VARENITA OF SIMI VALLEY

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: Based on medication review, the licensee did not comply with the section cited above as R1's medications Melatonin 3mg and Carbamazepine 200 mg each missing one extra dose, which poses an immediate health and safety risk to residents in care.

Official plan of correction

The Licensee has agreed to have an in-house training on properly administering medications to residents and submit proof to CCL no later than POC due date.

Deadline recorded: Aug 1, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87465(h)(6)(A-F)

Regulation authority

CCR

What the official deficiency says

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: name of resident, physician, drug name, strength, quantity, date filled, prescription number and the name of the issuing pharmacy. This requirement is not met as evidenced by: Based on medication review, the licensee did not comply with the section cited above as meds for 3 out of 5 residents were not documented on the CSMDR and meds for 2 out of 5 residents were missing start dates, which poses a potential health and safety risk to residents in care.

Official plan of correction

The Licensee has agreed to have an in-house training on properly documenting medications on the CSMDR and submit proof to CCL no later than POC due date.

Deadline recorded: Aug 1, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87355(e)(3)

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: (3) Request a transfer of a criminal record clearance as specified in Section 87355(c) or This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, the licensee did not comply with the section cited above as S1 was hired by the facility on 04/29/2023 but have not been associated to the facility since 02/21/2024, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/27/2025 Plan of Correction S1 was re-associated to the facility during today's visit. POC has been met.

Official classification

Type B

Official code

1569.625(b)(2)

Regulation authority

HSC

What the official deficiency says

(2) In addition to paragraph (1), training requirements shall also include an additional 20 hours annually, eight hours of which shall be dementia care training, as required by subdivision (a) of Section 1569.626, and four hours of which shall be specific to postural supports, restricted health conditions, and hospice care, as required by subdivision (a) of Section 1569.696. This training shall be administered on the job, or in a classroom setting, or both, and may include online training. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, the licensee did not comply with the section cited above as three out of ten staff do not have the required annual training completed, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/28/2025 Plan of Correction The Licensee will ensure all staff completes necessary yearly training and submit proof to CCLD no later than POC due date.

Official classification

Type B

Official code

87468.1(a)(2)

Regulation authority

CCR

What the official deficiency says

Personal Rights of Residents in All Facilities ...To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This requirement was not met as evidenced by Based on observations and interviews, the Licensee did not comply with the section cited above, as expired COVID test kits were used to test residents, which poses a potential personal rights risk to residents in care.

Official plan of correction

POC cleared during visit. Licensee has discarded expired test kits and LPA observed new COVID test kits in storage. No further action required.

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

Official classification

Type B

Official code

1569.655

Regulation authority

HSC

What the official deficiency says

(a)If a licensee of a residential care facility for the elderly increases the rates of fees for residents or makes increases in any of its rate structures for services, the licensee shall provide no less than 60 days' prior written notice to the residents or the residents' representatives setting forth the amount ... of the increase, the reason for the increase, and a general description of the additional costs, except for an increase in the rate due to a change in the level of care of the resident.... This requirement is not met as evidenced by:

Official plan of correction

The Licensee will review regulation and submit a written letter certifying that, moving forward, they will ensure to follow and adhere to Health & Safety Code 1569.655(a); The written letter must be sent to the LPA by the POC due date. Based on record review, the licensee did not comply with the section cited above as the resident’s admissions agreement are not updated or have an addendum on file that reflects residents new structure of level of care levels as stated on plan of operation, which poses a potential personal rights risk to persons in care.

Deadline recorded: Mar 27, 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(a)(1)(3) 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… and to be free from... punishment, humiliation, intimidation, abuse, or other actions of a punitive nature… This requirement was not met as evidenced by:

Official plan of correction

The Licensee has agreed to conduct an in-house training on residents’ personal rights and submit proof to CCL no later than 01/19/2024. Based on the information obtained and reviewed, the Licensee did not comply with the section cited above as S1 slapped R1 while providing care, which posed an immediate safety risk to residents in care.

