VINE RIDGE SENIOR LIVING

Official classification

Type A

Official code

87202(a)

Regulation authority

CCR

What the official deficiency says

87202 Fire Clearance (a) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department, or district providing fire protection services, or the State Fire Marshal. ... This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above in a large ottoman was observed to be blocking the Emergency Exit door at the South-West end of the memory care unit which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

Licensee or Administrator to submit an LIC 9098 Self Certification stating that going forward all exit doors and pathways will be clear and unobstructed to Community Care Licensing by POC due date of 7/10/2026.

Deadline recorded: Jul 10, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

877506(a)

Regulation authority

CCR

What the official deficiency says

87506 Resident Records (a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location... and to licensing agency staff. This requirement is not met as evidenced by: Based on observation & record review, the licensee did not comply with the section cited above in that three (3) of three (3) residents (R1, R2, R3) MARs were not initialed by staff on dates noted in findings which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Licensee or Administrator to provide training in Medication Management record keeping for all staff currently administering medications. Additionally, the facility will provide it’s most recent Medication Management audit to Community Care Licensing (CCL). Proof of training to include training materials and signatures of staff members attending training to be sent to CCL by POC due date of 5/28/2026.

Deadline recorded: May 28, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87211(a)(1)(B)

Regulation authority

CCR

What the official deficiency says

87211 Reporting Requirements (a) Each licensee shall furnish to the licensing agency...(1) A written report shall be submitted to the licensing agency...(B) Any serious injury...while the resident is under facility supervision. This requirement is not met as evidenced by: Based on observation & record review, the licensee did not comply with the section cited above in that an Incident Report was not Submitted for R1 for an injury sustained at the facility which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Licensee or Administrator will submit facility policies and processes for submitting Incident Reports to Community Care Licensing within the regulated time frame. Additionally, the facility will train all staff members on these policies and processes. These policies and processes and proof of staff training are to be submitted to Community Care Licensing by POC due date of 5/13/2026.

Deadline recorded: May 13, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(a)(4)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care (a) A plan for incidental medical... shall be developed...by compliance with the following: (4) The licensee shall assist residents with self-administered medications as needed. This requirement is not met as evidenced by: Based on interview & record review, the licensee did not comply with the section cited above in that on 3/8/2026 medication prescribed for resident R2 was given to resident R1 which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

Licensee or Administrator will submit proof that all of the facility's Medication Aids have retaken " Hour 3 " training as shown in the facility's Medication Training Program to Community Care Licensing by POC due date of 3/13/2026. Additionally, the facility will develop and submit Procedures for Medication Errors to Community Care Licensing by POC due date of 3/13/2026.

Deadline recorded: Mar 13, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.2(a)(19)

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...(19)To have prompt access to review all of their records and to purchase photocopies...shall be provided within two (2) business days... This requirement is not met as evidenced by: Based on interview & record review, the licensee did not comply with the section cited above in that R1's representatives were not provided copies of documents in R1's file within the regulated time frame which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Licensee or Administrator to provide all requested documents to R1's representatives by POC due date of 2/6/2026. Additionally, Licensee or Administrator will submit an LIC 9098 Self Certifying that they have reviewed California Code of Regulations 87468.2 Additional Personal Rights of Residents in Privately Operated Facilities and California Code of Regulations 87506 Resident Records to Community Care Licensing by POC due date of 2/6/2026.

Deadline recorded: Feb 6, 2026. A deadline is not proof that correction was completed.

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 and record review, the licensee did not comply with the section cited above in that staff member S1 had no proof of annual training in their file and staff member S3 had only completed 9.75 hours of annual training which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/28/2025 Plan of Correction Licensee or Administrator to submit proof that staff members S1 and S3 have completed their required annual training to Community Care Licensing by POC due date of 11/28/2025.

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

87303 Maintenance and Operation (a)The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance...for the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by: Based on observation & interview, the licensee did not comply with the section cited above in that a large portion of the floor in the memory care dining/common area floor was in disrepair. The flooring strips were bubbled and loose which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Licensee to provide plans on what is being done mitigate the trip hazard in the memory care dining/common area floor to Community Care Licensing by POC due date of 9/9/2025. Licensee will also provide photographs of the repaired floor as soon the floor repair is completed.

Deadline recorded: Sep 9, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87355(d)(3)

Regulation authority

CCR

What the official deficiency says

(3) The licensee shall submit these fingerprints to the California Department of Justice, along with a second set of fingerprints for the purpose of searching the records of the Federal Bureau of Investigation, or comply with Section 87355(c), prior to the individual's employment, residence, or initial presence in the facility. 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 did not receive Guardian Background Clearance prior to employment at the facility which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/19/2025 Plan of Correction Licensee or Administrator will submit an LIC 9098 Proof of Correction self certifying that staff member S1 will not work at the facility until they have received Guardian background fingerprint check clearance.

