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Inspection visit

Routine inspection

MONTGOMERY SPRINGS MANORLicense 01560150610 citations on this visit
10 citations recorded

Inspector’s narrative

What the inspector wrote

On this day, March 8, 2024, at 10:45 a.m., Licensing Program Analyst (LPA) Delmundo arrived unannounced to conduct an annual required inspection. LPA met with staff, Jonalyn Legarto and Medelmira Cloma. LPA called and spoke with Mirriam Paras, administrator, who stated she can not come to the facility, and authorized Jonalyn Legarto to sign and receive this report. Facility has LIC808 Mitigation Plan. Administrator submitted the LIC9282 Infection Control Plan on March 5, 2024. LPA toured the facility inside out with Jonalyn Legarto. Facility is a two level home. LPA inspected the kitchen, dining area, living room, bedrooms, bathrooms, front, side and backyards. Food supplies were observed good for 2 days of perishables and 7 days of non-perishables. Central storage for medications was observed locked. Hot water temperature in one of the bathrooms on the ground floor was tested. Fire extinguisher was observed fully charge with tag showed serviced 9/22/23. LPA interviewed 2 residents. LPA observed the following: -at 11:15 a.m., staff medications and vitamins, scissors and disinfecting spray in area adjacent to the kitchen. -at 11:21 a.m., cleaning agents in kitchen cabinet under the sink without lock. -at 11:23 a.m, rubbing alcohol, medications and scissors in resident's room. Razors in the ensuite bathroom in this resident's room. .continued on 809C CONTINUATION: -at 11:34 a.m., Icy Hot pain reliever ointment in another resident's room on the ground floor. -at 11:35 a.m., Lysol toilet bowl cleaner in the common bathroom on the ground floor. Toilet paper holder in this bathroom broken and door paint dilapidated. -at 11:42 a.m., Tums, motor oil for shredder in another resident's room. Trash can in this room and rooms on the second floor without lids. -at 11:46 a.m., toilet paper holder in another common bathroom on the first floor broken, dilapidated door paint and rotten wood transition on the flooring. - at 11:49 a.m., storage on the second floor converted into staff's room. -at 11:50 a.m., mildew on the shower door in second floor bathroom. - at 11:52 a.m., bread toaster. Hydrogen Peroxide and medications i n one of resident's room on the second floor. -no auditory signals on the exit doors of 2 residents rooms. -at 12:01 p.m., staff clothing, personal belongings, medications and scissors in other residents' room on the second. Two staff were interviewed who stated staff sleeps and use the resident's bed. -at 12:19 p.m., tools in unlocked tool cart. bleach, shovel, pieces of wood, Pine Sol cleaning agent in the backyard. -at 12:34 p.m., hot water temperature in one of the common bathroom was measured at 137.8 degrees Farenheit. -at 2:50 p.m., cleaning supplies, pails of paint and pieces of wood in the side yard. -no disaster drill on file. LPA interviewed 2 staff and administrator who all stated they don't do disaster drill. Deficiencies are cited from Title 22 California Code of Regulations, and cited on 809Ds. A $500.00 civil penalty is assessed for fire safety violation in converting the storage into staff bedroom, and will continue for $100.00/day until corrected. Deficiencies, plan and proof of corrections and civil penalty was discussed with administrator over the phone. Due to time constraint, LPA will come back to continue inspection. Exit interview conducted. Appeal Rights, LIC421IM, LIC9098 Proof of Correction form and copy of this report provided.

Citations

12 citations 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.

  • 1569.695(f)(1)Type B

    Based on observation, the licensee did not comply with the section cited above in not having evacuation chair which poses potential safety risk to persons in care.

  • 87202(a)Type A

    Based on observation, the licensee did not comply with the section cited above in converting the storage into staff bedroom which poses an immediate safety and/or personal rights risk to persons in care.At $500.00 civil penaty is assessed.

  • 87303(a)Type B

    Based on observation, the licensee did not comply with the section cited above in the following which pose a potential personal rights risks to persons in care: toilet paper holder in 2 bathrooms broken; 2 bathroom doors with dilapidated paint; wood transition in bathroom flooring rotten.

  • 87303(e)(2)Type A

    Based on observation, the licensee did not comply with the section cited above in hot water at 137.8 degrees Fahrenheit.which poses an immediate health, safety and/or personal rights risk to persons in care.

  • 87303(f)(3)Type B

    Based on observation, the licensee did not comply with the section cited above in trash cans in residents' rooms with no lids which pose a potential health and/or personal rights risk to persons in care.

  • 87307(a)Type B

    Based on observation and interview, the licensee did not comply with the section cited above in staff sleeping in the resident's room which poses a potential personal rights risk to persons in care.

  • 87307(d)(6)Type A

    Based on observation, the licensee did not comply with the section cited above in stairway on the second floor from resident's room going to the backyard blocked with rusted lamp and commode which poses an immediate safety and/or personal rights risk to persons in care.

  • 87309(a)Type A

    Based on observation, the licensee did not comply with the section cited above in the following: unlocked staff medications, scissors, razors, cleaning supplies, tools cart, shovel, pails of paint, bleach, rubbing alcohol, Hydrogen Peroxide; bread toaster in one of the residents' rooms, These pose an immediate health, safety and/or personal rights risk to persons in care.

  • 1569.269(a)(1)Type B

    §1569.269 Enumerated rights; severability (a) Residents of residential care facilities for the elderly shall have all of the following rights:(1) To be accorded dignity in their personal relationships with staff, residents, and other persons.-This requirement is not met as evidenced by: -Based on interviews, the licensee did not comply with the section when staff made an inappropriatec comment toward resident which posed personal rights risk to person in care.

  • 87303(i)Type A

    Based on observation, the licensee did not comply with the section cited above in 2 exit doors with no auditory signals which pose an immediate health, safety and/or personal rights risk to persons in care.

  • 87411(a)Type B

    87411 Personnel Requirements - General: (a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs........-This requirement is not met as evidenced by: -Based on interviews, observation and records review, the licensee did not comply to the section above in not having sufficient staffing to be able to redirect resident timely and properly which poses potential personal rights risks to persons in care.

  • 1569.695(c)Type B

    Based on interviews, the licensee did not comply with the section cited above in not conducting drills which poses a potential safety risk to persons in care.

FAQ · About this visit

Common questions about this visit

What happened during the March 8, 2024 inspection of MONTGOMERY SPRINGS MANOR?

This was a inspection inspection of MONTGOMERY SPRINGS MANOR on March 8, 2024. 10 citations were issued: 5 Type A (serious) and 5 Type B.

Were any citations issued to MONTGOMERY SPRINGS MANOR on March 8, 2024?

Yes, 10 citations were issued (5 Type A, 5 Type B). The first citation was for: "Based on observation, the licensee did not comply with the section cited above in not having evacuation chair which pos..."

What type of inspection was this?

This was a inspection inspection. inspection 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.