Deficiency Type
POC Due Date /
Section Number | DEFICIENCIES | PLAN OF CORRECTIONS(POCs) |
Type A
06/24/2021
Section Cited
CCR
87618(b)(5)
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87618 Oxygen Administration - Gas and Liquid (b) In addition to Section 87611(b), the licensee shall be responsible for the following: (5) Ensuring that facility staff have knowledge of, and ability in the operation of the oxygen equipment. This requirement was not met evidenced by
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Plan of Correction POC Licensee agrees to provide training to staff on how to operate oxygen equiptment by POC due date. |
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14 | Licensee not having trained staff to operate all oxygen equiptment for residents in care. Based on review of records and interview with Licensee, Licensee did not not have training for staff to operate oxygen equiptment, which poses an immediate health and safety risk to residents in care. | 8
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Type A
06/24/2021
Section Cited
CCR87613(a)(2)(B)
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7 | 87613 General Requirements for Restricted Health Conditions
(a) Prior to admission of a resident with a restricted health condition, the licensee shall:(2) Ensure that facility staff who will participate in meeting the resident’s specialized care needs complete training provided by a licensed professional sufficient to meet those needs.(B) Training shall be completed prior to the staff providing services to the resident.
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Plan of Correction POC
Licensee agrees to submit documentation on how the regulation will be met for future residents and necessary training for staff by POC due date. |
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14 | This requirement was not met as evidenced by interviews with licensee and the lack of documentation( no care plans) received from the licensee. Based on review of records, Licensee did not have training for staff to care for hospice residents, which poses an immediate health and safety risk for residents in care. | 8
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Deficiency Type
POC Due Date /
Section Number | DEFICIENCIES | PLAN OF CORRECTIONS(POCs) |
Type A
06/24/2021
Section Cited
CCR
87618(b)(3)(A)
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87618 Oxygen Administration - Gas and Liquid (b) In addition to Section 87611(b), the licensee shall be responsible for the following: (3) Ensuring that the use of oxygen equipment meets the following requirements: (A) A report shall be made in writing to the local fire jurisdiction that oxygen is in use at the facility.
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Plan of Correction POC Licensee agrees to provide proof of reporting oxygen dependent residents to the local fire department. |
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This requirement was not met as evidenced by Licensee not notifying the local fire department of oxygen dependent residents. Based on review of records and interview with Licensee, Licensee did not notify the local fire department of oxygen dependent residents, which poses an immediate health and safety risk for residents in care. | 8
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Type A
06/24/2021
Section Cited
CCR87705(c)(5)
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7 | 87705 Care of Persons with Dementia (c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following:(5) Each resident with dementia shall have an annual medical assessment as specified in Section 87458, Medical Assessment, and a reappraisal done at least annually, both of which shall include a reassessment of the resident’s dementia care needs.
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7 | Plan of Correction POC Licensee agrees to update medical assessments for dementia residents and submit current assessments to LPA by POC due date. |
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This requirement was not met as evidenced by Licensee not having a current medical assessment for R1. Based on review of records and interview with Licensee, Licensee did not have a current assessment for R1 since 2017, which poses an immediate health and safety risk for residents in care. | 8
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Deficiency Type
POC Due Date /
Section Number | DEFICIENCIES | PLAN OF CORRECTIONS(POCs) |
Type A
06/24/2021
Section Cited
HSC
1569.73(h)
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7 | 1569.73 Terminally ill residents; or terminally ill persons to be accepted as a resident; transferring hospice care and waivers; resident care and supervision (h) Nothing in this section shall be construed to relieve a licensed residential care facility for the elderly of its responsibility to notify the appropriate fire authority of the presence of a bedridden resident in the facility as required under subdivision (f) of Section 1569.72, and to obtain and maintain a fire clearance as required under Section 1569.149.
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Plan of Correction POC Licensee agrees to obtain the proper fire clearance for bedridden residents in care and submit proof to LPA by POC due date. Civil Penalties were issued. |
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This requirement was not met as evidenced by Licensee not notifying the local fire department of admitting 5 bedridden residents. Based on review of records and interview with Licensee, Licensee did not notify the local fire departmet of admitting 5 bedridden residents and obtaining the proper fire clearance. | 8
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Type B
06/17/2021
Section Cited
CCR87211(a)(1)
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Reporting Requirements Reporting Requirments: A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence.other death reports were not submitted.This requirement was not met as evidenced by late reporting | 1
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7 | Plan of Correction POC Licensee agrees to submit a written response to on the understanding of this regulation and how it will be met by POC due date. |
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date stamped from CCL on 3/19/21 for a death that occured on 3/1/21 and while reviewing records it was found other death reports were not submitted. Based on interview and review of records Licensee did not have death reports for residents that were in care | 8
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