Community Care Licensing

SUPERVISOR'S NAME: Bethany Moellers TELEPHONE: (707) 588-5040 LICENSING EVALUATOR NAME: Dina Alviso TELEPHONE: (707) 588-5082 LICENSING EVALUATOR SIGNATURE: DATE: 09/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/16/2024

FACILITY NAME: MAGGIE'S CARE HOME	FACILITY NUMBER: 496803929
	VISIT DATE: 09/16/2024

FACILITY NAME: MAGGIE'S CARE HOME	FACILITY NUMBER: 496803929
	VISIT DATE: 09/16/2024

FACILITY NAME: MAGGIE'S CARE HOME	FACILITY NUMBER: 496803929
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/16/2024

Type A

Section Cited

CCR

87465(h)(2)

87465(h)(2) Incidental Medical and Dental Care-The following requirements shall apply to medications which are centrally stored: 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 is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	LPA observed resident medications stored in open area on two refrigerator shelves, allowing the medications to be accessible to others/residents; Licensee/Administrator Heherson Garcia stated they were injectable medications/medications of a resident (resident (R1) LPA observed the kitchen cabinet where all other resident medications were being stored was observed to have a lock hanging off it but not secured closed/locked, allowing all medications to be accessible to all others/residents, the licensee did not comply with the section cited above, which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 09/17/2024
	Plan of Correction
1 2 3 4	POC CLEARED BY THE FOLLOWING: Licensee/Administrator went and bought a locking medication box, and put all the refrigerated medications into it, locking it up. Licensee/Administrator locked the medication cabinet, after the LPA requested them to do it during the inspection. Licensee to ensure all medications are centrally stored,locked and inaccessible at all times as required by regulation.

Section Cited

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

SUPERVISOR'S NAME: Bethany Moellers TELEPHONE: (707) 588-5040 LICENSING EVALUATOR NAME: Dina Alviso TELEPHONE: (707) 588-5082 LICENSING EVALUATOR SIGNATURE: DATE: 09/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/16/2024

Document Has Been Signed on 09/16/2024 05:16 PM - It Cannot Be Edited

FACILITY NAME: MAGGIE'S CARE HOME	FACILITY NUMBER: 496803929
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/16/2024

Type B

Section Cited

CCR

87625(a)(1)(D)

Managed Incontinence 87625(a)(1)(D) The licensee shall be permitted to accept or retain a resident who has a manageable bowel and/or bladder incontinence condition under the following circumstances: The condition can be managed with any of the following: The use of incontinent care products. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	LPA observed that a residents room had a pad that had been used, it had dried urine stains visible on it. and it was folded up and in the the bathroom cubby,the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 09/20/2024
	Plan of Correction
1 2 3 4	Licensee/Administrator to ensure all residents that are incontinent are kept clean and dry, and that incontinent care products, including pads used, are clean and sanitary at all times for the residents use. All used and soiled pads are to be discarded and not used again. Administrator discarded the soiled pad. Ensure the facility is free from urine and feces orders; Ensure the facility is using sanitary incontinent products. Submit plan of ensuring compliance with this regulation. POC due 9/20/24.

Type B

Section Cited

CCR

87307(a)(3)(C)

87307(a)(3)(C) Personal Accommodations and Services -The following provisions shall apply, The use of common wash cloths and towels shall be prohibited. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	LPA observed that washcloths were hanging on the bathroom towel bars for resident use in two resident bathrooms that are shared; LPA observed two showering scrubbers in the shower caddy, both were well worn, for resident use. LPA discussed having sufficient supply of washcloths/linens that can be used and put to wash to ensure sanitary conditions for residents and their hygiene care at all times. LPA observed that the bathrooms didn’t have paper towels for resident use to help ensure sanitary hygiene care for all residents. Administrator put paper towels in the bathrooms, the licensee did not comply with the section cited above, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 09/20/2024
	Plan of Correction
1 2 3 4	Licensee/Administrator to ensure paper towels are made available in the bathrooms so hand twoels and/or wash cloths are not used to dry hands as this is not sanitary. Ensure that wash cloths/towels/hand towels are used for residents as needed, and all residents individual towels are all washed and kept clean and sanitary. Submit how the facility will remain in compliance with this regulation and ensure residents have bathing/hygiene linens that are clean and sanitary, including when washing and drying their hands. POC due 9/20/24.

SUPERVISOR'S NAME: Bethany Moellers TELEPHONE: (707) 588-5040 LICENSING EVALUATOR NAME: Dina Alviso TELEPHONE: (707) 588-5082 LICENSING EVALUATOR SIGNATURE: DATE: 09/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/16/2024

Document Has Been Signed on 09/16/2024 05:16 PM - It Cannot Be Edited

FACILITY NAME: MAGGIE'S CARE HOME	FACILITY NUMBER: 496803929
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/16/2024

Type B

Section Cited

HSC

1569.625(b)(1)(1)

HSC 1569.625(b)(1) The department shall adopt regulations to require staff members of residential care facilities for the elderly who assist residents with personal activities of daily living to receive appropriate training. This training shall consist of 40 hours of training. A staff member shall complete 20 hours, including six hours specific to dementia care, as required by subdivision (a) of Section 1569.626 and four hours specific to postural supports, restricted health conditions, and hospice care, as required by subdivision (a) of Section 1569.696, before working independently with residents. The remaining 20 hours shall include six hours specific to dementia care and 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 LPA's file review staff S3 lacks proof of Health & Safety Code required training-RCFE. lacks 40 hour initial training, and proof of 20 hour annual training, the licensee did not comply with the section cited above in [count] out of [total count] [(objects) (persons)] [identifiers] which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 10/16/2024
	Plan of Correction
1 2 3 4	Licensee to ensure all staff obtain and complete required forty (40) hour training/ twenty (20) hour required training, per health and safety code. Submit proof of staff having completed all training by POC due date of 10/16/24.

SUPERVISOR'S NAME: Bethany Moellers TELEPHONE: (707) 588-5040 LICENSING EVALUATOR NAME: Dina Alviso TELEPHONE: (707) 588-5082 LICENSING EVALUATOR SIGNATURE: DATE: 09/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/16/2024