NAPA-SONOMA QUALITY CARE HOME LLC

Official classification

Type A

Official code

87465(h)(2)

Regulation authority

CCR

What the official deficiency says

Incidental Medical and Dental Care- The following requirements shall apply to medications which are centrally stored: 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. This requirement is not met as evidenced by: Deficient Practice Statement LPA observed the medication cabinet had the lock on it, and it had the key inserted and hanging in the lock. Resident medications were stored in this cabinet, and all medications were not secure and inaccessible to residents in care. , the licensee did not comply with the section cited above, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/18/2025 Plan of Correction Licensee to ensure that the medication cabinet that medications are centrally stored in, is locked , secure, and inaccessible to residents in care, and others that do not handle medications. Plan of correction on how facility will comply with this regulation in the future. POC due 9/18/2025.

Official classification

Type A

Official code

87465(h)(5)

Regulation authority

CCR

What the official deficiency says

87465 (h)(5) Incidental Medical and Dental Care- The following requirements shall apply to medications which are centrally stored: Each resident's medication shall be stored in its originally received container. No medications shall be transferred between containers. This requirement is not met as evidenced by: Deficient Practice Statement LPA observed that in a drawer in the kitchen were pre-poured medications, pm medications, for residents in care. Regulation does not allow for pre-poured medications, facility is not in compliance., the licensee did not comply with the section cited above, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/18/2025 Plan of Correction Licensee to ensure that the medications are not pre-poured in advance, facility to ensure compliance with regulation. Submit plan of correction regarding 87465(h)(5) and staff assisting residents with medications as needed/required. POC due 9/18/25.

Official classification

Type A

Official code

87555(b)(9)

Regulation authority

CCR

What the official deficiency says

General Food Service Requirements 87555(b)(9) 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 food not stored appropriately during the inspection; Food leftovers, cold soup in a small pot on the stove, two plates of food sitting in a cold counter-top oven, and leftover cold rice sitting in a rice cooker on the counter. Three small fruit plates uncovered on a shelf in the refrigerator, and a small, uncovered bowl of sliced apple that had turned brown in the refrigerator. LPA observed that food is not being stored appropriately in order to prevent them from potential contamination], the licensee did not comply with the section cited above, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/18/2025 Plan of Correction Licensee to hold an in-service training with staff regarding facility’s storage of food, food preparation, and food services. Submit plan of correction in how the facility will ensure that propper food storage is done by all staff when handling all food in the facility. Submit proof of training by 9/26/25. Proof of training to, include trainer, topics, date, time spent, attendees, and employee signatures. Submit plan of correction by 9/18/25..

Official classification

Type B

Official code

87555(b)(21)

Regulation authority

CCR

What the official deficiency says

General Food Service Requirements 87555(b)(21)- Freezers of adequate size shall be maintained at a temperature of 0 degrees F (-17.7 degrees C), and refrigerators of adequate size shall maintain a maximum temperature of 40 degrees F (4 degrees C). They shall be kept clean and food stored to enable adequate air circulation to maintain the above temperatures. This requirement is not met as evidenced by: Deficient Practice Statement LPA observed the freezer in the garage to be dirty inside, with food stains, food crumbs, and in need of a deep cleaning. , 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: 09/30/2025 Plan of Correction Licensee to ensure that the freezer is cleaned and a maintainance plan for keeping the freezer/appliances imaintained in a clean manner as needed/required. Submit that this correction has been complete, photos, and future compliance. plan. POC due 9/30/25.

Official classification

Type B

Official code

Not listed

Regulation authority

Not listed

What the official deficiency says

87307(a) Personal Accommodations and Services- Living accommodations and grounds shall be related to the facility's function. The facility shall be large enough to provide comfortable living accommodations and privacy for the residents, who reside in the facility. This requirement was not met as evidenced by: LPA observed a resident room that had some facility items stored in it, these are not the resident's personal belongings. LPA obtained pictures. LPA observed a compact refrigerator for facility resident medications. LPA observed facility linens stored in the cabinets that are in the residents room. Per interviews with staff these are linens that belong to the facility. There are other facility items stored in the glass cabinets that are facility belongings. This is a risk to resident's personal rights.

