Inspection visit

complaintOctober 12, 2021

Clean visit · 0 citations

Inspector’s narrative

What the inspector wrote

-On 6/17/21, R1 was taken to the hospital due to mood changes and the RP was notified by text from the facility staff, -On 6/21/21, R1 was sent to hospital for slurred speech, staff notified RP, -On 7/1/21, RP emailed screen shots of the texts received from facility staff regarding the notifications of the incidents. Based on interviews and medical records and documentation (texts), the preponderance of evidence standards has not been met; therefore, the above allegation(s) is found to be UNFOUNDED. “This agency has investigated the complaint alleging, the above-mentioned allegation. We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. We have therefore dismissed the complaint.” Per the California Code of Regulations, Title 22, Division 6, Chapter 8, no violations were cited during this visit. An exit interview was conducted, and a copy of this report was provided via email and an electronic email read receipt confirms receiving these documents. The Medical Records revealed that R1 had hematoma and fractured ribs of varying stages of healing. R1 was discharged back to the home the same day. On 6/21/21, R1 was sent to ER again for slurred speech. An interview with R1-R3 revealed that staff are not rough when handling residents and they have not heard of or seen anyone with bruising or that has been bruised. Staff stated during interviews that R1 was heavy, fragile, and bruised easily and that they tried many ways to transfer R1 comfortably. An interview of the MD revealed that R1 did not have any red flags, breathing normally, and that typically a patient with cracked ribs would be in pain. The MD stated that it is not known if this was caused by a single event or several events. The MD contacted R1’s Primary Care Physician (PCP) who indicated R1 is taking baby Aspirin which could contribute to the bruising. The PCP instructed the facility to discontinue the use of the baby Aspirin. Based on interviews and medical records, the preponderance of evidence standards has not been met; therefore, the above allegation(s) is found to be UNSUBSTANTIATED. A finding that the complaint is Unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 8, no deficiencies cited. An exit interview was conducted, and a copy of this report was provided via email and an electronic email read receipt confirms receiving these documents.

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.

87465(a)(5)Type A
Incidental Medical and Dental CareA plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following: The licensee shall assist residents with self administered medications as needed. This requirement is not met as evidenced by: medications were found on residents' room floor, in wheelchair bag, and in pocket of residentBased on interviews, confirmed the pills were found to not have been taken by resident and found later, facility did not ensure medication administration assistanceThis violation poses an immediate health, and safety risk to residents in care.
87465(d)(1Type A
Incidental Medical and Dental CareIf the resident is unable to determine his/her own need for a prescription or nonprescription PRN medication, and is unable to communicate his/her symptoms clearly, facility staff designated by the licensee, shall be permitted to assist the resident with self-administration provided all of the following requirements are met: Facility staff shall contact the resident's physician prior to each dose, describe the resident's symptoms, and receive direction to assist the resident in self-administration of that dose of medication. The date and time of each contact with the physician, and the physician's directions, shall be documented and maintained in the resident's facility record. The date and time the PRN medication was taken, the dosage taken, and the resident's response shall be documented and maintained in the resident's facility record. This requirement is not met as evidenced by: Facility did not refill medications timely. Based on interviews that confirmed, the Licensee did not refill medication or administer medications as prescribed. This possess an immediate health and safety risk to residents in care.
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87465(h)(5)Type A
Incidental Medical and Dental CareThe following requirements shall apply to medications which are centrally stored:Each resident's medication shall be stored in its originally received container. No medications shall be transferred between containers. This requirement is not met as evidenced by: pills were found on the medication cart unlabeled and not prepared for passingBased on interviews, confirmed the pills were found and not labeled facility did not ensure pills were in its original containerThis violation poses an immediate health, and safety risk to residents in care.
87468.2(a)(4)Type A
Additional Personal Rights of Residents in Privately Operated FacilitiesTo care,...and services that meet their individual needs... This requirement is not met as evidenced by: the residents who paid for additional services were billed and the services were not renderedBased on interviews, confirmed the residents services such as bathing and medication management was not rendered but billedThis violation poses an immediate health, and safety risk to residents in care.

FAQ · About this visit

Common questions about this visit

What happened during the October 12, 2021 inspection of ACC MAPLE TREE VILLAGE?

This was a complaint inspection of ACC MAPLE TREE VILLAGE on October 12, 2021. The inspection found no deficiencies and no citations were issued.

Were any citations issued to ACC MAPLE TREE VILLAGE on October 12, 2021?

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 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·October 12, 2021