Deficiency Type
POC Due Date /
Section Number | DEFICIENCIES | PLAN OF CORRECTIONS(POCs) |
Type A
12/16/2022
Section Cited
| 1
2
3
4
5
6
7 | Administrator - Qualifications and Duties: All facilities shall have a qualified and currently certified administrator. The licensee and the administrator may be one and the same person. The administrator shall have sufficient freedom from other responsibilities and shall be on the premises a sufficient number of hours to permit adequate attention to the management and administration of the facility as specified in this section. When the administrator is not in the facility, there shall be coverage by a designated substitute who shall have qualifications adequate to be responsible and accountable for management and administration of the facility as specified in this section. The Department may require that the administrator devote additional hours in the facility to fulfill his/her responsibilities when the need for such additional hours is substantiated by written documentation. This requirement was not met as evidenced by: | 1
2
3
4
5
6
7 | Licensee agrees to submit documentation for approving a new certified administrator to the department by the POC due date. |
 | 8
9
10
11
12
13
14 | Based on reviewed records, the department confirming the former administrator resigned on 10/21/22 and the facility has not submitted a new administrator for approval, This poses an immediate health and safety risk to residents in care. | 8
9
10
11
12
13
14 | |
Type A
12/16/2022
Section Cited
| 1
2
3
4
5
6
7 | Incidental Medical and Dental Care: The licensee shall arrange, or assist in arranging, for medical and dental care appropriate to the conditions and needs of residents. This requirement was not met as evidenced by: | 1
2
3
4
5
6
7 | Licensee will provide training to all staff who administer medications to ensure all appropriate documentation is followed regarding medication administration. documentation of training and training materials used for all staff who administer medications will be submitted to the department by the POC due date. |
| 8
9
10
11
12
13
14 | Based on LPAs review of medication administration logs for R1 which revealed facility staff administering medications failed to properly document. medications administered to residents on 10/24/22 and 10/25/22 which poses an immediate health, safety and personal rights risk to residents in care. | 8
9
10
11
12
13
14 | |
Deficiency Type
POC Due Date /
Section Number | DEFICIENCIES | PLAN OF CORRECTIONS(POCs) |
Type A
12/16/2022
Section Cited
| 1
2
3
4
5
6
7 | Incidental Medical and Dental Care: Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. This requirement was not met as evidenced by: | 1
2
3
4
5
6
7 | Facility relocated items to a secure location and will submit a written plan of correction detailing the procedures for staff to follow when a prescription medication is delivered or dropped off at the facility for a resident and will be submitted to the department by the POC due date, |
| 8
9
10
11
12
13
14 | LPAs counducted a walkthrough of the facility and observed a bag of prescription medications stored in a facility office that was not locked and accessible to residents in care which poses an immediate health, safety and personal rights risk to residents in care. | 8
9
10
11
12
13
14 | |
Type A
12/16/2022
Section Cited
| 1
2
3
4
5
6
7 | Sale of licensed facility; resulting issuance of new license; procedure: The licensee shall provide written notice to the department and to each resident or his or her legal representative of the licensee's intent to sell the facility at least 30 days prior to the transfer of the property or business, or at the time that a bona fide offer is made, whichever period is longer. This requirement was not met as evidenced by: | 1
2
3
4
5
6
7 | Licensee shall obtain a lease back agreement that will be in place until an application has been submitted for a change of ownership and the change of ownership has been approved by the department and the new management group receives a license for operation at this location. |
| 8
9
10
11
12
13
14 | Based on reviewed records, the Licensee did not notify the department of the sale of the property to Reliance Group Investments, LLC and the Licensee no longer has control of property which poses an immediate health,safety and personal rights risk to residents in care. | 8
9
10
11
12
13
14 | |
Deficiency Type
POC Due Date /
Section Number | DEFICIENCIES | PLAN OF CORRECTIONS(POCs) |
Type A
12/16/2022
Section Cited
| 1
2
3
4
5
6
