CLEARWATER AT SONOMA HILLS

Official classification

Type A

Official code

87463(g)(1)

Regulation authority

CCR

What the official deficiency says

87463(g)(j) Reappraisals-The licensee shall ensure corresponding changes are made in the care and supervision provided to the resident. The licensee shall evaluate staffing needs to ensure that there is a sufficient number of direct care staff, as specified in Section 87411, Personnel Requirements – General, to support each resident's physical, social, emotional, safety and health care needs, as identified in their current appraisal. Per review of records, R1 is not to be in the community/out of the facility unsupervised per medical assessment, and review of resident records. R1 exited and AWOL the facility without staff’s knowledge on 8/14/25, 8/2/25, 6/6/25, and 5/8/25. This is a risk to health & safety of resident in care.

Official plan of correction

Licensee to ensure that R1's care plan reflects current needs of the resident, and ensure sufficienting staffing at all times to ensure all R1's needs are met, including not exiting the building without staff's knowledge and supervision. Submit how the facility plans to meet R1's current needs, including their wandering/awol behavior, helping to ensure R1's health & safety. Proof of correction to be submitted by 8/25/25. POC due by 8/21/25.

Deadline recorded: Aug 20, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87211(a)(1)

Regulation authority

CCR

What the official deficiency says

87211(a)(1)-Reporting Requirements-Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: 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's name, age, sex and date of admission; date and nature of event; attending physician's name, findings, and treatment, if any; and disposition of the case Per record review, The Department was not in receipt of R1’s AWOL incidents that occurred on 5/8/25 and 6/6/25. This is a risk to personal rights and/or health & safety of resident in care..

Official plan of correction

Licensee to ensure all resident incidents are reported as required per regulations. Submit incident reports on R1 of AWOL occurrences on 6/6/25, and 5/8/25. Submit plan of future compliance with this regulation. POC due 9/5/25.

Deadline recorded: Sep 5, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87411(C)(1)

Regulation authority

CCR

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 LPA's staff record reviews, staff S1 and S4 lack required first aid certification, the licensee did not comply with the section cited above in [2] out of [6], which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/02/2025 Plan of Correction Licensee/Administrator to ensure staff S1 and S2 obtain required first aid certification. Submit proof of first aid certification no later than 7/2/25. POC due 7/2/25.

Official classification

Type A

Official code

87555(b)(9)

Regulation authority

CCR

What the official deficiency says

87555(b)(9)- General Food Service Requirements- The following food service requirements shall apply: Procedures which protect the safety, acceptability and nutritive values of food shall be observed in food storage, preparation and service. This requirement is not met as evidenced by: Deficient Practice Statement LPA observed open commercial size boxes/bags of chocolate chips, pancake mix, walnuts, horchata drink mix, and jello pudding mix, open in the kitchen/pantry with no means to close the packages securely in order to prevent them from potential contamination. LPA obtained pictures for the file, the licensee did not comply with the section cited above in which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/25/2025 Plan of Correction Licensee to ensure food supplies are stored appropriately, using procedures which protect the safety, acceptability and nutritive values of food items. Submit plan of correction in how the facility will correct the deficiency, and the plan to hold an in-service training with staff on the policy and procedures of food storage. Proof of training to, include trainer, topics, date, time spent, attendees, and employee signatures. Submit proof of training by 4/1/25. Submit plan of correction by 3/25/25.

Official classification

Type B

Official code

87468.1(a)(1)

Regulation authority

CCR

What the official deficiency says

87468.1(a)(1) Personal Rights of Residents in All Facilities- Residents in all residential care facilities for the elderly shall have all of the following personal rights: To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement was not met as evidenced by: LPA interviews identified that staff, S2, made an inappropriate comment during the meeting held to address a resident's (R1) care plan; In summary, the comment regarded the hygiene care plan, previously this type of plan was referred to as the " grandma and grandpa stinky club. " This is a potential risk to residents' personal rights and/or risk to health and safety.

Official plan of correction

Licensee/Administrator to ensure that no residents personal rights are violated, per regulation. Contact Sonoma County Ombudsman Agency and schedule a " Resident Personal Rights " training for care staff, including S2. Once the training is obtained from the Ombudsman Agency for facility staff, submit proof of training, and plan of facility future compliance with this regulation. POC due by 5/3/24.

Deadline recorded: May 3, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

1569.69(a)

Regulation authority

HSC

What the official deficiency says

(a) Each residential care facility for the elderly licensed under this chapter shall ensure that each employee of the facility who assists residents with the self-administration of medications meets all of the following training requirements: This requirement is not met as evidenced by: Deficient Practice Statement Based on file/record review, the licensee did not comply with the section cited above in 4 out of 4 medication technician staff files/records lacked required inital and/or annual medication administration trainining documentation, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/18/2024 Plan of Correction Licenssee to submit a plan of correction regarding how they will bring this citaion into complaince, including staff obtaining required medication training. Then follow up with proof of the minimum required medication training for idientified medication technicians (see documented staff names provided) within 45-days.

