Community Care Licensing

Document Has Been Signed on 03/16/2022 01:13 PM - It Cannot Be Edited

FACILITY NAME:	LAS CASITAS ASSISTED LIVING		FACILITY NUMBER:	197605806
ADMINISTRATOR:	NATALIE GONZALEZ		FACILITY TYPE:	740
ADDRESS:	1633-1645 N. HOLLYWOOD WAY		TELEPHONE:	(818) 238-9951
CITY:	BURBANK	STATE: CA	ZIP CODE:	91505
CAPACITY: 17		CENSUS: 13	DATE:	03/16/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:20 AM
MET WITH:	Patricia Garcia, Manager		TIME COMPLETED:	01:15 PM

SUPERVISORS NAME: Lisa Hicks LICENSING EVALUATOR NAME: Noemi Galarza LICENSING EVALUATOR SIGNATURE: DATE: 03/16/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/16/2022

Link to Parent Document Below:

FACILITY NAME: LAS CASITAS ASSISTED LIVING	FACILITY NUMBER: 197605806
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/16/2022

Type A

Section Cited

CCR

87468.1(a)(2)

(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, furnishings and equipment. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observaton, the licensee did not comply with the section cited above in that LPA was not screened upon entry, which poses an immediate health, safety or personal rights risk to persons in care. COVID-19 screening protocols i.e. visitor sign-in binder, thermometer, and screening questions were not observed to be in place. Home health staff were also present during today's visit, and were not screened.
	POC Due Date: 03/17/2022
	Plan of Correction
1 2 3 4	Administrator shall put in place COVID-19 infection control visitor screening practices. Submit in writing how this was corrected, and include a picture of the screening area.

Type A

Section Cited

CCR

87705(f)(1)

(f) The following shall be stored inaccessible to residents with dementia: (1) Knives, matches, firearms, tools and other items that could constitute a danger to the resident(s). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above in that during the physical plant tour of resident rooms, dementia residents (R1-R2's) room had a Febreze deodorizer and Clorox cleaning supplies inside room 1641, which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 03/17/2022
	Plan of Correction
1 2 3 4	Administrator shall conduct staff training regarding regulation 87705, check all resident rooms for potential hazards, and submit proof of correction by POC due date.

SUPERVISOR'S NAME: Lisa Hicks LICENSING EVALUATOR NAME: Noemi Galarza LICENSING EVALUATOR SIGNATURE: DATE: 03/16/2022

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/16/2022

Link to Parent Document Below:

FACILITY NAME: LAS CASITAS ASSISTED LIVING	FACILITY NUMBER: 197605806
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/16/2022

Type A

Section Cited

CCR

87705(l)(2)

(l) The following initial and continuing requirements shall be met for the licensee to lock exterior doors or perimeter fence gates: (2) The licensee shall ensure that the fire clearance includes approval of locked exterior doors or locked perimeter fence gates. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above in that the main entrance gate is locked, and had a metal wire on the top of the gate preventing anyone inside the premises from exiting. In addition, the rear gate had a lock that prevents the right side door from opening. Locking mechanisms that require a key and/or inaccessible to residents for exit are against fire safety code which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 03/17/2022
	Plan of Correction
1 2 3 4	Administrator shall remove all locks that require key on exit doors, and wire placed by staff in the front entrance door. Submit picture proof, staff training log, and a written statement of what was done to correct it.

Section Cited

	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

SUPERVISOR'S NAME: Lisa Hicks LICENSING EVALUATOR NAME: Noemi Galarza LICENSING EVALUATOR SIGNATURE: DATE: 03/16/2022

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/16/2022

Link to Parent Document Below:

FACILITY NAME: LAS CASITAS ASSISTED LIVING	FACILITY NUMBER: 197605806
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/16/2022

Type B

Section Cited

CCR

87208(a)

(a) Each facility shall have and maintain a current, written definitive plan of operation. The plan and related materials shall be on file in the facility and shall be submitted to the licensing agency with the license application. Any significant changes in the plan of operation which would affect the services to residents shall be submitted to the licensing agency for approval. The plan and related materials shall contain the following: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and record review, the licensee did not comply with the section cited above in that LPA requested to see the Plan of Operation to check meal/dining services, but staff was not able to find the Plan of Operation, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 03/21/2022
	Plan of Correction
1 2 3 4	Administrator shall submit a copy of the plan of operation, and ensure it is in the facility at all times.

Type B

Section Cited

HSC

1569.695(c)

(c) A facility shall conduct a drill at least quarterly for each shift. The type of emergency covered in a drill shall vary from quarter to quarter, taking into account different emergency scenarios. An actual evacuation of residents is not required during a drill. While a facility may provide an opportunity for residents to participate in a drill, it shall not require any resident participation. Documentation of the drills shall include the date, the type of emergency covered by the drill, and the names of staff participating in the drill. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above in that staff was not able to find record of the last facility emergency drill, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 03/21/2022
	Plan of Correction
1 2 3 4	Administrator shall conduct quarterly emergency drills. Submit proof of emergency drill by POC due date.

SUPERVISOR'S NAME: Lisa Hicks LICENSING EVALUATOR NAME: Noemi Galarza LICENSING EVALUATOR SIGNATURE: DATE: 03/16/2022

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/16/2022