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Inspection visit

Follow-up on corrections

CALIFORNIA MISSION INNLicense 1986031611 citation on this visit
1 citation recorded

Inspector’s narrative

What the inspector wrote

Licensing Program Analyst (LPA) Galarza conducted a Case Management-Deficiencies visit due to information obtained during complaint control #: 28-AS-20210105160055 visit. LPA met with Business Director Haigaz Kazazian and explained the purpose of the visit. On 12/26/2020, resident (R1) fell in the Memory Care Unit TV room and sustained an injury in the face/eye area. The facility failed to report the incident within reporting requirements time frame. In addition, during the course of the complaint investigation LPA requested a copy of the incident report but it was never provided. Per current administration staff the incident report was given to former Administrator Lori Waters, but it was not submitted to Community Care Licensing. Per Title 22, Division 6, Chapter 8, Article 04. Operating Requirements 87211(a)(1) " A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below...." Deficiencies are cited in LIC 809D. Exit interview conducted with Business Director Haigaz Kazazian. Appeal Rights were issued.

Citations

2 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.

  • 87211(a)(1)Type B

    87211(a)(1). Reporting Requirements. A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below. This report shall include the resident's name, age, sex and date of admission; date and nature of event; attending physician's name, findings, and treatment, if any; and disposition of the case. Based on record review and interviews conducted the facility failed to report a fall incident involving resident (R1). The incident occurred on 12/26/2020. The facility did not submit the incident report to Licensing or furnish a copy when requested for complaint control #: 28-AS-20210105160055. This poses a potential health and safety risk to residents in care.

  • 87705(f)(1)Type A

    87705(f)(1). Care of Persons with Dementia. The following shall be stored inaccessible to residents with dementia: (1) Knives, matches, firearms, tools and other items that could constitute a danger to the resident(s).This requirement was not met by evidence of: Based on records review and interviews conducted on 12/19/2020 the facility failed to store hand sanitizer in a locked PPE cart and resident (R1) drank the hand sanitizer bottle. Items that could constitue a danger to Dementia residents must be inaccessible.This poses an immediate healthy & safety risk.

FAQ · About this visit

Common questions about this visit

What happened during the June 22, 2021 inspection of CALIFORNIA MISSION INN?

This was a other inspection of CALIFORNIA MISSION INN on June 22, 2021. 1 citation were issued: 1 Type B.

Were any citations issued to CALIFORNIA MISSION INN on June 22, 2021?

Yes, 1 citation was issued (0 Type A, 1 Type B). The first citation was for: "87211(a)(1). Reporting Requirements. A written report shall be submitted to the licensing agency and to the person respo..."

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.