Community Care Licensing

SUPERVISOR'S NAME: Maribeth Senty TELEPHONE: (916) 263-4813 LICENSING EVALUATOR NAME: Kevin Mknelly TELEPHONE: (209) 814-1925 LICENSING EVALUATOR SIGNATURE: DATE: 02/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/08/2024

Document Has Been Signed on 02/20/2024 02:40 PM - It Cannot Be Edited

FACILITY NAME: COMPASSION CARE	FACILITY NUMBER: 312700277
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/08/2024

Type A

Section Cited

CCR

87705(f)(1)

(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 observations, the licensee did not comply with the section cited above in knives, chemicals and medications obseved unsecured which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 02/09/2024
	Plan of Correction
1 2 3 4	Items secured while LPA present. Licenseee will submit proof of retraining of caregivers by the POC date of 2/29/24

Section Cited

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

SUPERVISOR'S NAME: Maribeth Senty TELEPHONE: (916) 263-4813 LICENSING EVALUATOR NAME: Kevin Mknelly TELEPHONE: (209) 814-1925 LICENSING EVALUATOR SIGNATURE: DATE: 02/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/08/2024

Document Has Been Signed on 02/20/2024 02:40 PM - It Cannot Be Edited

FACILITY NAME: COMPASSION CARE	FACILITY NUMBER: 312700277
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/08/2024

Type B

Section Cited

CCR

87463(c)

(c) The licensee shall arrange a meeting with the resident, the resident's representative, if any, appropriate facility staff, and a representative of the resident's home health agency, if any, when there is significant change in the resident's condition, or once every 12 months, whichever occurs first, as specified in Section 87467, Resident Participation in Decision Making. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on records review, the licensee did not comply with the section cited above in 5 of 5 resident files which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 02/29/2024
	Plan of Correction
1 2 3 4	Licensee will submit updated service plans with dates for planned review dates if not signed when submitted. POC due by 2/29/24

Type B

Section Cited

CCR

87705(c)(5)

(c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following: (5) Each resident with dementia shall have an annual medical assessment as specified in Section 87458, Medical Assessment, and a reappraisal done at least annually, both of which shall include a reassessment of the resident's dementia care needs. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on records review, the licensee did not comply with the section cited above in 3 out of 5 resident files which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 02/29/2024
	Plan of Correction
1 2 3 4	Licensee will submit completed up to date LIC 602s of the appointment date if later that the POC date.

SUPERVISOR'S NAME: Maribeth Senty TELEPHONE: (916) 263-4813 LICENSING EVALUATOR NAME: Kevin Mknelly TELEPHONE: (209) 814-1925 LICENSING EVALUATOR SIGNATURE: DATE: 02/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/08/2024