Official classification

Type B

Official code

87211(g)

Regulation authority

CCR

What the official deficiency says

87211 (g) Reporting Requirements: The licensee shall notify the Department, in writing, within thirty (30) days of the hiring of a new administrator. This requirement is not met as evidenced by: Based on records review, the licensee did not notify the Department of the change of administrator in writing within thirty (30) days of the hiring of a new administrator back in December 2023, which is a potential risk to the health and safety of residents in care.

Official plan of correction

Licensee agrees to ensure that any changes to the facility will be reported as required by Title 22 Regulations # 87211. Licensee will submit LIC9098 self-certification form that they understand and compliance with regulation to CCL by POC due date.

Deadline recorded: Jul 19, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87412(c)

Regulation authority

CCR

What the official deficiency says

(c) Licensees shall maintain in the personnel records verification of required staff training and orientation. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPAs record review, the licensee did not comply with the section cited above in 5 out of 5 staff records did not maintain in the personnel records verification of required staff training and orientation, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/10/2023 Plan of Correction Licensee to submit a written plan to address staff orientation and completion of required annual training, as well as how facility will show evidence of future completed training. Plan to be submitted to CCL by POC due date of 11/10/2023.

Official classification

Type B

Official code

87463(c)

Regulation authority

CCR

What the official deficiency says

87463 Reappraisals:(c) The licensee shall arrange a meeting with the resident, the resident’s representative,...when there is significant change in the resident’s condition, or once every 12 months. This requirement was not met as evidenced by: Based on record review and interviews, Licensee did not ensure that a documented reassessment was completed following the 8/29/2022 Physician’s Report indicating a significant change in condition. This is a potential risk to the health and safety of residents in care.

Official plan of correction

Facility agrees to submit proof that all staff have been trained on regulations 87463 Reappraisals and 87466 Observation of a Resident no later than POC due date 09/29/2023.

Deadline recorded: Sep 29, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87208(a)

Regulation authority

CCR

What the official deficiency says

87208 Plan of Operation:(a) Each facility shall have and maintain a current, written definitive plan of operation. This requirement was not met as evidenced by: Based on record review and interviews, Licensee did not ensure that their plan of operation was followed by changing care level fees to reflect services provided immediately following a resident’s significant change in condition. This is a potential risk to the health and safety of residents in care.

Official plan of correction

Facility agrees to submit self-certification, that all residents will be assessed following a significant change of condition and that assessment will be documented, no later than POC due date 09/29/2023.

Deadline recorded: Sep 29, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.1(a)(2)

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:(2) To be accorded safe, healthful & comfortable accommodations, furnishings and equipment. This requirement hasn't been met based on LPA observation that 2 of 7 staff did not have a mask on while in common areas of the facility, in violation of official government orders requiring the wearing of face coverings while working under specified conditions. This is a potential risk to health & safety of residents.

Official plan of correction

Administrator agrees to conduct an in-service training with all facility staff to ensure they understand that face coverings continue to be required in a licensed facility for all staff and visitors. Proof of in-service to includes date of training, duration and signature of attendees to be submitted to CCL no later than POC due date, 1/23/2023.

Deadline recorded: Jan 23, 2023. 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, Plan of Operation, the plan of operation shall address the needs of residents with dementia, including: (2) Safety measures to address behaviors such as wandering, aggressive behavior and ingestion of toxic materials. This requirement is not met as evidenced by: Deficient Practice Statement Based on interview and record review, the licensee did not comply with the section cited above in one out of one instance of a memory care resident eloping the facility which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/01/2022 Plan of Correction Facility has assessed each delayed egress/exit to ensure they are functioning properly, increased monitoring and safety checks and resident was put on alert charting. Defiency is cleared.

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, & competent to provide services necessary to meet resident needs. In facilities licensed for 16 or more, sufficient support staff shall be employed to ensure provision of personal assistance & care as required.. Additional staff shall be employed as necessary to perform office work, cooking, house cleaning, laundering, & maintenance of buildings, equipment and grounds. This requirement was not met based on: Per interviews & document review, Licensee did not ensure sufficient staffing. This is an immediate risk to the health and safety of residents in care.

Official plan of correction

Per discussion with Licensee, they are actively recruiting, hiring and training staff. Facility has brought staff from their other facilities to cover shifts. Facility to provide, in writing, their plan to ensure staffing while new staff are being trained by POC due date, 8/31/22.

Deadline recorded: Aug 31, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87464(f)(4)

Regulation authority

CCR

What the official deficiency says

*Amended* 87464 Basic Services (f) Basic services shall at a minimum include:...(4) Personal assistance and care as needed by the resident and as indicated in the pre-admission appraisal, with those activities of daily living such as dressing, eating, bathing and assistance with taking prescribed medications ... This requirement was not met based on: Per interviews & document review, Licensee did not ensure that resident's needs were being met. This is an immediate risk to the health and safety of residents in care.

