Deficiency Type
POC Due Date /
Section Number | DEFICIENCIES | PLAN OF CORRECTIONS(POCs) |
Type A
11/18/2021
Section Cited
CCR
87506(a)
| 1
2
3
4
5
6
7 | Resident Records: (a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility...readily available to facility staff and to licensing agency staff. This requirement was not met as evidenced by: | 1
2
3
4
5
6
7 | Licensee agrees to obtain all required documents for R1 and update R1's file. Licensee additionally agrees to review Title 22 Regulation Section 87506 regarding resident records. Licensee to provide LPA Colvin with Self-Certification of having read the Regulation Section, as well as Statement of Understanding |
 | 8
9
10
11
12
13
14 | Based on record review, the Licensee did not comply with the above regulation with at least one resident. LPAs observed the file for R1 to be missing most documents, including Physician's Report, Pre-Appraisal, and Admissions Agreeement. This is an immediate safety risk to R1. | 8
9
10
11
12
13
14 | of all documents required to be in every resident's file. Self-Certification and Statement of Understanding to be submitted to LPA Colvin by Plan of Correction date of 11/18/21. |
Type B
12/03/2021
Section Cited
CCR87412(g)
| 1
2
3
4
5
6
7 | Personnel Records: (g) All personnel records shall be maintained at the facility and shall be available to the licensing agency for review. This requirement was not met as evidenced by: | 1
2
3
4
5
6
7 | Licensee agrees to obtain all required documents for all staff working at facility and update R1's file. Licensee additionally agrees to review Title 22 Regulation Section 87412 regarding resident records. Licensee to provide LPA Colvin with Self-Certification of having read the Regulation Section, as well as |
| 8
9
10
11
12
13
14 | Based on record review, the Licensee did not comply with the above regulation with at least two staff (S1 & S2). LPAs observed that there were no staff files present for S1 or S2. This is a potential safety risk for all residents in care. | 8
9
10
11
12
13
14 | Statement of Understanding of all documents required to be in every staff's file. Self-Certification and Statement of Understanding to be submitted to LPA Colvin by Plan of Correction date of 11/18/21. |
Deficiency Type
POC Due Date /
Section Number | DEFICIENCIES | PLAN OF CORRECTIONS(POCs) |
Type A
11/18/2021
Section Cited
CCR
87355(e)(1)
| 1
2
3
4
5
6
7 | Criminal Record Clearance: (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance...as required by the Department... This requirement was not met by: | 1
2
3
4
5
6
7 | Licensee agrees to have S1 & S2 leave the facility immediately and not to return until proof of approved fingerprint clearance and transfer to the facility has been obtained. Licensee to provide LPA Colvin with a staff schedule for the next two weeks (starting tonight) reflecting who will be working at the facility while S1 & S2 |
| 8
9
10
11
12
13
14 | Based on record review, the Licensee did not comply with the above regulation with two staff members (S1 & S2). LPA Colvin confirmed that neither S1 nor S2 have approved fingerprint clearance to work at a licensed facility. This is an immediate health and safety risk to all residents in care. | 8
9
10
11
12
13
14 | are out. Licensee to ensure adequate staff coverage at all times. Staff schedule to be submitted to LPA Colvin by Plan of Correction date of 11/18/21. |
Type B
12/03/2021
Section Cited
CCR87465(h)(6)(E)
| 1
2
3
4
5
6
7 | Incidental Medical and Dental Care: (h) The following requirements shall apply...: (6) The licensee shall be responsible for assuring that a record of centrally stored prescription medications for each resident is maintained... and includes: (E) The prescription number... This requirement was not met by: | 1
2
3
4
5
6
7 | Licensee agrees to create a Centrally Stored Medciation Log for each resident and list all medications and required information, as listed in Title 22 Regulation Section 87465. Licensee to provide LPA Colvin with a copy of this log by Plan of Correction date of 12/3/21. |
| 8
9
10
11
12
13
14 | Based on record review, the Licensee did not comply with the above requirement with at least one resident. LPAs observed that R1 has multiple PRN medications but did not observe a record of the medication which lists the prescription number. This is a potential health risk to R1. | 8
9
10
11
12
13
14 | |
Deficiency Type
POC Due Date /
Section Number | DEFICIENCIES | PLAN OF CORRECTIONS(POCs) |
Type A
11/18/2021
Section Cited
CCR
87465(h)(2)
| 1
2
3
4
5
6
7 | Incidental Medical and Dental Care: (h) The following requirements shall apply to medications which are centrally stored: (2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees... This requirement was not met by: | 1
2
3
4
5
6
7 | Licensee agrees to create a plan to ensure all refridgerated medications are kept at the required tempurature while remaining locked and secured. Licensee to provided LPA Colvin with plan and photographs of implementation by Plan of Correction date of 11/18/21. |
| 8
9
10
11
12
13
14 | Based on observations, the Licensee did not comply with the above regulation with one medication (insulin). LPA Colvin observed unlocked/unsecured insulin in the facility's kitchen fridge, which was easily accessible. This is an immediate health/safety risk to all residents in care. | 8
9
10
11
12
13
14 | |
Type B
12/03/2021
Section Cited
CCR87465(e)(1)
| 1
2
3
4
5
6
7 | Incidental Medical and Dental Care: (e) For every prescription and nonprescription PRN medication...there shall be a...written order from a physician...maintained in the residents file... shall contain... (1) The specific symptoms which indicate the need for the use of the medication. This requirement was not met by: | 1
2
3
4
5
6
7 | Licensee agrees to obtain a written prescription for all PRN medications for R1 (and other residents), which includes the information required as noted in Regulation Section 87465. Licensee to provide LPA Colvin with a copy of the written prescriptions for PRNs for R1 by 12/3/21. |
| 8
9
10
11
12
13
14 | Based on record review, the Licensee did not comply with the above requirement with at least one resident. LPAs observed that R1 has multiple PRN medications, but there was no written order which stated the symptoms for which the medications are for. This is a potential health risk to R1. | 8
9
10
11
12
13
14 | |