FILLMORE COUNTRY CLUB

Official classification

Type A

Official code

87465(a)(6)

Regulation authority

CCR

What the official deficiency says

(6) When requested by the prescribing physician or the Department, a record of dosages of medications which are centrally stored shall be maintained by the facility. This requirement is not met as evidenced by: Deficient Practice Statement Based on records review the licensee did not comply with the section cited above as (3) residents did not have a centrally stored medications list on file for review, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/15/2025 Plan of Correction Licensee agreed to create a centrally stored medication list for those (3) residents and review section cited then provide LPA with a written plan to ensure future compliance and send to LPA via email by COB 12/15/2025.

Official classification

Type A

Official code

87465(h)(5)

Regulation authority

CCR

What the official deficiency says

(h) The following requirements shall apply to medications which are centrally stored: (5) Each resident's medication shall be stored in its originally received container. No medications shall be transferred between containers. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and records review the licensee did not comply with the section cited above as (4) residents had their medications pre-pored in cassettes, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/15/2025 Plan of Correction Licensee agreed to discontinue to prefill medications and review section cited then provide LPA with a written plan to ensure future compliance and send to LPA via email by COB 12/15/2025.

Official classification

Type B

Official code

1569.695(f)(1)

Regulation authority

HSC

What the official deficiency says

(f) A facility shall have both of the following in place: (1) An evacuation chair at each stairwell, on or before July 1, 2019. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation the licensee did not comply with the section cited above as one (1) stairwell did not have an emergency evac chair, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/26/2025 Plan of Correction Licensee agreed to obtain a new evacuation chair and install on the stairwell then provide LPA with a photo via email by COB 12/26/2025.

Official classification

Type A

Official code

1569.695(f)(1)

Regulation authority

HSC

What the official deficiency says

(f) A facility shall have both of the following in place: (1) An evacuation chair at each stairwell, on or before July 1, 2019. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation during facility inspection, the licensee did not comply with the section cited above in three (3) out of three (3) stairwells, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/08/2023 Plan of Correction Administrator will order three evacuation chairs for each of the three stairwells located in the facility and provide proof of the order and expected delivery date to CCL on or before 12/8/2023. Once the chairs have been received and placed in the stairwells, Administrator will provided photos of the placement of the chairs to CCL.

Official classification

Type A

Official code

87303(e)(2)

Regulation authority

CCR

What the official deficiency says

87303 Maintenance and Operation (e) Water supplies and plumbing fixtures shall be maintained as follows: (2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degree C) and not more than 120 degree F (49 degree C). This requirement is not met as evidenced by: Deficient Practice Statement Based on observation through temperature testing, the licensee did not comply with the section cited above in three (3) out of three (3) resident room faucets tested (readings were 121.8*F, 128.5*F, 127.4*F), which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/08/2023 Plan of Correction Administrator immediately turned the water heater temperature down during the visit. He will check temperatures in the rooms to ensure the temperature is between 105*F - 120*F and send photos of the temperature readings to CCL on or before 12/08/2023.

Official classification

Type A

Official code

87464(f)(1)(c)

Regulation authority

CCR

What the official deficiency says

87464 Basic services (f)(1)(c) " Care and supervision " means the facility assumes responsibility for...ongoing assistance with activities of daily living without which the resident’s physical health, mental health, safety, or welfare would be endangered. This requirement is not met as evidenced by: Based on interview and record review, R1 is not permitted to leave the facility unassisted, had a known elopement history, and eloped from the facility again, which poses an immediate safety risk to residents in care.

Official plan of correction

Facility added delayed egress on all upstairs stairwell doors. Additonally, facility added a camera in the downstairs exit stairwell, which alerts staff of any motion in that area. Administrator also agreed to author an addentum to the facility's dementia care plan to include elopement procedures. Addendum will be sent to CCL by 01/17/2023.

Deadline recorded: Jan 17, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87466

Regulation authority

CCR

What the official deficiency says

87466 Observation of the Resident. The licensee shall ensure that residents are regularly observed for changes in physical, mental, emotional and social functioning and that appropriate assistance is provided when such observation reveals unmet needs. This requirement is not met as evidenced by: The facility did not comply with the section cited above as R1 left the facility unattended and was found 1 block away from the facility which posses and immediate health, safety and peronnal rights risk to person in care.

Official plan of correction

Admin stated they will update the Plan of care accordingly and consult with POA, and will conduct training on all staff regarding dementia. Admin will submit all paperwork to LPA via email.

Deadline recorded: Apr 12, 2022. A deadline is not proof that correction was completed.