BONNIE'S CARE HOME

Official classification

Type A

Official code

87465(g)

Regulation authority

CCR

What the official deficiency says

The licensee shall immediately telephone 9-1-1 if an injury or other circumstance has resulted in an imminent threat to a resident’s health including, but not limited to, an apparent life-threatening medical crisis except as specified in Sections 87469(c)(2), (c)(3), or (c)(4). This facility was found to be deficient as evidenced by learning that facility staff would contact the facility designated Administrator first before immediately calling 911 for threats to resident health and safety. This posed an immediate risk to the health, safety, and personal rights to residents in care.

Official plan of correction

The facility designated Administrator stated that all facility staff will undergo training, for no less than (1) hour in duration, on the topics of resident rights and immediate notification to 911. A statement of correction, along with documented proof of updated training, will be conducted and completed with submission into CCL by the due date for review by this LPA. Proof of training will include the topics covered for training, name of trainer(s), duration of training, and name of all attendees.

Deadline recorded: Jun 16, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87467(a)

Regulation authority

CCR

What the official deficiency says

Prior to, or within two weeks of the resident’s admission, 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... to prepare a written record of the care the resident will receive in the facility, and the resident’s preferences regarding the services provided at the facility. This requirement was not met as evidenced by LA Jensen's record review for R1. This poses a potential risk to the health, safety and personal rights of residents in care.

Official plan of correction

The Licensee agrees to create a new needs and service plan template and to send revised needs and service plans for all residents to the Department by the POC due date.

Deadline recorded: Jan 16, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87217(b)

Regulation authority

CCR

What the official deficiency says

Every facility shall take appropriate measures to safeguard residents' cash resources, personal property and valuables which have been entrusted to the licensee or facility staff. This requirerment was not met as evidenced by: Based on LPA Jensen's interview with staff and observation of a blank LIC 621 the faciity did not follow it's own policies for safeguarding resident valuables.

Official plan of correction

An attestation will be sent by email to the Department stating that Maria Araiza will personally label and maintain written logs of resident property effective immmediately. This Plan of Corretion is based on facility staff request. No further action required.

Deadline recorded: Dec 11, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87411(c)

Regulation authority

CCR

What the official deficiency says

Personnel Requirements - General All RCFE staff who assist residents with personal activities of daily living shall receive initial and annual training as specified in Health and Safety Code sections 1569.625 and 1569.69. This requirement was not met as evidenced by: Based on LPA Jensen's file review, S1 has not had training since 2022. This poses a potential risk to the health safety and personal rights of residents in care.

Official plan of correction

Please have all staff members complete required training by POC due date and submit signed documentation as verification that training has been completed.

Deadline recorded: Oct 9, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87458

Regulation authority

CCR

What the official deficiency says

a) Prior to a person's acceptance as a resident, the licensee shall obtain and keep on file, documentation of a medical assessment...(b) The medical assessment shall include, ...an examination for communicable tuberculosis. This requirement was not met as evidenced by LPA Jensen's review of staff files in which 2 of 2 residents did not have TB tests documented.

Official plan of correction

Staff called hospice and arranged for TB tests to be completed by tomorrow in the presence of the LPA. No further action required.

Deadline recorded: Sep 12, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87203

Regulation authority

CCR

What the official deficiency says

Fire Safety All facilities shall be maintained in conformity with the regulations adopted by the State Fire Marshal for the protection of life and property against fire and panic. This requirement was not met as evidenced by: Based on LPA Jensen's observation and care providers statement that the facility does not have carbon monoxide detectors. This poses an immediate risk to the health safety and personal rights of residents in care

Official plan of correction

The Licensee has replaced the fire extinguisher and will purchase and install carbon monoxide detectors by POC due date.

Deadline recorded: Sep 5, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87555(b)(26)

Regulation authority

CCR

What the official deficiency says

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 was not met as evidenced by: Based on LPA Jensen's observations the facility did not have 2 days worth of perishable foord or 7 days worth of non-perishable food

Official plan of correction

Maria Araiza purchased food and had it delivered in the repsence of the LPA. No further plan of correction is required at this time.

Deadline recorded: Sep 4, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

80072(a)(2)

Regulation authority

CCR

What the official deficiency says

Personal Rights To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs. This requirement was not met as evidenced by: Based on an interview with R2 and LPA Jensen's measurement of the bedroom doorway, R2 cannot exit the bedroom in her wheelchair. This poses an immediate risk to the health, safety and personal rights of residents in care.

Official plan of correction

LPA Jensen asked a home health aid/social worker assigned to the resident to assist with residents wheel chair not fitting through doorway during the course of the visit. Licensee will follow up to advise of outcome by 9/9/24.

Deadline recorded: Sep 4, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87205

Regulation authority

CCR

What the official deficiency says

The licensee... shall exercise general supervision over the affairs of the licensed facility and establish policies concerning its operation in conformance with these regulations and the welfare of the individuals it serves. This requirement was not met as evidenced by: Based on Licensee's confirmation that staff were not associated and notice of intent to sell or transfer had not been given despite technical assistance being provided by LPA Jensen on 7/19/2024. This poses an immediate risk to the health, safety and personal rights of residents in care.

