MARBELLA VISALIA

Official classification

Type A

Official code

87309(a)

Regulation authority

CCR

What the official deficiency says

(a) Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients. This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above LPA observed cleaning cart was left unlocked in the facility hallway with chemicals/ cleaning supplies accessible to residents.

Official plan of correction

Licensee / Administrator agrees to submit a statement of intent by due date to complete an in-service training with all staff regarding keeping disinfectants, cleaning solutions unaccusable to residents and submit records when completed

Deadline recorded: Aug 8, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(a)(4)

Regulation authority

CCR

What the official deficiency says

87465(a)(4) Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following: (4) The licensee shall assist residents with self-administered medications as needed. This requirement is not met as evidenced by: Based on observation, interview, and record, facility did not comply with the regulations listed above, which poses an immediate health and safety risk to residents in care. R1 – R6 did not receive their medications the evening of 3/2/26.

Official plan of correction

Facility has made the following corrections: Facility has removed med-tech to caregiver duties. Facility has received 3 key copies from Pharmacy. Facility has implemented rules to ensure keys are not misplaced in the future. Licensee agrees to submit a statement of intent regarding training by due date. Licensee will conduct medication training with all Med-Tech staff and submit documentation of training when completed.

Deadline recorded: Mar 7, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(h)(6)

Regulation authority

CCR

What the official deficiency says

87465(h)(6) - Incidental Medical and Dental Care: (h)The following requirements shall apply to medications which are centrally stored: (6)The licensee shall be responsible for assuring that a record of centrally stored prescription medications for each resident is maintained for at least one year and includes… This requirement is not met as evidenced by: Based on interviews conducted and records reviewed, facility had an issues receiving Centrally Stored Medication records from Pharmacy. Facility staff were supposed to log medications on Centrally Stored Medication and Destruction log and failed to do so.

Official plan of correction

Licensee agrees to submit a statement of intent regarding training by due date. Licensee will conduct medication training with all Med-Tech staff and submit documentation of training when completed.

Deadline recorded: Mar 9, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(a)(4)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following: (4) The licensee shall assist residents with self-administered medications as needed. This requirement is not met as evidenced by: Based on observation, interview, and record, facility did not comply with the regulation listed above, which poses an immediate health and safety risk to residents in care. R2 was not assisted with medication as needed/prescribed. R2’s medication Ropinirole HCL1 MG Tablet- Take 1 tablet by mouth at bedtime. This medication is showing with a start date of 1/15/2026, the bubble pack holds 30 pills, there are still 5 pills left in the bubble pack. LPA reviewed MARs which did not indicate the medication was missed or refused by the resident. The MARs shows this medication has been taken every night as prescribed, at 8:00 PM from January 15, 2026 thru February 11, 2026. R2 has too many pills left in the bubble pack, which indicates medication was missed or not given on three different occasions.

Official plan of correction

Facility provided current training verification of MedTech staff.

Deadline recorded: Feb 13, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87609(b)(4)(A-C)

Regulation authority

CCR

What the official deficiency says

87609 Allowable Health Conditions and the Use of Home Health Agencies (b) Incidental medical care may be provided to residents through a licensed home health agency provided the following conditions are met: (4) The licensee and home health agency agree in writing on the responsibilities of the home health agency, and those of the licensee in caring for the resident’s medical condition(s). (A) The written agreement shall reflect the services, frequency and duration of care. (B) The written agreement shall include day and evening contact information for the home health agency, and the method of communication between the agency and the facility, which may include verbal contact, electronic mail, or logbook. (C) The written agreement shall be signed by the licensee or licensee representative, and representative of the home health agency, and placed in the resident’s file. This requirement is not met as evidenced by: Based on observation, interview, and record, facility did not comply with the regulation listed above, which poses a potential health and safety risk to residents in care. LPA reviewed R3 & R4's files which did not have a Home Health Care Plan. The plans cannot be followed if there is no home health care plan on file.

Official plan of correction

Licensee was able to obtain copy of current Home Health Care Plan and will obtain plans for future residents.

