FOOTPRINT CARE HOME

Official classification

Type A

Official code

87202(a)

Regulation authority

CCR

What the official deficiency says

(a) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, or the State Fire Marshal. Prior to accepting or retaining any of the following types of persons, the applicant or licensee shall notify the licensing agency and obtain an appropriate fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, or the State Fire Marshal: This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and interview, the licensee did not comply with the section cited above by having a bedridden resident without approved fire clearance and the smoke alarm not working which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/11/2026 Plan of Correction By POC date, the Administrator agrees to notify the fire depatment of the bedridden resident and fix the smoke alarm. By 07/17/2026, Administrator will notify LPA of their plan for R2. Proof of correction will be sent to CCLD.

Official classification

Type A

Official code

87309(a)

Regulation authority

CCR

What the official deficiency says

(a) Except as specified in subsection (b), the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances, knives, matches, tools, sharp objects, and other similar items which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above by having unlocked prescribed ointment in R1's room which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/11/2026 Plan of Correction Staff locked the medication during the visit. Deficiency cleared.

Official classification

Type B

Official code

1569.625(b)(1)

Regulation authority

HSC

What the official deficiency says

(1) The department shall adopt regulations to require staff members of residential care facilities for the elderly who assist residents with personal activities of daily living to receive appropriate training. This training shall consist of 40 hours of training. A staff member shall complete 20 hours, including six hours specific to dementia care, as required by subdivision (a) of Section 1569.626 and four hours specific to postural supports, restricted health conditions, and hospice care, as required by subdivision (a) of Section 1569.696, before working independently with residents. The remaining 20 hours shall include six hours specific to dementia care and shall be completed within the first four weeks of employment. The training coursework may utilize various methods of instruction, including, but not limited to, lectures, instructional videos, and interactive online courses. The additional 16 hours shall be hands-on training. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and record review, the licensee did not comply with the section cited above by not having sufficient hours of annual training for S2 and S3 for 2026 for which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 07/31/2026 Plan of Correction By POC date, staff agrees to complete staff training and send proof to CCLD.

Official classification

Type B

Official code

87555(b)(27)

Regulation authority

CCR

What the official deficiency says

(27) All kitchen areas shall be kept clean and free of litter, rodents, vermin and insects. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above by having ants on one of the kitchen drawers filled with spices which poses a potential health and safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/17/2026 Plan of Correction Staff cleaned the kitchen drawer during the visit. Deficiency cleared.

Official classification

Type B

Official code

87465(a)(4)

Regulation authority

CCR

What the official deficiency says

(4) The licensee shall assist residents with self-administered medications as needed. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above by not having doctor's order for R2's prescription and over the counter medication which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/31/2026 Plan of Correction By POC date, staff agrees to obtain doctor's order for R2's medication and send proof to CCLD.

Official classification

Type B

Official code

87405(a)

Regulation authority

CCR

What the official deficiency says

(a) All facilities shall have a qualified and currently certified administrator…When the administrator is not in the facility, there shall be coverage by a designated substitute who shall have qualifications adequate to be responsible and accountable for management and administration of the facility as specified in this section. The Department may require that the administrator devote additional hours in the facility to fulfill his/her responsibilities when the need for such additional hours is substantiated by written documentation. This requirement is not met as evidenced by: Deficient Practice Statement Based on observations the licensee did not comply with the section cited above in not having an qualified administrator at the facility which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/31/2026 Plan of Correction By POC date, Licensee agreed read regulation 87405(a), hire a qualified and certified administrator, send all required documents to make the change of administrator to CCL

Official classification

Type B

Official code

87608(a)(5)(A)

Regulation authority

CCR

What the official deficiency says

(A) A bed rail that extends from the head half the length of the bed and used only for assistance with mobility shall be allowed. 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 by not having a doctor's order for R2's half bed rail which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/31/2026 Plan of Correction By POC date, the staff agrees to obtain a doctor's order for R2's bed rail.

Official classification

Type B

Official code

87405(a)

Regulation authority

CCR

What the official deficiency says

(a) ...The administrator shall have sufficient freedom from other responsibilities and shall be on the premises a sufficient number of hours… This requirement is not met as evidenced by: Based on interview, the licensee did not comply with the section cited above by not having the administrator at the facility for a sufficient number of hours which poses a potential safety risk in persons in care.

Official plan of correction

The Administrator agrees to send an updated LIC500 for all the staff, send Administrator time sheet every week for a month, and be available for phone call when licensing calls. Proof of correction will be sent to CCLD by POC date.

