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Inspection visit

Follow-up on corrections

MORI MANORLicense 0192010547 citations on this visit
7 citations recorded

Inspector’s narrative

What the inspector wrote

On this day, July 27, 2023 at 12:30 p.m, Licensing Program Analyst (LPA) Delmundo arrived unannounced to conduct a case management visit. LPA was granted entry by staff, Rosa Maria Munoz. LPA called and spoke over the phone with Ferdinand Ferdie' Gutierrez, administrator, and informed the purpose of visit. Administrator arrived after several minutes. The other 2 staff. Maria Manjarez and Beatriz Munoz, arrived at around 1:00 pm. On July 6, 2023, LPAs Delmundo and Fontanilla observed Medication Administration Record for May 2023 showed Insulin was administered by staff but not for June and July 2023; however, this medication was last filled 6/21/23. This medication is for resident (R4) and LPAs interviewed staff (S3) who stated she administered the insulin in May and didn't do the administration in June and July. However, during today's visit. July 27, 2023, in the presence of the administrator S3 stated she didn't administer the insulin but signed the May 2023 MAR. Also on July 6, 2023, LPAs requested for the following documents to be submitted by July 20,2023: 1. LIC9282 Infection Control Plan - this document has not been submitted as of this day. 2. Proof of $3M liability insurance coverage - administrator showed to LPA the insurance coverage for Manor Manor facility; however, the licensee on the document is not that of Mori Manor, LLC which is the current licensee. On this day, July 27, 2023, LPA observed staff (S1) working at the facility, and S1 is not fingerprint cleared and associated to this facility. LPA verified, and S1 and adminstrator stated S1 started working July 24, 2023. Staff Schedule effective July 24, 2023 also showed S2 on the schedule. LIC500 Personnel Report dated July 18, 2023 showed S2 was emplored 9/2022. Guardian Portal showed S2 has fingerprint clearance but not associated to this facility. ......continued on 809C Deficiencies are cited from Title 22 California Code of Regulations, and listed on 809Ds. A $400.00 civil penalty is assessed for section 87355(e)(1) for S1 who is not fingerprint cleared, and $250.00 for repeat violation of section 87355(e)(2) within 12 month period. Deficiencies, plan and proof of corrections and civil penalties were discussed with the administrator. Copy of this report, Appeal Rights, LIC9098 Proof of Correction form, LIC421IM and LIC421FC Civil Penalty Assessments, and copy of this report provided.

Citations

8 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.

  • 1569.312(a)Type A

    §1569.312 Basic services requirements Every facility required to be licensed under this chapter shall provide at least the following basic services: (a) Care and supervision as defined in Section 1569.2.-This requirement is not met as evidenced by: -Based on interviews and review of police reports, the licensee did not comply with the section above for R1 who was able to AWOL which posed immediate safety risk to person in care.

  • 1569Type B

    §1569.69 Employees assisting residents with self-administration of medication; training requirements(b) Each employee who received training and passed the examination... and who continues to assist with the self-administration of medicines, shall also complete four hours.. of in-service training on medication-related issues in each succeeding 12-month period.-This requirement is not met as evidenced by:-Based on records review and interview, the licensee did not comply with the section for S3 not having the required hours of annual medication training,

  • 87355(e)(1)Type A

    87355 Criminal Record Clearance(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required.... ... by the Department-This requirement is not met as evidenced by:-Based on observation, interview and Guardian Portal check, the licensee did not comply with section above for having S1 work without fingerprint clearance.This is a repeat violation.

  • 87355(e)(2)Type B

    87355 Criminal Record Clearance(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (2) Request a transfer of a criminal record clearance ... This requirement is not met as evidenced by:-Based on records review, the licensee did not comply with the section above for S2 who is not associated to this facility.This is a repeat violation within 12 month period. First violation was issued on 7/18/23.

  • 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 records review, the licensee did not comply with the section above for staff affixing initial on R4's MAR but the medication was not administered.

  • 87465(e)Type A

    87465 Incidental Medical and Dental Care: (e) For every prescription and nonprescription PRN medication for which the licensee provides assistance there shall be a signed, dated written order from a physician, on a prescription blank, maintained in the residents file..... -This requirement is not met as evidenced by:-Based on observation and interview, the licensee did not comply with the section above for R4 who has insulin but no file and/or record of doctor's order. Insulin was not administered and facility does not have discontinued order. It's not clear it the med is still needed.

  • 87470(c)Type B

    87470 Infection Control Requirements(c) An Infection Control Plan shall be developed by the licensee and shall be included in the Plan of Operation required by Section 87208.-This requirement in not met as evidenced by: -Based on interview and records review, the licensee did not comply with the section above for not having an Infection Control Plan which poses potentiall health risk to persons in care.

  • 1569.605Type B

    §1569.605 Liability insurance; coverage requirements: On and after July 1, 2015, all residential care facilities for the elderly, .... shall maintain liability insurance covering injury to residents and guests in the amount of at least one million dollars ($1,000,000) per occurrence and three million dollars ($3,000,000) in the total annual aggregate.....-This requirement is not met as evidenced by:-Based on records review and interview, the licensee did not comply with the section for not having insurance coverage under licensee's name.

FAQ · About this visit

Common questions about this visit

What happened during the July 27, 2023 inspection of MORI MANOR?

This was a other inspection of MORI MANOR on July 27, 2023. 7 citations were issued: 2 Type A (serious) and 5 Type B.

Were any citations issued to MORI MANOR on July 27, 2023?

Yes, 7 citations were issued (2 Type A, 5 Type B). The first citation was for: "§1569.312 Basic services requirements Every facility required to be licensed under this chapter shall provide at least t..."

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.