GOLDEN AGE VI

Official classification

Type A

Official code

87307(a)(2)(B)

Regulation authority

CCR

What the official deficiency says

(2) Resident bedrooms shall be provided which meet, at a minimum, the following requirements: (B) No room commonly used for other purposes shall be used as a sleeping room for any resident. This includes any hall, stairway, unfinished attic, garage, storage area, shed or similar detached building. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and record review, the licensee did not comply with the section cited above by using a resident bedroom as a staff bedroom. Based on facility records, the bedroom nearest to the laundry room has been approved as a resident bedroom rather than a staff bedroom. This poses a immediate health,safety and person rights risks to persons in care.

Official plan of correction

POC Due Date: 10/25/2023 Plan of Correction Licensee shall provide a statement of correction and move the staff bedroom to the correct bedroom based on facility sketch by the POC date.

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 observation, the licensee did not comply with the section cited above by not ensuring that the facility was in a clean, safe and sanitary condition at all times. It was observed that the cement walkway is lifted about 6 inches off the ground, there was trash around the back yard, and LPA observed a strong smell of urine in 2 out 4 resident bedrooms.

Official plan of correction

POC Due Date: 11/24/2023 Plan of Correction Licensee shall provide a plan of correction regarding the following items. Services rendered must be sent to the LPA by the POC date.

Official classification

Type B

Official code

87456(a)(2)

Regulation authority

CCR

What the official deficiency says

(a) Prior to accepting a resident for care and in order to evaluate his/her suitability, the facility shall, as specified in this article 8: (2) Perform a pre-admission appraisal. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and record review, the licensee did not comply with the section above by ensuring that 5 out 6 residents have a completed pre-admission appraisal. This poses a potential health, safety and personal rights risks to persons in care.

Official plan of correction

POC Due Date: 11/24/2023 Plan of Correction Licensee shall provide a statement of correction to the LPA by POC date. Licensee shall complete pre-appraisal for all residents. Copies of pre-appraisal shall provide to the LPA by POC date.

Official classification

Type B

Official code

87456(a)(3)

Regulation authority

CCR

What the official deficiency says

(a) Prior to accepting a resident for care and in order to evaluate his/her suitability, the facility shall, as specified in this article 8: (3) Obtain and evaluate a recent medical assessment. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and record review, the licensee did not comply with the section cited above by not ensuring that 5 out 6 residents had a current medical assessment. This poses a potential health, safety and person rights risks to persons in care.

Official plan of correction

POC Due Date: 11/24/2023 Plan of Correction Licensee shall provide a statement of acknowledgement and provide updated medical assessment to LPA by the POC date.

Official classification

Type B

Official code

87457(c)(1)

Regulation authority

CCR

What the official deficiency says

(c) Prior to admission a determination of the prospective resident's suitability for admission shall be completed and shall include an appraisal of his/her individual service needs in comparison with the admission criteria specified in Section 87455, Acceptance and Retention Limitations. (1) The appraisal shall include, at a minimum, an evaluation of the prospective resident's functional capabilities, mental condition and an evaluation of social factors as specified in Sections 87459, Functional Capabilities and 87462, Social Factors. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and record review, the licensee did not comply with the section cited above in by not ensuring that a current needs and services plan was conducted for 5 out 6 residentse. This poses a potential health, safety, and personal rights risks to persons in care.

Official plan of correction

POC Due Date: 11/24/2023 Plan of Correction Licensee shall provide a statement of acknowledgement and provide updated needs and services plan to LPA by the POC date.

Official classification

Type A

Official code

87555(b)(26)

Regulation authority

CCR

What the official deficiency says

(26) Supplies of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days shall be maintained on the premises. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above by not ensuring there was enough food supply for the residents in care. This poses an immediate health, safety and personal rights risks to persons in care.

Official plan of correction

POC Due Date: 10/25/2023 Plan of Correction Licensee shall provide a statement of acknowledgement. Proof of purchase and a picture of food purchased must be provided to the LPA by POC date.

Official classification

Type B

Official code

87755(c)

Regulation authority

CCR

What the official deficiency says

87755 Inspection Authority of the Licensing Agency The licensing agency shall have the authority to inspect, audit, and copy resident or facility records upon demand during normal business hours. Records may be removed if necessary for copying. Removal of records shall be subject to the requirements in Sections 87412(f), 87506(d), and 87508(b). This facility Licensee failed to meet the set deadlines for submission of all requested forms and documents into CCL.

Official plan of correction

This facility representative stated that all requested forms and documents will be completed and submitted into CCL by the required due date of 02/02/2022.

Deadline recorded: Feb 2, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

Not listed

Regulation authority

Not listed

What the official deficiency says

87705(f)(2) Care of Persons with Dementia Care of Persons with Dementia (2) Over-the-counter medication, nutritional supplements or vitamins, alcohol, cigarettes, and toxic substances such as certain plants, gardening supplies, cleaning supplies and disinfectants shall be inaccessible to residents with dementia. This requirement has not been met as evidenced by: The Licensee did not ensure toxins were locked as LPA observed cleaning supplies and toxins in the living room, bathroom and garage. This violation posses an immediate health and safety risk to the residents in care.

Deadline recorded: Oct 26, 2021. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

Not listed

Regulation authority

Not listed

What the official deficiency says

87465(h)(2) Incidental Medical and Dental Care (h) The following requirements shall apply to medications which are centrally stored: (2) 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 has not been met as evidenced by: The Licensee did not ensure medications were locked in refridgerator. This violation posses an immediate health and safety risk to the residents in care.

Deadline recorded: Oct 26, 2021. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

Not listed

Regulation authority

Not listed

What the official deficiency says

87608(a)(3) Postural Supports (a) Based on the individual's preadmission appraisal, and subsequent changes to that appraisal, the facility shall provide assistance and care for the resident in those activities of daily living which the resident is unable to do for himself/herself. Postural supports may be used under the following conditions. (3) A written order from a physician indicating the need for the postural support shall be maintained in the resident’s record. The licensing agency shall be authorized to require other additional documentation if needed to verify the order. This requirement has not been met as evidenced by: The Licensee did not ensure residents using hospital beds had a physicians order. This violation posses an potential health and safety risk to the residents in care.

Deadline recorded: Nov 5, 2021. A deadline is not proof that correction was completed.