Immediate Civil Penalty assessed in the amount of $500.

Deadline recorded: Feb 12, 2022. A deadline is not proof that correction was completed.