BROOKDALE CHANATE

Official classification

Type A

Official code

1569.269(A)(6)

Regulation authority

HSC

What the official deficiency says

§1569.269 Enumerated rights (a) Residents of RCFE shall have all of the following rights: (6) To care, supervision & services that meet their individual needs & are delivered by staff that are sufficient in numbers... & competency to meet their needs. This requirement has not been met as evidence by: Based on LPA’s records review of alarm response report, staff schedules for the month of June 2025 & interviews conducted with staff & residents in care, the facility did not ensure that staff on duty was sufficient to respond in a timely manner to assist residents in care which poses an immediate risk to the health & safety of residents in care.

Official plan of correction

Administrator agrees to submit a plan to ensure staffing is adequate to meet residents’ needs timely. Written plan will be submitted to CCL by POC due date. The Department will be scheduling a meeting to discuss areas of concern and non-compliance.

Deadline recorded: Aug 12, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

87303(a) Maintenance and Operation. The facility shall be clean, safe, sanitary and in good repair at all times. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA's/ED observation, interview and record review, the licensee did not comply with the section cited above in two resident's toilets were observed dirty, one located in the assisted living and one located in the memory care unit. Based on records review, the facility housekeeping schedule revealed that the dirty toilet should have been cleaned today by 10am which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/06/2026 Plan of Correction Administrator agrees to submnit a written plan how the facility will prevent this type of incidents from happening and they will submit written plan to CCL by POC due date to clear the citation.

Official classification

Type B

Official code

87555(b)(9)

Regulation authority

CCR

What the official deficiency says

87555(b)(9) General Food Service Requirements. 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 Based on LPAs observation and interview with administrator the facility failed to label and or cover two prepared left over fruit cups and tray containing at least 38 pieces of food were observed uncover and not labeled which poses a potential health and safety risk to residents in care.

Official plan of correction

POC Due Date: 02/06/2026 Plan of Correction Administrator agrees to conduct a staff training pertaining to food storage and submit written plan how the facility will handle food storage of left overs by POC due date 2/6/26.

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 and dental care shall be developed by each facility...(4) The licensee shall assist residents with self-administered medications as needed. This requirement was not met by: Based on self-incident report the licensee did not comply with section above by not properly assisting R1 with their prescribed medication Namenta 5mg and 10mg resulting in overdosing resident in care, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

Facility to review all resident's medication and will contact an outside vendor to conduct medication training with all med techs. Facility to submit proof of training to CCL by POC due date. **civil penaltiy assessed for repeat violation within 12 months**

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

Official classification

Type B

Official code

1569.269

Regulation authority

HSC

What the official deficiency says

§1569.269 Enumerated rights... a)Residents...shall have all of the following rights:(6) To care, supervision, and services that meet their individual needs...delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs. This requirement was not met by licensee as evidenced by: Based on LPA record review of facility's pendant call button system log, the licensee did not comply with the section cited above in that between 2/9/25 and 2/13/25 residents pushed their pendant call button at least 192 times. Of those 192 times at least 42 never got a response, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Facility to ensure that pendant call button system is in good repair and operational, staff is sufficient to answer calls in a timely manner, when residents are in need of assistance. Facility to submit three day pendant call button system log to CCL showing all calls answered within a timely manner by plan of correction due date. Admin agrees that within 10-12 minutes can be defined as within a timely manner.

Deadline recorded: Mar 12, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87625(b)(3)

Regulation authority

CCR

What the official deficiency says

87625 Managed Incontinence (b) In addition to Section 87611... the licensee shall be responsible for the following:(3) Ensuring that incontinent residents are kept clean and dry and that the facility remains free of odors from incontinence. This requirement was not met by licensee as evidenced by: Based on LPA interviews of facility's pendant call button system log, the licensee did not comply with the section cited above in that two [2] out of [2] residents that require staff assistance to manage and change their briefs waited long periods of time before staff arrived to change them, on least two occasions they waited over an hour, hich poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Facility to conduct resident rights training for all care staff providing direct care to residents. Training to be at least one hour in duration and completed no later than 3/26/25.

