AUTUMN MANOR, LLC

Official classification

Type A

Official code

87705(f)(2)

Regulation authority

CCR

What the official deficiency says

87705(f)(2) Care of Persons with Dementia (f) The following shall be stored inaccessible to residents 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. 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 over the counter medications were observed in bedroom 3 which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/24/2021 Plan of Correction Administrator were made inaccessible during today's visit. Plan of correction met.

Official classification

Type A

Official code

87705(g)(1)

Regulation authority

CCR

What the official deficiency says

87705(g)(1) Care of Persons with Dementia (g) As required by Section 87468(a)(12), residents with dementia shall be allowed to keep personal grooming and hygiene items in their own possession, unless there is evidence to substantiate that the resident cannot safely manage the items. (1) Evidence means documentation from the resident’s physician that the resident is at risk if allowed direct access to personal grooming and hygiene items. 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 personal hygiene items were accessble in bedrooms 1 and 3 which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/24/2021 Plan of Correction Hygiene items were made in.accessible. Plan of correction met

Official classification

Type B

Official code

87458(b)(3)

Regulation authority

CCR

What the official deficiency says

87458 (b)(3) Medical Assessment (b) The medical assessment shall include, but not be limited to: (3) A record of current prescribed medications, and an indication of whether the medication should be centrally stored, pursuant to Section87465(h)(1). 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 4 out of 5 residents lacked physicians' orders for medication which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/01/2021 Plan of Correction Administrator will obtain physician orders for medications and provide copies of the orders to CCL on or before 10/01/2021.

Official classification

Type B

Official code

87303(e)(2)

Regulation authority

CCR

What the official deficiency says

87303(e)(2) Maintenance and Operation. (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, the licensee did not comply with the section cited above as water temperature measured below regulation which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 10/01/2021 Plan of Correction The Administrator will adjust the water heater, and keep a five day log to ensure water is within regulation. Submit log to CCL by 10/1/2021

Official classification

Type B

Official code

87468.1(a)(2)

Regulation authority

CCR

What the official deficiency says

87468.1(a)(2) Personal Rights of Residents in All Facilities. Residents...shall have all of the following personal rights: To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This requirement is not met as evidenced by: Based on interviews, the licensee did not comply with the section cited above, as residents were showered at an unreasonable time, which poses a potential personal rights risk to persons in care.

Official plan of correction

The Administrator has agreed to do the following: 1. The Administrator will review the policy and will re-evaluate it. The Administrator will submit a statement as to how the facility will maintain personal rights. Submit statement by 5/7/2021.

Deadline recorded: May 7, 2021. A deadline is not proof that correction was completed.