Deadline recorded: Feb 19, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87211(a)(1)(D)

Regulation authority

CCR

What the official deficiency says

87211 Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: (1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below. This report shall include the resident's name, age, sex and date of admission; date and nature of event; attending physician's name, findings, and treatment, if any; and disposition of the case. (D) Any incident which threatens the welfare, safety or health of any resident, such as psychological abuse of a resident by staff or other residents, or unexplained absence of any resident. Based on observation, interview, and record, facility did not comply with the regulation listed above, which poses a potential health and safety risk to residents in care. LPA reviewed R1's incident reports which did not indicate R1's fall was reported to the Dept.

Official plan of correction

Licensee will send a statement regarding steps taking to ensure reports are sent out. verification will be sent to the Dept by POC date.

Deadline recorded: Feb 19, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(a)(4)

Regulation authority

CCR

What the official deficiency says

a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following: (4) The licensee shall assist residents with self-administered medications as needed. Based on records reviewed and interviews conducted, R1’s medication count is not accurate and medication administered does not match the MARS, which poses an immediate Health & Safety risk to the residents.

Official plan of correction

Licensee agrees that all Med-Tech staff complete medication training. Licensee agees to submit completion documents to CCLD by POC due date.

Deadline recorded: Dec 31, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87211(a)(1)

Regulation authority

CCR

What the official deficiency says

87211(a)(1) Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: (1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below. This report shall include the resident's name, age, sex and date of admission; date and nature of event; attending physician's name, findings, and treatment, if any; and disposition of the case. LPA observed during an investigation that an indicent was not reported to Community Care Licensing.

Official plan of correction

Per Interim Executive Director/Administrator, an inservice training will be conducted by the POC date.

Deadline recorded: Dec 19, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87506(c)

Regulation authority

CCR

What the official deficiency says

87506 (c) All information and records obtained from or regarding residents shall be confidential. This requirement was not met as evidence by: Based on interviews conducted, residents’ information are provided to outside medi-cal assisted agencies programs for referral to verify if the resident meets programs requirement without resident’s knowledge, which poses/posed a potential health, safety, or personal rights risk to persons in care.

Official plan of correction

Written Plan of Correction shall be submitted to the Fresno CCL by POC due date 12/08/25.

Deadline recorded: Dec 8, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.2(a)(8)

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, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (8) To be free from neglect, financial exploitation, involuntary seclusion, punishment, humiliation, intimidation, and verbal, mental, physical, or sexual abuse. This requirement was not met as evidence by: review of records and interviews conducted. The licensee did not comply with the section cited above in that multiple residents had money or items stolen from them at the facility. This poses a potential health safety and or personal rights risk to residents in care.

Official plan of correction

Training will be completed with all staff on personal righst-financial exploitation. Training will include; what staff need to do when reported, what to fill out and who to notify. In-service sign in sheet and training material will be provided to CCL by POC date.

Deadline recorded: Dec 12, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

1569.153(i)

Regulation authority

HSC

What the official deficiency says

1569.153 Theft and loss program; standards, property inventories and surrender of personal effects; secured areas (i) Reports to the local law enforcement agency within 36 hours when the administrator of the facility has reason to believe resident property with a then current value of one hundred dollars ($100) or more has been stolen. Copies of those reports for the preceding 12 months shall be made available to the State Department of Social Services and law enforcement agencies. This requirement was not met as evidence by: record review. The licensee did not comply with the section cited above in that incidents of theft of $100 or more were not reported appropriately. This poses a potential health safety and or personal rights risk to residents in care.

Official plan of correction

Training to be completed with all staff on theft and loss program standards, property inventories and surrendering personal effects. In-service sign in sheet and training material will be provided to CCL by POC date as proof of correction.

Deadline recorded: Dec 12, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87211(a)

Regulation authority

CCR

What the official deficiency says

87211 Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following:… This requirement was not met as evidence by: records reviewed. The licensee did not comply with the section cited above in that special incident report(s) were not submitted to Community Care Licensing as required. This poses a potential health safety and or personal rights risk to residents in care.

