WOODWARD ASSISTED LIVING

Official classification

Type B

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 LPA record review, the licensee did not comply with the section cited above in that S1 ans S2 did not have current First Aid, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/19/2026 Plan of Correction Facility to submit to CCL current First Aid for S1 and S2 by plan of correction due date.

Official classification

Type A

Official code

1569.618(c)(3)

Regulation authority

HSC

What the official deficiency says

§1569.618 Administration and management of residential care facilities; substituted qualifications; employee scheduling (c)The facility shall employ... a sufficient number of staff members to... (3) Ensure that at least one staff member who has cardiopulmonary resuscitation (CPR) training and first aid training is on duty and on the premises at all times... This requirement was not met as evidenced by: Based on LPA and caregiver, LVN observation and record review, the licensee did not comply with the section cited above in that S2 has expired First Aid/CPR exp 1/10/2025. S4 did not have any CPR/First Aid on file, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

Facility to submit proof of First Aid/CPR certificate/card tfor S2 and S4 o be submitted to CCL no later than 3/21/25.

Deadline recorded: Mar 21, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

1569.625(b)(2)

Regulation authority

HSC

What the official deficiency says

§1569.625 Staff training; legislative findings; contents (2) In addition to paragraph (1), training requirements shall also include an additional 20 hours annually...This requirement is not met as evidenced by: Based on LPA and caregiver, LVN observation and record review the licensee did not comply with the section cited above in that all staff: S1, S2, S3, S4, S5, S6 and S7 did not have required training completed, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

Facility to submit plan to have all staff complete required number of hours (as identified by their start date) of training by plan of correciton due date of 3/21/25. Admin agrees to use Senior Community Learning for all staff training. Training certificates issued by Senior Community Learning in the required number of hours for each respective staff: S1, S2. S3, S4, S5, S6, and S7 to be completed and sent to CCL by no later than 4/3/25.

Deadline recorded: Mar 21, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87412(g)

Regulation authority

CCR

What the official deficiency says

87412 Personnel Records (g) All personnel records shall be maintained at the facility. This requirement is not met as evidenced by:Based on LPA and caregiver, LVN observation and record review, the licensee did not comply with the section cited above in that S6 and S7 did not have Health Screen, Training, TB, or any paperwork on file, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

Facility to submit Health Screen with TB clearance or LIC503, LIC501, and copy of First Aid/CPR for S6 and S7 to CCL by plan of correction due date of 3/21/25.

Deadline recorded: Mar 21, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87463(i)

Regulation authority

CCR

What the official deficiency says

87463 Reappraisals (i) When there is significant change in condition... or once every 12 months, whichever occurs first, the licensee shall arrange an in-person or virtual meeting or conference call to share the reappraisal with the resident, the resident's representative, if applicable, and appropriate facility staff, asspecified in Section 87467, Resident Participation in Decision Making. This requirement is not met as evidenced by: Based on LPA and caregiver, LVN observation and record review, the licensee did not comply with the section cited above in that Resident (R1) has an appraisal on file but not current (11/2023) and residents (R2 and R3) did not have an appraisal on file at all which poses an immediatel health, safety or personal rights risk to persons in care.

Official plan of correction

Facility to submit current and complete Appraisal for R1, R2, and R3 by plan of correction due date, including resident or resident's responsible party's signature and date of receipt by plan of correciton due date.

Deadline recorded: Mar 21, 2025. 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

87355 Criminal Record Clearance (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)... This requirement is not met as evidenced by:Based on LPA and caregiver, LVN observation and record review, the licensee did not comply with the section cited above in that Staff S6 was not associated to the facility, which poses an immeidatel health, safety or personal rights risk to persons in care.

Official plan of correction

Facility to submit to CCL facility Guardian roster print out showing S6 as being associated to the facility by plan of correction due date.

Deadline recorded: Mar 21, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87555(b)(27)

Regulation authority

CCR

What the official deficiency says

87555 General Food Service Requirements(b) The following food service requirements shall apply: (27) All kitchen areas shall be kept clean and free of litter, rodents, vermin and insects. This requirement is not met as evidenced by: Based on LPA and caregiver, LVN observation and record review, the licensee did not comply with the section cited above in that black substance present in grout and spotted film around sink in grout, which poses an immeidate health, safety or personal rights risk to persons in care.

Official plan of correction

Facility to submit plan to have areas around sink free of black substances and film by plan of correction due date. Facility to submit pictures of cleaned kitchen area around kitchen sink free of black substances and film to CCL by no later than 3/28/25.

Deadline recorded: Mar 21, 2025. 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 was not met as evidenced by: Based on LPA and caregiver observation, the licensee did not comply with the section cited above in that rooms #1 and #3 had pervasive odor of urine which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

Facility to submti LIC9098 self-certifying they will ensure that incontinent residents are kept clean and dry and that the facility remains free of odors from incontinence by plan of correction due date.

