LA CONCEPCION RESIDENTIAL 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, the licensee did not comply with the section cited above by having a screw locking one of the sides gate, a screwdriver locking the other gate, and the physical plant of the facility not matching the approved facility sketch which poses an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 03/14/2026 Plan of Correction Administrator removed the screw and screwdriver from both gates. By 03/20/2026, Administrator agrees to send an updated facility sketch and LIC200 to request for fire inspection for the staff room. $500 of immediate civil penalty is assessed.

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 knife and scissors unlocked in the kitchen, Tylenol, Robitussin, Hydrocortisone Cream, Scissors, etc in R3's room, and disinfectants in the garage which poses an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 03/14/2026 Plan of Correction By POC date, the Administrator agrees to lock the items and send proof to CCLD.

Official classification

Type B

Official code

87355(e)(3)

Regulation authority

CCR

What the official deficiency says

(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (3) Request a transfer of a criminal record clearance as specified in Section 87355(c) or 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 S2 associated with the facility which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 03/20/2026 Plan of Correction By POC date, the Administrator agrees to associate S2 and send proof to CCLD.

Official classification

Type B

Official code

87506(a)

Regulation authority

CCR

What the official deficiency says

(a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff. 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. The residents' files are incomplete such as their Appraisal Needs and Services Plan (LIC625), Identification and Emergency Information (LIC601), and Physician Report (LIC602A) for R3 which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/27/2026 Plan of Correction By POC date, the Administrator agrees to complete all the residents' records and send proof to CCLD.

Official classification

Type B

Official code

1569.695(c)

Regulation authority

HSC

What the official deficiency says

(c) A facility shall conduct a drill at least quarterly for each shift. The type of emergency covered in a drill shall vary from quarter to quarter, taking into account different emergency scenarios. An actual evacuation of residents is not required during a drill. While a facility may provide an opportunity for residents to participate in a drill, it shall not require any resident participation. Documentation of the drills shall include the date, the type of emergency covered by the drill, and the names of staff participating in the drill. 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 fire drills conducted since September 15, 2025 which poses a potential safety risk to persons in care.

Official plan of correction

POC Due Date: 03/27/2026 Plan of Correction By POC date, the Administrator agrees to self certify the regulation and conducted a fire drill. Proof of correction will be sent to CCLD.

Official classification

Type B

Official code

87608(a)(3)

Regulation authority

CCR

What the official deficiency says

(a) Based on the individual's preadmission appraisal, and subsequent changes to that appraisal, the facility shall provide assistance and care for the resident in those activities of daily living which the resident is unable to do for himself/herself. Postural supports may be used under the following conditions: (3) A written order from a physician indicating the need for the postural support shall be maintained in the resident's record. The licensing agency shall be authorized to require other additional documentation if needed to verify the order. 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 R1, R2, and R4 half bed rail which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 03/27/2026 Plan of Correction By POC date, the Administrator agrees to obtain a doctors' order for R1, R2, and R4 for their half bed rail.

Official classification

Type B

Official code

87412(a)

Regulation authority

CCR

What the official deficiency says

(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain 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 the staff records incomplete. S1 is missing First Aid Certification, S2 and S3 are missing Health Screening, TB Test, and CPR certification which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/23/2026 Plan of Correction By POC date, the Administrator will obtain first aid for S1 and health screening,TB test, and CPR for S2 and S3. Proof of correction will be sent to CCLD by POC date.

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 a doctor’s order for the Melatonin and a discontinued order for sodium, docusate sodium, smartrx, blood sugar monitoring, etc. for R4 which poses a potential safety risk to persons in care.

Official plan of correction

POC Due Date: 03/27/2026 Plan of Correction By POC date, the Administrator agrees to obtain a doctor’s order and discontinued order for the medications and send proof to CCLD.

Official classification

Type A

Official code

87606(c)

Regulation authority

CCR

What the official deficiency says

87606(c) Care of Bedridden ResidentsTo accept or retain a person who is bedridden...a licensee shall obtain and maintain an appropriate fire clearance as specified in Section 87202, Fire Clearance. This requirement is not met as evidenced by: Based on interview and record review, the facility admitted a bed bound resident without an approved fire clearance which poses an immediate health and safety risk to residents in care.

Official plan of correction

Within 24 hours, the Administrator will notify the local fire department about the bedridden resident and send proof to CCLD. Then, the facility will send the LIC200 and the updated facility sketch by 06/18/2025 to apply for a bedridden fire clearance.

Deadline recorded: May 29, 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 in having the self closing latch tied with the string to lock the gate which poses an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 03/08/2025 Plan of Correction Administrator untied the string 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 in having the hot water measured at 129.1 degrees which poses an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 03/08/2025 Plan of Correction The licensee agrees to have the hot water temperature measured 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 in having a knife found in one of the kitchen drawers which poses an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 03/08/2025 Plan of Correction The licensee agrees to lock the knives in the cabinet and send proof to CCLD by POC date.