Official classification

Type A

Official code

87555(b)(23)

Regulation authority

CCR

What the official deficiency says

(b) The following food service requirements shall apply: (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 the observed food found left uncovered on the kitchen counter and several instances of unsealed/uncovered food in the walk-in refrigerator and freezer as well as in the dried goods storage room in the main kitchen, the licensee did not comply with the section cited above in several instances which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/18/2024 Plan of Correction Facility to hold an in-service trainig with all kitchen staff regarding proper food storage. Submit a plan of correction regarding how they plan to correct this citation to bring the facility into compliance within 24-hours. Them submit proof of completed training for all kitchen staff within 10-days.

Official classification

Type B

Official code

1569.625(b)(1)

Regulation authority

HSC

What the official deficiency says

(1) The department shall adopt regulations to require staff members of residential care facilities for the elderly who assist residents with personal activities of daily living to receive appropriate training. This training shall consist of 40 hours of training. A staff member shall complete 20 hours, including six hours specific to dementia care, as required by subdivision (a) of Section 1569.626 and four hours specific to postural supports, restricted health conditions, and hospice care, as required by subdivision (a) of Section 1569.696, before working independently with residents. The remaining 20 hours shall include six hours specific to dementia care and shall be completed within the first four weeks of employment. The training coursework may utilize various methods of instruction, including, but not limited to, lectures, instructional videos, and interactive online courses. The additional 16 hours shall be hands-on training. This requirement is not met as evidenced by: Deficient Practice Statement Based on file/record review, the licensee did not comply with the section cited above in 4 out of 6 direct care staff files/records missing required inital trainining documentation, including medication administration training for medication technicians, and 5 out of 6 staff files/records missing required annual training which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/18/2024 Plan of Correction Licenssee to submit a plan of correction regarding how they will bring this citaion into complaince, including staff obtaining required medication training. Then follow up with proof of the minimum required initial and annual medication training for idientified medication technicians (see documented staff names provided) within 30-days. Lastly, follow up within proof of the minimum required initial and annual training hours for identified staff (see documented staff names provided) completed within 45-days.

Official classification

Type B

Official code

87211(a)(1)

Regulation authority

CCR

What the official deficiency says

87211(a)(1) Reporting Requirements-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's name, age, sex and date of admission; date and nature of event; attending physician's name, findings, and treatment, if any; and disposition of the case, This requirement was not met as evidenced by: LPA's investigation finding that a resident's (R1) medication had not been centrally stored as required, and had been sent out of the community with another resident's medications during the discharge of R2. This is a potential risk to residents personal rights.

Official plan of correction

Administrator to submit an incident report as required, and to submit facility policies and procedures regarding reporting requirements. Submit a plan of future compliance-all due by 12/29/23.

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

Official classification

Type A

Official code

87355(e)(3)

Regulation authority

CCR

What the official deficiency says

(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: (3) Request a transfer of a criminal record clearance as specified in Section 87355(c) or 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 1 staff member was not associated to the facility. Furthermore, LPAs contacted the Santa Rosa Regional Office search the employee name and the employee was not found to be associated to Clearwater at Sonoma Hills. This poses an immediate health, safety or personal rights risk to residents in care.

Official plan of correction

POC Due Date: 03/29/2023 Plan of Correction Plan of Correction shall include that the licensee associate employee to the facility and submit plan on future compliance with this regulation. POC due date March 29, 2023.

Official classification

Type A

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 record review, the licensee did not comply with the section cited above in 4 out of 5 staff members did not have a current First Aid as required by Title 22 regulations. This poses an immediate health, safety or personal rights risk to persons in care

Official plan of correction

POC Due Date: 03/29/2023 Plan of Correction Plan of Correction all 4 staff need to obtain First Aid training as required; Submit copies of all 4 first aid training certificates by due date April 5, 2023. Furthermore, Licensee shall submit a plan for future compliance with this regulation by March 29, 2023.

Official classification

Type A

Official code

87309(a)

Regulation authority

CCR

What the official deficiency says

87309 Storage Space (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. (1) Storage areas for poisons, and firearms and other dangerous weapons shall be locked. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, LPAs observed 1 cleaning cart containing cleaners/toxins/disinfectants not being locked and staff was inside a Resident unit and away from the cart. This poses a Immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/29/2023 Plan of Correction Plan of Correction shall include staff training and the licensee to ensure that all toxins, disinfectants and cleaners are inaccessible to residents in care. Submit proof of in-service training on April 7, 2023 regarding the storage of toxins and cleaners. Furthermore, submit plan of correction and future compliance regarding this regulation by POC due date by March 29, 2023.