Deadline recorded: Mar 26, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87405(a)

Regulation authority

CCR

What the official deficiency says

87405(a) Administrator - Qualifications and Duties(a) All facilities shall have a qualified and currently certified administrator. This requirement is not met as evidenced by: Administrator does not have an actively current Administrator certificate. This poses an immediate health, safety or personal rights risk to residents Deficient Practice Statement Based on LPAs record review, the licensee did not comply with the section cited above in that Administrator's certificate was in renewal status but was subsequently removed from pending status due to not having enough training hours completed and required forms not submitted, which poses an immediate health, safety or personal rights risk to persons in care. **amended to include deficient practice statement language and plan of correction language due to computer printing error.**

Official plan of correction

POC Due Date: 03/06/2025 Plan of Correction Facility to submit plan of to complete the required remaining training hours needed and submit the forms necessary to obtain certificate renewal by plan of correction date of 3/6/25. *amended to correct plan of correction due date due to computer printing error*

Official classification

Type A

Official code

87202(a)

Regulation authority

CCR

What the official deficiency says

(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. Prior to accepting or retaining any of the following types of persons, the applicant or licensee shall notify the licensing agency and obtain an appropriate 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: Deficient Practice Statement Based on LPA and Admin observation and record review, the licensee did not comply with the section cited above in that Automatic Sprinkler System failed inspection per vendor inspection report and the Emergency exit door at the end of the AL hallway (NW exit hall #2) was propped open with a brick, which poses an immediate health, safety or personal rights risk to persons in care. *amended to include deficient practice statement language and plan of correction language due to computer printing error.**

Official plan of correction

POC Due Date: 03/14/2025 Plan of Correction Facility to submit vendor inspection report indicating Automatic Sprinkler System has passed inspection by plan of correciton due date. During visit on 2/19/25, LPA observed brick propping open exit door was removed and exit door closed, this portion of the deficiency is cleared. *amended to add POC language due to computer printing error*

Official classification

Type A

Official code

87355(e)

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: This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA and Admin observation and record review, the licensee did not comply with the section cited above in that S5, S6, S7, S8, S9, S10, and S11 did not have fingerprint clearance, which poses an immediate health, safety or personal rights risk to persons in care. *amended to include deficient practice statement language and plan of correction language due to computer printing error.* ***civil penalties assessed***

Official plan of correction

POC Due Date: 03/06/2025 Plan of Correction Facility to submit LIC9098 self-certifying that S5, S6, S7, S8, S9, S10, and S11 will not work or be present at the facility until fingerprint clearance is obtained and dcoumentation of fingerprint clearance is presnet in each staff's respective staff file. *amended to add POC language due to computer printing error* **civil penalties assessed**

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

(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 is not met as evidenced by: Deficient Practice Statement Based on LPAs and Admin observation, the licensee did not comply with the section cited above in that LPAs observed trash, food scraps and pieces of discarded food items, cup with black substance and white substance, and used paper towels to be discarded and piled up underneath sink in Memory Care kitchen, which poses a potential health, safety or personal rights risk to persons in care.**amended to include deficient practice statement language and plan of correction language due to computer printing error.**

Official plan of correction

POC Due Date: 03/07/2025 Plan of Correction Facility to submit pictures of cleaned Memory Care kitchen sink area including underneath the sink by plan of correction due date. *amended to add POC language due to computer printing error* LPA observed on cleaned sink on 3/5/25. Deficiency cleared.