Deadline recorded: Aug 23, 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

(1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below... This requirement is not met as evidenced by: Based on record review and interview, the licensee did not comply with the section cited above by not reporting any incidents regarding residents which poses a potential health and safety risks to persons in care.

Official plan of correction

The Administrator will self-certify and have in-service training for all staff regarding the regulation and send proof to CCLD by PC date.

Deadline recorded: Jul 23, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

1569.618(c)(3)

Regulation authority

HSC

What the official deficiency says

(c).... (3) Ensure that at least one staff member who has cardiopulmonary resuscitation (CPR) training and first aid training is on duty and on the premises at all times. This paragraph shall not be construed to require staff to provide CPR. This requirement is not met as evidenced by: Based on record review, the licensee did not comply with the section cited above by not having CPR and/or First Aid certification for the Administrator which poses a potential health and safety risk to persons in care.

Official plan of correction

Staff agrees to obtain First Aid and CPR certification for all the staff and send proof to CCLD by POC date.

Deadline recorded: Jul 23, 2025. A deadline is not proof that correction was completed.

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, ...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: Based on record review, the licensee did not comply with the section cited above by not having training for the Administrator which poses a potential health and safety to persons in care.

Official plan of correction

Staff agrees to obtain training for all the staff and send proof to CCLD by POC date.

Deadline recorded: Jul 30, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87412(g)

Regulation authority

CCR

What the official deficiency says

(g) All personnel records shall be maintained at the facility. This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above by not having the completed staff files at the facility which poses a potential safety risk to persons in care.

Official plan of correction

The staff agrees to obtain and complete all staff files. Proof of correction will be sent to CCLD by POC date.

Deadline recorded: Aug 6, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87506(b)

Regulation authority

CCR

What the official deficiency says

(b) Each resident’s record shall contain at least the following information: This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above by not have the completed files for resident's which poses a potential safety risk to persons in care.

Official plan of correction

The Administrator agrees to complete the residents' file and send proof to CCLD by POC date.

Deadline recorded: Aug 6, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87608(a)(5)(A)

Regulation authority

CCR

What the official deficiency says

(A) A bed rail that extends from the head half the length of the bed and used only for assistance with mobility shall be allowed. This requirement is not met as evidenced by: Based on observation and record review, the licensee did not comply with the section cited above by not having a half bed rail order for R1 and R2 which poses a potential health and safety risk to persons in care.

Official plan of correction

The staff agrees to get a doctor's order for R1 and R2's half bed rail and send proof to CCLD by POC date.

Deadline recorded: Aug 6, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87202(a)

Regulation authority

CCR

What the official deficiency says

(a) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, or the State Fire Marshal. Prior to accepting or retaining any of the following types of persons, the applicant or licensee shall notify the licensing agency and obtain an appropriate fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, or the State Fire Marshal: This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above by having the side gate locked with a Masterlock and wooden board and the right side with metal chains which poses an immediate health and safety rights risk to persons in care.

Official plan of correction

POC Due Date: 06/25/2025 Plan of Correction Staff removed the Masterlock, wooden board, and metal chains from both side gates during the visit. Deficiency cleared. Civil Penalty of $500 is assessed.

Official classification

Type A

Official code

87303(e)(2)

Regulation authority

CCR

What the official deficiency says

(e) Water supplies and plumbing fixtures shall be maintained as follows: (2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degrees C) and not more than 120 degree F (49 degrees C). This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above by having the water temperature measured at 131.5 degrees Fahrenheit which poses an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 06/25/2025 Plan of Correction The Administrator agrees to lower the water temperature to be within range and send proof to CCLD by POC date.

Official classification

Type A

Official code

87309(a)

Regulation authority

CCR

What the official deficiency says

(a) Except as specified in subsection (b), the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances, knives, matches, tools, sharp objects, and other similar items which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above by having unlocked medication in the kitchen fridge which poses an immediate safety risk to persons in care.

Official plan of correction

POC Due Date: 06/25/2025 Plan of Correction Staff removed the medication during the visit. Deficiency cleared.

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 observation, the licensee did not comply with the section cited above by not having training for staff which poses a potential health and safety to persons in care.

Official plan of correction

POC Due Date: 07/08/2025 Plan of Correction The Administrator agrees for staff to complete their training and submit proof to CCLD by POC date.

Official classification

Type B

Official code

87555(b)(25)

Regulation authority

CCR

What the official deficiency says

(b) The following food service requirements shall apply: (25) Soaps, detergents, cleaning compounds or similar substances shall be stored in areas separate from food supplies. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above by having canned goods in the same storage area as laundry detergent, Ajax cleaning supply, dish soap, Febreeze, etc. which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 07/02/2025 Plan of Correction Staff separated the canned goods and cleaning supplies during today's visit. Deficiency cleared.

