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Inspection visit

Incident investigation

ALMOND HEIGHTSLicense 342700525
Clean visit · 0 citations

Inspector’s narrative

What the inspector wrote

Licensing Program Analysts (LPAs) Talwinder Bains and Lavinia Muscan arrived at the facility unannounced on 03/20/24 to conduct a case management inspection to follow up on a choking incident on 03/11/24 for resident, R1 at the facility. LPAs met with Executive Director (ED), Stephan McDonald and explained the purpose of the visit. Facility submitted incident report to department on 03/18/24 about resident, R1 who had choking incident on 03/11/24 in the main dining room around 10.30am. Facility staff took appropriate measures and performed Heimlick Manuever on R1. R1 was back to their baseline after this incident. Facility notified R1s family, hospice agency, physician and other required agencies as required. After reviewing the incident report and information gathered, it has been determined that facility took appropriate measures to address R1s choking incident on 03/11/24. No citations were observed or cited per Title 22 Regulations. Exit interview conducted and copy of the report has been provided.

Citations

5 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.

  • 87412(a)Type B

    Based on record review and interviews it has been concluded that facility does not have Personnel form (LIC 501) for 3 staff out of 10, first aid and CPR certification for 3 out of 10 staff, and Health Screening/TB for 2 out of 10 staff files, which poses/posed a potential health, safety or personal rights risk to persons in care.

  • 87465(h)(1)Type A

    Based on observatios and staff interviews for medication audit, LPA learned that R1 and R2 have medications in their rooms and they have dementia diagnosis and cannot manage their medications per physicians orders, which poses an immediate health, safety or personal rights risk to persons in care.

  • 87411Type A

    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 information of the incident for R1 and R2, R1 and R2, AWOL from the facility on 02/26/24. This poses a immediate risk to the health and safety of residents in care.

  • 87705(c)(5)Type B

    87705-Care of Persons with Dementia-(c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following:(5) Each resident with dementia shall have an annual medical assessment as specified in Section 87458, Medical Assessment, and a reappraisal done at least annually.. this requirement is not met as evidence by; Record review and gathered information indicated that facility does not have updated Medical Assesment (LIC602) and Re-appriasal completed for R1 as required which poses a potenial risk to health and safety for residents in care.

  • 87211(a)(D)Type B

    87211-Reporting Requirements(a) (D)- (a) Each licensee shall furnish to the licensing agency such reports as the Department….(D) Any incident which threatens the welfare, safety or health of any resident,…… unexplained absence of any resident…..This requirement is not met as evidenced by; Based on records review,it has been observed that facility did not report R1 and R2s AWOL incident for 02/26/24 to department as required which poses potential health and safety risks for residents in care.

FAQ · About this visit

Common questions about this visit

What happened during the March 20, 2024 inspection of ALMOND HEIGHTS?

This was a other inspection of ALMOND HEIGHTS on March 20, 2024. The inspection found no deficiencies and no citations were issued.

Were any citations issued to ALMOND HEIGHTS on March 20, 2024?

No citations were issued during this inspection. The facility was found to be in compliance with all applicable regulations.

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.