SERENITY VILLA II

Official classification

Type A

Official code

87468.2(a)(4)

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...residents...shall have all of the following personal rights: (4) To care, supervision, and services that meet their individual needs and are 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: LPA observation of postural support used as a restraint, which poses an immediate health, safety or personal rights risk to persons in care. Deficient Practice Statement Based on LPA observation and interview, the licensee did not comply with the section cited above in that LPA observed postural support used as a restraint on R1, R2, and R3, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/16/2025 Plan of Correction Facility to submit plan to register all staff to particiapte/attend the ombudsman program for personal rights. Facility to submit plan to contact the local ombusdman to facilitate personal rights trainign for all staff by plan of correction due date. Facility to get the date of the next soonest personal rights training and provide the date to CCL by no later than 10/23/25. Once attendance/ particiaption is completed facility to submit training certificate or record showing all staff in attendance, hours of attendance, date of attendance, and instructor name. Training to be completed no later than December of 2025.

Official classification

Type A

Official code

87608(a)(4)

Regulation authority

CCR

What the official deficiency says

87608 Postural Supports (a)...Postural supports may be used under the following conditions. (1) ....used to achieve proper body position and balance, to improve a resident's mobility and independent functioning, or to position rather than restrict movement including, but not limited to, preventing a resident from falling out of bed, a chair, etc. This requirement not met by licensee as evidenced by LPA observation of postural support used as a restraint, which poses an immediate health, safety or personal rights risk to persons in care. Deficient Practice Statement Based on LPA observation and interview, the licensee did not comply with the section cited above in that LPA observed postural supports used as restraints on R1, R2, and R3, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/16/2025 Plan of Correction Admin to submit LIC9098 self-certifying all facility staff will immediately cease using postural supports as a restraint by plan of correction due date.

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 LPA and licensee observation, the licensee did not comply with the section cited above in that pile of feces was located in bottom drawer of small nightstand in closet of room #7, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/22/2025 Plan of Correction Facility to submit LIC9098 self-certifying all staff will keep facility free from incontinence and incontinence odors at all times.

Official classification

Type B

Official code

87468.1(a)(1)

Regulation authority

CCR

What the official deficiency says

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 is not met as evidenced by: Based on LPA interviews, the licensee did not comply with the section cited above in that facility staff was observed to have yelled at residents, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

Facility has terminated staff found to have yelled at residents. Deficiency cleared.

Deadline recorded: Jul 1, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87303(e)(2)

Regulation authority

CCR

What the official deficiency says

87303(e)(2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degree C) and not more than 120 degree F (49 degree C). This requirement is not met as evidenced by: Water temperature in sinks accessible to residents in care measured at 88.2, 87.3, and 126.7 degrees F all which are not within the allowable ranges of 105 to 120 degrees F. Deficient Practice Statement Based on LPAs and Licensee observation, the licensee did not comply with the section cited above in faucets used by and accessible to residents, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/27/2023 Plan of Correction Licensee has contacted hot water tank installer to address water temperature regulation and delivery. Licensee will submit repair receipt from water tank installer. Licensee will also submit as proof of correction a 2 week measurement log of water temperature readings, taken once in the morning and once at night, showing temperatures in compliance with regulation 87303(e)(2).

Official classification

Type A

Official code

87405(d)(2)

Regulation authority

CCR

What the official deficiency says

Administrator Qualifications and Duties- 87405(d)(2) The administrator shall have the qualifications specified in Sections 87405(d)(1) through (7). If the licensee is also the administrator, all requirements for an administrator shall apply:.Knowledge of and ability to conform to the applicable laws, rules and regulations. This requirement is not met as evidenced by: LPA's observations, staff did not screen the LPA when having them enter the facility or at any time once inside the facility until the LPA requested the staff to screen LPA. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA observations, and interview with staff, the licensee did not comply with the section cited above in screening all visitors which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/26/2022 Plan of Correction Licensee to ensure that all staff and all visitors are screened as required, including temperatures being taken, and all information being logged. Licensee to review with all staff the screening procedures and ensure staff are doing the screening as required-hold an inservice with your staff. Proof of correction to follow on 10/31/22. Plan of correction due 10/26/22