Community Care Licensing

Document Has Been Signed on 01/31/2025 06:38 PM - It Cannot Be Edited

Harpreet Humpal TELEPHONE: (510) 529-9416 James Sampair TELEPHONE: (510) 286-4201 DATE: 01/31/2025

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

FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/31/2025

FACILITY NAME: WALNUT CREEK SENIOR LIVING	FACILITY NUMBER: 075601579
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/31/2025

Section Cited

CCR

87411(c)(1)

(1) Staff providing care shall receive appropriate training in first aid from persons qualified by such agencies as the American Red Cross. 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. 2 of 6 staff members have no record of completing first aid training within the past 2 years, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 02/28/2025
	Plan of Correction
1 2 3 4	On or before the due date the Licensee will submit proof to LPA that the 2 of 6 staff members have completed their first aid training and proof of training has been added to their records.

Section Cited

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

Harpreet Humpal TELEPHONE: (510) 529-9416 James Sampair TELEPHONE: (510) 286-4201 DATE: 01/31/2025

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

FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/31/2025

FACILITY NAME: WALNUT CREEK SENIOR LIVING	FACILITY NUMBER: 075601579
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/31/2025

Section Cited

HSC

1569.626(a)(2)

(a) All residential care facilities for the elderly shall meet the following training requirements, as described in Section 1569.625, for all direct care staff: (2) Eight hours of in-service training per year on the subject of serving residents with dementia. This training shall be developed in consultation with individuals or organizations with specific expertise in dementia care or by an outside source with expertise in dementia care. In formulating and providing this training, reference may be made to written materials and literature on dementia and the care and treatment of persons with dementia. This training requirement may be satisfied in one day or over a period of time. This training requirement may be provided at the facility or offsite and may include a combination of observation and practical application. 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. 0 of 6 staff had a record of 8 hours of dementia training within the past 12 months, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 02/28/2025
	Plan of Correction
1 2 3 4	On or before the due date the Licensee will submit proof to LPA that the 6 of 6 staff members have completed 8 hours of dementia training and proof of training has been added to their records.

Section Cited

Harpreet Humpal TELEPHONE: (510) 529-9416 James Sampair TELEPHONE: (510) 286-4201 DATE: 01/31/2025

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

FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/31/2025

FACILITY NAME: WALNUT CREEK SENIOR LIVING	FACILITY NUMBER: 075601579
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/31/2025

Section Cited

HSC

1569.696(a)(2)

(a) All residential care facilities for the elderly shall provide training to direct care staff on postural supports, restricted conditions or health services, and hospice care as a component of the training requirements specified in Section 1569.625. The training shall include all of the following: (2) Four hours of training thereafter of in-service training per year on the subject of serving those residents. 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. 0 of 6 staff had a record of 4 hours of training on postural supports, restricted conditions or health services, and hospice care within the past 12 months, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 02/28/2025
	Plan of Correction
1 2 3 4	On or before the due date the Licensee will submit proof to LPA that the 6 of 6 staff members have completed 4 hours of training on postural supports, restricted conditions or health services, and hospice care and proof of training has been added to their records.

Type B

Section Cited

HSC

1569.69(b)

(b) Each employee who received training and passed the examination required in paragraph (5) of subdivision (a), and who continues to assist with the self-administration of medicines, shall also complete eight hours of in-service training on medication-related issues in each succeeding 12-month period. 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. 0 of 6 staff had a record of 8 hours of training on medications within the past 12 months, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 02/28/2025
	Plan of Correction
1 2 3 4	On or before the due date the Licensee will submit proof to LPA that the 6 of 6 staff members have completed 8 hours of medication training and proof of training has been added to their records.

Harpreet Humpal TELEPHONE: (510) 529-9416 James Sampair TELEPHONE: (510) 286-4201 DATE: 01/31/2025

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

FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/31/2025