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Inspection visit

Follow-up on corrections

GRACE RETIREMENT VILLAGELicense 3060900494 citations on this visit
4 citations recorded

Inspector’s narrative

What the inspector wrote

Licensing Program Analyst (LPA) Alvaro Ramirez, Jr. conducted an unannounced visit to deliver findings on an investigation completed by the Department. LPA was greeted and granted entry into the facility by Receptionist Joo Eun Ra. LPA explained the reason for the visit. Administrator Assistant (ADA) Anna Jung arrived shortly after. During the course of the investigation, the following deficiencies were observed and are being cited via this case management deficiency. On August 24, 2023, during an investigatory follow up visit, Department staff made an unannounced visit to the facility and requested to speak to the Med Tech on duty after being informed Administrator Erik Doan and Licensed Vocational Nurse (LVN) Grace Park were not present. After waiting 15 minutes with no response, Department staff texted Administrator Erik Doan requesting for a status update. After an additional 15 minutes Doan responded that he would return to the facility once done with his meeting and that no one would be interviewed until he was present on site. It was discovered during the investigation process Resident 1 (R1) had left the property on May 21, 2023, unbeknown to the staff. R1 was disoriented and appearing ill out in on the public street shortly after 2:00 AM and was transported to the hospital. It was not until they were admitted to the hospital that Grace Retirement Village was notified of their whereabouts. On May 31, 2023, Resident 1 (R1) was hospitalized following an unwitnessed fall. Emergency Medical Technicians (EMTs) reported R1’s records were unavailable upon arriving to the facility as records were locked inaccessible to staff. The following is being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted, and a copy of this report, 9099-D Page, and Appeal Rights was left at the facility.

Citations

4 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.

  • 87405(a)Type B

    Administrator Qualifications and Duties. …When the administrator is not in the facility, there shall be coverage by a designated substitute who shall have qualifications adequate to be responsible and accountable for management and administration of the facility as specified in this section… This regulation was not met as evidenced by: Licensee failed to have a qualified designated substitute when Administrator was not in the facility on 8/24/23 as evidenced by Department staff observations and comments made by Administrator. This poses a potential risk to residents health and safety while in care.

  • 87464(f)(1)Type A

    87464(f)(1) Basic Services. Basic services shall at a minimum include: Care and supervision…This requirement was not met as evidence by: Licensee failed to ensure R1 was receiving care and supervision which resulted in R1 sustaining a burn from an unknown cause while in the care of the facility as evidence by interviews conducted and hospital records reviewed. This poses an immediate health and safety risk to residents in care.

  • 87469(c)(1)Type B

    Advanced Directives and Requests Regarding Resuscitative Measures. Immediately telephone 9-1-1, present the advance directive and/or request regarding resuscitative measures form to the responding emergency medical personnel… This regulation was not met as evidenced by: Licensee failed to ensure records were made available to emergency personnel as evidenced by records being locked inaccessible to staff. This poses a potential risk to resident’s health and safety while in care.

  • 87755(b)Type B

    Inspection Authority of the Licensing Agency. The licensee shall ensure that provisions are made for private interviews with any resident or any staff member... This regulation was not met as evidenced by: Licensee failed to ensure provisions were made for private interviews with staff on 8/24/23 as evidenced by Administrator’s statements. This poses a potential risk to residents’ personal rights and safety while in care.

FAQ · About this visit

Common questions about this visit

What happened during the December 20, 2023 inspection of GRACE RETIREMENT VILLAGE?

This was a other inspection of GRACE RETIREMENT VILLAGE on December 20, 2023. 4 citations were issued: 1 Type A (serious) and 3 Type B.

Were any citations issued to GRACE RETIREMENT VILLAGE on December 20, 2023?

Yes, 4 citations were issued (1 Type A, 3 Type B). The first citation was for: "Administrator Qualifications and Duties. …When the administrator is not in the facility, there shall be coverage by a de..."

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.