Community Care Licensing

Document Has Been Signed on 10/26/2024 02:33 PM - It Cannot Be Edited

Tony Vasallo TELEPHONE: (323) 981-3977 Mary G Flores TELEPHONE: 323-981-3965 DATE: 10/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/26/2024

FACILITY NAME: LAS CASITAS ASSISTED LIVING	FACILITY NUMBER: 197605806
	VISIT DATE: 10/26/2024

FACILITY NAME: LAS CASITAS ASSISTED LIVING	FACILITY NUMBER: 197605806
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/26/2024

Type A

Section Cited

CCR

87303(e)(2)

(e) Water supplies and plumbing fixtures shall be maintained as follows: (2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degrees C) and not more than 120 degree F (49 degrees C). 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 6 out 7 resident bathrooms water temperature was tested between 125.2-143.8 which is not within the required 105-120 degrees F., which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 10/27/2024
	Plan of Correction
1 2 3 4	Administrator will adjust the water heater and will certify in writing that will ensure water temperature is within the required 105-120 degrees F., to the department by POC due date 10/27/24.

Type A

Section Cited

CCR

87309(a)

(a) 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 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 cleaning supplies were observed unlocked at the time of the visit in the kitchen accessible to the residents which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 10/27/2024
	Plan of Correction
1 2 3 4	Administrator will provide in-service training to staff regarding dementia regulations and will provide a copy to the department by POC due date 10/27/24.

SUPERVISOR'S NAME: Tony Vasallo TELEPHONE: (323) 981-3977 LICENSING EVALUATOR NAME: Mary G Flores TELEPHONE: 323-981-3965 LICENSING EVALUATOR SIGNATURE: DATE: 10/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/26/2024

FACILITY NAME: LAS CASITAS ASSISTED LIVING	FACILITY NUMBER: 197605806
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/26/2024

Type A

Section Cited

CCR

87705(j)

(j) The licensee shall have an auditory device or other staff alert feature to monitor exits, if exiting presents a hazard to any resident. 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 3 out of 5 resident files reviewed residents have a dementia diagnosis which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 10/27/2024
	Plan of Correction
1 2 3 4	Administrator will provide auditory devices in each exit door and will provide a picture to the department by POC due date 10/27/24.

Section Cited

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

SUPERVISOR'S NAME: Tony Vasallo TELEPHONE: (323) 981-3977 LICENSING EVALUATOR NAME: Mary G Flores TELEPHONE: 323-981-3965 LICENSING EVALUATOR SIGNATURE: DATE: 10/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/26/2024

FACILITY NAME: LAS CASITAS ASSISTED LIVING	FACILITY NUMBER: 197605806
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/26/2024

Type B

Section Cited

HSC

1569.618(c)(3)

(c)The facility shall employ, and the administrator shall schedule, a sufficient number of staff members to do all of the following: (3) Ensure that at least one staff member who has cardiopulmonary resuscitation (CPR) training and first aid training is on duty and on the premises at all times. This paragraph shall not be construed to require staff to provide CPR. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in 4 out of 4 staff files reviewed staff las CPR training was conducted in 2019 which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 11/01/2024
	Plan of Correction
1 2 3 4	Administrator will ensure staff takes CPR/First Aid training and submit a copy to the department by POC due date 11/1/24.

Type B

Section Cited

CCR

87412(d)

(d) The licensee shall maintain documentation that an administrator has met the certification requirements specified in Section 87406, Administrator Certification Requirements or the recertification requirements in Section 87407, Administrator Recertification Requirements. 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 current administrator certificate or training were not available for review which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 11/01/2024
	Plan of Correction
1 2 3 4	Administrator will provide a copy of current administrator certificate or eopies of certification submitted to the department for renewal, or enrollement to renew certificate to the department by POC due date 11/1/24.

