198603504-12-5-2023-28-AS-NGAA-CY93R3-20231205172805

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198603504
Report Date: 12/05/2023
Date Signed: 12/05/2023 05:28:10 PM

Document Has Been Signed on 12/05/2023 05:28 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME:	LA POSADA		FACILITY NUMBER:	198603504
ADMINISTRATOR:	DIANA BAUTISTA		FACILITY TYPE:	740
ADDRESS:	8120 PAINTER AVE		TELEPHONE:	(562) 945-2651
CITY:	WHITTIER	STATE: CA	ZIP CODE:	90602
CAPACITY:	114	CENSUS: 91	DATE:	12/05/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Diana Bautista, Administrator		TIME COMPLETED:	05:30 PM

NARRATIVE

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Licensing Program Analysts (LPA) Galarza and Sanjay Vaid conducted an unannounced Required- 1 year visit using the full Care Compliance and Regulatory Enforcement (CARE) Tools. The purpose of the visit was explained to Business Office Manager Andrea Lopez. Administrator Diana Bautista arrived later.

During today's visit the following was completed:

LPAs toured the interior and exterior physical plant. All common areas, activity rooms, common bathrooms, kitchen, dining room, 20 resident rooms, med-tech room, and laundry rooms were inspected.
The Memory Care Unit had an unlocked drawer with 2 pairs of scissors and sharp office supplies. Citation was issued.
Review of medications and Medication Administration Records were reviewed. A total of 11 medication records were reviewed. Residents (R1 & R2) did not have PRN medications at the facility. Citation was issued.
A total of 4 resident files were reviewed.
Upon return LPA will finish reviewing resident files, and will review all staff files. One (1) resident was interviewed. Other resident interviews and staff interviews are pending.

Due to time constraints, an annual continuation visit will be conducted at a future date.

Exit interview was conducted with Administrator Diana Bautista. A copy of the report and appeal rights were issued.

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Noemi Galarza	TELEPHONE: (323) 981-3974
LICENSING EVALUATOR SIGNATURE:	DATE: 12/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 12/05/2023 05:28 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: LA POSADA	FACILITY NUMBER: 198603504
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/05/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

87465(c)(2)

Incidental Medical and Dental Care Services

(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: (2) Once ordered by the physician the medication is given according to the physician's directions. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation during medication review, the licensee did not comply with the section cited above in that two (2) residents [R1 & R2} had unfilled PRN medications, which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 12/06/2023
	Plan of Correction
1 2 3 4	Administrator shall ensure all missing PRN medications are filled by tomorrow. In addition, all staff that dispense medications shall receive in-service training. Submit in writting how this was corrected and attach proof of training by tomorrow.

Type A

Section Cited

CCR

87705(f)(1)

Care of Persons with Dementia

(f) The following shall be stored inaccessible to residents with dementia: (1) Knives, matches, firearms, tools and other items that could constitute a danger to the resident(s). 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 that the Memory Care Unit had an unlocked drawer with 2 pairs of scissors and sharp office supplies, which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 12/06/2023
	Plan of Correction
1 2 3 4	Administrator shall submit a written plan of correction, proof of staff training, and a video/picture of the Memory Care unit cabinet showing that a lock was installed in the drawer.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Noemi Galarza	TELEPHONE: (323) 981-3974
LICENSING EVALUATOR SIGNATURE:	DATE: 12/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2023

LIC809 (FAS) - (06/04)

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