Deficiencies per Year
36
27
18
9
0
Moderate
Inspection Report
Routine
Census: 35
Deficiencies: 34
Sep 3, 2024
Visit Reason
Routine inspection of Valencia at Willow Creek Assisted Living Facility to review compliance with licensing rules and regulations, including resident rights, personnel, medication administration, and facility maintenance.
Findings
The inspection identified several areas of noncompliance including resident rights, medication administration, staffing, and facility maintenance. Some deficiencies were corrected during the inspection, while others require follow-up.
Severity Breakdown
Level 3: 34
Deficiencies (34)
| Description | Severity |
|---|---|
| Two residents' safety checks were not performed. | Level 3 |
| Four residents' assessments lacked required information and signatures. | Level 3 |
| One resident did not have a CNA on duty 24 hours a day. | Level 3 |
| Medication administration records had errors and missing documentation. | Level 3 |
| Facility did not maintain proper emergency and disaster plans. | Level 3 |
| Housekeeping staff did not follow proper cleaning and sanitation procedures. | Level 3 |
| Resident funds were not managed according to policy. | Level 3 |
| Resident records were incomplete or missing required documentation. | Level 3 |
| Food service employees worked in food service only; no cross-training noted. | Level 3 |
| Maintenance logs were not maintained; facility had cleaning agents and dangerous materials accessible. | Level 3 |
| Laundry services lacked proper documentation and procedures. | Level 3 |
| Staff did not have required training on emergency procedures and first aid. | Level 3 |
| Pets policy was not fully compliant; no vaccination records for some animals. | Level 3 |
| Respite services were not provided as licensed. | Level 3 |
| Adult day care services were not provided as licensed. | Level 3 |
| Disaster and emergency preparedness plans were incomplete or missing. | Level 3 |
| Food services lacked proper documentation and employee training. | Level 3 |
| Housekeeping services did not meet sanitation standards; cleaning supplies accessible to residents. | Level 3 |
| Resident rights were not fully protected; some residents lacked proper notification and documentation. | Level 3 |
| Resident admission and discharge procedures were incomplete or missing documentation. | Level 3 |
| Medication administration errors and documentation deficiencies were noted. | Level 3 |
| Resident funds management was not compliant with policy; missing documentation and controls. | Level 3 |
| Pets policy was not fully compliant; some animals lacked vaccination records. | Level 3 |
| Respite services were not provided as licensed. | Level 3 |
| Adult day care services were not provided as licensed. | Level 3 |
| Staffing levels and training did not meet licensing requirements. | Level 3 |
| Resident records were incomplete or missing required documentation. | Level 3 |
| Food service employees worked in food service only; no cross-training noted. | Level 3 |
| Maintenance logs were not maintained; facility had cleaning agents and dangerous materials accessible. | Level 3 |
| Laundry services lacked proper documentation and procedures. | Level 3 |
| Staff did not have required training on emergency procedures and first aid. | Level 3 |
| Pets policy was not fully compliant; no vaccination records for some animals. | Level 3 |
| Respite services were not provided as licensed. | Level 3 |
| Adult day care services were not provided as licensed. | Level 3 |
Report Facts
Number of residents present: 35
Number of rule noncompliances: 34
Inspection start time: 08:30
Inspection end time: 20:00
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