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True or False:
Licensing reports for the previous 12 months were visibly posted.
Licensing Program Analyst (LPA) generated this form to address deficiencies observed during an unrelated complaint investigation. While touring the facility, LPA observed numerous deficiencies:
Licensing reports for the previous 12 months are not posted.
LPA observed a basket of ___________________ to be located on the second floor walkway.
LPA observed a basket of cleaning supplies to be located on the second floor walkway. It contained hazardous cleaning agents and was not locked. Civil penalty of $1,000 to be assessed for third violation of the same subsection within 12 months.
True or False:
The LPA did not have a thermometer to test the water temperature at the time of the visit.
The facility’s hot water temperature was deemed to be excessive. LPA did not have a thermometer at the time of visit, but was unable to keep hands under the hot water. Administrator was present while LPA tested the water, and agreed with LPA that the temperature was excessive and unsafe. Staff member accompanied LPA to test the temperature and agreed that it is excessive.
Match this deficiency with the proper Plan of Correction.
A penalty of $50 per day, per cited violation, shall be assessed for all serious deficiencies that are not corrected by the date specified in the notice of deficiency, up to a maximum of $150 per day. Two plans of correction weren’t met by facility.
| Deficiency Type / Section Number | DEFICIENCIES | PLAN OF CORRECTIONS (POCs) |
|---|---|---|
| Type A 06/14/2017 Section Cited 87705(f)(2) | 87705(f)(2) Care of Persons with Dementia. The following items shall be made inaccessible to residents with dementia: Over-the-counter medication, nutritional supplements or vitamins, alcohol, cigarettes, and toxic substances such as certain plants, gardening supplies, cleaning supplies and disinfectants. LPA observed a basket of cleaning supplies to be unsecured and containing hazardous items (comet, lysol, etc). | Administrator secured hazardous items during visit, POC cleared on site. Civil penalty of $1,000 issued for third violation of the same subsection within 12 months 1569.4(h) Any residential care facility for the elderly that is assessed a civil penalty pursuant to subdivision (g) that repeats the same violation of this chapter within 12 months of the violation subject to subdivision (g) shall be assessed an immediate civil penalty of one thousand dollars ($1,000) and one hundred dollars ($100) for each day the violation continues until the deficiency is corrected. |
| Type A 06/16/2017 Section Cited 87303(e)(2) | 87303(e)(2) Maintenance and Operation. Hot water provided for the use of residents shall be maintained between 105 and 120 degrees F. LPA observed the water temperature in rooms 1, 3, 9, and 22 to be excessive and unsafe, staff agreed. | Administrator will begin submitting water temperature logs to licensing on a weekly basis, beginning on the POC due date and continuing until all resident sinks are within the acceptable temperature range. Documenatation of plumbing inspection/repairs will also be submitted by the indicated date. |
| Type A 06/16/2017 Section Cited 87761(a) | (a) A penalty of $50 per day, per cited violation, shall be assessed for all serious deficiencies that are not corrected by the date specified in the notice of deficiency, up to a maximum of $150 per day. Two plans of correction with a due date 6/2/17 weren’t met by facility. | Administrator will provide the training and repair documentation that was required by the plans of correction issued on 5/31/17. Civil penalties in the amount of $1100 issued for the period of 6/3/17 to today. |
| Type B 06/16/2017 Section Cited 1569.38(a) | a) Each residential care facility for the elderly shall place in a conspicuous place copies of all licensing reports issued by the department within the preceding 12 months, and all licensing reports issued by the department resulting from the most recent annual visit of the department to the facility. This subdivision shall not apply to any portion of a licensing report referring to a complaint that was found by the department to be unfounded or unsubstantiated. The facility, during the admission process, shall inform the resident and the resident’s responsible person in writing that licensing reports are available for review at the facility, and that copies of licensing reports and other documents pertaining to the facility are available from the appropriate district office of the department. The facility shall provide the telephone number and address of the appropriate district office. | Administrator will ensure that the required reports are posted by the indicated day, and will provide a written statement to LPA confirming their understanding of and intent to abide by this regulation. LPA observed the facility to not have any reports from licensing posted in a publicly visible location. |
