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Inspection visit

Incident investigation

MARYMOUNT VILLA RETIREMENT CENTERLicense 0156010831 citation on this visit
1 citation recorded

Inspector’s narrative

What the inspector wrote

On 5/12/2021 at 3:05PM, Licensing Program Analysts (LPAs) G. Luk and L. Hall arrived unannounced to conduct a case management inspection in regards to incident report received on 5/10/2021. LPAs met with Administrator, Dolly Rizvi. Incident report dated 5/10/2021 revealed that R1 AWOL and facility notified law enforcement and R1's responsible party. R1 was found by police a couple hours later and was escorted back to the facility. Interview with S1 revealed that R1 left the facility during morning shift change. S1 stated that facility staff looked for residents near BART and local shops, but unable to find R1. Facility staff called police and police was able to find R1 after a couple hours. S1 stated that R1 was given a different medication dosage when family member was caring for R1. S1 has changed noc/morning shift change procedures after incident to prevent future AWOLs. R1 has a new doctor's order for medications after consulting with R1's family. The deficiency was observed (see LIC 809D) and cited from the California Code of Regulation, Title 22. Failure to correct the deficiency may result in civil penalty. Exit interview conducted with Dolly Rizvi. A copy of this report and appeal rights provided.

Citations

1 citation recorded*CCLD

What does Type A vs Type B mean?

Type A. Serious citation. Imminent or substantial risk to children. The regulator requires corrective action immediately and may impose a civil penalty.

Type B. Lower-severity citation. Corrective action required, no imminent risk. The regulator monitors compliance on the next visit.

  • 87705(c)(4)Type B

    Care of Persons with Dementia. There is an adequate number of direct care staff to support each resident’s physical, ...safety...needs... This requirement is not met as evidence by: Based on interview, licensee did not comply with the section cited above due to resident AWOL which poses a potential health and safety risk to the residents in care.

FAQ · About this visit

Common questions about this visit

What happened during the May 12, 2021 inspection of MARYMOUNT VILLA RETIREMENT CENTER?

This was a other inspection of MARYMOUNT VILLA RETIREMENT CENTER on May 12, 2021. 1 citation were issued: 1 Type B.

Were any citations issued to MARYMOUNT VILLA RETIREMENT CENTER on May 12, 2021?

Yes, 1 citation was issued (0 Type A, 1 Type B). The first citation was for: "Care of Persons with Dementia. There is an adequate number of direct care staff to support each resident’s physical, ......"

What type of inspection was this?

This was a other inspection. other inspections are conducted by CCLD as part of their licensing oversight.

SourceView on CCLDView original report

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Data from CCLD public records. Last updated . If you believe any information is inaccurate, report it here.