Official classification

Type B

Official code

87411(f)

Regulation authority

CCR

What the official deficiency says

(f) All personnel, including the licensee and administrator, shall be in good health, and physically and mentally capable of performing assigned tasks. Good physical health shall be verified by a health screening, including a chest x-ray or an intradermal test, performed by a physician not more than six (6) months prior to or seven (7) days after employment or licensure. A report shall be made of each screening, signed by the examining physician. The report shall indicate whether the person is physically qualified to perform the duties to be assigned, and whether he/she has any health condition that would create a hazard to him/herself, other staff members or residents. A signed statement shall be obtained from each volunteer affirming that he/she is in good health.Personnel with evidence of physical illness or emotional instability that poses a significant threat to the well-being of residents shall be relieved of their duties. 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 not having a TB test for S4 which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 03/28/2025 Plan of Correction The licensee agrees to have staff get TB test and send proof to CCLD by POC date.

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

(a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. 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 having oxygen tanks, portable oxygen machine, crutches, commode, BBQ pit, etc in the backyard that needs to be removed which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 03/21/2025 Plan of Correction The licensee agrees to schedule a bulk removal and send proof to CCLD by POC date.

Official classification

Type B

Official code

87307(d)(6)

Regulation authority

CCR

What the official deficiency says

(6) All outdoor and indoor passageways and stairways shall be kept free of obstruction. 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 having the passageway in front of the garage door blocked with toilet paper, TV, ladder, etc which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 03/14/2025 Plan of Correction The licensee agrees to clear the passageway and send proof to CCLD by POC date.

Official classification

Type B

Official code

87355(e)(3)

Regulation authority

CCR

What the official deficiency says

(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (3) Request a transfer of a criminal record clearance as specified in Section 87355(c) or 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 not having S4 associated to the facility which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 03/14/2025 Plan of Correction The licensee agrees to have S4 associated to the facility and send proof to CCLD by POC date.

Official classification

Type B

Official code

87411(c)(1)

Regulation authority

CCR

What the official deficiency says

(1) Staff providing care shall receive appropriate training in first aid from persons qualified by such agencies as the American Red Cross. 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 not having First Aid Certification for S2 to S4 which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 03/21/2025 Plan of Correction The licensee agrees to obtain First Aid Certification for S2 to S4 and send proof to CCLD by POC date.

Official classification

Type B

Official code

87468(c)(2)(A)

Regulation authority

CCR

What the official deficiency says

(c) Licensees shall prominently post personal rights, nondiscrimination notice, and complaint information in areas accessible to residents, representatives, and the public. (2) Information on the appropriate reporting agency in case of a complaint or emergency, including procedures for filing confidential complaints, shall be posted as follows: (A) Licensees may use the Residential Care Facility for the Elderly (RCFE) Complaint Poster (PUB 475) or may develop their own poster as provided in this section. A poster developed by the licensee shall contain the same content as the PUB 475. The poster that is posted shall be 20” x 26” in size and be posted in the main entryway of the facility. PUB 475 may be accessed, downloaded, and printed from the www.ccld.ca.gov website. 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 not having the Complaint poster which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 03/14/2025 Plan of Correction The licensee ordered the poster on this date and will send proof of the poster by POC date.

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 in having R1 to R4 resident files incomplete which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 03/28/2025 Plan of Correction The licensee agrees to complete all the resident's files and send proof to CCLD by POC date.

Official classification

Type B

Official code

1569.695(a)

Regulation authority

HSC

What the official deficiency says

(a)In addition to any other requirement of this chapter, a residential care facility for the elderly shall have an emergency and disaster plan that shall include, but not be limited to, all of the following: 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 not having the Emergency Disaster Plan incomplete and not filled out which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 03/28/2025 Plan of Correction The licensee agrees to complete the Emergency Disaster Plan and send proof to CCLD by POC date.

Official classification

Type B

Official code

1569.695(c)

Regulation authority

HSC

What the official deficiency says

(c) A facility shall conduct a drill at least quarterly for each shift. The type of emergency covered in a drill shall vary from quarter to quarter, taking into account different emergency scenarios. An actual evacuation of residents is not required during a drill. While a facility may provide an opportunity for residents to participate in a drill, it shall not require any resident participation. Documentation of the drills shall include the date, the type of emergency covered by the drill, and the names of staff participating in the drill. 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 conducting quarterly drills which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 03/28/2025 Plan of Correction The licensee agrees to conduct a drill and send proof to CCLD by POC date.