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 LPAs and Admin observation and record review, the licensee did not comply with the section cited above in that S1, S2, S3, and S4 did not have the required number of training hours completed, which poses a potential health, safety or personal rights risk to persons in care. **amended to include deficient practice statement language and plan of correction language due to computer printing error.**

Official plan of correction

POC Due Date: 03/21/2025 Plan of Correction Facility to submit current completed training hours for S1, S2, S3, and S4 in the amount of hours required per regulation based on thier respective lengths of employment by plan of correciton due date. *amended to add POC language due to computer printing error*

Official classification

Type B

Official code

87625(b)(3)

Regulation authority

CCR

What the official deficiency says

(b) In addition to Section 87611, General Requirements for Allowable Health Conditions, the licensee shall be responsible for the following: (3) Ensuring that incontinent residents are kept clean and dry and that the facility remains free of odors from incontinence. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPAs observation, the licensee did not comply with the section cited above in that LPA observed notable urine smell coming from room next Sauna room in Memory Care, which poses a potential health, safety or personal rights risk to persons in care. **amended to include deficient practice statement language and plan of correction language due to computer printing error.**

Official plan of correction

POC Due Date: 03/07/2025 Plan of Correction Facility to submit LIC9098 self-certifying they have cleaned and addressed the incontinence odor issue from the Memory Care Unit and that they further self-certify that the facility will remain free of incontinence odors at all times. *amended to correct plan of correction due date due to computer printing error*

Official classification

Type A

Official code

87202(a)

Regulation authority

CCR

What the official deficiency says

(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. Prior to accepting or retaining any of the following types of persons, the applicant or licensee shall notify the licensing agency and obtain an appropriate 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: Deficient Practice Statement Based on [(observation) (interview) (record review)], 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.

Official plan of correction

POC Due Date: Plan of Correction

Official classification

Type A

Official code

87355(e)

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: This requirement is not met as evidenced by: Deficient Practice Statement Based on [(observation) (interview) (record review)], 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.

Official plan of correction

POC Due Date: Plan of Correction

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

(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 is not met as evidenced by: Deficient Practice Statement Based on [(observation) (interview) (record review)], 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: Plan of Correction

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) (interview) (record review)], 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: Plan of Correction

Official classification

Type B

Official code

87625(b)(3)

Regulation authority

CCR

What the official deficiency says

(b) In addition to Section 87611, General Requirements for Allowable Health Conditions, the licensee shall be responsible for the following: (b) In addition to Section 87611, General Requirements for Allowable Health Conditions, the licensee shall be responsible for the following: (3) Ensuring that incontinent residents are kept clean and dry and that the facility remains free of odors from incontinence. This requirement is not met as evidenced by: Deficient Practice Statement Based on [(observation) (interview) (record review)], 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: Plan of Correction

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 and dental care shall be developed by each facility...(4) The licensee shall assist residents with self-administered medications as needed. This requirement was not met by licensee in that another resident's medication was administered to R2, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

Facility to conduct medication training and administer written medication test (as outlined in HSC 1569.69(a)(5)) with staff (S1), Med Tech responsible for the error. Facility to submit proof of training to CCL by plan of correction due date. **civil penaltiy assessed for repeat violation within 12 months**

Deadline recorded: Jan 17, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87211(a)(1)(D)

Regulation authority

CCR

What the official deficiency says

87211 Reporting Requirements(a) Each licensee shall furnish to the licensing agency such reports...: (1) A written report shall be submitted to the licensing agency...for the resident within seven days of the occurrence of any of the events...(D) Any incident which threatens the welfare, safety or health of any resident...This requirement was not met by licensee as evidenced by: CCL did not receive an Incident Report for R1's medication error, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Facility to submit LIC9098 self-certifying that facility will submit to CCL an Incident Report in compliance with regulation, by plan of correction due date. (Facility has already satisfied plan of correction, deficiency cleared) **citation is being issued as a result of amendment of 9099D of complaint 21-AS-20241217154914**

Deadline recorded: Jan 10, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87507(f)

Regulation authority

CCR

What the official deficiency says

87507 Admission Agreements (f) The licensee shall comply with all applicable terms and conditions set forth in the admission agreement, including all modifications and attachments. This requirement was not met by licensee as evidenced by: Facility did not provide resident's authorized representative with the correct refund and facility billed resident's authorized representative after resident's departure from facility for incontinence items, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Facility to submit LIC9098 self-certifying they will, to the best of their ability, mitigate billing errors by reviewing all billing statements before issuing to residents and/or their responsible parties, by plan of correction due date.