Official classification

Type A

Official code

87465(c)(2)

Regulation authority

CCR

What the official deficiency says

Incidental Medical & Dental Care 87465(c)(2) If the resident's physician has stated in writing that the resident is unable to determine his/her own need for nonprescription PRN medication, but can communicate his/her symptoms clearly, facility staff designated by the licensee shall be permitted to assist the resident with self-administration, provided all of the following requirements are met: (2) Once ordered by the physician the medication is given according to the physician's directions. This requirement is not met as evidenced by: LPA reviewed incident report on resident medication errors, and interviewed staff- Three(3) residents received medications in error, medications were not provided as ordered by the Physician. This is a risk to residents Health & Safety. Civil Penalty assessed in the amount of $1000.

Official plan of correction

Licensee to ensure all residents receive medications as prescribed the Physician. Licensee to hold an in-service with all staff medication technicians regarding " Resident Medication Assistance " . Submit proof of training by 11/3/22. Submit plan of correction by 10/28/2022.

Deadline recorded: Oct 28, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87555(b)(9)

Regulation authority

CCR

What the official deficiency says

87555 (b)(9) General Food Service-Requirements (b) The following food service requirements shall apply: (9)Procedures which protect the safety, acceptability and nutritive values of food shall be observed in food storage, preparation and service. This requirement was not met as evidenced by: LPA reviewed incident report of meat that was undercooked being served to memory care residents. Residents did consume the food. This is a health and safety risk to residents in care.

Official plan of correction

Licensee to ensure that all food served to residents is handled appropriately, cooked as required for health and safety of residents who eat the food. Retrain staff who cook and prepare food/meals regarding preparation and service to residents in care, ensuring safety practices at all times. Submit proof of training by 11/3/22. Submit plan of correction by 10/28/2022.

Deadline recorded: Oct 28, 2022. 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(b)(2)Care of Persons with Dementia - Safety measures to address behaviors such as wandering. ***Based on incident report Resident R1 & R2 eleoped from facility without staff knowledge , the facility failed to take safety measures to address behaviors such as wandering for residents R1 & R2 which poses an immediate Health, Safety risk to residents in care. As per staff interviews and incident reports, residents left the facility w/out staff knowledge. In both cases they left facility & were alert by individuals that observed residents being at risk., one resident wandered away from the facility and the other resident wandered outside to the front of the assisted living facility.unsupervised.

Official plan of correction

Licensee agrees to ensure elopement plan; and address frequency of awol drills for staff-training with all MC staff, regarding elopment and wandering behaviors. Proof of training with participants signature, trainer, & date of training; and elopement plan, as well as what is the facility plan for avoiding elopements, to be submitted to CCL by 6/15/22. Date for schedule staff training & elopement plan to be submitted to CCL by 6/3/22.

Deadline recorded: Jun 3, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(c)(2)

Regulation authority

CCR

What the official deficiency says

(c) If the resident's physician has stated in writing that the resident is unable to determine his/her own need for nonprescription PRN medication, but can communicate his/her symptoms clearly, facility staff designated by the licensee shall be permitted to assist the resident with self-administration, provided all of the following requirements are met: (2) Once ordered by the physician the medication is given according to the physician's directions. This requirement is not met as evidenced by: Deficient Practice Statement LPA's review of resident incidents, R1 12/5, R2 11/20, R3 3/20/22, R4 11/20, & R5 10/12 & 10/13, residents had not received their medication as prescribed by the Physician. Based on LPA's record reviews on resident incident reports, the licensee did not comply with the section cited above in [5] out of [5] resident assistance with prescribed medications which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/24/2022 Plan of Correction Licensee to ensure that all staff that handle medications, and assist residents with their medications, are in-serviced regarding medication assistance, and also ordering medication refills in a timely manner for residents in care. The plan of correction is due no later than 3/24/22. Provide proof of training as listed above, include Trainer-Topics- Date/Time spen-Attendees-due 1/30/22.

Official classification

Type A

Official code

87465(a)(5)

Regulation authority

CCR

What the official deficiency says

Incidental Medical and Dental Care 87465(a)(5)The licensee shall assist residents with self-administered medications as needed. This requirement has not been met as evidence by: LPA's observations, review of records, and interviews with Administrator and Health Services Director regarding the incident reports submitted on medication errors by staff assisting residents, (R1through R5, with prescribed medications and failing to ensure medications are given as prescribed. This ia an immediate health and safety risk to residents in care.

Official plan of correction

The facility Administrator will ensure all medication technicians have medication training and ensure that all medication techniicans are observed and trained in all aspects of medication assisstance to the residents in care. Please submit plan of correction, when the medication trainings will be held, and what the topics covered will be, and who will be the Trainer. This is due by 10/4/2021. Submit no later than 10/18/21, with completed medication trainings, with above information, including date/time/attendees as proof of needed and current training.

Deadline recorded: Oct 4, 2021. A deadline is not proof that correction was completed.