MELOS CARE HOME II

Official classification

Type B

Official code

87309(a)

Regulation authority

CCR

What the official deficiency says

(a) Except as specified in subsection (b), the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances, knives, matches, tools, sharp objects, and other similar items which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage. 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 a razor and nail polish were in an unlocked drawer which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/05/2026 Plan of Correction At the time of the visit the items were relocated. Administrator agrees to review with staff what items need to be secured and submit a statement of understanding of the regulation by POC due date.

Official classification

Type B

Official code

87465(h)

Regulation authority

CCR

What the official deficiency says

(h) The following requirements shall apply to medications which are centrally stored: 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 one (1) out of three (3) centrally stored medication destruction records were not accurately documented missing a start date which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/19/2026 Plan of Correction Administrator will conduct a medication audit, review CSMDR logs and submit a self certification that an audit of medication has been conducted by POC due date.

Official classification

Type B

Official code

1569.605

Regulation authority

HSC

What the official deficiency says

On and after July 1, 2015, all residential care facilities for the elderly, except those facilities that are an integral part of a continuing care retirement community, shall maintain liability insurance covering injury to residents and guests in the amount of at least one million dollars ($1,000,000) per occurrence and three million dollars ($3,000,000) in the total annual aggregate, caused by the negligent acts or omissions to act of, or neglect by, the licensee or its employees. This requirement is not met as evidenced by: Deficient Practice Statement Based on interview and record review, the licensee did not comply with the section cited above as the facility did not have active liability insurance which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/06/2025 Plan of Correction Administrator agreed to obtain active liability insurance and send proof to CCLD no later than POC due date.

Official classification

Type B

Official code

1569.153(d)

Regulation authority

HSC

What the official deficiency says

(d) A written resident personal property inventory is established upon admission and retained during the resident’s stay in the residential care facility for the elderly. Inventories shall be written in ink, witnessed by the facility and the resident or resident’s representative, and dated. A copy of the written inventory shall be provided to the resident or the person acting on the resident’s behalf. All additions to an inventory shall be made in ink, and shall be witnessed by the facility and the resident or resident’s representative, and dated. Subsequent items brought into or removed from the facility shall be added to or deleted from the personal property inventory by the facility at the written request of the resident, the resident’s family, a responsible party, or a person acting on behalf of a resident. The facility shall not be liable for items which have not been requested to be included in the inventory or for items which have been deleted from the inventory. A copy of a current inventory shall be made available upon request to the resident, responsible party, or other authorized representative. The resident, resident’s family, or a responsible party may list those items which are not subject to addition or deletion from the inventory, such as personal clothing or laundry, which are subject to frequent removal from the facility. 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 residents did not have completed personal property inventory sheets which poses a potential personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/06/2025 Plan of Correction Administrator agreed to complete personal property inventory sheets for the identified individuals and send proof to CCLD no later than POC due date.

Official classification

Type A

Official code

87464(f)(1)

Regulation authority

CCR

What the official deficiency says

(f) Basic services shall at a minimum include: (1) Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). This requirement is not met as evidenced by: Based on interview and record review, the licensee did not comply with the above cited section, as staff were aware R1 is at risk of elopement and has unsteady gait and R1 was left unsupervised, which resulted in R1 eloping and sustaining injury, which poses an immediate safety risk to persons in care.

Official plan of correction

Administrator stated additional supervision has been provided to R1 since returning to the facility. Administrator agreed to complete a new needs and service assessment for R1 and indicate what steps will be taken when R1 expresses a desire to exit the facility. Licensee also agreed to install a lock to the interior laundry room door and possibly an auditory device to the exterior exit gate. Proof of stated items will be sent to CCLD by POC due date.

Deadline recorded: Apr 9, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87355(e)

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: This requirement is not met as evidenced by: Deficient Practice Statement Based on interview and record review, the licensee did not comply with the section cited above. Staff #2 did not obtain fingerprint clearance and was observed at the facility providing care to residents. Staff #2 stated start of emplyoment with this facility was 05/18/2024. This poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/19/2024 Plan of Correction Administrator escorted staff #2 out. Administrator shall obtain clearance prior to having staff work with residents.

Official classification

Type A

Official code

87705(f)

Regulation authority

CCR

What the official deficiency says

(f) The following shall be stored inaccessible to residents with dementia: 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. Cleaning, disinfectance, medication, vitamins, supplements, hygiene items observed in the resident rooms, bathroom and kitchen cabinet accessible to residents and others. This poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/19/2024 Plan of Correction Administrator removed items and locked them up during todays visit. Administrator agreed to provide in-service trainig to staff and provide proof of inservice training to LPA by 07/22/2024.

Official classification

Type B

Official code

87412(c)

Regulation authority

CCR

What the official deficiency says

(c) Licensees shall maintain in the personnel records verification of required staff training and orientation. 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. Required staff training records are not maintained on file for review. This poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/26/2024 Plan of Correction Administrator shall develop and organize staff training records so that it is easily available for review by the department.

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

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. LPA observed clutter of bulky items stacked/stored accessible in the backyard in the designated backyard area for residents use. This poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/26/2024 Plan of Correction Administrator shall clear the backyard of the clutter/bulky items stored accessible to residents in care.

Official classification

Type B

Official code

1569.625(b)(1)

Regulation authority

HSC

What the official deficiency says

(1) The department shall adopt regulations to require staff members of residential care facilities for the elderly who assist residents with personal activities of daily living to receive appropriate training. This training shall consist of 40 hours of training. A staff member shall complete 20 hours, including six hours specific to dementia care, as required by subdivision (a) of Section 1569.626 and four hours specific to postural supports, restricted health conditions, and hospice care, as required by subdivision (a) of Section 1569.696, before working independently with residents. The remaining 20 hours shall include six hours specific to dementia care and shall be completed within the first four weeks of employment. The training coursework may utilize various methods of instruction, including, but not limited to, lectures, instructional videos, and interactive online courses. The additional 16 hours shall be hands-on 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. Administrator did not have available the staff training as required and outlined above. This poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/26/2024 Plan of Correction Administrator agreed to gather and review staff training completed by the staff and provide the required training records as outlined above by due date.

Official classification

Type B

Official code

87465(h)(4)

Regulation authority

CCR

What the official deficiency says

(h) The following requirements shall apply to medications which are centrally stored: (4) All centrally stored medications shall be labeled and maintained in compliance with state and federal laws. No persons other than the dispensing pharmacist shall alter a prescription label. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview, record review, the licensee did not comply with the section cited above. LPA observed resident medication prescriptions altered to include start dates. This poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/19/2024 Plan of Correction Administrator acknowledged understanding of the requirement and stated that moving forward they will not write on the prescription labels. Corrected during visit.

Official classification

Type B

Official code

87608(a)(3)

Regulation authority

CCR

What the official deficiency says

(a) Based on the individual's preadmission appraisal, and subsequent changes to that appraisal, the facility shall provide assistance and care for the resident in those activities of daily living which the resident is unable to do for himself/herself. Postural supports may be used under the following conditions: (3) A written order from a physician indicating the need for the postural support shall be maintained in the resident's record. The licensing agency shall be authorized to require other additional documentation if needed to verify the order. This requirement is not met as evidenced by: Deficient Practice Statement Based on interview and record review, the licensee did not comply with the section cited above. Four out of five residents files did not have an order for the half rail observed on the beds. This poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/26/2024 Plan of Correction Administrator agreed to obtain prescriptions for the half bed rails for the four residents identified during todays visit with half bed rails on the beds. Submit copy of the bed rail orders for the four resident.