Official plan of correction

The Licensee provided notice if intent to sell during the course of this visit as well LIC 9182's for employees needing transfers. The Licensee agrees to provide all residents with notification of the intention to sell by the POC due date.

Deadline recorded: Aug 2, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

80087(a)(1)

Regulation authority

CCR

What the official deficiency says

Buildings and Grounds The licensee shall take measures to keep the facility free of flies and other insects. This requirement was not met as evidenced by: Based on LPA Jensen's observation of insects on the floor and in the cupboards.

Official plan of correction

The Licensee agrees to have a pest control company complete a service by POC due date and agrees to establish bi-monthly pest service.

Deadline recorded: Aug 8, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87506(a)

Regulation authority

CCR

What the official deficiency says

Resident Records The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility ... readily available ... to licensing agency staff. This requirement was not met as evidenced by: Based on LPA Jensen's record review, R1 lacked a pre-placement appraisal, needs and service plan and complete hospice care plan. This poses an immediate risk to the health, safety and personal rights of residents in care.

Official plan of correction

The Licensee agrees to submit an attestation that all resident files and hospice care plans are fully updated and complete by 9/2/24.

Deadline recorded: Aug 2, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87506(a)

Regulation authority

CCR

What the official deficiency says

Resident Records The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff. This requirement was not met based on: Based on the Licensee/Administrator's own admission that facility records were not created upon acceptance of R1 and a lack of required records for R2 based on LPA Jensen's file review. This poses an immediate risk to the health, safety and personal rights of residents in care.

Official plan of correction

The Licensee will send an attestation by email to maja.jensen@dss.ca.gov by 4/13/24 that all current resident files will be reviewed and updated for compliance CCR 87506 by 5/12/24.

Deadline recorded: Apr 13, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87633(b)(4)

Regulation authority

CCR

What the official deficiency says

Hospice Care of Terminally Ill Residents A current and complete hospice care plan shall be maintained in the facility for each hospice resident and include the following: ...A description of the area of licensee’s responsibility for implementing the plan including, but not limited to, facility staff duties; record keeping; and communication with the hospice agency, resident’s physician, and the resident’s responsible person(s), if any. This description shall include the type and frequency of the tasks to be performed by the facility. This requirement was not met based on LPA Jensen's review of the resident file and lack of a hospice care plan for R2. This poses a potential risk to the health, safety and personal rights of residents in care.

Official plan of correction

The Licensee agrees to update all current resident files for residents on hospice with a comprehensive plan that is in compliance with CCR 87633 in it's entirety.

Deadline recorded: May 12, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87405(d)(2)

Regulation authority

CCR

What the official deficiency says

The administrator shall have the qualifications specified in Sections 87405(d)(1) through (7). ... (2) Knowledge of and ability to conform to the applicable laws, rules and regulations. This requirement was not met based on: The Licensee/Administrator's own admission that she was not aware of requirements surrouding resident records and admission agreements. This poses a potential risk to the health, safety and personal rights of residents in care.

Official plan of correction

The Licensee/Administrator agrees to complete an additional 5 hours of Administrator training with a focus on hospice care and record keeping.

Deadline recorded: May 12, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87507(e)

Regulation authority

CCR

What the official deficiency says

Admission Agreements The licensee shall provide a copy of the signed and dated current admission agreemen... immediately upon signing the admission agreement or modification. This requirement was not met based on: the Licensee's own admission that a signed copy was not provided to the resident's responsible party. This poses a potential health, safety and personal rights risk to residents in care.

Official plan of correction

The Licensee agrees to sign an attestation that CCR 87507 has been read, understood and will be complied with in it's entirety and will email teh attestation to maja.jensen@dss.ca.gov by the Plan of Correction due date.

Deadline recorded: Apr 17, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

1569.652(c)

Regulation authority

HSC

What the official deficiency says

Termination of admission agreement upon death of resident; ... (c) A refund of any fees paid in advance covering the time after the resident’s personal property has been removed from the facility shall be issued..., within 15 days after the personal property is removed. The Licensee failed to meet this requirement when they altered their original admissions agreement to state that no refunds woud be given.

Official plan of correction

The Licesnee shall revert back to the orignal agreement immediately and any desired changes to it (incuding rate increases) shall be submitted to the appropriate DSS branch for prior approval before being put into practice. Licensee agreed to submit an updated signed and version of the orignal admission agreement to kimberly.viarella@dss.ca.gov by 09/11/23 for review.

Deadline recorded: Sep 11, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87202(a)(2)

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: (2) Bedridden persons This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview and record review, the licensee did not comply with the section cited above when 2 out of 5 residents transitioned to a bedridden condition without having the proper fire clearance in place. This which poses/posed an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/08/2023 Plan of Correction The Licensee will submit an updated LIC 200 with an updated facility sketch to kimberly.viarella@dss.ca.gov by the close of business on 08/08/23.

