Inspection visit

complaintSeptember 22, 2021

ACC MAPLE TREE VILLAGELicense 3427006833 citations on this visit

3 citations recorded

Inspector’s narrative

What the inspector wrote

On a normal day, there would be 2 caregivers and a medication technician (MT) on each, the memory care side and the assisted living side of the building. LPA received information during interviews of staff that due to a shortage of staff, they were forced sometimes to work consecutive eight hour shifts for AM, PM, and Night (NOC). Although, the facility was using a staffing agency, the schedule showed that on several days, there was insufficient staffing. The staffing agency was not being utilized on the days when there were 1 or 2 caregivers on shift without a Medication Technician. Allegation deemed SUBSTANTIATED Regarding allegation, “Licensee did not ensure residents needs are met” LPA observed on the staff biweekly work schedule, that on several days there were 1 or 2 caregivers without a MT. In addition, the 2 caregivers were separated with 1 caregiver for the memory care unit and 1 for the assisted living area. During interviews 3 employees confirmed that the residents were not assisted with a 2-person assist when there was a shortage of staff. The staff stated that when there was 1 caregiver the MT would assist with the 2 persons assist until it was time for medication passes. During the time of medication pass the residents could not be assisted. Allegation deemed SUBSTANTIATED Regarding allegation, “No qualified Administrator available”, LPA obtained information during interviews of 3 employees who verified that the previous two Administrator(s) was unable to be reached when staff attempted to contact them during night (NOC) shift between the dates of 10/2/2020 and 3/26/21. Allegation deemed SUBSTANTIATED Based on observation, interviews, and documentation the preponderance of evidence standards has been met; therefore, the above allegation(s) is found to be SUBSTANTIATED. A finding that the complaint allegation is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 8, the following deficiencies are being cited on the attached 9099D during this visit. If any of the cited deficiencies are not corrected by the noted due dates; civil penalties may be assessed. The Administrator was provided a copy of their rights (LIC9058) and their signature on this form acknowledges receipt of these rights. An exit interview was conducted, a copy of the report was given.

Citations

3 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 A
Administrator - Qualifications and DutiesAll facilities shall have a qualified and currently certified administrator. The licensee and the administrator may be one and the same person. The administrator shall have sufficient freedom from other responsibilities and shall be on the premises a sufficient number of hours to permit adequate attention to the management and administration of the facility as specified in this section. 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. The Department may require that the administrator devote additional hours in the facility to fulfill his/her responsibilities when the need for such additional hours is substantiated by written documentation. This requirement is not met as evidenced by: Administrator(s) were not reachable during NOC shiftBased on interviews of staff who confirmed the previous administrators did not ensure coverage while not present in the facility during the NOC shiftThis violation poses an immediate health, and safety risk to residents in care.
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87411(a)Type A
Personnel Requirements - GeneralFacility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. In facilities licensed for sixteen or more, sufficient support staff shall be employed to ensure provision of personal assistance and care as required in Section 87608, Postural Supports. Additional staff shall be employed as necessary to perform office work, cooking, house cleaning, laundering, and maintenance of buildings, equipment and grounds. The licensing agency may require any facility to provide additional staff whenever it determines through documentation that the needs of the particular residents, the extent of services provided, or the physical arrangements of the facility require such additional staff for the provision of adequate services. This requirement is not met as evidenced by: Staff were forced to work extra shifts to assist the residents with care and supervision and staffing agency was not used on those days.Based on documentation and interviews the facility failed to ensure staffing was sufficient in numbers for resident care and supervisionThis violation poses an immediate health, and safety risk to residents in care.
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87468.2(a)(4)Type A
Additional Personal Rights of Residents in Privately Operated Facilities In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs. This requirement is not met as evidenced by: the residents who required a 2-person assist was not assisted due to a staffing shortageBased on interviews, staff confirmed sometimes the residents were not assisted when there was not enough staff, or the MT needed to pass medicationsThis violation poses an immediate health, and safety risk to residents in care.
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FAQ · About this visit

Common questions about this visit

What happened during the September 22, 2021 inspection of ACC MAPLE TREE VILLAGE?

This was a complaint inspection of ACC MAPLE TREE VILLAGE on September 22, 2021. 3 citations were issued: 3 Type A (serious).

Were any citations issued to ACC MAPLE TREE VILLAGE on September 22, 2021?

Yes, 3 citations were issued (3 Type A, 0 Type B). The first citation was for: "Administrator - Qualifications and DutiesAll facilities shall have a qualified and currently certified administrator. Th..."

What type of inspection was this?

This was a complaint inspection. Complaint inspections are triggered when someone reports a concern about the facility to CCLD.

SourceView on CCLD View original report

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Data from CCLD public records. Last updated May 25, 2026. If you believe any information is inaccurate, report it here.

complaint·September 22, 2021