7 | Sale of licensed facility; resulting issuance of new license; procedure: Except as provided in subdivision (e), the property and business shall not be transferred until the buyer qualifies for a license or provisional license within the appropriate provisions of this chapter. This requirement was not met as evidenced by: | 1
2
3
4
5
6
7 | Management group must submit a new application for a change in ownership to the department and obtain a license prior to operating the facility. |
| 8
9
10
11
12
13
14 | Based on reviewed records, statements obtained from the Licensee that they have sold the property and business and are no longer involved in operation of the facility and the facility is being fully operated by new ownership which has not submitted an application for change of ownership which poses an immediate health, safety and personal rights risk to residents in care. | 8
9
10
11
12
13
14 | |
Type A
12/16/2022
Section Cited
| 1
2
3
4
5
6
7 | Incidental Medical and Dental Care: The licensee shall arrange, or assist in arranging, for medical and dental care appropriate to the conditions and needs of residents. This requirement was not met as evidenced by: | 1
2
3
4
5
6
7 | Licesncee will provide a written plan of correction to the department detailing the steps the facility will take to ensure the violation is not repeated by the POC due date. |
| 8
9
10
11
12
13
14 | Based on LPAs review of resident records, LPA observed missing blood glucose monitoring (BGM) records and observed the facility was not following physician's instructions of (BGM) four (4) times a day. LPA only observed BGM recorded three (3) times a day which poses an immedate health, safety and presonal rights risk to residents in care. | 8
9
10
11
12
13
14 | |
Deficiency Type
POC Due Date /
Section Number | DEFICIENCIES | PLAN OF CORRECTIONS(POCs) |
Type A
12/16/2022
Section Cited
| 1
2
3
4
5
6
7 | Maintenance and Operation: The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement was not met as evidenced by: | 1
2
3
4
5
6
7 | Licensee will provide a written plan of correction to address the steps the facility will take to ensure all housekeeping is conducted in a manner that meets the residents needs by the POC due date. |
| 8
9
10
11
12
13
14 | Based on LPA's observations of standing water pooling on the floor of the upstairs bathroom utilized by residents. LPA also observed in room number 12 a large number of flies present and crawling over bedridden resident's legs which poses an immediate health, safety and personal rights risk to residents in care. | 8
9
10
11
12
13
14 | |
Type A
12/16/2022
Section Cited
| 1
2
3
4
5
6
7 | Resident’s Bill of Rights: To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs. This requirement was not met as evidenced by: | 1
2
3
4
5
6
7 | Facility will provide a written plan of correction that indicates the steps the facility will take to ensure the residents needs will be met to ensure medication administration, housekeeping and care and supervision will be addressed to ensure the resident's needs are met. |
| 8
9
10
11
12
13
14 | Based on LPAs observations of facility operation including inability of staff to complete all physician directions as ordered by the physician including blood glucose monitoring and to provide a clean and safe living environment including presences of insects and pests in the facility and on residents and standing water in the bathroom. LPA observed that staff are not currently meeting the needs of residents which poses an immediate health, safety and personal rights risk to residents in care. | 8
9
10
11
12
13
14 | |
Deficiency Type
POC Due Date /
Section Number | DEFICIENCIES | PLAN OF CORRECTIONS(POCs) |
Type A
12/16/2022
Section Cited
| 1
2
3
4
5
6
7 | Care of Persons with Dementia: Without violating Section 87468, Personal Rights, facility staff shall attempt to redirect a resident who attempts to leave the facility. This requirement was not met as evidenced by: | 1
2
3
4
5
6
7 | Facility Licensee will submit a written plan of correction indicating the steps the facility will take to ensure adequate supervision of residents in care to prevent future unauthorized absences from residents. Plan will be submitted to the department by the POC due date. |
| 8
9
10
11
12
13
14 | Based on reviewed records, resident with dementia was identified as unable to leave the facility unassisted, eloped from the facility without staff knowledge which poses an immediate heath, safety and personal rights risk to residents in care. | 8
9
10
11
12
13
14 | |
| 1
2
3
4
5
6
7 | | 1
2
3
4
5
6
7 | |
| 1
2
3
4
5
6
7 | | 1
2
3
4
5
6
7 | |