Deficiency Type
POC Due Date /
Section Number | DEFICIENCIES | PLAN OF CORRECTIONS(POCs) |
Type A
07/12/2023
Section Cited
CCR
87405(b)
| 1
2
3
4
5
6
7 | (b)The administrator shall have the qualifications specified in Sections 87405(d)(1) through (7). If the licensee is also the administrator, all requirements for an administrator shall apply.
This requirement is not met as evidenced by: | 1
2
3
4
5
6
7 | Licensee will submit an updated Administration Certification and a written plan to demonstrate DRS's understanding of Title 22 policies pertaining to care and supervision of residents. DRS to submit a written and signed statement understanding of this regulation by POC date. |
 | 8
9
10
11
12
13
14 | Based on interview with Wellness Director and Independent Living Director of Resident Services failed to do any detailed followup on the financial abuse and completed an assessment on R1 which poses an immediate Health, Safety, or Personal Rights risk to persons in care | 8
9
10
11
12
13
14 | DRS will discuss the guidelines with R1's responsible party on the private caregivers paperwork necessary for them to continue to work in the faciltity. DRS will reach out to the
private caregiver agency to obtain alll neccessary paperwork and place with Human Resources at the facility. |
Type A
07/12/2023
Section Cited
CCR87606(c)
| 1
2
3
4
5
6
7 | 87606 Care of Bedridden Residents: (c) To accept or retain a bedridden person, other than for a temporary illness or recovery from surgery, a facility shall obtain and maintain an appropriate fire clearance as specified in Section 87202(a). This requirement is not met as evidenced by: | 1
2
3
4
5
6
7 | DRS will submit bedridden clearance request for R1's room to the Department and provide a written plan to understand the regulations. DRS will write a letter to DSS for bedridden clearance and inform Fire Department regarding bedridden clearance. |
| 8
9
10
11
12
13
14 | Based on interview, observation and record review, R1 is bedridden per physician's report and the room in whcih resident currently resides in does not have a bedridden clearance from Fire Department poses an immediate Health, Safety, or Personal Rights risk to persons in care | 8
9
10
11
12
13
14 | |
Deficiency Type
POC Due Date /
Section Number | DEFICIENCIES | PLAN OF CORRECTIONS(POCs) |
Type A
07/12/2023
Section Cited
CCR
87466
| 1
2
3
4
5
6
7 | Observation of the resident: The licensee shall ensure that residents are regularly observed for changes ...and that appropriate assistance is provided when such observation reveals unmet needs. This requirement is not met as evidenced by: Based on record review and interview, | 1
2
3
4
5
6
7 | DRS will submit a written plan on the facility's policy and procedure as well as a wrriten statement on understanding the regulation by POC date. |
| 8
9
10
11
12
13
14 | R1 is bedridden with contractures, incontinent (bowel and bladder), unabe to care for self including medication management due to neurocognitve disorder which requiring needs care and supervision which poses an immediate Health, Safety, or Personal Rights risk to persons in care. | 8
9
10
11
12
13
14 | |
Type B
07/18/2023
Section Cited
CCR87616(a)
| 1
2
3
4
5
6
7 | Exception for Health Conditions: (a) ...the licensee may submit a written exception request if he/she agrees that the resident has a prohibited and/or restrictive health condition but believes that the intent of the law can be met through alternative means. This requirement is not met as evidenced by: | 1
2
3
4
5
6
7 | DRS will submit a written plan on the facility's policy and procedure as well as a wrriten statement on understanding the regulation by POC date. |
| 8
9
10
11
12
13
14 | Based on observation and record review, the IL director did not submit an exception request for R1’s suprapubic catheter which poses a potential Health, Safety, or Personal Rights risk to persons in care | 8
9
10
11
12
13
14 | |
Deficiency Type
POC Due Date /
Section Number | DEFICIENCIES | PLAN OF CORRECTIONS(POCs) |
Type A
07/12/2023
Section Cited
CCR
1569.17(b)(2)(D)
| 1
2
3
4
5
6
7 | (D) A third-party contractor or other business professional retained by the client and at the facility at the request or by the permission of that client. These individuals may not be left alone with other clients.
This requirement is not met as evidenced by: | 1
2
3
4
5
6
7 | DRS will submit a written plan on the facility's policy and procedure as well as a wrriten statement on understanding the regulation by POC date. |
| 8
9
10
11
12
13
14 | Based on record review and interview, R1's private caregivers S1, S2, S3 were left alone in R1's room and had access to the facility and left unattended which poses a potential Health, Safety, or Personal Rights risk to persons in care. | 8
9
10
11
12
13
14 | |
Type A
07/12/2023
Section Cited
CCR87355(e)
| 1
2
3
4
5
6
7 | 87355 Criminal Record Clearance: (e) All individuals subject to a criminal record review ... shall prior to working, residing or volunteering in a licensed facility. (1) Obtain a California clearance or a criminal record exception....
This requirement is not met as evidenced by: | 1
2
3
4
5
6
7 | DRS will submit a written plan on the facility's policy and procedure as well as a wrriten statement on understanding the regulation by POC date. DRS will obtain criminal records for S1-S3 and other private caregivers working with R1. |
| 8
9
10
11
12
13
14 | Based on interview and observation, S1, S2, and S3 worked for R1 and reside at R1's apartment without a criminal background clearance which poses a potential Health, Safety, or Personal Rights risk to persons in care. | 8
9
10
11
12
13
14 | |