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Inspection visit

Office review

NICK'S MAPLE HOME IIILicense 3618810353 citations on this visit
3 citations recorded

Inspector’s narrative

What the inspector wrote

On this day, Licensee Najeh Hamed and Licensing Program Analysts (LPA) Anna Bueno met at the San Bernardino Regional Office. The purpose of today's meeting is to deliver findings on complaint number 56-AS-20221104151616. During the investigation of the above mentioned complaint the following violations were discovered. Refer to LIC809-D for deficiency cited. Violation discovered are listed below: 87208(c) Resident records revealed one resident has a diagnosis of Dementia. This facility has not submitted to a Dementia care plan to the Department and therefore is not authorized to provide care and supervision to residents with Dementia. 87204(b) The facility license identifies first floor bedroom as the only non-ambulatoy bedroom. During the investigation, Resident 1 was occupying bedroom #5 in the second floor. 87506(b) Nine resident records were reviewed and all had missing documents such as, LIC 602 Physician's report, admission agreement, Pre-admission appraisal and/or re-appraisal. An exit interview was conducted with and a copy of this report, LIC809-D, and appeal rights

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.

  • 87204(b)Type B

    Resident rooms approved for 24-hour care of ambulatory residents only shall not accommodate non ambulatory residents. Residents whose condition becomes non ambulatory shall not remain in rooms restricted to ambulatory residents. This requirement was not met as evidenced by:Resident 1 is non-ambulatory is occupying bedroom #5. Fire clearance only allow the 1st floor bedroom to be occupied by non-ambulatory clients. This poses a potential health and safety risk to residents in care.

  • 87208(c)Type A

    (c) A licensee who accepts or retains residents diagnosed by a physician to have dementia shall include additional information in the plan of operation as specified in Section 87705(b). This requirement was not met as evidenced by:One of 9 resident records revealed that one resident is diagnosed with Dementia. This poses an immediate health and safety risk to residents in care.

  • 87506(b)Type B

    Resident Records(b) Each resident’s record shall contain at least the following information... (1) through (17)(F)This requirement was not met as evidenced by: Nine resident records were reviewed and all had missing documents such as, LIC 602 Physician's report, admission agreement, Pre-admission appraisal and/or re-appraisal.

  • 87204(a)Type A

    A licensee shall not operate a facility beyond the conditions and limitations specified on the license, including specification of the maximum number of persons who may receive services at any one time. An exception may be made in the case of catastrophic emergency when the licensing agency may make temporary exceptions to the approved capacity. This requirement was not met as evidenced by:Three of 8 records were reviewed and found to be non-ambulatory. This poses an immediate health and safety risk to residents in care.

FAQ · About this visit

Common questions about this visit

What happened during the March 20, 2023 inspection of NICK'S MAPLE HOME III?

This was a other inspection of NICK'S MAPLE HOME III on March 20, 2023. 3 citations were issued: 1 Type A (serious) and 2 Type B.

Were any citations issued to NICK'S MAPLE HOME III on March 20, 2023?

Yes, 3 citations were issued (1 Type A, 2 Type B). The first citation was for: "Resident rooms approved for 24-hour care of ambulatory residents only shall not accommodate non ambulatory residents. R..."

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.