Official classification

Type B

Official code

87506(b)

Regulation authority

CCR

What the official deficiency says

(b) Each resident's record shall contain at least the following information: 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 by having R2 and R3's files incomplete which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 07/08/2025 Plan of Correction The Administrator agrees to complete the residents' file and send proof to CCLD by POC date.

Official classification

Type B

Official code

87608(a)(5)(A)

Regulation authority

CCR

What the official deficiency says

(A) A bed rail that extends from the head half the length of the bed and used only for assistance with mobility shall be allowed. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and record review, the licensee did not comply with the section cited above by not having a half bed rail order for R1 and R2 which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 07/08/2025 Plan of Correction The Administrator agrees to get a doctor's order for R1 and R2's half bed rail and send proof to CCLD by POC date.

Official classification

Type B

Official code

1569.618(c)(3)

Regulation authority

HSC

What the official deficiency says

(c)The facility shall employ, and the administrator shall schedule, a sufficient number of staff members to do all of the following: (3) Ensure that at least one staff member who has cardiopulmonary resuscitation (CPR) training and first aid training is on duty and on the premises at all times. This paragraph shall not be construed to require staff to provide CPR. 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 by not having CPR and/or First Aid certification for all the staff which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 07/02/2025 Plan of Correction The Administrator agrees to train all staff in CPR and/or First and send proof to CCLD by POC date.

Official classification

Type B

Official code

87412(g)

Regulation authority

CCR

What the official deficiency says

(g) All personnel records shall be maintained at the facility. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above by not having the staff files at the facility which poses a potential safety risk to persons in care.

Official plan of correction

POC Due Date: 07/08/2025 Plan of Correction The Administrator agrees self certify the regulation, store the staff files at the facility, and send proof to CCLD by POC date.

Official classification

Type B

Official code

87412(g)

Regulation authority

CCR

What the official deficiency says

(g) All personnel records shall be maintained at the facility. This requirement is not met as evidenced by: Deficient Practice Statement Based on interview and record review, the licensee did not comply with the section cited aboveby not having the staff records at the facility which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/22/2024 Plan of Correction The facility agrees to store the staff records at the facility by POC date. Proof of correction will be sent to CCLD by POC date.

Official classification

Type B

Official code

87463(a)

Regulation authority

CCR

What the official deficiency says

(a) The pre-admission appraisal shall be updated, in writing as frequently as necessary to note significant changes and to keep the appraisal accurate. The reappraisals shall document changes in the resident's physical, medical, mental, and social condition. Significant changes shall include but not be limited to: This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, and record review, the licensee did not comply with the section cited above by not having a completed Lic625 (Needs and service plan) for R1 in residents file which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/03/2023 Plan of Correction Licensee agreed to complete an Lic625- Needs and service plan and to submit a copy as proof to CCL by POC due date.

Official classification

Type A

Official code

87203

Regulation authority

CCR

What the official deficiency says

87203 Fire Safety: All facilities shall be maintained in conformity with the regulations adopted by the State Fire Marshal for the protection of life and property against fire and panic This requirement is not met as evidenced by Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above by not having operable fire alarms in the facility, which poses an immediate health and safety rights risk to persons in care.

Official plan of correction

POC Due Date: 08/20/2022 Plan of Correction Administrator agrees to fix and install new batteries in the fire alarm and to submit a voice recording for 2 mintues to CCL by POC due date.

Official classification

Type B

Official code

87405(a)(3)

Regulation authority

CCR

What the official deficiency says

87405 Administrator - Qualifications and Duties: (a) All facilities shall have a qualified and currently certified administrator. The licensee and the administrator may be one and the same person. The administrator shall have sufficient freedom from other responsibilities and shall be on the premises a sufficient number of hours to permit adequate attention to the management and administration of the facility as specified in this section. (3) Ability to maintain or supervise the maintenance of financial and other records. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview, and record review, the licensee did not comply with the section cited above by not keeping the files of a resident who passes away in the facility available, which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 08/26/2022 Plan of Correction Licensee agrees to keep all files available in the facility and to submit a self-certification to CCL by POC due date.

Official classification

Type B

Official code

87506(b)(13)

Regulation authority

CCR

What the official deficiency says

87506 Resident Records: (b) Each resident’s record shall contain at least the following information: (13) Continuing record of any illness, injury, or medical or dental care, when it impacts the residents’ ability to function or needed services. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, and record review, the licensee did not comply with the section cited above by not updating progess notes for R1 in his file, which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 08/26/2022 Plan of Correction Licensee agrees to update progess notes for all residents in the future and to submit a self-certification to CCL by POC due date.