Deadline recorded: Jan 16, 2025. 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 and dental care shall be developed by each facility...(4) The licensee shall assist residents with self-administered medications as needed. This requirement was not met by licensee as evidenced by: Based on LPA record review, R1 received the incorrect dosing of Sevelamer from 11/27/24 through 12/16/24, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

Facility has discontinued incorrect prescription dose for R1 and implemented dosing that matches physician's orders for R1. Facility to submit plan to conduct training for all Med Techs on ensuring the reisdent's current medications on eMAR match respective residents' physician's orders by plan of correction due date. Proof of training to be submitted to CCL no later than 1/3/25

Deadline recorded: Dec 30, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87355(d)

Regulation authority

CCR

What the official deficiency says

Criminal Record Clearance (d) All individuals subject to criminal record review shall be fingerprinted. Licensee did not meet this requirement as evidenced by; interim administrator does not have fingerprint clearance. This poses an immediate Health, safety or personal rights risk to residents*civil penalty assessed*

Official plan of correction

Interim Administrator to submit LIC9098 by plan of correction due date, indicating they will not be present or working at the facility, and will not return to the facility until after they have obtained fingerprint clearance, is associated to facility, and submited proof of required clearance and association to CCL.

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

Official classification

Type A

Official code

87405(a)

Regulation authority

CCR

What the official deficiency says

Administrator - Qualifications and Duties(a) All facilities shall have a qualified and currently certified administrator. Licensee did not meet this requirement as evidenced by: interim Administrator does not have an actively current Administrator certificate. This poses an immediate Health, safety or personal rights risk to residents

Official plan of correction

Facility to submit written plan indicating plan for implementation and start date of qualified and certified administrator. Facility to submit all required documents for change of Adminstrator as well. Plan to be submitted to CCL by plan of correction due date of 11/18/2024

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

Official classification

Type B

Official code

87705(c)(4)

Regulation authority

CCR

What the official deficiency says

87705 Care of Persons with Dementia (c)(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 was not met as evidenced by: incident of resident elopment, which poses a potential health, safety or personal rights risk to residents in care.

Official plan of correction

Facility immediately conducted elopement training with staff. Training record provided to LPA. Additionally, Adminstrator has implemented census check and egress door check as part of shift change procedure. Deficiency cleared.

Deadline recorded: Aug 20, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87645(h)(6)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care (h)The following requirements shall apply to medications which are centrally stored: (6) The licensee shall be responsible for assuring that a record of centrally stored prescription medications for each resident is maintained for at least one year and includes: This requirement is not met as evidenced by: Deficient Practice Statement Based on record review and observations made, the Licensee did not comply with the section cited above. Licensee did not ensure that a resident routine medications were documented and centrally stored as required. This poses a potential health, safety or personal rights risk to residents in care.

Official plan of correction

POC Due Date: 02/26/2024 Plan of Correction Licensee to conduct a OTC medication audit and ensure that all resident medications are documented appropriately per Title 22 regulations. Licensee to conduct an in-service training for all medication technicians reviewing how to centrally store medications. Training to include the following: Date of Training, Training Topics, Job Role, Staff Names and Signatures. Proof of audit and in-service training to be submitted by POC due date of 02/26/2024.

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 was not met as evidenced by: based on record review, the Licensee did not comply with the section cited above. Multiple call records showed that residents waited for at least 30 minutes or longer to receive assistance from care staff or did not receive assistance at all. This poses an immediate health, safety or personal rights risk to residents in care.

Official plan of correction

Licensee to submit a written plan outlining how resident care needs will be met when all or part of the facility's signal system is inoperable. Plan to be submitted by POC due date, 01/09/2024.

