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Inspection visit

Routine inspection

SIMI VALLEY RESIDENTIAL CARE IVLicense 5658004172 citations on this visit
2 citations recorded

Inspector’s narrative

What the inspector wrote

Licensing Program Analysts (LPA's) JoAnn Rosales and Teresa Camara conducted an unannounced Required -1 Year inspection. LPA's met with Administrator Maria Mendez. Today's evaluation included but was not limited to: building and grounds, resident rooms, bathrooms, hot water temperature (read at 105.2 degrees F) in common resident bathroom, common areas, personal accommodations, food and first aid supplies . LPA observed lamps/lights as well as sufficient furnishings and linens for each room. LPA observed fire extinguisher fully charged. Centrally stored medicines are kept in a cabinet just outside the kitchen. Hygiene items are being provided. Grab bars and non-skid materials were present in the bathrooms. LPA observed facility to be a comfortable temperature throughout the visit. Smoke alarms and carbon monoxide detectors were tested and were operable at the time of the visit. Indoor and outdoor area toured passageways were free from obstruction. LPA reviewed resident records and medications. LPA reviewed staff records. During facility tour LPA observed one central entry point designated for universal entry screening. Cleaning supplies were observed and infection control practices were discussed. During the facility tour on 9/21/21 at 11:30 am with the Administrator LPA observed resident #2 (R2's) ibuprofen in a kitchen drawer accessible to residents. During the facility tour on 9/21/21 at 11:41 am with the Administrator LPA observed antacid tablets and menthol cough suppressant/oral anesthetic drops in R1's bedroom accessible to residents. During a review of resident medications on 9/21/21 starting at 1:42 pm with the Administrator LPA observed that R1 is prescribed Melatonin 3 mg 1 tablet at BT and is being given Melatonin 5 mg 1 tablet at BT. Continued on 809C Pursuant to Title 22 Division 6 Chapter 8 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D): Exit interview conducted, today's reports and appeal rights were reviewed and emailed to the Administrator.

Citations

2 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

    Based on medication review, the licensee did not comply with the section cited above in 1 out of 12 medications for R1 which poses an immediate health risk to persons in care.

  • 87705(f)(2)Type A

    Based on LPA's observation and record review, the licensee did not comply with the section cited above in 2 out of 12 medications for R1 and 1 out of 1 medications for R2 which poses an immediate health risk to persons in care.

FAQ · About this visit

Common questions about this visit

What happened during the September 21, 2021 inspection of SIMI VALLEY RESIDENTIAL CARE IV?

This was a inspection inspection of SIMI VALLEY RESIDENTIAL CARE IV on September 21, 2021. 2 citations were issued: 2 Type A (serious).

Were any citations issued to SIMI VALLEY RESIDENTIAL CARE IV on September 21, 2021?

Yes, 2 citations were issued (2 Type A, 0 Type B). The first citation was for: "Based on medication review, the licensee did not comply with the section cited above in 1 out of 12 medications for R1 w..."

What type of inspection was this?

This was a inspection inspection. inspection 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.