Official plan of correction

Training will be completed with all staff on reporting requirements and mandated reporting. In-service sign in sheet and training material will be provided to CCL by POC date as proof of correction.

Deadline recorded: Dec 12, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87506(a)

Regulation authority

CCR

What the official deficiency says

87506 Resident Records. (a) 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 observed as evidenced by. The facility staff failed to keep at the facility and provide requested documents for R1 which were requested and agreed upon due date, of November 14th, 2025 which poses potential health and safety risk to persons in care.

Official plan of correction

The facility staff will review and follow regulations regarding residents records. A plan with detailing steps the facility will take to ensure the requirements for Resident records are met will be submitted to the Fresno CCL by the POC due date 11/29/2025.

Deadline recorded: Nov 29, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87411(d)(4)

Regulation authority

CCR

What the official deficiency says

87411(d)(4) Knowledge required to safely assist with prescribed medications which are self-administered. This requirement was not met as evidenced by: Based on observation, records reviewed, and interview conducted, R1 was given evening medication Atorvastatin and staff recorded that medication was administered. Atorvastatin medication tablet was found the following day. S1 did not ensure R1’s evening medication was administered as prescribed prior to recording that medication was administered, which poses/posed an immediate health and safety risk for the person in care.

Official plan of correction

S1 received in-services training on medication on 11/04/25. Record of S1’s in-service training was received. POC cleared during visit.

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

Official classification

Type B

Official code

87211(a)(1)

Regulation authority

CCR

What the official deficiency says

87211(a)(1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below. This report shall include the resident's name, age, sex and date of admission; date and nature of event; attending physician's name, findings, and treatment, if any; and disposition of the case. This requirement was not met as evidenced by: Based on record review and interview conducted, a written report was not reported to the department within 7 days of incident when R1’s Atorvastatin medication tablet was found the following day after medication was recorded administered, this poses a potential health and safety risk to residents in care.

Official plan of correction

A plan detailing steps the facility will take to ensure the requirements for Reporting requirements are met will be submitted to the Fresno CCL by the POC due date 11/21/25.

Deadline recorded: Nov 24, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468(c)

Regulation authority

CCR

What the official deficiency says

87468 Personal Rights (c) Licensees shall prominently post personal rights, nondiscrimination notice, and complaint information in areas accessible to residents, representatives, and the public. This requirement was not met as evidence by LPA observation. The licensee did not comply with the section cited above in that required postings are not posted in the facility. This poses a potential health safety and or personal rights risk to residents in care.

Official plan of correction

RCD stated they will have posting placed up in the facility. RCD stated they will take pictures showing the posting were placed as proof of correction.

Deadline recorded: Nov 7, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468(c)(2)(A)

Regulation authority

CCR

What the official deficiency says

87468 Personal Rights (c) Licensees shall prominently post personal rights, nondiscrimination notice, and complaint information in areas accessible to residents, representatives, and the public. (2) Information on the appropriate reporting agency in case of a complaint or emergency, including procedures for filing confidential complaints, shall be posted as follows: (A) Licensees may use the Residential Care Facility for the Elderly (RCFE) Complaint Poster (PUB 475) or may develop their own poster as provided in this section. A poster developed by the licensee shall contain the same content as the PUB 475. The poster that is posted shall be 20 " x 26 " in size and be posted in the main entryway of the facility. PUB 475 may be accessed, downloaded, and printed from the www.ccld.ca.gov website. This requirement was not met as evidence by LPA observation. The licensee did not comply with the section cited above in that the RCFE complaint poster was not posted at the facility. This poses a potential health safety and or personal rights risk to residents in care.

Official plan of correction

RCD stated they will have the RCFE complaint poster placed up. A picture will be sent to CCL as proof of correction by POC date.

Deadline recorded: Nov 7, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87405(d)(1)

Regulation authority

CCR

What the official deficiency says

87405 Administrator - Qualifications and Duties (d) 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. (1) Knowledge of the requirements for providing care and supervision appropriate to the residents. This requirement was not met as evidence by residents file review. The licensee did not comply with the section cited above in that review of special incident reports disclosed R3 had an allergic reaction on 5/14/25 and R1 had medication in their room unlocked and accessible on 5/15/25. This poses a potential health safety and or personal right risk to residents in care.

