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13 | At approximately 10:45AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced, to conduct an investigation into the above allegations. LPA was met by Caregiver Corina Anguiano. LPA toured the building, interviewed staff and reviewed records. Based on interviews conducted, facility staff did not assist with administering medications as ordered. Resident was prescribed antibitics and they were not given as ordered. Resident required eye drops that were not administered as ordered. Based on interviews conducted, there were long delays in communication with Licensee. Residents responsible party requested information and it took several days for a return call. This occurred on multiple occasions. Based on records reviewed, resident moved into the facility on 12/12/2023 and did not receive a copy of the agreement until February. Based on records reviewed, resident went to the emergency room on 09/10/2024. Licensee did not send notification to the department of this unusual incident.
Based on the Departments investigation, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED.
Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
This report was reviewed with Corina Anguiano and Appeal rights were given.
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| Substantiated | Estimated Days of Completion: |
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13 | At approximately 10:45AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced, to conduct an investigation into the above allegations. LPA was met by Caregiver Corina Anguiano. LPA toured the building, interviewed staff and reviewed records. LPA measured water temperature on 10/16/2024 and again during today's visit. The water temperature measured within regulation between 105 and 120 degrees on both visits. Based on a review of records, LPA did not find documentation of an order for resident to be walked. Physicial excersise is important, however residents have the right to decline participation. Based on records reviewed and interviews conducted, a refund was issued by the Licensee within the 15 day requirement. The refund was not received by the reciepient and another check was issued. Based on interviews conducted and observation, medications are in bubble packs and is dispensed at the time medication is given. LPA was informed that before bubble packs, medication was prepared 24 hours in advance, but that procedure has not been used since.
Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are Unsubstantiated. |
| Unsubstantiated | Estimated Days of Completion: |
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Deficiency Type
POC Due Date /
Section Number | DEFICIENCIES | PLAN OF CORRECTIONS(POCs) |
Type A
11/16/2024
Section Cited
CCR
87465(a)(4) | 1
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7 | 87465 Incidental Medical and Dental Care:(4) The licensee shall assist residents with self-administered medications as needed.This requirement is not met as evidenced by: Based on records reviewed and interviews conducted, Licensee did not ensure medications were administered as | 1
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7 | Licensee to ensure residents are assisted with medication as ordered by physician. Licensee to conduct training for all staff on medication procedures. Training to be scheduled by POC date of 11/16/2024 and to be completed by 12/20/2024. Sign in sheet of completed training to be submitted to CCL |
 | 8
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14 | ordered. Resident did not receive eye drops as ordered and resident antibiotics were not given as ordered. This poses an immediate Health risk to residents in care. | 8
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14 | by 12/20/2024. |
Type B
12/20/2024
Section Cited
CCR
87468.1(a)(9) | 1
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5
6
7 | 87468.1 Personal Rights of Residents in All Facilities: (9) To have communications to the licensee from their representatives answered promptly and appropriately. This requirement is not met as evidenced by: Based on interviews conducted, Licensee did not promptly respond to resident representatives | 1
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7 | Licensee to ensure residents representatives communications are answered promptly. Licensee to review regulation 87468.1 and submit self certification of their understanding. Self certification to be submitted to CCL by POC date of 12/20/2024. |
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14 | This poses a potential personal rights risk to residents in care. | 8
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14 | |
Deficiency Type
POC Due Date /
Section Number | DEFICIENCIES | PLAN OF CORRECTIONS(POCs) |
Type B
12/20/2024
Section Cited
CCR
87507(e) | 1
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7 | 87507 Admission Agreements:(e) The licensee shall provide a copy of the signed and dated current admission agreement, and all subsequent signed and dated modifications, to the resident or the resident's representative, if any, immediately upon signing the admission agreement or modification. | 1
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7 | Licensee shall review regulation 87507 and submit self certification that they understand and will comply going forward. Self certification shall be submitted to CCL by POC date of 12/20/2024. |
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14 | This requirement is not met as evidenced by: Based on interviews conducted, resident nor their representative received a copy of the admission agreement immediately after signing. This poses a potential Health, Safety or Personal rights risk to residents in care. | 8
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14 | |
Type B
12/20/2024
Section Cited
CCR
87211(a)(1)(D) | 1
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7 | 87211 Reporting Requirements:(D) Any incident which threatens the welfare, safety or health of any resident, such as psychological abuse of a resident by staff or other residents, or unexplained absence of any resident. This requirement is not met as evidenced by: Based on records reviewed | 1
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7 | Licensee shall review regulation 87211 and submit self certification that they understand and will comply going forward. Self certification shall be submitted to CCL by POC date of 12/20/2024. |
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14 | Licensee did not follow regulation by not notifying the Department of a residents visit to the emergency room. This poses a potential Health, Safety or Personal rights risk to residents in care. | 8
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