SUPERVISOR'S NAME: Tony Vasallo TELEPHONE: (323) 981-3977 LICENSING EVALUATOR NAME: Mary G Flores TELEPHONE: 323-981-3965 LICENSING EVALUATOR SIGNATURE: DATE: 10/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/26/2024

FACILITY NAME: LAS CASITAS ASSISTED LIVING	FACILITY NUMBER: 197605806
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/26/2024

Type B

Section Cited

HSC

1569.625(b)(2)

(2) In addition to paragraph (1), training requirements shall also include an additional 20 hours annually, eight hours of which shall be dementia care training, as required by subdivision (a) of Section 1569.626, and four hours of which shall be specific to postural supports, restricted health conditions, and hospice care, as required by subdivision (a) of Section 1569.696. This training shall be administered on the job, or in a classroom setting, or both, and may include online training. 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 3 out of 4 staff did not have records of training within the last 12 months which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 11/01/2024
	Plan of Correction
1 2 3 4	Administrator will provide staff with 20 hours of training including the topics above and will submit a copy to the department by POC due date 11/1/24.

Type B

Section Cited

CCR

87458(b)(1)

(b) The medical assessment shall include, but not be limited to: (1) 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, other contagious/infectious or contagious diseases or other medical conditions which would preclude care of the person by the facility. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in [count] out of 1 out of 5 residents, resident #3 did not have a copy of TB test clearance which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 11/01/2024
	Plan of Correction
1 2 3 4	Administrator will obtain TB test clearance for R3 and submit a copy to the department by POC due date 11/1/24.

SUPERVISOR'S NAME: Tony Vasallo TELEPHONE: (323) 981-3977 LICENSING EVALUATOR NAME: Mary G Flores TELEPHONE: 323-981-3965 LICENSING EVALUATOR SIGNATURE: DATE: 10/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/26/2024

FACILITY NAME: LAS CASITAS ASSISTED LIVING	FACILITY NUMBER: 197605806
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/26/2024

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 record review, the licensee did not comply with the section cited above in last fire drill was conducted on 10/19/19 which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 11/01/2024
	Plan of Correction
1 2 3 4	Adminsitrator will provide an emergency dril and will submit a copy to the deparment by POC due date 11/1/24.

Type B

Section Cited

CCR

87608(a)(3)

(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
1 2 3 4	Based on observation and record review, the licensee did not comply with the section cited above in 8 out of 9 residents have half bed rails in their beds which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 11/01/2024
	Plan of Correction
1 2 3 4	Administrator will submit a bed rail request order from the physician to the department by POC due date 11/1/24.

SUPERVISOR'S NAME: Tony Vasallo TELEPHONE: (323) 981-3977 LICENSING EVALUATOR NAME: Mary G Flores TELEPHONE: 323-981-3965 LICENSING EVALUATOR SIGNATURE: DATE: 10/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/26/2024

FACILITY NAME: LAS CASITAS ASSISTED LIVING	FACILITY NUMBER: 197605806
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/26/2024

Type B

Section Cited

CCR

87705(c)(5)

(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. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in 3 out of 5 residents, R3 last physician's report was conducted on 6/12/19 and no appraisal was done, R4 last physician's report was 11/9/21 and no appraisal was done, and R5 physician's report was 2/22/21 and appraisal done 2/15/21 which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 11/02/2024
	Plan of Correction
1 2 3 4	Administrator will request a physician report for R3-R5 and will conduct an appraisal for R3-R5 and will submit a copy for each to the department by POC due date 11/2/24.

Type B

Section Cited

CCR

87412(b)(2)

87412 Personnel Records (b) Personnel records shall be maintained for all volunteers and shall contain the following: (2) Health screening documents as specified in Section 87411(f). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in 2 out of 4 staff, S3-S4 did not have a health screening/TB test on file which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 11/01/2024
	Plan of Correction
1 2 3 4	Administrator will ensure staff obtain a health screening TB test and submit a copy to the department by POC due date 11/1/24.

SUPERVISOR'S NAME: Tony Vasallo TELEPHONE: (323) 981-3977 LICENSING EVALUATOR NAME: Mary G Flores TELEPHONE: 323-981-3965 LICENSING EVALUATOR SIGNATURE: DATE: 10/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/26/2024