Official plan of correction

RCD stated they will update the board in the kitchen to include type of diet, food texture type and allergies. An in-sevice will be completed with all kitchen staff and care staff. In-service sign in sheet and traiing material will be sent to CCL as proof of correction.

Deadline recorded: Nov 7, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.1(a)(3)

Regulation authority

CCR

What the official deficiency says

87468.1 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: (3) To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature, such as withholding residents’ money or interfering with daily living functions such as eating, sleeping, or elimination. This requirement was not met as evidence by LPA observations on 6/10/25 and 10/25/25. The licensee did not comply with the section cited above in that a gate with lock to kitchenette preventing access to food/drink and posing a tripping hazard observed in memory care. This poses a potential health safety and or personal rights risk to residents in care.

Official plan of correction

RCD stated that gate and lock will be removed by maintenence.RCD stated they will also have staff remove knobs/place a locking mechanism on stove when not in use. Pictures will be provided to CCL by POC date as proof of correction.

Deadline recorded: Nov 7, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87468.2(a)(8)

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, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (8) To be free from neglect, financial exploitation, involuntary seclusion, punishment, humiliation, intimidation, and verbal, mental, physical, or sexual abuse. This requirement was not met as evidenced by: Licensee cashed and deposited two of R1's checks into facility bank account which poses an immediate health safety and or personal rights risk to residents in care.

Official plan of correction

Licensee agrees to submit a plan on how this regulation will be met by POC due date 09/29/25.

Deadline recorded: Sep 29, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87468.1(a)(15)

Regulation authority

CCR

What the official deficiency says

87468.1 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: (15) To send and receive unopened correspondence in a prompt manner. This requirement was not met as evidenced by: Licensee opened R1's mail without permission which poses a health safety and or personal rights risk to residents in care.

Official plan of correction

Licensee agree to conduct a staff training on personal rights and will submit training date and agenda by POC due date 09/29/25.

Deadline recorded: Sep 29, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87507(g)(5)(A)

Regulation authority

CCR

What the official deficiency says

87507 Admission Agreements (g) Admission agreements shall specify the following: (5) Refund conditions (A) Facility policy concerning refunds, including the conditions under which a refund for advanced monthly fees will be returned.... pursuant to Health and Safety Code section 1569.652. This requirement was not met as evidenced by: Licensee did not refund R1 timely. R1's admissions agreement states refunds will be issued within 21 business days. R1 moved out of facility on 7/3/25 and refund was not issued until 8/22/25 which poses a potential health safety and or personal rights risk to residents in care.

Official plan of correction

Licensee agrees to submit in writing to LPA how this regulation will be met by POC due date 10/3/25

Deadline recorded: Oct 3, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87211(a)(2)

Regulation authority

CCR

What the official deficiency says

87211 Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following:2) Occurrences, such as epidemic outbreaks, poisonings, catastrophes or major accidents which threaten the welfare, safety or health of residents, personnel or visitors, shall be reported within 24 hours either by telephone or facsimile to the licensing agency and to the local health officer when appropriate. This requirement was not met by: Licensee did not report R1's contagious prohibited condition, which poses a potential health, safety and or personal rights risk to residents in care.

Official plan of correction

Licensee agrees to submit a written understanding of the regulation by POC due date 5/30/25.

Deadline recorded: May 30, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(a)(4)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following: (4) The licensee shall assist residents with self-administered medications as needed. This requirement was not met as evidenced by: Licensee did not ensure R1 swallowed administered AM medication which was later found in the afternoon which poses an immediate health safety and or personal rights risk.

Official plan of correction

Plan of Correction Licensee agrees to conduct a staff training on administering medications. POC was cleared during visit. Training was conducted on 5/16/25 by LVN.

Deadline recorded: May 24, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87555(b)(29)

Regulation authority

CCR

What the official deficiency says

87555 General Food Service Requirements (b)The following food service requirements shall apply: (29) All equipment, fixed or mobile, and dishes, shall be kept clean and maintained in good repair and free of breaks, open seams, cracks or chips. This requirement was not met as evidenced by: Based on observations and interview the facility kitchen sink disposal has not been operating causing water to buildup in the sink.