Deadline recorded: Jan 18, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87555(b)(8)

Regulation authority

CCR

What the official deficiency says

(b) The following food service requirements shall apply: (8) All food shall be of good quality. Commercial foods shall be approved by appropriate federal, state and local authorities. Food in damaged containers shall not be accepted, used or retained. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPAs observation during inspection, the licensee did not comply with the section cited above as a substantial amount of non-perishable items were in poor condition as they were observed past their expiration date, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/18/2024 Plan of Correction Licensee discarded all expired items and ordered new items during the inspection. POC has been met.

Official classification

Type A

Official code

1558

Regulation authority

HSC

What the official deficiency says

(a) The department may prohibit any person from... continuing the employment of, or allowing in a licensed facility or certified family home, or allowing contact with clients of a licensed facility or certified family home by, any employee, prospective employee, or person who is not a client who has: (2) Engaged in conduct that is inimical to the health, morals, welfare, or safety of either the people of this state or an individual in, or receiving services from, the facility or certified family home. This requirement is not met as evidenced by:

Official plan of correction

The Licensee has agreed to the following: 1.) The Licensee terminated S1. 2.) The Licensee will submit a plan on how the facility will ensure this situation does not occur again and submit to CCL by 12/15/2023. Civil Penalty issued. Based on S1’s admission and photos of the crystal marijuana submitted by S1, S1 was under the influence of drugs while working at the facility, which posed an immediate health and safety risk to residents in care.

Deadline recorded: Dec 4, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87465(h)(6)(A-F)

Regulation authority

CCR

What the official deficiency says

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... This requirement is not met as evidenced by: Based on LPA observation and record review, the licensee did not comply with the section cited above as R1’s centrally stored medication and destruction record is missing centrally stored medication expiration and start date, which poses a potential health and safety to residents in care.

Official plan of correction

The Licensee has agreed to conduct a training with staff on properly and completely filling out CSMDR and submit proof to CCL by 08/31/2023.

Deadline recorded: Aug 31, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(h)(2)

Regulation authority

CCR

What the official deficiency says

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 is not met as evidenced by: Based on record review and interviews, the licensee did not comply with the section cited above as narcotics, a controlled medication which is being centrally stored went missing without a trace, which poses an immediate health and safety risk to residents in care.

Official plan of correction

The Licensee will conduct a training with staff regarding Regulation 87465 and submit proof to CCL. POC has been met.

Deadline recorded: Aug 14, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87303(a)(1)

Regulation authority

CCR

What the official deficiency says

Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors.Floor surfaces… shall be maintained in a clean and odorless condition. This requirement is not met as evidenced by: Based on LPA observation during the facility walkthrough, the licensee did not comply with the section cited above, as R1’s bedroom has a lingering smell of pet urine, which poses a potential health and safety risk to residents in care.

Official plan of correction

The Licensee has agreed to replace carpet in Resident's apartment and submit proof CCL

Deadline recorded: Aug 31, 2023. 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

(c) The licensee shall arrange a meeting with the resident, the resident’s representative, if any, appropriate facility staff,...when there is significant change in the resident’s condition, or once every 12 months, whichever occurs first,.. This requirement is not met as evidence by: Based on interviews and resident records review the licensee/facility staff did not comply with the section cited above as R1's reappraisal were not done when a change in condition occured, which poses a potential health, safety and personal rights risk to residents in care.

Official plan of correction

Administrator agreed to submit a self certification letter explaining what changes have been made and any inservice training provide to staff as plan of correction for future compliance.

Deadline recorded: Apr 25, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87468.1(a)(2)

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: (2) To be accorded safe, healthful and comfortable accommodations... This requirement was not met as evidenced by: Based on LPA observation, the licensee did not comply with the section cited above as facility staff were observed NOT wearing masks/face coverings properly (on their chin) while inside the facility during an outbreak, which poses an immediate health, safety, and personal rights risk to persons in care.

Official plan of correction

Health & Wellness Director has agreed to hold training with all staff about proper mask-wearing and COVID-19 prevention protocol and provide training records to CCL by 09/27/2022.

Deadline recorded: Sep 26, 2022. A deadline is not proof that correction was completed.