Deficiency Type
POC Due Date /
Section Number | DEFICIENCIES | PLAN OF CORRECTIONS(POCs) |
Type B
03/07/2024
Section Cited
CCR
87465(e)(1-4)
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7 | Incidental Medical and Dental Care:For every prescription and nonprescription PRN medication for which the licensee provides assistance there shall be a signed, dated written order from a physician, on a prescription blank, maintained in the residents file, and a
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7 | The Licensee will review Section 87465 entirely and all resident files to ensure that there is a copy of the Physicians Order maintained in every residents file or contact the prescribing physician and obtain a copy for all the medications that are centrally stored by 3/7/24. |
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14 | label on the medication. Both the physician's order and the label shall contain at least all of the following information. (1) specific symptoms which indicate the need for the use of the medication.(2) exact dosage.(3)minimum number of hours between doses.(4)The maximum number of doses allowed in each 24-hour period. This requirement is not met per review of R1's file | 8
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14 | Provide a signed written statement that you have read Section 87465 and understand the requirements and that all residents files have been reviewed and now contain the required physicians order by 3/7/24 |
Type B
03/07/2024
Section Cited
CCR87465(b)
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7 | Incidental Medical and Dental Care: If the resident's physician has stated in writing that the resident is able to determine and communicate his/her need for a prescription or nonprescription PRN medication, facility staff shall be permitted to assist the resident with self-
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7 | The Licensee will review all residents files to ensure that they all contain PRN Authoriazation letters for all residents' PRN medications. A copy of the PRN Authorization letter will be provided to the Department for review by 3/7/24 |
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14 | administration of his/her PRN medication. This requirement was not met as evidenced by: Resident #1 has been prescribed PRN Acetaminophen 325mg, Clonidine 1mg and Tizanidine 2mg and no PRN Authorization letter was observed in Resident's file. Staff are making the decision to dispense PRN medication. | 8
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Deficiency Type
POC Due Date /
Section Number | DEFICIENCIES | PLAN OF CORRECTIONS(POCs) |
Type B
03/07/2024
Section Cited
CCR
87507(c)
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7 | Admissions Agreement:Admission agreements shall be signed and dated, acknowledging the contents of the document, by the resident or the resident’s representative, if any, and the licensee or the licensee’s designated representative no later than seven days following admission. | 1
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7 | Licensee will review all residents file to ensure that there is a signed admission agreement for every resident or ensure that one is completed and the original is maintained in each resident's file and a copy is given to the resident by 3/7/24 |
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14 | Attachments to the agreement may be utilized as long as they are also signed and dated as prescribed above. Per review of Resident #1's file, the Admission Agreement is not signed | 8
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Type B
03/07/2024
Section Cited
CCR87458(a)
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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. The licensee shall be permitted to use the form LIC 602 (Rev. 9/89), | 1
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7 | The Licensee will ensure that all medical assessments(LIC602 - Physician's Report) are completely filled out and signed by the physician. Licensee will review all residents file to ensure that Physicians Reports have been obtained for every resident, is complete and is signed by the physician and |
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14 | Physician's Report, to obtain the medical assessment. This requirement was not met as evidenced by: Resident #1's physician report is not signed. | 8
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14 | maintain in the resident's file by 3/7/24. Licensee will obtain a signed physician's report for Resident #1. A copy of the signed report will be faxed to LPA Yee |
Deficiency Type
POC Due Date /
Section Number | DEFICIENCIES | PLAN OF CORRECTIONS(POCs) |
Type B
03/01/2024
Section Cited
CCR
87632(d)(2)
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7 | Hospice Care Waiver: If the Department grants a hospice care waiver it shall stipulate terms and conditions of the waiver as necessary...The licensee shall notify the Department in writing within five working days of the initiation of hospice care services for any terminally ill resident in the facility or | 1
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7 | Licensee will read section 87632 and submit a written statement that the section was read and understood. A Hospice initiation Notification letter will also be processed for Resident #1 and submitted to the Department by 3/1/24 |
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14 | within five working days of admitting a resident already receiving hospice care services. The notice shall include the resident's name and date of admission to the facility and the name and address of the hospice. Hospice for resident was initiate on 1/23/24 and Department was not notified | 8
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