Deficiency Type
POC Due Date /
Section Number | DEFICIENCIES | PLAN OF CORRECTIONS(POCs) |
Type A
07/29/2022
Section Cited
CCR
87309(a)
| 1
2
3
4
5
6
7 | Storage Space
Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients.
This requirement was not met as evidenced by: | 1
2
3
4
5
6
7 | Administrator will store toxins an knives in a locked area inaccesible to clients and will review regulation 87309 with staff. POC will be submitted to CCLD via fax by POC due date. |
 | 8
9
10
11
12
13
14 | Based on observation, at 11:33am LPA Cifuentes observed kinfe in container on kitchen counter and at 11:38am, 11:46am and 11:50am LPA Cifuentes observed toxins in two of the bathrooms and R1's room. This is an immediate health and safety hazard for residents in care. | 8
9
10
11
12
13
14 | |
Type A
07/29/2022
Section Cited
CCR87309(a)(1)
| 1
2
3
4
5
6
7 | Storage Space
Storage areas for poisons, and firearms and other dangerous weapons shall be locked.
This requirement is not met as evidenced by: | 1
2
3
4
5
6
7 | Adminstrator will lock all storage areas containing knives, toxins/poisons. POC will be submitted to CCLD via fax by POC due date. |
| 8
9
10
11
12
13
14 | Based on observation, 11:33 LPA observed unlocked drawer in the kitchen where knives are stored. At 12:02pm LPA observed lock to closet were toxins are stored was not locked. This is an immediate health and safety hazard for residents in care. | 8
9
10
11
12
13
14 | |
Deficiency Type
POC Due Date /
Section Number | DEFICIENCIES | PLAN OF CORRECTIONS(POCs) |
Type B
08/18/2022
Section Cited
CCR
87458(a)
| 1
2
3
4
5
6
7 | Medical Assessment
Prior to a person's acceptance as a resident, the licensee shall obtain and keep on file, documentation of a medical assessment, signed by a physician, made within the last year...
This requirement is not met as evidenced by:
| 1
2
3
4
5
6
7 | Adminsitrator will obtain a Physician's report for R1 and review with staff regulaition section 87458 and write a statement confirming they have read and understood regulation. Facility will submit POC to CCLD via fax by POC due date. |
| 8
9
10
11
12
13
14 | Based on observation, At 10:20am LPA Cifuentes noted that Physician's Report for Resident 1 (R1) is not signed by a physician. This is a potentail health and safety risk to residents in care. | 8
9
10
11
12
13
14 | |
Type B
08/18/2022
Section Cited
CCR87458(b)(1)
| 1
2
3
4
5
6
7 | Medical Assessment
A physical examination of the resident indicating the physician's primary diagnosis and secondary diagnosis, if any and results of an examination for communicable tuberculosis...which would preclude care of the person by the facility.
This requirement is not met as evidenced by: | 1
2
3
4
5
6
7 | Adminsitrator will obtain TB tests for R1 and R2 and send POC to CCLD by POC due date. |
| 8
9
10
11
12
13
14 | Based on observation, At 10:18am LPA Cifuentes observed that R1and R2 do not have a TB test. This is a potential heath and safety risk to residents in care. | 8
9
10
11
12
13
14 | |
Deficiency Type
POC Due Date /
Section Number | DEFICIENCIES | PLAN OF CORRECTIONS(POCs) |
Type B
08/18/2022
Section Cited
CCR
87303(a)
| 1
2
3
4
5
6
7 | Maintenance and Operation
The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors
THis requirement is not met as evidenced by: | 1
2
3
4
5
6
7 | Administrator will fix lights and make and implement a plan for pest control involving a pest control companh and send proof of correction to CCLD via fax by POC due date. |
| 8
9
10
11
12
13
14 | Based on observation, at 11:18am LPA Cifuentes noted an assortment of empty boxes, boards and electrical parts around perimeter of facility. At 11:26am and 11:58am LPA noted that lights in bathroom 1 and 2 are in disrepair. At 11:30am LPA Cifuentes observed pests in facility kitchen. This is a potential health and safety risk for the clients in care. | 8
9
10
11
12
13
14 | |
Type B
08/18/2022
Section Cited
CCR87608(a)3
| 1
2
3
4
5
6
7 | Postural Supports
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: | 1
2
3
4
5
6
7 | Administrator will remove rails from beds and lap belt from resident until a physicians order is obtained and plan of correction is submitted to CCLD via fax by POC due date. |
| 8
9
10
11
12
13
14 | Based on observation, At 11:42 am and 11:44am LPA Cifuentes observed half-bed rails in bedrooms of R1, resident 2(R2) and resident 3 (R3) and a lap belt on R3 and no physicians order was found in residents files. | 8
9
10
11
12
13
14 | |
Deficiency Type
POC Due Date /
Section Number | DEFICIENCIES | PLAN OF CORRECTIONS(POCs) |
Type B
08/18/2022
Section Cited
CCR
87507(a)
| 1
2
3
4
5
6
7 | Resident Records
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: | 1
2
3
4
5
6
7 | Administrator will review medication adminstration practices with staff and submit a sign in sheet and summary of topics covered to CCLD via fax by POC due date. |
| 8
9
10
11
12
13
14 | Based on observation, at 11:56am LPA Cifuentes noted medication administration record was not marked for resident R3 from dates of 7/22/2022 until 7/28/2022. | 8
9
10
11
12
13
14 | |
| 1
2
3
4
5
6
7 | | 1
2
3
4
5
6
7 | |
| 1
2
3
4
5
6
7 | | 1
2
3
4
5
6
7 | |