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Inspection visit

Follow-up

SPYGLASS SENIOR VILLA 4License 0792010361 citation on this visit
1 citation recorded

Inspector’s narrative

What the inspector wrote

On 07/05/22 at 4:25 PM, Licensing Program Analyst LPA L. Holmes conducted an unannounced subsequent visit and met with Administrator, Shahid Siddiqi to deliver the findings of complaint 15-AS-20201007102423 for a closed facility. On 11/08/21 LPAs L Holmes and L Francisco requested for Administrator to submit the following documents to CCL by 11/15/21: Resident Roster for 2020 and 2021, Physician's Report, Needs and Services Plan, Centrally Stored Medication and MAR for August - September 2020, Identification and Emergency Information. LPA received incomplete documents on 11/15/2021. On 04/27/22 LPA requested All pages for the Physician’s Report for R1 dated May of 2020, Admission Agreement; R1’s last day at the facility was 09/28/2020. On 04/30/22 ADM said he'd get back to me and on 05/19/2022. ADM stated he located R1’s binder. The binder had incomplete and missing documents. Deficiencies is cited from California Code of Regulations (Title 22, Division 6, Chapter 8), is being cited on the attached LIC 9099D.

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.

  • 87506(e)Type B

    Retain original records for at least three years

    87506 Resident Records(e) Original records or photographic reproductions shall be retained for a minimum of three (3) years following termination of service to the resident.-This requirement is not met as evidenced by: -Based on interviews and record reviews, the licensee did not comply with the section above by not retaining all of R1's records for at least 3 years which posed potential health and personal rights risks to person in care.

FAQ · About this visit

Common questions about this visit

What happened during the July 5, 2022 inspection of SPYGLASS SENIOR VILLA 4?

This was an other inspection of SPYGLASS SENIOR VILLA 4 on July 5, 2022. 1 citation were issued: 1 Type B.

Were any citations issued to SPYGLASS SENIOR VILLA 4 on July 5, 2022?

Yes, 1 citation was issued (0 Type A, 1 Type B). The first citation was for: "87506 Resident Records(e) Original records or photographic reproductions shall be retained for a minimum of three (3) ye..."

What type of inspection was this?

This was an 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.