VALLEY VIEW CARE HOME

Official classification

Type B

Official code

87405(a)

Regulation authority

CCR

What the official deficiency says

87405 Administrator - Qualifications and Duties. (a) All facilities shall have a qualified and currently certified administrator. This requirement is not met as evidenced by: Based on LPAs'/licensee observation, interviews and record review, the licensee did not comply with the section cited above in not maintaining required facility documentation updated, which poses a potential risk to the health, safety, or personal rights to persons in care.

Official plan of correction

The licensee agrees to submit written plan agreeing to comply with administrator qualifications including accountable staff that will be responsible of mantaining facility documentation and medication updated to clear the citation by POC due date of 6/17/2026.

Deadline recorded: Jun 17, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(e)

Regulation authority

CCR

What the official deficiency says

(e) For every prescription and nonprescription PRN medication for which the licensee provides assistance there shall be a signed, dated written order from a physician on a prescription blank, maintained in the resident's file, and a label on the medication. Both the physician's order and the label shall contain at least all of the following information. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA and licensee record review, the licensee did not comply with the section cited above in that resident (R3) had Docusate Sodium 100mg and Senna 8.6mg medications but there was not a corresponding signed doctor's order on file, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/05/2026 Plan of Correction Facility to submit plan to conduct medication management training with all staff administering medication by plan of correction due date. Training logs to be submitted to CCL by no later than 6/11/26.

Official classification

Type B

Official code

1569.72(f)

Regulation authority

HSC

What the official deficiency says

(f) Notwithstanding the length of stay of a bedridden resident, every facility admitting or retaining a bedridden resident, as defined in this section, shall, within 48 hours of the resident’s admission or retention in the facility, notify the local fire authority with jurisdiction in the bedridden resident’s location of the estimated length of time the resident will retain his or her bedridden status in the facility. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA and licensee observation, interview, and record review, the licensee did not comply with the section cited above in that Resident (R1) in room #2 is bedridden and on hospice. However, licensee could not show documentation of notification to fire departmen, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/11/2026 Plan of Correction Facility to submit to CCL proof of notification to fire dept of bedridden resident in rm#2 by plan of correction due date. If fax is provided as proof of notification, facility to submit along with fax the fax transmission page showing successful transmission.

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 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

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 licensee observation and record review, the licensee did not comply with the section cited above in that S1, S2, S3 and S4 did not have current !st Aid/CPR which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/04/2025 Plan of Correction Licensee to submit plan to have all staff complete 1st Aid/CPR training by plan of correction due date. Completed 1st Aid/CPR course cards/certificates of compeltion to be submitted to CCL no later than 6/27/25

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 nad licensee observation and record review, the licensee did not comply with the section cited above in that S1 did not have fingerprint clearance, which poses an immediate health, safety or personal rights risk to persons in care. **civil penalty assessed, see LIC421BG

Official plan of correction

POC Due Date: 06/04/2025 Plan of Correction Licensee to submit LIC9098 self-certifying that S1 will not be present in any capacity at facility or on premises until fingerprint clearance obtained.

Official classification

Type A

Official code

87412(c)

Regulation authority

CCR

What the official deficiency says

(c) Licensees shall maintain in the personnel records verification of required staff training and orientation. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA and licensee observation and record review, the licensee did not comply with the section cited above in that S1, S2, S3, and S4 did not have current training completed, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/04/2025 Plan of Correction Licensee to submit plan to have all staff current in annual training by plan of correction due date. Licensee to submit proof of training completed for all staff by no later than 6/27/25. **civil penalty assessed for repeat violation within a 12 month period, see LIC421FC

Official classification

Type A

Official code

87463(a)

Regulation authority

CCR

What the official deficiency says

(a) The pre-admission appraisal, as specified in Section 87457, Pre-Admission Appraisal, shall be updated, in writing as frequently as necessary or once every 12 months, whichever occurs first, to note significant changes in condition, as defined in Section 87101, Definitions, and to keep the appraisal accurate. For the purposes of this section, the updated pre-admission appraisal shall be referred to as the reappraisal. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA and licensee observation and record review, the licensee did not comply with the section cited above inthast R1 and R2 did not have current apprisals on file, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/04/2025 Plan of Correction Licensee to submit plan to complete a current appraisal for R1 and R2 by plan of correction due date. Licensee to submit appraisals for R1 and R2 by no later than 6/27/25. Appraisals to be signed by licensee and residents or residents' responsible parties.

