SLEEPY HOLLOW ASSISTED LIVING

Official classification

Type B

Official code

87405(d)(2)

Regulation authority

CCR

What the official deficiency says

Administrator - Qualifications and Duties 87405(d)(2) The administrator...If the licensee is also the administrator, all requirements for an administrator shall apply.(2) Knowledge of and ability to conform to the applicable laws, rules and regulations. This requirement is not met as evidenced by: Licensee/Administrators not engaging in the CHOW process as directed in the 9/15/2025 Office meeting.

Official plan of correction

Licensee to provide letter self-certifying that they will provide monthly updates on status of submitted application by plan of correction due date. This will be due every 22nd of the month. Facility to review Administrator qualifications and duties regulation and provide a monthly update on status of submitted application.

Deadline recorded: Jul 24, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87109(b)

Regulation authority

CCR

What the official deficiency says

87109 Transferability of License (b)The licensee shall notify the licensing agency and all residents receiving services, or their representatives, in writing as soon as possible and in all cases at least thirty (30) days prior to the transfer of the property or business... This requirement is not met as evidenced by: Based on interview & record review, the licensee did not comply with the section cited above in the licensee did not notify Community Care Licensing within thirty (30) business days of the transfer of the facility to a Limited Liability Corporation which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Licensee to notify CCL regarding their choice to either remove facilities form LLC or keep them in the LLC by no later than 9/29/25. If they choose to keep in the LLC, licensee will provide proof to Community Care Licensing that an application has been submitted to the Centrailized Application Bureau by plan of correction due date of 10/13/2025.

Deadline recorded: Oct 13, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(h)(1)(C)(2)

Regulation authority

CCR

What the official deficiency says

87465(h)(1)(C )(2) Incidental Medical and Dental Care- Because of potential dangers related to the medication itself, or due to physical arrangements in the facility and the condition or the habits of other persons in the facility,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 was not met as evidenced by: LPAs observed numerous over-the-counter medications on R2's side bed table in their room. Resident's medications are provided by staff assistance. Resident does not centrally store and/or handle own medications, per interviews. This is a health & Safety risk to residents in care. LPA obtained photos.

Official plan of correction

Licensee to ensure that all medications are centrally stored and inaccessible to residents in care. Hold an in--service medication training with all staff. Submit plan of correction by 2/19/25. Submit proof of training by 2/28/25.

Deadline recorded: Feb 19, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87309(a)

Regulation authority

CCR

What the official deficiency says

87309(a)Storage Space and Access-Except as specified in subsection (b), the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances, knives, matches, tools, sharp objects, and other similar items which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage. This requirement was not met as evidenced by: LPAs observed a facility bathroom that is under renovations unlocked, making tools stored in the bathroom accessible to residents in care, and observed trip hazards, a lip of some tile fitted on the floor, and the hole in the floor where the toilet was removed. There is no door knob lock on the bathroom door leaving all accessible to residents in care. This is a health & safety risk to the residents in care. LPA obtained photos.

Official plan of correction

Licensee to ensure the bathroom that is under renovation is kept locked and inaccessible to all residents in care at all times. Once the bathroom renovation is complete, it may be open to sue by residents in care. Submit plan of renovation estimated completion date, and plan of securing the bathroom, ensuring it is inaccessible. POC due 2/19/25.

Deadline recorded: Feb 19, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87705(f)(1)(2)

Regulation authority

CCR

What the official deficiency says

87705(f)(1)(2) Care of Persons with 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). Over-the-counter medication, nutritional supplements or vitamins, alcohol, cigarettes, and toxic substances such as certain plants, gardening supplies, cleaning supplies and disinfectants. This requirement is not met as evidenced by: Deficient Practice Statement LPAs' observed the staff room on the first floor unlocked, which had cigarettes, matches, and over the counter medications left accessible to residents in care. LPAs observed second floor staff room unlocked, which had numerous bottles of alcohol and disinfectants/cleaners left accessible 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: 12/07/2024 Plan of Correction Licensee/Administrator to ensure that staff rooms remain locked and inaccessible to residents in care and/or remove all items listed above to ensure residents have no access to the items listed above found in both staff rooms. Staff locked the room on the first floor, and Administrator to ensure the door leading to the second floor staff room is locked and inaccessible to residents in care. Submit plan of correction by 12/7/24.

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. 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 LPAs observed a hallway entry with the floor’s wooden transition strip with a large chunk missing which has created a health & safety hazard for potential to trip and/or fall, an outlet in a resident room is missing, 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: 12/09/2024 Plan of Correction Licensee/Administrator to ensure that the floor's transition strip is repaired and/or replaced as needed for the safety of residents, staff and others who are in the facility. Licensee to ensure the outlet cover is replaced in residents room. Submit photo of outlet cover having been replaced. Submit photos of the repaired and/or replaced transition strip, with written self confirmation of having completed the correction. POC due 12/09/24.

Official classification

Type B

Official code

1569.695(a)(2)

Regulation authority

CCR

What the official deficiency says

1569.695(a)(2) In addition to any other requirement of this chapter, a residential care facility for the elderly shall have an emergency and disaster plan that shall include, but not be limited to, all of the following: Plans for the facility to be self-reliant for a period of not less than 72 hours immediately following any emergency or disaster, including, but not limited to, a short-term or long-term power failure. If the facility plans to shelter in place and one or more utilities, including water, sewer, gas, or electricity, is not available, the facility shall have a plan and supplies available to provide alternative resources during an outage. This requirement is not met as evidenced by: Deficient Practice Statement LPAs observed that the facility lacked an adequate emergency food supply as required by the health and safety code, 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: 12/13/2024 Plan of Correction Licensee agrees to obtain needed emergency food supplies per requirements by H & S code; Please submit a list and picture(s) of supplies no later than POC due date, 12/13/24.

Official classification

Type B

Official code

87468(c)(2)

Regulation authority

CCR

What the official deficiency says

87468(c)(2)(A- Personal Rights- Licensees shall prominently post personal rights, nondiscrimination notice, & complaint information in areas accessible to residents, representatives, & the public. (2) Information on the appropriate reporting agency in case of a complaint or emergency, including procedures for filing confidential complaints, shall be posted as follows: (A) Licensees may use the RCFE Complaint Poster (PUB 475) or may develop their own poster as provided in this section. A poster developed by the licensee shall contain the same content as the PUB 475. The poster that is posted shall be 20” x 26” in size and be posted in the main entryway of the facility. PUB 475 may be accessed, downloaded, and printed from the www.ccld.ca.gov website. This requirement is not met as evidenced by: Deficient Practice Statement LPAs observed that the facility had no complaint poster up and visible per regulation requirement, 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: 12/13/2024 Plan of Correction Licensee agrees to post the CCL Complaint Poster per regulation; Submit a picture showing the poster is in the main entryway no later than POC due date, 12/13/24.