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Inspection visit

Routine inspection (multi-day)

MONTGOMERY SPRINGS MANORLicense 0156015068 citations on this visit
8 citations recorded

Inspector’s narrative

What the inspector wrote

On this day, Licensing Program Analyst (LPA) Delmundo arrived unannounced to continue the annual required inspection that was started on 3/08/24. LPA met with Mirriam Paras, administrator, and informed the reason for visit. LPA reviewed 5 staff and 5 residents files, and interviewed 2 staff. Residents' medications were checked and compared with doctor's orders and LIC622 Centrally Stored Medication and Destruction Records. Facility does not handle residents' cash resources. LPA obtained updated/current copies of the following documents: 1. LIC308 Designation of Facility Responsibility 2. LIC610E Emergency Disaster Plan (9 pages) 3. Proof of $3M liability Insurance coverage 4. Proof of Control of Property/Lease Agreement (expiration: 1/31/25) LPA observed the following: -at 1:35 p.m., S1 has no First Aid certificate on file (expired 6/2017). -at 1:45 p.m to 2:35 p.m., staff (S2, S3 and S5) do not have First Aid certificate. Required training for 2023 for postural support/restricted health condition/hospice care and medication training incomplete - only 2 hours medication, 2 hours postural support on file. -at 2:40 p.m., staff (S4) no training record on file for 2019, 2020, 2021. No First Aid certificate on file. -at 2:45 p.m., residents' (R1, R2, R3) LIC602A Physician's Report over a year old (on file dated 8/05/21 for R1, 2/20/23 for R2, 7/08/22 for R3). .....continued on 809C (page 2) Page 2 -no doctor's order on file for R1, R3 and R5's half bed rails. -residents (R3 and R4) who are not able to exit on their own due to medical diagnosis/condition (non-ambulatory) are in bedrooms not fire cleared for non-ambulatory. -at 3:40 p.m., resident (R5) has no medical assessment (LIC602A) on file. -at 5:00 p.m., no doctor's order on file for the following: R1's 10 medications; R2's 5 medications; 2 of R5's medications. Deficiencies are cited from Title 22 California Code of Regulation, and listed on 809Ds. A $500.00 civil penalty is assessed for deficiency section 87705(c)(1) and will continue for $100.00/day until corrected. Any repeat violation within 12 month period may result in civil penalties. Deficiencies and plan and proof of corrections were discussed with the administrator. Exit interview conducted. Appeal Rights, LIC421IM Civil Penalty Assessment, LIC9098 Proof of Correction form and copy of this report provided.

Citations

11 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.

  • 1569.625(b)(2)Type B

    Based on records review, the licensee did not comply with the section cited above in staff (S2, S3, S4, S5) not having the complete required number of hours of annual training which poses potential health, safety and/or personal rights risks to persons in care.

  • 87411(c)Type B

    Based on record review, the licensee did not comply with the section cited above in S1's first aid certificate expired and S2, S3, S4 & S5 not having first aid certificates on file which pose a potential health, safety and/or personal rights risks to persons in care.

  • 87458(a)Type B

    Based on record review, the licensee did not comply with the section cited above in R5 not having medical assessment (LIC602A) which poses a potential health and/or personal rights risks to persons in care.

  • 87458(b)(5)Type B

    Based on observation, interviews and record review, the licensee did not comply with the section cited above in R3 and R4's ambulatory status not consistent with mental/medical condition (non-ambulatory) which pose a potential health, safety and/or personal rights risks to persons in care.

  • 87458(c)Type B

    Based on record review, the licensee did not comply with the section cited above in R1,R2 & R3’s LIC602A Physician'sReports over a year old which pose a potential health and/or personal rights risks to persons in care.

  • 87465(e)Type A

    Based on records review, the licensee did not comply with the section cited above in not having doctor's order which pose an immediate health, and/or personal rights risks to persons in care for the following: R`1's 10 medications; R2's 5 medications; 2 of R5's medications;

  • 87608(a)(3)Type B

    Based on record review, the licensee did not comply with the section cited above in not having doctor's order for R1, R3 and R5's bedrails which pose a potential safety and/or personal rights risk to persons in care.

  • 87202aType A

    87202(a) Alll facilities shall maintain a fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, or the State Fire Marshall........-This requirement is not met as evidenced by: -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.

  • 87307(d)(6)Type B

    8730787307 Personal Accommodations and Services: (d)(6) All outdoor and indoor passageways and stairways shall be kept free of obstruction.-This requirement is not met as evidenced by: -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

    87309 Storage Space: (a) Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients.-This requirement is not met as evidenced by:-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 risks to persons in care.

  • 87705(c)(1)Type A

    Based on records review, interviews and observation, the licensee did not comply with the section cited above in 2 residents (R3 and R4) in bedrooms not fire cleared for non-ambulatory which poses an immediate safety and/or personal rights risks to persons in care.A $500.00 civil penalty is assessed.

FAQ · About this visit

Common questions about this visit

What happened during the April 26, 2024 inspection of MONTGOMERY SPRINGS MANOR?

This was a other inspection of MONTGOMERY SPRINGS MANOR on April 26, 2024. 8 citations were issued: 2 Type A (serious) and 6 Type B.

Were any citations issued to MONTGOMERY SPRINGS MANOR on April 26, 2024?

Yes, 8 citations were issued (2 Type A, 6 Type B). The first citation was for: "Based on records review, the licensee did not comply with the section cited above in staff (S2, S3, S4, S5) not having ..."

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.