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25 | Licensing Program Analyst (LPA) Araceli Canela arrived unannounced to conduct a case management visit and gather information/records regarding a self reported incident by the facility on 2/9/2024 that involved staff S2, S3, S4 and resident R1. LPA met with Executive Director /Administrator, Jasmine Seiffert, took statement and requested records for Community Care Licensing to review incident.
In addition LPA returned to issue citations that were observed on 2/2/2024 during a complaint investigation, but LPA was unable to issue citations due to time restraints. On 2/2/2024 LPA discovered staff S1 who had been working, was fingerprint cleared, but was not associated to this facility as required. In addition LPA found resident R1 and R2 who have a Dementia Diagnoses to have items such as a cup filled with some type of vitamins, a sharp knife, bottle of window cleaner and a hammer. R1 and R2 are not in memory care unit, but occupy a room in assisted living. On 2/2/2024, LPA along with staff S2 removed the items from the residents rooms and placed them inaccessible. LPA went over such items with Administrator during the visit.
During today's visit LPA went into R1 and R2s bedroom and did not observe any vitamins or sharp items; a bottle of cleaning solution and the hammer where in the top shelf, inaccessible to R1.
The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted and appeal of rights provided. |
Deficiency Type
POC Due Date /
Section Number | DEFICIENCIES | PLAN OF CORRECTIONS(POCs) |
Type A
03/04/2024
Section Cited
CCR
87705(f)(2)
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7 | 87705(f)(2)Care of Persons with Dementia(f) The following shall be stored inaccessible to residents with dementia:(2) Over-the-counter medication, nutritional supplements or vitamins, alcohol, cigarettes, and toxic substances such as certain plants, gardening supplies, cleaning supplies and disinfectants.
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7 | Facility to send in written statement on how they will stay in compliance. |
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14 | This requirement was not met as evidenced by: During the inspection of 2/2/2024 LPA found, cleaning solution, hammer, knife and cup of vitamins accessible to resident R1 and R2. This is an immediate risk to the health and safety of residents in care. | 8
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14 | POC due date 3/5/2024 to LPA A Canela |
Type B
03/05/2024
Section Cited
CCR87355(e)(b)
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7 | 87355(e)(b) 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:(2) Request a transfer of a criminal record clearance as specified in Section 87355(c) | 1
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7 | Facility immediately processed paperwork to associate S1. Facility to send in written statement on how they will stay in compliance and ensure |
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14 | This requirement was not met as evidenced by: during the inspection of 2/2/2024, LPA discovered staff S1 who was working, had been fingerprinted, but previous Administrator forgot to properly associate S1 to this facility. This is a potential risk to the health and safety of residents in care. | 8
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14 | all new staff and current staff are fingerprint cleared and properly associated to this facility prior to working or volunteering. POC due date 3/5/2024 to LPA A Canela |