Official classification

Type A

Official code

87618(b)(3)(A)

Regulation authority

CCR

What the official deficiency says

(3) Ensuring that the use of oxygen equipment meets the following requirements: (A) A report shall be made in writing to the local fire jurisdiction that oxygen is in use at the facility. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA and licensee observation and record review the licensee did not comply with the section cited above in that Residents in rooms #3 and #6 have oxygen in use but licensee could not produce notification fax to fire dept, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/04/2025 Plan of Correction Licensee to privide CCL proof of notification that facility rooms #3 and #6 have oxygen in use to Santa Rosa fire dept by plan of correction due date.

Official classification

Type A

Official code

87618(b)(3)(B)

Regulation authority

CCR

What the official deficiency says

(3) Ensuring that the use of oxygen equipment meets the following requirements: (B) “No Smoking-Oxygen in Use” signs shall be posted in the appropriate areas. 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 Residents in rooms #3 and #6 have oxygen in use but no sign of use present, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/04/2025 Plan of Correction Facility to submit pictures of oxygen in use sign on rooms #3 and #5 by plan of correction due date.

Official classification

Type B

Official code

1569.695(c)

Regulation authority

HSC

What the official deficiency says

(c) A facility shall conduct a drill at least quarterly for each shift. The type of emergency covered in a drill shall vary from quarter to quarter, taking into account different emergency scenarios. An actual evacuation of residents is not required during a drill. While a facility may provide an opportunity for residents to participate in a drill, it shall not require any resident participation. Documentation of the drills shall include the date, the type of emergency covered by the drill, and the names of staff participating in the drill. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA and licensee interview and record review, the licensee did not comply with the section cited above in that facility’s last quarterly disaster drills were conducted last conducted 4/19/24, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/27/2025 Plan of Correction Facility to conduct diaster drill and provide documentation of drill to CCL by plan of correction due date.

Official classification

Type A

Official code

87412(a)(11)

Regulation authority

CCR

What the official deficiency says

(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information (11) A health screening as specified in Section 87411, Personnel Requirements - General. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA and licensee observation and record review, the licensee did not comply with the section cited above in that S1 and S3 did not have Health screen on file, poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/04/2025 Plan of Correction Facility to submit plan to have S1 and S3 complete Health screen with TB clearance by plan of correctiond due date. Copies of Health Screen to be submitted to CCL by no later than 6/27/25. **civil penalty assessed for repeat violation within 12 months, see LIC421FC

Official classification

Type A

Official code

87465(a)

Regulation authority

CCR

What the official deficiency says

87465 (a)(4) The licensee shall assist residents with self-administered medications as needed. This requirement is not met as evidenced by: Based on LPA and Admin observation and record review, the licensee did not comply with the section cited above in that LPA and Admin observed medication errors during spot check of R2s medication: Vitamin B12 bubble pack with start date of 5/15/2024 had one tablet missing. Levothyroxine with start date of 5/15/2024 had one tablet missing which poses an immediate health, safety or personal rights risk to persons in care

Official plan of correction

Facility to submit plan to train staff on how to properly administer medication to residents by plan of correction due date of 7/22/2024. Training materials to be submitted to CCL for approval. Training logs to contain name of trainer, (continued below) (continued from above) name of course, duration of course in hours, dated completed and employee attendee. Training to be completed no later than 7/26/2024

Deadline recorded: Jul 22, 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

87405 Administrator - Qualifications and Duties 87405 (a) All facilities shall have a qualified and currently certified administrator. This requirement is not met as evidenced by: Based on LPA and Admin observation and record review, the licensee did not comply with the section cited above in that Josephine Credo, Administrator could not provide a copy of current Administrator Certificate or provide copy of email indicating receipt of renewal payment from CCL, which poses a immediate health, safety or personal rights risk to persons in care.

