Community Care Licensing

Document Has Been Signed on 09/15/2021 03:40 PM - It Cannot Be Edited

FACILITY NAME:	LA POSADA IN GLENDORA		FACILITY NUMBER:	198603124
ADMINISTRATOR:	DIAZ, RAFAEL		FACILITY TYPE:	740
ADDRESS:	1239 S SUNFLOWER AVE		TELEPHONE:	(562) 774-7167
CITY:	GLENDORA	STATE: CA	ZIP CODE:	91740
CAPACITY: 6		CENSUS: 6	DATE:	09/15/2021
TYPE OF VISIT:	Case Management - Annual Continuation	UNANNOUNCED	TIME BEGAN:	12:46 PM
MET WITH:	Santos Valencia, Caregiver		TIME COMPLETED:	03:50 PM

SUPERVISORS NAME: Wei Siew Ho LICENSING EVALUATOR NAME: Tony Vasallo LICENSING EVALUATOR SIGNATURE: DATE: 09/15/2021

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

FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/15/2021

Link to Parent Document Below:

FACILITY NAME: LA POSADA IN GLENDORA	FACILITY NUMBER: 198603124
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/15/2021

Type B

Section Cited

CCR

87411(a)

(a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. In facilities licensed for sixteen or more, sufficient support staff shall be employed to ensure provision of personal assistance and care as required in Section 87608, Postural Supports. Additional staff shall be employed as necessary to perform office work, cooking, house cleaning, laundering, and maintenance of buildings, equipment and grounds. The licensing agency may require any facility to provide additional staff whenever it determines through documentation that the needs of the particular residents, the extent of services provided, or the physical arrangements of the facility require such additional staff for the provision of adequate services. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observations and records reviewed, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care. Routine symptom screening (+/- temperature and symptom check) has been initiated at entry for all staff, residents, and visitors. This practice has a health and safety impact that includes, but is not limited to personal rights, health-related services, responsibility for providing care and supervision, and personnel requirements. LPA's and visitors were not screened during annual visits conducted on 9/10/21 and 9/15/21.
	POC Due Date: 09/22/2021
	Plan of Correction
1 2 3 4	Administrator will provide training to staff regarding routine symptom screening for all visitors. Proof of training will be submitted by 9/22/21.

SUPERVISOR'S NAME: Wei Siew Ho LICENSING EVALUATOR NAME: Tony Vasallo LICENSING EVALUATOR SIGNATURE: DATE: 09/15/2021

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

FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/15/2021

Link to Parent Document Below:

FACILITY NAME: LA POSADA IN GLENDORA	FACILITY NUMBER: 198603124
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/15/2021

Type B

Section Cited

CCR

87465(h)(6)(A-F)

This requirement is not met as evidenced by:(6) The licensee shall be responsible for assuring that a record of centrally stored prescription medications for each resident is maintained for at least one year and includes:(A)The name of the resident for whom prescribed.(B)The name of the prescribing physician.(C)The drug name, strength and quantity.(D) The date filled. (E) The prescription number and the name of the issuing pharmacy.(F) Instructions, if any, regarding control and custody of the medication.
	Deficient Practice Statement
1 2 3 4	Based on observation and record review, the licensee did not comply with the section cited above in 5 out of 6 residents which poses a potential health, safety or personal rights risk to persons in care. Resident #3's (R3) record did not include Quetiapine Fumarate 50 mg and Simvastatin 20 mg medication. Resident #2's (R2) record did not include Hydrocodone 325 mg and Escitalopram 20 mg medication. Resident #4 (R4), Resident #5 (R5), Resident #6 (R6) did not have a list of medications, but had medication present in the facility.
	POC Due Date: 09/29/2021
	Plan of Correction
1 2 3 4	Administrator will correct R2 and R3 medication records. Administrator will obtain a medication list for R4, R5, and R6. Medication records will be submitted by 9/29/21.

Section Cited

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

SUPERVISOR'S NAME: Wei Siew Ho LICENSING EVALUATOR NAME: Tony Vasallo LICENSING EVALUATOR SIGNATURE: DATE: 09/15/2021

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

FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/15/2021