ANGELEON CARE HOME

Official classification

Type B

Official code

1569.625(b)(2)

Regulation authority

HSC

What the official deficiency says

(2) In addition to paragraph (1), training requirements shall also include an additional 20 hours annually, eight hours of which shall be dementia care training, as required by subdivision (a) of Section 1569.626, and four hours of which shall be specific to postural supports, restricted health conditions, and hospice care, as required by subdivision (a) of Section 1569.696. This training shall be administered on the job, or in a classroom setting, or both, and may include online training. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, the licensee did not comply with the section cited above in having staff complete and document annual trainings which poses potential personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/03/2026 Plan of Correction By POC facility agrees to get all staff up to date on trainings and notify CCLD

Official classification

Type B

Official code

87463(a)

Regulation authority

CCR

What the official deficiency says

(a) The pre-admission appraisal, as specified in Section 87457, Pre-Admission Appraisal, shall be updated, in writing as frequently as necessary or once every 12 months, whichever occurs first, to note significant changes in condition, as defined in Section 87101, Definitions, and to keep the appraisal accurate. For the purposes of this section, the updated pre-admission appraisal shall be referred to as the reappraisal. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, the licensee did not comply with the section cited above in 5 out of 5 resident records reviewed not having appraisals which poses a potential personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/03/2026 Plan of Correction By POC facility agrees to ensure all residents have their required appraisals and notify CCLD

Official classification

Type B

Official code

87211(a)(1)

Regulation authority

CCR

What the official deficiency says

Reporting Requirements. (a) Each licensee shall furnish to the licensing agency such reports as the Department may require... (1) A written report shall be submitted to the licensing agency...within seven days of the occurrence... This requirement is not met as evidence by: Based on record review, licensee did not comply with the section cited above by not submitting an incident report to CCLD which poses a potential health and safety risk to the persons in care.

Official plan of correction

Facility has agreed to obtain and submit a written incident report regarding R1's elopement to CCLD by POC date.

Deadline recorded: Mar 25, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87463(a)

Regulation authority

CCR

What the official deficiency says

Reappraisals. (a) The pre-admission appraisal, as specified in Section 87457, Pre-Admission Appraisal, shall be updated in writing as frequently as necessary or once every 12 months, whichever occurs first...This requirement is not met as evidence by: Based on record review, licensee did not comply with the section cited above by not having a preplacement appraisal or reappraisal for R1 which poses a potential health and safety risk to the persons in care.

Official plan of correction

Facility has agreed to obtain a preplacement/reappraisal for R1 and submit a copy to CCLD by POC date.

Deadline recorded: Mar 25, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87411(a)

Regulation authority

CCR

What the official deficiency says

Personnel Requirements - General. (a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs...This requirement is not met as evidence by: Based on record review, licensee did not comply with the section cited above by having a resident leave the facility unassisted which poses a potential health and safety risk to the persons in care.

Official plan of correction

Facility has agreed to create a written plan regarding care for residents who cannot leave the facility unassisted and submit plan to CCLD by POC date.

Deadline recorded: Mar 25, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87224(f)

Regulation authority

CCR

What the official deficiency says

87224 Eviction Procedures (f) A written report of any eviction shall be sent to the licensing agency within five (5) days. -This requirement is not met as evidenced by: Based on interviews and records reviewed, ADM did not comply with the section above by not providing notice of eviction to CCL for R3 which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Administrator (ADM) to rescind notice, provide a copy to R1, RP & CCLD. ADM to review the regulation, self-certify, and provide proof to CCL by POC date.

Deadline recorded: Apr 13, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87211(a)(1)

Regulation authority

CCR

What the official deficiency says

87211 Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: (1) A written report shall be submitted to the licensing agency... -This requirement is not met as evidenced by: ADM did not comply with the section above by not providing documented UIRs to CCL for R3 which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

ADM to review the regulation, self-certify, and provide proof of all staff signatures to CCL by POC date.

Deadline recorded: Apr 17, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.1(a)(3)

Regulation authority

CCR

What the official deficiency says

87468.1 Personal Rights of Residents in All Facilities (a)...shall have all of the following personal rights: (3)...free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature...such as withholding residents’ money or interfering with daily living functions... –This requirement is not met as evidenced by: ADM did not comply with the section above by not upholding the person rights of R3 which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

ADM to review the regulation, self-certify, and provide proof of all staff signatures to CCL by POC date.

Deadline recorded: Apr 10, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87412(f)

Regulation authority

CCR

What the official deficiency says

(f) All personnel records shall be available to the licensing agency to inspect, audit, and copy upon demand during normal business hours. Records may be removed if necessary for copying. Removal of records shall be subject to the following requirements: This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, the licensee did not comply with the section cited above in by not having training records available for Administrator and Care Staff which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/09/2024 Plan of Correction Administrator to submit a copy of all updated training to CCLD by POC due date.

Official classification

Type B

Official code

87465(a)(8)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following: (8) If a facility has no medical unit on the grounds, a complete first aid kit shall be maintained and be readily available in a specific location in the facility. The kit shall be a general type approved by the American Red Cross, or shall contain at least the following: This requirement is not met as evidenced by: Deficient Practice Statement Based on observation the licensee did not comply with the section cited above in by not having a complete First Aid kit with a manual of instructions which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/09/2024 Plan of Correction Administrator to purchase a new First Aid kit and submit photo to CCLD by POC due date.