Official plan of correction

Admin to submit picture of email and/or letter indicating receipt of renewal payment for Administrator Certificate from CCL or picture of current Administrator Certificate by plan of correction due date 7/22/2024

Deadline recorded: Jul 22, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87412(c)

Regulation authority

CCR

What the official deficiency says

87412 (c) Licensees shall maintain in the personnel records verification of required staff training and orientation. This requirement is not met as evidenced by: Based on LPA and Admin observation and record review, the licensee did not comply with the section cited above in that S3, S4, and S5 did not have Training records available, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

Facility to submit pictures of completed training logs for S3, S4, and S5 by plan of correction due date. Training materials to be submitted to CCL for approval. Training logs to contain name of trainer, name of course, duration of course in hours, dated completed and (continued below) (continued form above) employee attendee name. Training to be completed no later than plan of correction due date 7/26/2024

Deadline recorded: Jul 26, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87412(a)

Regulation authority

CCR

What the official deficiency says

87412(a) The licensee shall ensure that personnel records are maintained... Each personnel record shall contain the following information: (11) A health screening as specified in Section 87411, Personnel Requirements - General. This requirement is not met as evidenced by: Based on LPA and Admin observation and record review, the licensee did not comply with the section cited above in that S2, S4, and S5 did not have Heath Screens, which poses an potential health, safety or personal rights risk to persons in care.

Official plan of correction

Facility to submit pictures of completed Health Screens for S2, S4, and S5 by plan of correction due date of 7/26/2024

Deadline recorded: Jul 26, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87463(c)

Regulation authority

CCR

What the official deficiency says

87463 (c) The licensee shall arrange a meeting with the resident, the resident's representative.. when there is significant change in the resident's condition, or once every 12 months, whichever occurs first, as specified in Section 87467, Resident Participation in Decision Making. This requirement is not met as evidenced by: Based on LPA and Admin observation and record review, the licensee did not comply with the section cited above in that R1, R2, and R5 did not have any Appraisal Needs and Services Plan (R5 had plan present but not dated at the top of appraisal -note says to see 602, 602 dated 2022), which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Facility to submit pictures to CCL of current Appraisal, Needs, and Services Plans for R1, R2, and R5 by plan of correction due date of 7/26/2024

Deadline recorded: Jul 26, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87705(c)

Regulation authority

CCR

What the official deficiency says

87705(c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following: (5) Each resident with dementia shall have an annual medical assessment...This requirement is not met as evidenced by: Based on LPA and Admin observation and record review, the licensee did not comply with the section cited above in that R1, R2, and R5 have diagnosis of Dementia but their Physician's Reports are dated 2022 which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Facility to submit pictures to CCL of current Physician's Report for R1, R2, and R5 by plan of correction due date of 7/26/2024

Deadline recorded: Jul 26, 2024. 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

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 Admin observation, the licensee did not comply with the section cited above in that bedroom #2 had a soft spot underneath wood flooring, when pressed upon with weight, floor gives way and sinks in and there is a hole in the kitchen wall by outlet near door exiting to the backyard, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/12/2024 Plan of Correction Facility to submit pictures of repairs along with LIC9098 self-certifying repairs have been completed by plan of correction due date.

Official classification

Type B

Official code

87303(e)(5)

Regulation authority

CCR

What the official deficiency says

(e) Water supplies and plumbing fixtures shall be maintained as follows: (5) Non-skid mats or strips shall be used in all bathtubs and showers. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA and Admin observation the licensee did not comply with the section cited above in that the resident bathroom next to laundry room had non-skid mat present but mat had black spots and film underneath mat, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/29/2024 Plan of Correction Facility to submit pictures of non-skid mat present in resident bathroom next to laundry room free from black film and/or spots by plan of correction due date.

Official classification

Type B

Official code

87463(c)

Regulation authority

CCR

What the official deficiency says

(c) The licensee shall arrange a meeting with the resident, the resident's representative, if any, appropriate facility staff, and a representative of the resident's home health agency, if any, when there is significant change in the resident's condition, or once every 12 months, whichever occurs first, 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 Admin observation and record review, the licensee did not comply with the section cited above in that R1, R2, and R5 did not have any Appraisal Needs and Services Plan (R5 had plan present but not dated at the top of appraisal -note says to see 602, 602 dated 2022), which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/12/2024 Plan of Correction Facility to submit pictures to CCL of current Appraisal, Needs, and Services Plans for R1, R2, and R5 by plan of correction due date.