Official classification

Type B

Official code

1569.627(i)

Regulation authority

HSC

What the official deficiency says

(i) Changes in condition, including, but not limited to, when and under what circumstances are changes made to a participant's care plan. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview, and record review, the licensee did not comply with the section cited above in 2 of 5 residents when they transitioned to bedridden, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/08/2023 Plan of Correction The Licensee has already corrected this deficiency by obtaining updated physician's reports.

Official classification

Type B

Official code

1569.652

Regulation authority

HSC

What the official deficiency says

This requirement is not met as evidenced by: Deficient Practice Statement Termination of admission agreement upon death or a resident... refund of fees paid... notice of contract termination Based on interview and record review, the licensee did not comply with the section cited above when they included a section in their admissions agreement refusing to refund money to residents which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/30/2023 Plan of Correction Licensee shall update their admissions application to include an appropriate refund policy and will submit it to kimberly.viarella@dss.ca.gov by 08/30/2023.

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

This requirement is not met as evidenced by: Maintenance and Operation 87303(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. Deficient Practice Statement Based on observation and interview, the licensee did not comply with the section cited above when 8 screens out of the total number of windows and sliders that the facility possessed were damaged. LPA witnessed insects inside the facility. This poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/30/2023 Plan of Correction The Licensee shall have all screens repaired so they prevent insects from entering the facility. Pictures of the repaired windows / sliders will be submitted to kimberly.viarella@dss.ca.gov by 08/30/2023. The Licensee will also submit a copy of the pest control bill with the date stamp showing the day the facility was treated.

Official classification

Type A

Official code

87411(c)

Regulation authority

HSC

What the official deficiency says

Personnel Requirements-General All RCFE staff who assist residents with personal activities of daily living shall receive initial and annual training as specified in Health and Safety Code sections 1569.625 and 1569.69 This facility was found to be deficient as evidenced by the presence of facility personnel who were not properly trained to adequately provide care and supervision to the residents. This posed an immediate threat to the Health, Safety, and Personal Rights of the residents in care.

Official plan of correction

Facility representative stated that facility staff persons should be trained and certified as such in order to adequately provide care and supervision to the residents. A statement of correction, along with proof of training for no less than (1) hour in duration, will be completed and submitted into CCL by the due date of 01/26/2023. This training requirement should encompass the importance of required training topics and adequate care and supervision. Proof of training should include the name of the trainer, topics that were covered, and list of the participants.

Deadline recorded: Jan 26, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87464(f)(4)

Regulation authority

CCR

What the official deficiency says

Basic Services Personal assistance and care as needed by the resident and as indicated in the pre-admission appraisal, with those activities of daily living such as dressing, eating, bathing and assistance with taking prescribed medications, as specified in Section 87608, Postural Supports. This facility was found to be deficient as evidenced in that it did not properly make sure that facility residents' basic care needs were always met and fulfilled by sufficient facility care staff. This posed an immediate threat to the Health, Safety, and Personal Rights of the residents in care.

Official plan of correction

Facility representative stated that facility staff persons should be trained and certified as such in order to adequately provide care and supervision to the residents. A statement of correction, along with proof of training for no less than (1) hour in duration, will be completed and submitted into CCL by the due date of 01/26/2023. This training requirement should encompass the importance of required training topics and providing proper care and supervision at all times to the residents. Proof of training should include the name of the trainer, topics that were covered, and list of the participants.

Deadline recorded: Jan 26, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.1(a)(11)

Regulation authority

CCR

What the official deficiency says

Personal Rights of Residents in all Facilities To have their visitors, including Ombudspersons and advocacy representatives, permitted to visit privately during reasonable hours and without prior notice, provided that the rights of other residents are not infringed upon. This facility was found to be deficient as evidenced by the posting of altered visiting hours and policies which contradicted the visiting policies already set forth in the facility program and Admission Agreement (LIC 604).

Official plan of correction

Facility representative stated that the posting will be removed and this facility will only follow the visiting policies already set forth in the program and Admission Agreement (LIC 604). A statement of correction, along with removal of the posting, will be completed and submitted into CCL by the due date of 01/26/2023.

Deadline recorded: Jan 26, 2023. 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 observation, the licensee did not comply with the section cited above since the backyard will need to be cleaned up and the debris/unused items will need to be removed which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/26/2022 Plan of Correction Facility designated staff member stated that all unused items in the backyard will be removed and discarded. A statement of correction will be submitted. along with photos of the cleared/cleaned backyard area, into CCL for review by this LPA by the due date of 10/26/2022.

Official classification

Type B

Official code

87303(c)

Regulation authority

CCR

What the official deficiency says

(c) All window screens shall be clean and maintained in good repair. 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 that several bedroom and common room window screens were either ripped, torn, or in need of repair which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/26/2022 Plan of Correction Facility designated staff member stated that all facility window screens will be reviewed and repaired as needed. A statement of correction will be completed, along with photos of all updated window screens, will be submitted into CCL for review by this LPA by the due date of 10/26/2022.