Deadline recorded: Jan 9, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87303(i)

Regulation authority

CCR

What the official deficiency says

87303 Maintenance & Operation (i) Facilities shall have signal systems...:(1)All facilities licensed for 16 or more...(A) Operate from each resident's living unit. (B) Transmit a visual and/or auditory signal to a central staffed location or produce... signal...loud enough to summon staff. This requirement was not met as evidenced by: based record review and interviews conducted, Licensee did not comply with section cited above. Facility call cords need replacement and pagers don't always indicate resident calls. This poses an immediate health, safety or personal rights risk to residents in care.

Official plan of correction

Licensee to submit a written plan/protocol on how facility will ensure that their signal system equipment remains operable. Facility to also outline how resident care will be maintained and responded to timely by care staff. Plan/protocol to be submitted by POC due date of 01/09/2024. Licensee to conduct In-service training on facility plan/policy with all care staff. In-service Training to include the following information: Date of Training, Training Topics, Job Role, Staff Names and Signatures by POC due date of 01/18/2024.

Deadline recorded: Jan 9, 2024. A deadline is not proof that correction was completed.

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. Licensee did not meet this requirement based on document review confirming that the call bells for multiple residents was not responded to by staff. This is an immediate risk to the health and safety of residents in care.

Official plan of correction

Based on conversation with facility management, facility has provided and plans to provide additional training to staff regarding responding to the needs of residents. Deficiency is cleared.

Deadline recorded: Dec 1, 2023. 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 and dental care shall be developed by each facility. Plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following: (4) The licensee shall assist residents with with self-administered medications as needed. This requirement was not met as evidenced by report review showing that two residents were not provided medications as prescribed. This is an immediate risk to health and safety of residents.

Official plan of correction

Facility agrees to provide an in-service to all staff who assist with self-administrator of medication regarding facility protocol regarding inputting new and/or updated medications into the internal database and submit planned training schedule date to CCL no later than, 11/21/2023

Deadline recorded: Nov 21, 2023. A deadline is not proof that correction was completed.

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. In facilities licensed for sixteen or more, sufficient support staff shall be employed to ensure provision of personal assistance and care as required in Section 87608, Postural Supports...This requirement was not been met as evidenced by interviews and record review showing that caregivers have worked by themselves despite residents requireing two-person assists. This is an immediate risk.

Official plan of correction

Facility agrees to submit a written plan indicating how they will ensure sufficient staffing at all times to meet the needs of residents who require a two-person assist no later than 11/21/2023.

Deadline recorded: Nov 21, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87464(d)

Regulation authority

CCR

What the official deficiency says

87464 Basic Services A facility need not accept a particular resident for care. However, if a facility chooses to accept a particular resident for care, the facility shall be responsible for meeting the resident's needs as identified in the pre-admission appraisal specified in Section 87457, Pre-admission Appraisal and providing the other basic services specified below, either directly or through outside resources. This requirement was not met as evidenced by interviews revelaing that there is not always incontinence supplies resulting in staff using supplies from other residents.

Official plan of correction

Facility agrees to provide training to staff regarding facility protocol to obtain incontinence supplies and submit proof of training to CCL no later than 11/30/2023.

Deadline recorded: Nov 30, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87211(a)(1)(A)

Regulation authority

CCR

What the official deficiency says

87211 Reporting Requirement (a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including...the following: (1) A written report shall be submitted to the licensing agency & to person responsible for the resident within 7 days of the occurrence of any of the events specified in (A) through (D) below...(A) Death of any resident from any cause regardless of where the death occurred... Licensee didn't meet requirement as evidenced by: Based on interviews & document review death report was not provided to responsible person.

Official plan of correction

Facility to submit self-certification that they have provided the death report to R1's responsible party/representative no later than 11/10/2023

Deadline recorded: Nov 10, 2023. 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, and competent to provide the services necessary to meet resident needs. Licensee did not meet this requirement based on interviews that confirm not all resident's needs were met timely due to the signal system being down and staff not being able to supervise per stated protocol. This is an immediate risk to the health and safety of residents in care.