Official classification

Type B

Official code

87705(c)(5)

Regulation authority

CCR

What the official deficiency says

(c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following: (5) Each resident with dementia shall have an annual medical assessment as specified in Section 87458, Medical Assessment, and a reappraisal done at least annually, both of which shall include a reassessment of the resident's dementia care needs. 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 R1, R2, and R5 have diagnosis of Dementia but their Physician's Reports are dated 2022 which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/12/2024 Plan of Correction Facility to submit pictures to CCL of current Physician's Report for R1, R2, and R5 by plan of correction due date.

Official classification

Type B

Official code

87405(a)

Regulation authority

CCR

What the official deficiency says

87405 Administrator - Qualifications and Duties 87405 (a) All facilities shall have a qualified and currently certified administrator. 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 Josephine Credo, Administrator could not provide a copy of current Administrator Certificate or provide copy of email indicating receipt of renewal payment from CCL, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/29/2024 Plan of Correction Admin to submit picture of email and/or letter indicating receipt of renewal payment for Administrator Certificate from CCL or picture of current Administrator Certificate by plan of correction due date.

Official classification

Type B

Official code

87412(a)(11)

Regulation authority

CCR

What the official deficiency says

87412(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: (11) A health screening as specified in Section 87411, Personnel Requirements - General. 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 S2, S4, and S5 did not have Heath Screens, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/05/2024 Plan of Correction Facility to submit pictures of completed Health Screens for S2, S4, and S5 plan of correction due date.

Official classification

Type A

Official code

87465(a)(4)

Regulation authority

CCR

What the official deficiency says

87465 (a)(4) The licensee shall assist residents with self-administered medications as needed. 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 LPA and Admin observed medication errors during spot check of R2s medication: Vitamin B12 bubble pack with start date of 5/15/2024 had one tablet missing. Levothyroxine with start date of 5/15/2024 had one tablet missing which poses an immediate health, safety or personal rights risk to persons in care

Official plan of correction

POC Due Date: 05/23/2024 Plan of Correction Facility to submit plan to train staff on how to properly adminsiter medication to residents by plan of correction due date of 5/23/2024. Training materials to be submitted to CCL for approval. Training logs to contain name of trainer, name of course, duration of course in hours, dated completed and employee attendee. Training to be completed no later than 6/12/2024

Official classification

Type B

Official code

87412(c)

Regulation authority

CCR

What the official deficiency says

87412 (c) Licensees shall maintain in the personnel records verification of required staff training and orientation. 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 S3, S4, and S5 did not have Training records available, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/12/2024 Plan of Correction Facility to submit pictures of completed training logs for S3, S4, and S5 by plan of correction due date. Training materials to be submitted to CCL for approval. Training logs to contain name of trainer, name of course, duration of course in hours, dated completed and employee attendee.

Official classification

Type A

Official code

1569.618(c)(3)

Regulation authority

HSC

What the official deficiency says

HSC 1569.618(c)(3)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 Admin observation and record review, the licensee did not comply with the section cited above in that S1, S2, S3, S4, and S5 did not have current First Aid/CPR, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/23/2024 Plan of Correction Facility to submit plan to have S1, S2, S3, S4, and S5 obtain First Aid/CPR certification. Certification to be completed for all identified staff no later than 6/5/2024

Official classification

Type B

Official code

1569.695(c)

Regulation authority

HSC

What the official deficiency says

(c) A facility shall conduct a drill at least quarterly for each shift. The type of emergency covered in a drill shall vary from quarter to quarter, taking into account different emergency scenarios. An actual evacuation of residents is not required during a drill. While a facility may provide an opportunity for residents to participate in a drill, it shall not require any resident participation. Documentation of the drills shall include the date, the type of emergency covered by the drill, and the names of staff participating in the drill. This requirement is not met as evidenced by: Deficient Practice Statement Based on an interview with the Administrator and Record Review, the licensee did not comply with the section cited above in which the facility did not conduct a drill at least quarterly for each shift which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/08/2023 Plan of Correction Plan of Correction shall include a statement regarding future compliance. In addition, Licensee shall fill out at LIC 9098 Self-Certification form reading and understanding the regulation as it relates to conducting quarterly drills and retaining the record of the drills that are conducted.