GENESIS RCFE

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 interview and record review, the licensee did not comply with the section cited above, as resident (R1) has not received an annual routine visit with a licensed medical professional within twelve months as their last medical assessment is dated 12/21/2021 which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/06/2026 Plan of Correction Administrator shall provide an updated Medical Assessment for R1 and self certify that they understand that all residents must receive an annual routine visit with a licensed medical professional once every twelve months. POC to be submitted to CCL by 03/06/2026.

Official classification

Type B

Official code

87411(c)(1)

Regulation authority

HSC

What the official deficiency says

87411(C)(1) Personell Requirements, General- All RCFE staff who assist residents with personal activities of daily living shall receive initial and annual training as specified in Health and Safety Code sections 1569.625 and 1569.69. 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 record review, the licensee did not comply with the section cited above in three out of four staff do not have a current First-Aid/CPR certification on file which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/06/2026 Plan of Correction Licensee/Administrator to ensure staff S1, S2, and S3 obtain required first aid certification. Licensee to submit proof of first aid certification for S1, S2, and S3 by 03/06/2026 to CCL.

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 review of records, Staff #4 & #5 lack a health screening report, and #4 lacks TB test and results. the licensee did not comply with the section cited above, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/17/2025 Plan of Correction Licensee to ensure that staff #4 and #5 obtain a health screening, for #4 including a TB test, and results, by 2/17/25. Submit copies of the documents by POC due 10/24/23

Official classification

Type B

Official code

87457(c)

Regulation authority

CCR

What the official deficiency says

(c) Prior to admission a determination of the prospective resident's suitability for admission shall be completed and shall include an appraisal of their individual service needs in comparison with the admission criteria specified in Section 87455, Acceptance and Retention Limitations. This requirement is not met as evidenced by: Deficient Practice Statement Based on file review and interview with Licensee facility did not have pre-Admission appraisals for 2 of 4 residents in the facility which poses a potential risk to residents in care. LPA observed that R1, R2 were admitted without a preappraisal, no care plans are on file.

Official plan of correction

POC Due Date: 02/17/2025 Plan of Correction Licensee agrees to submit a written plan for future compliance in how the following areas are performed; pre-appraisals . In addition, appraisal for R1, R2, with Written plan to be submitted to CCL by POC date of 02/17/2025 to clear POC.

Official classification

Type B

Official code

1569.651(g)

Regulation authority

HSC

What the official deficiency says

(g) If the applicant decides not to enter the facility prior to the facility’s completion of a preadmission appraisal or if the facility fails to provide full written disclosure of the preadmission fee charges and refund conditions, the applicant or the applicant’s representative shall be entitled to a refund of 100 percent of the preadmission fee. This requirement has not been met as evicenced by ***Based on interviews with licensee & outside party and documents obtained, Licensee did not comply with Health & Safety Code regulations provided. This is a potential risk to the health and safety of residents in care.

Official plan of correction

Licensee agrees to comply with regulation cited and refund due and provide a full copy of the admission agreement including preadmission fee/deposit for departments review. Facility has refunded monies.

Deadline recorded: Sep 6, 2024. 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 record review, the licensee did not comply with the section cited above in 4 of 4 staff records reviewed. Records did not contain evidence of completed training. This poses/posed a potential health, safety or personal rights risk to persons in care

Official plan of correction

POC Due Date: 02/09/2024 Plan of Correction Licensee to submit written plan, detailing how facility will conduct and keep track of completed annual staff training. Written plan to be submitted to CCL by POC date of 02/09/2024.

Official classification

Type B

Official code

87457(c)

Regulation authority

CCR

What the official deficiency says

(c) Prior to admission a determination of the prospective resident's suitability for admission shall be completed and shall include an appraisal of his/her individual service needs in comparison with the admission criteria specified in Section 87455, Acceptance and Retention Limitations. This requirement is not met as evidenced by: Deficient Practice Statement Based on file review and interview with Licensee facility did not have preappraisals done for 5 of 5 residents in the facility which poses a potential risk to residents in care. LPA observed that R1, R2, R3, R4 & R5 were admitted without a preappraisal, no care plans are on file.

Official plan of correction

POC Due Date: 02/09/2024 Plan of Correction Facility agree to submit a written plan for future compliance in how the following areas are performed; pre-appraisals . In addition, appraisal for R1, R2, R3, R4, & R5 with all signatures and Written plan to be submitted to CCL by POC date of 02/9/2024

Official classification

Type B

Official code

87463(c)

Regulation authority

CCR

What the official deficiency says

(c) The licensee shall arrange a meeting with the resident, the resident's representative, if any, appropriate facility staff, and a representative of the resident's home health agency, if any, when there is significant change in the resident's condition, or once every 12 months, whichever occurs first, as specified in Section 87467, Resident Participation in Decision Making. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA/Licensee's file review showing that resident's care plans for 2 out of 2 residents (R2 & R3) were not been performed and signed by the resident of their representative within last 12 months. This is a potential risk to the health and safety of residents in care.