Official plan of correction

Executive Director agrees to obtain estimate of repair/replacement and schedule repair. Once service is completed Executive Director will submit proof of service.

Deadline recorded: Dec 6, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87468.1(a)(1)(3)

Regulation authority

CCR

What the official deficiency says

87468.1 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. (3) To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature, such as withholding residents’ money or interfering with daily living functions such as eating, sleeping, or elimination. This requirement is not met as evidenced by: Based on staff and resident interviews staff we observed speaking rudely to residents and being “rough” when providing care. Interviews revealed when residents required additional support of time residents were intimidated or punished.

Official plan of correction

Administrator to submit plan of intent by due date to conduct in-service training on Regulation 87468.1 Personal Rights of Residents in All Facilities and submit records when completed.

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

Official classification

Type A

Official code

87465(a)(4)

Regulation authority

CCR

What the official deficiency says

87465(a)(4) Incidental Medical and Dental Care. The licensee shall assist residents with self-administered medications as needed. This requirement is not met as evidenced by: Based on the interviews conducted Staff missed medicaiton or missed dosage for residents.

Official plan of correction

POC – Discussed during the NCC.

Deadline recorded: Jul 31, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87411(a)

Regulation authority

CCR

What the official deficiency says

87411(a) Personnel Requirements – General - Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. This requirement was not met as evidenced by: Based on the interviews conducted and records reviewed, R1 sustained multiple fractures after staff failed to abide by R1’s care plan and fell, which poses an immediate health and safety risk to the residents in care.

Official plan of correction

POC – Discussed during the NCC.

Deadline recorded: Jul 31, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87411(d)(3)

Regulation authority

CCR

What the official deficiency says

87411(d)(3) Personnel Requirements – General - Skill and knowledge required to provide necessary resident care and supervision, including the ability to communicate with residents. This requirement was not met as evidenced by: Based on the interviews conducted and records reviewed, staff were not trained on two person transfers of R1, which poses an immediate health and safety risk.

Official plan of correction

POC – Discussed during the NCC.

Deadline recorded: Jul 31, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87507(f)

Regulation authority

CCR

What the official deficiency says

87507(f) Admission Agreements - The licensee shall comply with all applicable terms and conditions set forth in the admission agreement, including all modifications and attachments. This requirement was not met as evidenced by: Based on the records reviewed and interviews conducted, staff failed to abide by the resident’s care plan of providing 2 person transfers for R1, which poses a potential health and safety risk.

Official plan of correction

POC – Discussed during the NCC.

Deadline recorded: Jul 31, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87309(a)

Regulation authority

CCR

What the official deficiency says

(a) Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, record review, the licensee did not comply with the section cited above in 3 out of 6 residents rooms were observed with sharps, chemicals which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/17/2024 Plan of Correction Items were removed or locked during inspection. Administrator to visit all resident rooms to ensure no sharps or chemicals are kept in rooms. Administrator to submit a report of findings to LPA when completed.

Official classification

Type A

Official code

87555(b)(26)

Regulation authority

CCR

What the official deficiency says

(b) The following food service requirements shall apply: (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 and interview, the licensee did not comply with the section cited above in 1 out of 1 nonperishable foods did not meet 7 day requirements which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/17/2024 Plan of Correction Administrator to re-stock non-perishable food to meet requirements and submit pictures, receipts of purchase by due date.

Official classification

Type A

Official code

87465(c)(3)

Regulation authority

CCR

What the official deficiency says

(c) If the resident's physician has stated in writing that the resident is unable to determine his/her own need for nonprescription PRN medication, but can communicate his/her symptoms clearly, facility staff designated by the licensee shall be permitted to assist the resident with self-administration, provided all of the following requirements are met: (3) A record of each dose is maintained in the resident's record. The record shall include the date and time the PRN medication was taken, the dosage taken, and the resident's response. 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 1 out of 3 residentsr response was not documented to PRN medication which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/17/2024 Plan of Correction Administrator to submit a statement of intent for implementation of new process to complete the required documentation of PRN medication and complete an in service training of change of processes.