Official plan of correction

Licensee agrees to submit an updated policy outlining how all staff including but not limited to kitchen staff, caregivers, Medication Technicians and Activity Directors will be notified of resident's needs and how facility will ensure the needs are met by POC due date, 8/312022.

Deadline recorded: Aug 31, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

87303 Maintenance and Operation (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 based on interviews and LPA observation showing that the delayed egress doors in Memory Care are not functioning correctly and there is visible evidence of a plumbing leak on the cealing in Assisted Living. This is an immediate risk to the health asnd safety of residents in care.

Official plan of correction

Facility representative agrees to submit dates of when repairs are planned for by POC due date, 8/20//2022. Facility also agrees to notify LPA once repairs are completed.

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

Official classification

Type B

Official code

87705(I)(5)

Regulation authority

CCR

What the official deficiency says

87705 Care of Persons with Dementia (l) The following initial and continuing requirements shall be met for the licensee to lock exterior doors or perimeter fence gates: (5) Interior and exterior space shall be available on the facility premises to permit residents with dementia to wander freely and safely. This requirement has not been met based on LPA observation showing that the door that goes into the outdoor area automatically locks which does not allow resident to wander freely. This is a potential risk to the personal rights of residents in care.

Official plan of correction

Facility representative agrees to submit date of when door will be repaired to allow for residents to wander freely by POC due date, 8/22//2022. Facility also agrees to notify LPA once repair is completed.

Deadline recorded: Aug 22, 2022. 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... This requirement has not been met as evidenced by interviews confirming that a resident in memory care goes into other resident's rooms and goes through their personal items. This is a potential risk to the personal rights of residents in care.

Official plan of correction

Administrator agrees to conduct an in-service for all staff regarding regulation 87468.2 and will submit a sign-in sheet showing staff have been trained to CCL by POC due date, 7/1/2022.

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

Official classification

Type A

Official code

87705

Regulation authority

CCR

What the official deficiency says

87705 Care of Persons with Dementia (c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following: (4) There is an adequate number of direct care staff to support each resident’s physical, social, emotional, safety and health care needs as identified in his/her current appraisal. This requirement has not been met as evidenced by interview and document review indicating that a resident in Memory Care eloped the facility and staff did not respond to the delayed egress alarm. This is an immediate risk to the health and safety of residents in care.

Official plan of correction

Administrator agrees to submit staffing plan that includes use of staffing agencies, if necessary, to ensure resident's needs are met timely by POC due date, 3/12/2021.

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

Official classification

Type A

Official code

87411

Regulation authority

CCR

What the official deficiency says

87411 Personnel Requirements - General (a) Facility personnel shall at all times be sufficient in numbers, & competent to provide the services necessary to meet resident needs. In facilities licensed for 16 or more, sufficient support staff shall be employed to ensure provision of personal assistance and care as required in Section 87608... This requirement has not been met based on document review and interviews indicating that facility is short staffed resulting in needs being delayed or not met. This is an immediate risk to the health and safety of residents in care.

Official plan of correction

Administrator agrees to submit staffing plan that includes use of staffing agencies, if necessary, to ensure resident's needs are met timely by POC due date, 3/12/2021.

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

Official classification

Type A

Official code

87309(a)

Regulation authority

CCR

What the official deficiency says

87309(a) STORAGE SPACE. 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. ***Based upon observation, this requirement has not been met as evidenced by: Laundry products and cleanser observed accessible to residents. This posed an immediate risk to the health of residents in care.

Official plan of correction

Administrator will conduct additional training for all staff on topics covered by 87309. Proof of training to be submitted to CCL by POC date in order to clear the deficiency.

Deadline recorded: Oct 22, 2021. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(h)(2)

Regulation authority

CCR

What the official deficiency says

87465(h)(2) Incidental Medical and dental Care. Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. ***Based upon observation, this requirement has not been met as evidenced by: LPA observed prescription eye drops in unlocked resident’s room on September 02, 2021. This posed an immediate risk to health and safety of residents in care.

Official plan of correction

Administrator shall provide refresher training to all staff on the topics covered under 87465 and will provide proof of training by POC date in order to clear the deficiency.

Deadline recorded: Sep 20, 2021. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87405(h)(4)

Regulation authority

CCR

What the official deficiency says

87405(h)(4) Administrator – Qualifications and Duties. The administrator shall have the responsibility to: ….(4) Recruit, employ and train qualified staff, and terminate employment of staff who perform in an unsatisfactory manner. ***Based upon statements and records review, this requirement has not been met as evidenced by: S3 and S5 have provided care to residents without all required training. This posed an immediate risk to the residents in care.

Official plan of correction

Administrator will prepare, sign and date a declaration stating that all staff will be trained, as required, prior to any caregiving duties. Administrator will submit proof of training for any staff dispensing medications or providing care giving who have not been trained per requirements of Title Twenty-Two regulations. Declaration and proposed training due by POC date to with follow-up training verification to follow.

Deadline recorded: Sep 20, 2021. A deadline is not proof that correction was completed.