Official plan of correction

POC Due Date: 02/09/2024 Plan of Correction Licensee agreed to review all resident's care plans, update them accordingly and send self-certification that this process had been completed to CCL by POC due date.

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 file review and interview, the licensee did not conduct & document an emergency drill within the past quarter. This poses a potential health and safety risk to residents in care.

Official plan of correction

POC Due Date: 02/09/2024 Plan of Correction Licensee agrees to conduct and document disaster drills every 3 months on all shifts with all direct care staff and submit proof to CCL by POC 2/9/2024.

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 dpt.. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the Licensee did not comply with the section cited above in 2 out of 2 fire extinguisher was not serviced since August 4, 2021 which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/13/2023 Plan of Correction Licensee will contact the Fire Department to have fire extinguisher serviced. Licensee agreed to submit self-certification form as a proof of Correction (POC) that fire extinguishers have been serviced and charged by a fire extinguisher service company or the Fire Department by POC due date 1/13/2022.

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: Knives, matches, firearms, tools and other items that could constitute a danger to the resident(s) This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the Licensee did not comply with the section cited above in 1out of 1 kitchen drawer containing knives and other sharps, was witnessed by LPA/Licensee to be unlocked, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/13/2023 Plan of Correction Licensee to ensure that all sharp objects and toxins are stored in a locked storage inaccessible to residents at all times. Licensee to provide training of regulation for caregivers (with signed /dated proof) and submit to CCL by EOB 1/13/2023.

Official classification

Type A

Official code

87309(a)

Regulation authority

CCR

What the official deficiency says

: 87309(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 LPA's observation, the licensee did not comply with the section cited above in 1 out of 1 kitchen sink cabinet containg toxins was unlocked, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/13/2023 Plan of Correction Licensee agrees to conduct an immediate staff training to ensure dangerous items are stored inaccessible at all times. Licensee also agrees to submit staff training and signature sheet to CCL by POC 1/13/2023.

Official classification

Type A

Official code

87468.1(a)(2)

Regulation authority

CCR

What the official deficiency says

87468.1(a)(2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment This requirement is not met as evidenced by: Deficient Practice Statement Based on observation of S1 and S2 not wearing a mask upon LPA arrival. This is an immediate Health and Safety risk to residents in care.

Official plan of correction

POC Due Date: 05/13/2022 Plan of Correction Administrator agrees to immediately conduct a staff training to ensure all staff are wearing masks and wearing them properly while in the facility. Administrator agrees to submit POC to CCL by 5/13/2022.

Official classification

Type A

Official code

87355(e)(2)

Regulation authority

CCR

What the official deficiency says

87355(e)(2) Criminal Record Clearance...Request a transfer of a criminal record clearance as specified in Section 87355(c) This requirement is not met as evidenced by: Deficient Practice Statement Based on observation & record review Administrator didn't comply w/section cited above in 1 out of 4 staff weren't associated to facility which poses a potential health, safety or personal rights risk to persons in care. During visit on 5/12/2022 LPA observed staff S2 was working w/residents and not associated to facility

Official plan of correction

POC Due Date: 05/13/2022 Plan of Correction Admin agrees to associated S2 by POC date 05/13/2022. Admin agrees to ensure any staff working or residing in the facility are fingerprint cleared and associated. Due to Administrators failure to associate S1 to the facility Civil Penalties are being issued today in the amount of $500.00.

Official classification

Type B

Official code

87411(c)(1)

Regulation authority

CCR

What the official deficiency says

87411(c)(1) PERSONNEL REQUIREMENTS GENERAL; Staff shall receive first aid training from persons qualified by such agencies as the American Red Cross. Deficient Practice Statement This requirement is not met as evidenced by: Based on interview with Licensee, the facility did not ensure that all staff have current 1st aid. LPA learned that 4 of 4 staff do not have proof of current first aid certification which poses a potential health & safety risk to residents in care.

Official plan of correction

POC Due Date: 05/31/2022 Plan of Correction Licensee to ensure that all staff have current first aid certification at all times. Licensee to submit proof of First Aid Certification for staff S1, S2, S3 & S4 to CCL by POC date of 5/31/2022.

Official classification

Type B

Official code

87507

Regulation authority

CCR

What the official deficiency says

87507 Admission Agreements: This requirement has not been met as evidence by: Deficient Practice Statement Based on file review & interviews, the licensee did not comply with the section cited above in 4 out of 4, adm agreement of residents in care which poses a potential personal right risk for residents in care.

Official plan of correction

POC Due Date: 05/31/2022 Plan of Correction Licensee agrees to have admissions agreement updated according with Title 22 Regulations under St. Michael license facility on file for all residents. Licensee to submit to CCL copy of all ad. agreements for residents in care by POC date of 5/31/2022.