Official classification

Type A

Official code

87458(b)(1)

Regulation authority

CCR

What the official deficiency says

(b) The medical assessment shall include, but not be limited to: (1) A physical examination of the resident indicating the physician's primary diagnosis and secondary diagnosis, if any and results of an examination for communicable tuberculosis, other contagious/infectious or contagious diseases or other medical conditions which would preclude care of the person by the facility. 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 3 out of 5 residents records reviewed, which poses an immediate health, safety or personal rights risk to persons in care. R1's physicians report does not contain accurate diagnoses of Diabetes, medication management regarding insulin and glucose testing. R2’s Physicians report missing ambulatory status.

Official plan of correction

POC Due Date: 07/17/2024 Plan of Correction AD has agreed to obtain an updated physician’s report for R1. Additionally, an audit will be conducted of all physicians reports to ensure current/accurate information. Written statement of audit will be submitted for documentation of correction. All resident identified as needing updated Physicians report will obtain a current report.

Official classification

Type A

Official code

87309(a)

Regulation authority

CCR

What the official deficiency says

87309(a) Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients. This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above in 1 out of 1 unlocked maintenance room that contained Clorox Bleach Cleaner, Bleach Wipes, sharp tools, aerosol cans which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

Administrator to submit a statement in writing regarding plans to provide an in-service training to all staff and submit by due date. Training records to be submitted as completed.

Deadline recorded: Mar 14, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87555(b)(29)

Regulation authority

CCR

What the official deficiency says

(b) The following food service requirements shall apply: (29) All equipment, fixed or mobile, and dishes, shall be kept clean and maintained in good repair and free of breaks, open seams, cracks or chips. 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 1 out of 1 Ice Machine to have brown buildup underneath the door lift area which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/06/2023 Plan of Correction Administrator to have staff unplug, defrost and deep clean ice machine and complete routine cleaning to prevent future issues.

Official classification

Type A

Official code

87465(a)(4)

Regulation authority

CCR

What the official deficiency says

(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 observation and record review, the licensee did not comply with the section cited above in 2 out of 4 person medication audit revealed for Resident 1 (R1) 2 dosages missed with no notes on MARS and Resident 2 (R2) one pill was missing which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/06/2023 Plan of Correction Administrator to submit a statement of intent to provide training to all staff in regard to correct documentation of Centrally stored medication and destruction record (CSMDR) and MARs. Administrator to conduct medication audit to ensure medications are given as prescribed

Official classification

Type A

Official code

87355(a)

Regulation authority

CCR

What the official deficiency says

87355 Criminal Record Clearance (a) The Department shall conduct a criminal record review of all individuals specified in Health and Safety Code section 1569.17 and shall have the authority to approve or deny a facility license, or employment, residence, or presence in the facility, based upon the results of such review. Staff 1's background clearance was still pending while staff was working at the facility, which poses an immediate health, safety, or personal rights risk to residents in care.

Official plan of correction

***Plan of Correction already completed at time of visit*** Facility terminated Staff 1 on 1/26/2023.

Deadline recorded: Mar 1, 2023. A deadline is not proof that correction was completed.

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 records reviewed and interview conducted, on 06/01/22 Staff 1 (S1) removed resident 1 (R1) items from resident room without resident’s permission which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Licensee shall submit a plan of steps that will be taken to ensure the regulation is met by the due date.

Deadline recorded: Aug 30, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87309(a)

Regulation authority

CCR

What the official deficiency says

87309(a) Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, at 12:00PM LPA and Administrator observed a Clorox Bleach Germicidal Cleaner bottle on top of counter in the dining room while 18 residents were sitting in the dining room. At 12:10 PM, LPA and Administrator observed five cleaning chemicals stored under sink in the activity room unlock accessible to residents in care this poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/25/2022 Plan of Correction Administrator immediately removed the cleaning chemical bottles and locked in housekeeping storage room. POC cleared during visit