Community Care Licensing

Type B

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 physical plant observations the licensee did not comply with the section cited above. The facility main entrance does not have required COVID-19 signs posted at the entrance. Signs are not posted throughout the facility in common areas, hallways, and public restrooms to promote handwashing, cough/sneeze etiquette, and physical distancing. During resident room checks 11 out of 12 resident rooms, staff break room, and 3rd floor common area did not have hand sanitizer available for residents and/or staff. Housekeeping staff (S1) was passing through the main lobby area with a supply cart and was observed not wearing a mask. In addition, the majority of the residents walking or lounging in common areas were not wearing masks. This poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 06/08/2021
	Plan of Correction
1 2 3 4	Administrator shall submit a written plan of correction stating how the deficiency will be corrected. In addition, a staff in-service shall be completed. Submit proof of training.

Section Cited

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

SUPERVISOR'S NAME: Lisa Hicks TELEPHONE: (323) 981-3972 LICENSING EVALUATOR NAME: Noemi Galarza TELEPHONE: (323) 981-3974 LICENSING EVALUATOR SIGNATURE: DATE: 06/01/2021

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

FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/01/2021

Type A

Section Cited

CCR

87465(c)(1)

87465(c)(1). Incidental Medical and Dental Care (c) If the resident's physician has stated in writing that the resident is unable to determine his/her own need for nonprescription PRN medication but can communicate his/her symptoms clearly, facility staff designated by the licensee shall be permitted to assist the resident with self-administration, provided all of the following requirements are met: (1) There is written direction from a physician, on a prescription blank, specifying the name of the resident, the name of the medication, all of the information in Section 87465(e), instructions regarding a time or circumstance (if any) when it should be discontinued, and an indication when the physician should be contacted for a medication reevaluation. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on medication record review, the licensee did not comply with the section cited above. Six (6) medication records were reviewed. Two (2) residents [R1 & R2] MAR records were not accurate. Medications were listed on Medication Administration Record (MAR), but staff stated the medications have not been re-ordered because medications should be discharged. Physician discharge orders were not observed. [(observation) (interview) (record review)], [count] out of [total count] [(objects) (persons)] [identifiers] which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 06/02/2021
	Plan of Correction
1 2 3 4	Facility administration shall submit a written plan of how the deficiency was corrected. Facility shall contact resident's MD to obtain medication discounted order. Facility shall conduct staff in-service training regarding discontinued medication orders, documentation, and medication administration protocols. Submit proof of med-tech in-service training.

SUPERVISOR'S NAME: Lisa Hicks TELEPHONE: (323) 981-3972 LICENSING EVALUATOR NAME: Noemi Galarza TELEPHONE: (323) 981-3974 LICENSING EVALUATOR SIGNATURE: DATE: 06/01/2021

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

FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/01/2021