Deficiency Type
POC Due Date /
Section Number | DEFICIENCIES | PLAN OF CORRECTIONS(POCs) |
Type B
02/19/2025
Section Cited
CCR
87211(a)(1)(D)
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7 | Reporting Requirements:(a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following:
A written report shall be submitted to the licensing agency and to the person responsible for the resident withing seven | 1
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7 | Licensee will review Title 22, Section 87211 Reporting Requirements and will submit a signed written statement that the section was read and understood and how the Licensee will ensure that all incidents are reported to the Department within 7 days by 2/19/25. Licensee will also complete and submit |
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14 | days of the occurrence of any of the events specified in (A) through (D) below.Any incident which threatens the welfare, safety or health of any resident, ....such as abuse of a resident by staff or other residents, or unexplained absence of any resident. Resident #1's hospitalizatio was not reported at all.
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14 | an LIC624 for Resident #1 hospitalization on 1/15/25 by no later than 2/13/25. |
Type B
02/14/2025
Section Cited
CCR87608(a)(5)(B)
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7 | Postural Supports- Based on the individual's preadmission appraisal, and subsequent changes to that appraisal, the facility shall provide assistance and care for the resident....Postural supports may be used under the following conditions. Under no circumstances shall postural supports include tying, depriving, or
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7 | Licensee will immediately remove all full bed rails from the facility hospitals beds currently mounted with full bed rails unless the hospice care plan specifies the need for full bed rails. Evidence will be submitted to the Department by 2/14/25 that the full bed rails have been removed or that the full bed rails are |
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14 | limiting the use of a resident's hands or feet.Bed rails that extend the entire length of the bed are prohibited except for residents who are currently receiving hospice care and have a hospice care plan that specifies the need for full bed rails. Residents all have full bedrails equipped on theri hospital beds.
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14 | included in the resident's hospice care plan. |
Deficiency Type
POC Due Date /
Section Number | DEFICIENCIES | PLAN OF CORRECTIONS(POCs) |
Type B
02/19/2025
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....which shall include, but not be limited to, the following requirements: The licensee shall notify the Department in writing within five working days of the intiation of hospice care services for
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7 | Licensee will read Title 22 Sections 87632 and 87633 and submit a signed written statement that the section was read and will be adhered too. Licensee will also complete and submit a hospice intiation letter for Resident #2 to the Department by 2/19/25 |
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14 | any terminally ill resident in the facility or 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. Resident #2 is on hospice and the Department was not notified | 8
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Type B
02/19/2025
Section Cited
CCR87506(b)(10)
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7 | Resident records: Each resident’s record shall contain at least the following information:
10) Reports of the medical assessment specified in Section 87458, Medical Assessment, and of any special problems or precautions. Resident #1's
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7 | Licensee will ensure that a medical assessement is conducted and maintained in the residents files at all times. Resident #1 no longer resides at the facility. Licensee will contact Resident #5's physician and obtain a complete physicians report to address the missing primary and secondary diagnosis |
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14 | file does not contain a Medical Asssessment and Resident #5 's medical assessment is incomplete - does not have the resident's primary and secondary diagnosis | 8
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14 | for Resident #5 by 2/19/25 |
Deficiency Type
POC Due Date /
Section Number | DEFICIENCIES | PLAN OF CORRECTIONS(POCs) |
Type A
02/13/2025
Section Cited
CCR
87555(b)(26)
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7 | General Food Services: The following food service requirements shall apply: 26) Supplies of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days shall be maintained on the premises. Per review of the perishable foods, bell | 1
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7 | Licensee will ensure that perishable foods for a minimum of 2 days and non-perishable for 7 days are maintained on the premises at all time. Licensee will purchase perishable and non-perishable foods that meets Title 22 requirements and submit evidence that |
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14 | peppers, tomatoes and 2 oranges were observed in the kitchen and non-perishable foods such as canned soups, apple sauces, canned corn, peas, 12 small cans of tuna and 2 cans of chicken, 2 jars of spaghetti sauce and noodles were obsevred. Per staff today is marketing day. | 8
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14 | the required amount of foods were purchased and will be maintained by 2/13/25. |
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