Official plan of correction

Submit photos of resident's R1's room cleared of all facility items, and the refrigerator. Include a written self certification letter of understanding that R1's room and no other resident room is to be used for facility storage. POC due 11/18/24.

Deadline recorded: Nov 18, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87555(b)(8)

Regulation authority

CCR

What the official deficiency says

(b) The following food service requirements shall apply: (8) All food shall be of good quality. Commercial foods shall be approved by appropriate federal, state and local authorities. Food in damaged containers shall not be accepted, used or retained. This requirement is not met as evidenced by: Deficient Practice Statement LPA observed vegetables in the refrigerator that were no longer fresh, and of good quality, some were old and rotting. LPA obtained pictures], the licensee did not comply with the section cited above in storage of food maintaining quality and nutritive values, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/18/2023 Plan of Correction Licensee to ensure they go through both refrigerators, and remove and discard any food items, including vegetables, that are old, rotting, and no longer safe for residents to consume; Also submit a plan on maintaining the food items ensuring that food is fresh, of good quality and nutritive value for thr residents. Plan of correction due 10/19/23.

Official classification

Type A

Official code

87465(h)(2)

Regulation authority

CCR

What the official deficiency says

Incidental Medical and Dental 87465(h)(2) 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. This requirement is not met as evidenced by: Deficient Practice Statement LPA observed the large cabinet with all resident medications to not be locked, and a metal box in the refrigerator with medications that was unlocked, making all medications accessible to residents, and to staff/individuals that should not have access to the medications., the licensee did not comply with the section cited above,which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/18/2023 Plan of Correction Licensee to ensure all medications are locked up and inaccessible to residents in care, any visitors to the facility, and to staff not trained to handle medications. POC due 10/19/23

Official classification

Type B

Official code

87411(c)(1)

Regulation authority

CCR

What the official deficiency says

87411(c)(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 LPA's revord review, staff #3 lacks first aid certification, the licensee did not comply with the section cited above in 1t] out of 4 [(objects) (persons)] [identifiers] which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/20/2023 Plan of Correction Licensee to ensure that all staff have required first aid training; Submit copy of S3's first aid certification to the Licensing Department by POC due date of 10/20/23.

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

Maintenance and Operation 87303(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. LPA observed a resident room and bathroom with garbage cans without tight fitting lids, one of the garbage cans had a dirty diaper and other items used in cleaning and changing the resident. This requirement is not met as evidenced by: Deficient Practice Statement LPA observed a resident room and bathroom with garbage cans without tight fitting lids, one of the garbage cans had a dirty diaper and other items used in cleaning and changing the resident. , 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: 10/20/2023 Plan of Correction Licensee to ensure all facility garbage cans have tight fitting lids to ensure the facility is free from odors, including urine/feces odors, ensuring the facility is sanitary. Submit plan of correction by POC 10/20/23.

Official classification

Type B

Official code

1569.61

Regulation authority

HSC

What the official deficiency says

1569.625(b)(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 LPA's record reviews, S2 and S3 lack intitial training as required by H & S Code, 40 Hrs, with 20 initial hrs prior to working independently, S2 & S3 on shift only during the inspection, the licensee did not comply with the section cited above in [count] out of [total count] [(objects) (persons)] [identifiers] which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/03/2023 Plan of Correction Licensee to ensure all staff , S2, and S3, obtain required initial 40 hour training, the initial 20 hour training as required by H & S to be completed by 11/3/23. Submit proof of the 20 hrs required trainings having been completed, and the plan on ensuring the remainder of the 40 hrs is completed timely. POC due date of 11/03/23.

Official classification

Type B

Official code

87411(f)

Regulation authority

CCR

What the official deficiency says

87411(f)Personnel Requirements – General 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. This requirement is not met as evidenced by: Deficient Practice Statement Based on review of records, Staff #2 & #3 lack a health screening report, including 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: 10/24/2023 Plan of Correction Licensee to ensure that staff #2 and #3 obtain a health screening, including a TB test, and results, by 10/24/23. Submit copies of the documents by POC due 10/24/23.