Deadline recorded: Mar 21, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

1569.618(c)(3)

Regulation authority

HSC

What the official deficiency says

(c)The facility shall employ, and the administrator shall schedule, a sufficient number of staff members to do all of the following: (3) Ensure that at least one staff member who has cardiopulmonary resuscitation (CPR) training and first aid training is on duty and on the premises at all times. This paragraph shall not be construed to require staff to provide CPR. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA and caregiver, LVN observation and record review, the licensee did not comply with the section cited above in that S2 has expired First Aid/CPR exp 1/10/2025. S4 did not have any CPR/First Aid on file, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/21/2025 Plan of Correction Facility to submit plan to have S4 and S2 complete First Aid/CPR training. Training to be completed no later than 3/6/25. Proof of First Aid/CPR certificate/card to be submitted to CCL no later than 3/6/25.

Official classification

Type A

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 LPA and caregiver, LVN observation and record review, the licensee did not comply with the section cited above in that all staff: S1, S2, S3, S4, S5, S6 and S7 did not have required training completed, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/21/2025 Plan of Correction Facility to submit plan to have all staff complete required number of hours (as identified by their start date) of training by plan of correciton due date. Admin agrees to use Senior Community Learning for all staff training. Training certificates in the required number of hours for each respective staff: S1, S2. S3, S4, S5, S6, and S7 to be completed and sent to CCL by no later than 3/13/25.

Official classification

Type B

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 caregiver, LVN observation and record review, the licensee did not comply with the section cited above in that Emergency fire exit path partially obstructed by hospital bed, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/06/2025 Plan of Correction Facility to remove broken hospital bed by plan of correction due date. Facility to submit pictures of cleared emergency fire exit as proof of correction.

Official classification

Type B

Official code

87412(g)

Regulation authority

CCR

What the official deficiency says

(g) All personnel records shall be maintained at the facility. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA and caregiver, LVN observation and record review, the licensee did not comply with the section cited above in that S6 and S7 did not have Health Screen, Training, TB, or any paperwork on file, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/27/2025 Plan of Correction Facility to submit Health Screen with TB clearance or LIC503, LIC501, and copy of First Aid/CPR for S6 and S7 to CCL by plan of correction due date.

Official classification

Type B

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 LPA and caregiver, LVN observation and record review, the licensee did not comply with the section cited above in that Staff S6 was not associated to the facility, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/24/2025 Plan of Correction Facility to submit to CCL facility Guardian roster print out showing S6 as being associated to the facility by plan of correction due date.

Official classification

Type B

Official code

87555(b)(27)

Regulation authority

CCR

What the official deficiency says

(b) The following food service requirements shall apply: (27) All kitchen areas shall be kept clean and free of litter, rodents, vermin and insects. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA and caregiver, LVN observation and record review, the licensee did not comply with the section cited above in that black substance present in grout and spotted film around sink in grout, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/27/2025 Plan of Correction Facility to submit to CCL pictures of grout around kitchen sink free of black substances and film by plan of correction due date.

Official classification

Type B

Official code

87463(i)

Regulation authority

CCR

What the official deficiency says

(i) When there is significant change in condition, as defined in Section 87101, Definitions, or once every 12 months, whichever occurs first, the licensee shall arrange an in-person or virtual meeting or conference call to share the reappraisal with the resident, the resident's representative, if applicable, and appropriate facility staff, as specified in Section 87467, Resident Participation in Decision Making. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA and caregiver, LVN observation and record review, the licensee did not comply with the section cited above in that Resident (R1) has an appraisal on file but not current (11/2023) and residents (R2 and R3) did not have an appraisal on file at all which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/27/2025 Plan of Correction Facility to submit current and complete Appraisal for R1, R2, and R3 by plan of correction due date, including resident or resident's responsible party's signature and date of receipt by plan of correciton due date.

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 LPA and caregiver observation, the licensee did not comply with the section cited above in that rooms #1 and #3 had pervasive odor of urine which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/24/2025 Plan of Correction Facility to submi LIC9098 self-certifying they will ensure that incontinent residents are kept clean and dry and that the facility remains free of odors from incontinence by plan of correction due date.

Official classification

Type B

Official code

87555(b)(27)

Regulation authority

CCR

What the official deficiency says

(b) The following food service requirements shall apply: (27) All kitchen areas shall be kept clean and free of litter, rodents, vermin and insects. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above in the facility was found to have black spots of film around sink in grout, ants in the pantry, and both bugs and dead gnats in cabinet under the sink in kitchen, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/05/2024 Plan of Correction Facility to submit LIC9098 self-certifiying all items have beeb cleaned and corrected: black spots of film around sink in grout, ants in the pantry, and both bugs and dead ants in cabinet under the sink in kitchen