Community Care Licensing

SUPERVISOR'S NAME: Rikesha Stamps TELEPHONE: (951) -212-0616 LICENSING EVALUATOR NAME: Stephanie Martinez TELEPHONE: (951) 204-5924 LICENSING EVALUATOR SIGNATURE: DATE: 05/31/2024

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

FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/31/2024

Document Has Been Signed on 07/31/2024 11:12 AM - It Cannot Be Edited

FACILITY NAME: VISTA MONTANA SENIOR LIVING	FACILITY NUMBER: 336426330
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/31/2024

Type B

Section Cited

CCR

87467(a)(3)

RESIDENT PARTICIPATION IN DECISIONMAKING: Prior to, or within 2 weeks of the resident’s admission, 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, and any other appropriate parties, to prepare a written record of the care the resident will receive in the facility, and the resident’s preferences regarding the services provided at the facility. The licensee shall arrange a meeting with the resident and appropriate individuals identified in Section 87467(a)(1) to review and revise the written record as specified, when there is a significant change in the resident’s condition, or once every 12 months... 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 3 out of 3 residents who did not have a current written record of care. The Appraisal/Needs and Services Plan for R2 was last completed on 02/27/2023. The Appraisal/Needs and Services Plan for R3 and R5 were last completed on 02/24/2023. This poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 08/14/2024
	Plan of Correction
1 2 3 4	Interim-Administrator reported updated appraisals will be completed and proof submitted to the Department.

SUPERVISOR'S NAME: Rikesha Stamps TELEPHONE: (951) -212-0616 LICENSING EVALUATOR NAME: Stephanie Martinez TELEPHONE: (951) 204-5924 LICENSING EVALUATOR SIGNATURE: DATE: 07/31/2024

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

FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/31/2024

Document Has Been Signed on 07/31/2024 11:12 AM - It Cannot Be Edited

FACILITY NAME: VISTA MONTANA SENIOR LIVING	FACILITY NUMBER: 336426330
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/31/2024

Type B

Section Cited

HSC

1569.625(b)(2)

STAFF TRAINING; LEGISLATIVE FINDINGS; CONTENTS: In addition to paragraph (1), training requirements shall also include an additional 20 hours annually, eight hours of which shall be dementia care training, as required by subdivision (a) of Section 1569.626, and four hours of which shall be specific to postural supports, restricted health conditions, and hospice care, as required by subdivision (a) of Section 1569.696. This training shall be administered on the job, or in a classroom setting, or both, and may include online training. 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 4 out of 4 staff members who did not have the required training. 2 staff members, S3 & S5, did not have proof of Dementia Care training. S2, S3, & S4 did not have Restricted Healthcare training. S2, S3, S4, & S5 did not have postural support training or the complete hours for hospice care training. This poses a potential health, safety and personal rights risk to persons in care.
	POC Due Date: 08/21/2024
	Plan of Correction
1 2 3 4	Interim-Administrator stated an audit of staff training will be conducted to ensure it is complete. She reported proof of training will be provided to the Department.

Type B

Section Cited

HSC

1569.69(a)(1)

EMPLOYEES ASSISTING RESIDENTS WITH SELF-ADMINISTRATION OF MEDICATION; TRAINING REQUIREMENTS: Each residential care facility for the elderly licensed under this chapter shall ensure that each employee of the facility who assists residents with the self-administration of medications meets all of the following training requirements: In facilities licensed to provide care for 16 or more persons, the employee shall complete 24 hours of initial training. This training shall consist of 16 hours of hands-on shadowing training, which shall be completed prior to assisting with the self-administration of medications, and 8 hours of other training or instruction, as described in subdivision (f), which shall be completed within the first four weeks of employment. 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 1 out of 1 staff members who did not have the required training. Initial medication training was not observed on file for S5. This poses a potential health, safety and personal rights risk to persons in care.
	POC Due Date: 08/21/2024
	Plan of Correction
1 2 3 4	Interim-Administrator stated S5 will complete the initial training and proof of the training will be submitted to the Department.

SUPERVISOR'S NAME: Rikesha Stamps TELEPHONE: (951) -212-0616 LICENSING EVALUATOR NAME: Stephanie Martinez TELEPHONE: (951) 204-5924 LICENSING EVALUATOR SIGNATURE: DATE: 07/31/2024

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

FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/31/2024

Document Has Been Signed on 07/31/2024 11:12 AM - It Cannot Be Edited

FACILITY NAME: VISTA MONTANA SENIOR LIVING	FACILITY NUMBER: 336426330
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/31/2024

Type B

Section Cited

CCR

87609(b)(4)

ALLOWABLE HEALTH CONDITIONS AND THE USE OF HOME HEALTH AGENCIES: Incidental medical care may be provided to residents through a licensed home health agency provided the following conditions are met: The licensee and home health agency agree in writing on the responsibilities of the home health agency, and those of the licensee in caring for the resident’s medical condition(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 3 out of 3 residents who did not have a written agreement on file between the home health agency and the facility. This poses a potential health, safety and personal rights risk to persons in care.
	POC Due Date: 08/14/2024
	Plan of Correction
1 2 3 4	Interim-Administrator stated copies of the written agreements will be obtained and kept of file for appropriate residents.

Section Cited

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

SUPERVISOR'S NAME: Rikesha Stamps TELEPHONE: (951) -212-0616 LICENSING EVALUATOR NAME: Stephanie Martinez TELEPHONE: (951) 204-5924 LICENSING EVALUATOR SIGNATURE: DATE: 07/31/2024

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

FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/31/2024