Official classification

Type A

Official code

87606(c)

Regulation authority

CCR

What the official deficiency says

(c) To accept or retain a bedridden person, other than for a temporary illness or recovery from surgery, a facility shall obtain and maintain an appropriate fire clearance as specified in Section 87202(a). This requirement is not met as evidenced by: Deficient Practice Statement Per file review and observations, the facility has retained a bedridden resident, R1, but does not have the proper fire clearance as required], the licensee did not comply with the section cited above in [count] out of [total count] [(objects) (persons)] [identifiers] which poses an immediate health, safety or personal rights risk to persons in care. Civil Penalty will be assessed in the amount of $500, see LIC421IM.

Official plan of correction

POC Due Date: 10/18/2023 Plan of Correction Licensee tto ensure that residents admitted and residents retained are within the fire clearance approval. Licensee to submit updated facility sketch shwoing all resident rooms and current ambulatory/nonambulatory/bedridden status, submit an LIC200 completed, with the facility sketch by 10/18/23. The Department will request a fire clearance inspection by Local Fire Department. If not able to obtain and/or you don't want to try to obtain a new fire clearance, please submit plan of how you will bring the facility into compliance. POC due 10/19/23.

Official classification

Type A

Official code

87468.2(a)(1)

Regulation authority

CCR

What the official deficiency says

87468.2(a)(1) Additional Personal Rights of Residents in Privately Operated Facilities. 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: To have a reasonable level of personal privacy in accommodations, medical treatment, personal care and assistance, visits, communications, telephone conversations, use of the Internet, and meetings of resident and family groups. This requirement is not met as evidenced by: LPA observed the two staff on duty, S1 & S2, change a resident in the open sitting area by the front door entry of the facility; The resident was exposed to everyone who may walk into the room, staff, visitors, other residents.There was no personal privacy given to the resident when providing incontinent care services. Deficient Practice Statement Based on LPA's observation, the licensee did not comply with the section cited above in [1] out of [3] residents which poses an immediate personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/21/2022 Plan of Correction Licensee to ensure that all staff are in-serviced regarding all " residents rights " in regulations and ensure all residents are given personal privacy when providing personal service/care needs to to residents. Submit copy of training date & time spent, and all attendees by 10/25/22. Plan of correction due 10/21/22.

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: Deficient Practice Statement Based on LPA's [(observation) (interview) (record review)], the licensee did not comply with the section cited above-the garage has been renovated, a room was added and other renovations throughout the garage area, all work was done withoout required permits which poses an immediate health, safety risk to persons in care. Immediate Civil Penalty fine is assessed today in the amount of $500. LPA contacted the Fire Inspector Jim Thompson who came out to the facility and inspected the garage. LPA obtained a copy of Field Inspection Record from the Fire Inspector.

Official plan of correction

POC Due Date: 10/21/2022 Plan of Correction Licensee to ensure that they contact the Planning Department for a permit(s) and contact the Rohnert Park Fire Department, Fire Inspector Jim Thompson, regarding the converted garage to try and obtain approval on the renovations. Submit copy of obtained permit(s), approval and/or orders from Planning Department/Fire Department when received. Licensee to submit plan of correcting this fire safety violation, and continue to keep Licensing Agency updated on the garage conversion status. POC due 10/21/22.

Official classification

Type A

Official code

87468.1(a)(2)

Regulation authority

CCR

What the official deficiency says

Personal Rights 87468.1(a)(2)- Residents in assisted living-ensuring personal rights are not violated at any time. This requirement is not met as evidenced by: Staff observed to come to the front door entry to greet the LPA without a mask on. LPA discussed that all staff are required to wear a mask at all times. Deficient Practice Statement Based on LPA's [(observation), the licensee did not comply with the section cited above in [1] out of [2] staff persons, which poses an immediate health, safety and/or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/21/2022 Plan of Correction Licensee to ensure that staff are wearing appropriate PPE at all times as required. Licensee to hold an inservice with all staff the requirement of wearing an appropriate mask when working at the facility-at all times. Submit proof of inservice with all staff regarding mask requirement, and submit copy of attendees, date & time spent, by 10/24/22. Plan of correction due 10/21/22.