PEACEFUL PINES SENIOR LIVING CORP

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 recores review the licensee did not comply with the section cited above as there were no updated centrally stored medications onsite to review, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/07/2025 Plan of Correction Licensee agreed to keep full facility file and review section cited and create a written plan to ensure future compliance then sent to RO by COB 11/07/2025.

Official classification

Type B

Official code

87506(a)

Regulation authority

CCR

What the official deficiency says

(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 is not met as evidenced by: Deficient Practice Statement Based on records review the licensee did not comply with the section cited above as (2) out of (6) residents did not have a file to review onsite, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/14/2025 Plan of Correction Licensee agreed to keep full facility file and review section cited and create a written plan to ensure future compliance then sent to RO by COB 11/14/2025.

Official classification

Type B

Official code

87467(a)

Regulation authority

CCR

What the official deficiency says

(a) 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, and any other appropriate parties, 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 is not met as evidenced by: Deficient Practice Statement Based on records review , the licensee did not comply with the section cited above as R1's file did not have a completed admissions agreement which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/14/2025 Plan of Correction Licensee agreed to obtain signatures of appropriate parties for R1's admission agreement and review section cited and create a written plan to ensure future compliance then sent to RO by COB 11/14/2025.

Official classification

Type A

Official code

87468.1(a)(3)

Regulation authority

CCR

What the official deficiency says

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 interviews, the licensee did not comply with the section cited above when S1 caused bruising to R1’s arm and wrist after forcibly grabbing R1, which posed an immediate health and safety risk to residents in care.

Official plan of correction

Licensee agreed to review section cited with staff and provide a written plan on how they will ensure future compliance with the regulation and provide document to LPA via email by COB 08/01/2025.

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

Official classification

Type A

Official code

87705(f)(2)

Regulation authority

CCR

What the official deficiency says

The licensee shall ensure that the fire clearance includes approval of locked exterior doors or perimeter fence gates... to unlock exterior doors or perimeter fence gates. This requirement was not met as evidenced by: Based on observation and records review, the licensee did not comply with the section cited above as LPA observed a locked gate and no approved fire clearance on file, which poses an immediate health, safety and personal rights risk to residents in care.

Official plan of correction

Licensee agreed to have key lock replaced and provide a photo to LPA via email by COB 04/18/2025.

Deadline recorded: Apr 18, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.1(a)(2)

Regulation authority

CCR

What the official deficiency says

To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This requirement was not met as evidenced by: Based on interviews and records review, the licensee did not comply with the section cited above as R1 was moved to the exterior of the facility along with their belongings for an extended period of time, which poses a potential health, safety and personal rights risk to residents in care.

Official plan of correction

Licensee agreed review section cited and provide a statement of understanding to LPA via email by COB 04/25/2025.

Deadline recorded: Apr 25, 2025. A deadline is not proof that correction was completed.