Other·August 28, 2018

California Department of Public Health CA080000102 09/07/2017 AMAYA SPRINGS HEALTH CARE CENTER 8625 Lamar St Spring Valley, CA 91977 PREFIX TAG A000 Initial Comments ID PREFIX TAG CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY) COMPLETE DATE A000 The following reflects the findings of the California Department of Public Health during a staffing visit: Representing the Department: K.D., Associate Governmental Program Analyst. Welfare and Institutions (W&I) Code section 14126.022 sets forth the Department's authority to conduct audits of direct caregiver nursing services provided to residents of skilled nursing facilities, and to establish procedures for conducting such audits through All Facility Letters (AFLs). W&I Code section 14126.022 is attached hereto and incorporated herein as 'Attachment A.' AFL 11-19, setting forth the audit process and guidelines for facilities is available through the following link: http://www.cdph.ca.gov/certlic/facilities/Docum ents/LNC-AFL-11-19.pdf. Health and Safety Code (HSC), setting forth the requirements for Certified Nurse Assistants is available through the following link: http://www.leginfo.ca.gov/cgi-bin/displaycode? section=hsc&group=0100102000&file=1337-1338.5 A029 1276.5(a) HSC Section 1276 A029 (a) The department shall adopt regulations setting forth the minimum number of equivalent nursing hours per patient required in skilled nursing and intermediate care facilities, subject to the specific requirements of Section 14110.7 Licensing and Certification Division STATE FORM 6899 JKGV11 California Department of Public Health CA080000102 09/07/2017 AMAYA SPRINGS HEALTH CARE CENTER 8625 Lamar St Spring Valley, CA 91977 PREFIX TAG ID PREFIX TAG CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY) COMPLETE DATE of the Welfare and Institutions Code. However, notwithstanding Section 14110.7 or any other provision of law, commencing January 1, 2000, the minimum number of actual nursing hours per patient required in a skilled nursing facility shall be 3.2 hours, except as provided in Section 1276.9. This Statute is not met as evidenced by: Based on record review and interview, the above nursing facility was found out of compliance with Health and Safety Code 1276.5(a), the requirement for a minimum of 3.2 nursing hours per patient day for 4 out of 24 randomly selected days from February 27, 2017 through May 29, 2017: Findings: · The Director of Nursing (DON) failed to delineate time spent providing nursing services to skilled nursing care patients beyond the hours required to carry out the duties of the DON position per AFL 11-19, Section 1(A). · Salaried employee(s) failed to document: actual shift and meal break start and end times, along with their nursing services assignment, discipline, printed name and signature when providing nursing services to skilled nursing patients. Time spent providing nursing services could not be verified. Failure to provide the information has resulted in the exclusion of all service hours for such employees per AFL 1119, Section 6(a). · The total number of actual nursing hours performed by direct caregivers per patient day divided by the average census during the patient day failed to meet 3.2 Nursing Hours Licensing and Certification Division STATE FORM 6899 JKGV11 California Department of Public Health CA080000102 09/07/2017 AMAYA SPRINGS HEALTH CARE CENTER 8625 Lamar St Spring Valley, CA 91977 PREFIX TAG ID PREFIX TAG CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY) COMPLETE DATE per Patient Day per AFL 11-19, Section 2(a-c). · Facility failed to replace staff that did not work as scheduled, and/or did not schedule to meet a minimum of 3.2 Nursing Hours per Patient Day. As a result, the total number of actual nursing hours performed by direct caregivers per patient day divided by the average census during the patient day failed to meet 3.2 Nursing Hours per Patient Day per AFL 11-19, Section 2(a-c). Documentation requirements set forth in All Facilities Letter (AFL) 11-19 were not met. In the future, failure to properly complete the CDPH 612 forms (or facility equivalent) will result in a deficiency in addition to a finding of non-compliance with the 3.2 minimum NHPDD requirement for each day that proper documentation is not provided. The following documentation requirements were not met as evidenced by AFL 11-19: Section II. Guidelines, Sub-Section 6: Documentation Facilities will be expected to meet the following documentation requirements no later than 14 days from the date of this All Facilities Letter. Each facility shall maintain current, complete, and accurate personnel and payroll records for all employees in accordance with Title 22, Section 72533. The facility shall provide the following documentation upon request: 1. Census and NHPPD (CDPH 612 or facility alternative form). Licensing and Certification Division STATE FORM 6899 JKGV11 California Department of Public Health CA080000102 09/07/2017 AMAYA SPRINGS HEALTH CARE CENTER 8625 Lamar St Spring Valley, CA 91977 PREFIX TAG ID PREFIX TAG CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY) COMPLETE DATE DATE NHPPD 03/25/17 2.97 03/27/17 2.97 04/07/17 2.92 04/09/17 2.90 Licensing and Certification Division STATE FORM 6899 JKGV11