Official plan of correction

Administrator to provide CCL the written facility policy and/or protocol regarding how resident's needs are met when all or part of the signal system is inoperable and how resident's needs are met during those times by POC due date, 10/24/2023.

Deadline recorded: Oct 24, 2023. 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 Maintenance & 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: (A) Operate from each resident's living unit. (B) Transmit a visual and/or auditory signal to a central staffed location or produce an auditory signal at the living unit loud enough to summon staff. (C) Identify the specific resident living unit. Requirement not met based on interviews indicating signal system was inoperable for multiple weeks.

Official plan of correction

Signal system has been repaired. Deficiency is cleared.

Deadline recorded: Oct 24, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87468.1(a)(1)

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: (1) To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement has not been met based on interviews showing that S1 raised their voice at a resident. This is an immediate risk to personal rights.

Official plan of correction

Facility has addressed the situation and further correction is not needed. Deficiency is cleared.

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

Official classification

Type A

Official code

87303(i)(1)

Regulation authority

CCR

What the official deficiency says

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: (A) Operate from each resident's living unit. (B) Transmit a visual and/or auditory signal to a central staffed location or produce an auditory signal at the living unit loud enough to summon staff. (C) Identify the specific resident living unit Requirement has not been met based on review of review of call logs for resident over a f15 day period showing that out of 125 calls, 42 of them were responded to 15 minutes or later and 6 were not responded to. This is am immediate risk to health and safety.

Official plan of correction

Per discussion with Administrator, they will be adding a Quality Assurance componennt to ensure compliance and will submit more a detailed plan to CCL in writing to CCL by POC due date, 10/20/2022.

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

Official classification

Type A

Official code

87705(j)

Regulation authority

CCR

What the official deficiency says

87705 Care of Persons with Dementia (j) The licensee shall have an auditory device or other staff alert feature to monitor exits, if exiting presents a hazard to any resident. This requirement has not been met as evidenced by interview and document review showing that resident eloped the facility despite not being able to be in the community by themselves. This is an immediate risk to the health and safety nof residents in care.

Official plan of correction

Administrator agrees to submit the updated elopement protocol, which they have updated due to this incident to CCL by POC due date, 7/28/2022. An immediate civil penalty in the amount of $500.00 is issued today for the violation of a regulation resulting in bodily injury or illness of a person in care.

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

Official classification

Type A

Official code

87625(b)(3)

Regulation authority

CCR

What the official deficiency says

87625 Managed Incontinence (b) In addition to Section 87611, General Requirements for Allowable Health Conditions, the licensee shall be responsible for the following:(3) Ensuring that incontinent residents are kept clean and dry and that the facility remains free of odors from incontinence. This requirement has not been met as evidenced by interview and observation showing that a resident was left in a soiled brief until after eating and resident's room smelled of urine. This is an immediate risk to the health and safety nof residents in care.

Official plan of correction

Licensee agrees to submit planned date of a staff in-service regarding regulation 87625 by POC due date, 5/27/2022. In-service to be completed no later than 6/10/2022.

Deadline recorded: May 27, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87466

Regulation authority

CCR

What the official deficiency says

87466 Observation of the Resident. The licensee shall ensure that residents are regularly observed for changes in physical, mental, emotional & social functioning and that appropriate assistance is provided when such observation reveals unmet needs. When changes such as unusual weight gains... are observed, the licensee shall ensure that such changes are documented & brought to the attention of the resident's physician & the resident's responsible person, if any. Requirement hasn't been met as evidenced by facility not notifying doctor of weight loss. This is an immediate risk to the health and safety nof residents in care.

Official plan of correction

Licensee agrees to submit planned date of a staff in-service regarding regulation 87466 by POC due date, 5/27/2022. In-service to be completed no later than 6/10/2022.

Deadline recorded: May 27, 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

Adminsitrator agrees to submit a written plan indicating what they will do to ensure that residents do not go into other resident's rooms uninvited and/or go through other resident's personal property of resident by POC due date, 6/3/2022.

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