Inspection Results » Windsor Terrace of Westlake Village

Health Inspection on April 5, 2019 ^[1]

1. Pattern: No actual harm with potential for more than minimal harm that is not immediate jeopardy

   • Have a plan that describes the process for conducting QAPI and QAA activities. (Corrected 2019-05-02)
   • Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. (Corrected 2019-05-02)
   • Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift. (Corrected 2019-05-02)
   • Ensure each residentÂ’s drug regimen must be free from unnecessary drugs. (Corrected 2019-05-02)
   • Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. (Corrected 2019-05-02)
   • Honor the resident's right to organize and participate in resident/family groups in the facility. (Corrected 2019-05-02)
   • Ensure services provided by the nursing facility meet professional standards of quality. (Corrected 2019-05-02)

2. Isolated: No actual harm with potential for more than minimal harm that is not immediate jeopardy

   • Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason. (Corrected 2019-05-02)
   • Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted (Corrected 2019-05-02)
   • Reasonably accommodate the needs and preferences of each resident. (Corrected 2019-05-02)
   • Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. (Corrected 2019-05-02)
   • Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. (Corrected 2019-05-02)
   • Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. (Corrected 2019-05-02)
   • Provide or get specialized rehabilitative services as required for a resident. (Corrected 2019-05-02)
   • Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights. (Corrected 2019-05-02)