Official classification

Type B

Official code

87608(a)(3)

Regulation authority

CCR

What the official deficiency says

(a) Based on the individual's preadmission appraisal, and subsequent changes to that appraisal, the facility shall provide assistance and care for the resident in those activities of daily living which the resident is unable to do for himself/herself. Postural supports may be used under the following conditions: (3) A written order from a physician indicating the need for the postural support shall be maintained in the resident's record. The licensing agency shall be authorized to require other additional documentation if needed to verify the order. 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 half bed rails for R2 and R4 which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 03/28/2025 Plan of Correction The licensee agrees to obtain the doctor's order for the half bed rails and send proof to CCLD by POC date.

Official classification

Type B

Official code

87608(a)(5)(B)

Regulation authority

CCR

What the official deficiency says

(B) Bed rails that extend the entire length of the bed are prohibited except for residents who are currently receiving hospice care and have a hospice care plan that specifies the need for full bed rails. 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 a full bed rail for R3 which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 04/04/2025 Plan of Correction The licensee will send an exception request and send to CCLD by POC date.

Official classification

Type A

Official code

87411(f)

Regulation authority

CCR

What the official deficiency says

(f) All personnel, including the licensee and administrator, shall be in good health, and physically and mentally capable of performing assigned tasks. Good physical health shall be verified by a health screening, including a chest x-ray or an intradermal test, performed by a physician not more than six (6) months prior to or seven (7) days after employment or licensure. A report shall be made of each screening, signed by the examining physician. The report shall indicate whether the person is physically qualified to perform the duties to be assigned, and whether he/she has any health condition that would create a hazard to him/herself, other staff members or residents. A signed statement shall be obtained from each volunteer affirming that he/she is in good health.Personnel with evidence of physical illness or emotional instability that poses a significant threat to the well-being of residents shall be relieved of their duties. This requirement is not met as evidenced by: Deficient Practice Statement Based on file review conducted, the licensee did not comply with the section cited above in having R2 work without TB test and health screening which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/29/2024 Plan of Correction By POC date, Administrator will have S2 get TB test and do health screening and submit proof to CCL.

Official classification

Type A

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 file review conducted, the licensee did not comply with the section cited above in not having First aid training for both staff which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/22/2024 Plan of Correction By POC date, both staff will complete first aid training and submit proof to CCL.

Official classification

Type A

Official code

87303(e)(2)

Regulation authority

CCR

What the official deficiency says

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 having hot water at 135 degrees Fahrenheit which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/21/2024 Plan of Correction By POC date, Administrator will adjust hot water temperature within range and submit self-certificate of completion to CCL.

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

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 having screen door/window with hole/ripped, fire extinguisher not updated with inspection, having commodes, pieces of wood, mattress etc on the side and backyard which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/03/2024 Plan of Correction By POC date, Administrator will submit photo proof of completion to CCL.

Official classification

Type B

Official code

87705(5)

Regulation authority

CCR

What the official deficiency says

This requirement is not met as evidenced by: Deficient Practice Statement Based on file review, R1 who has dementia does not have an updated medical assessment. Last assessment is dated 2022.

Official plan of correction

POC Due Date: 04/03/2024 Plan of Correction Administrator will have R1 obtain an updated medical assessment and submit proof to CCL.

Official classification

Type B

Official code

87411(c)

Regulation authority

CCR

What the official deficiency says

This requirement is not met as evidenced by: Deficient Practice Statement Based on file review, the licensee did not comply with the section cited above in not having proof of staff training which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/10/2024 Plan of Correction By POC date, Administrator will submit to CCL proof of staff training.

Official classification

Type B

Official code

87608(a)(3)

Regulation authority

CCR

What the official deficiency says

This requirement is not met as evidenced by: Deficient Practice Statement Based on file review codnucted, the licensee did not comply with the section cited above in not having doctor's order for R2's 1/2 rails which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/03/2024 Plan of Correction The administrator will submit to CCL doctor's order for R2's 1/2 rails.

Official classification

Type B

Official code

87506(a)

Regulation authority

CCR

What the official deficiency says

This requirement is not met as evidenced by: Deficient Practice Statement Based on file review codnucted, the licensee did not comply with the section cited above in not having complete resident records on file which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/27/2024 Plan of Correction By POC date, Adinistrator will update all residents' files and submit self-certification of completion to CCL.

Official classification

Type B

Official code

1569.695(c)

Regulation authority

HSC

What the official deficiency says

(c) A facility shall conduct a drill at least quarterly for each shift. The type of emergency covered in a drill shall vary from quarter to quarter, taking into account different emergency scenarios. An actual evacuation of residents is not required during a drill. While a facility may provide an opportunity for residents to participate in a drill, it shall not require any resident participation. Documentation of the drills shall include the date, the type of emergency covered by the drill, and the names of staff participating in the drill. This requirement is not met as evidenced by: Deficient Practice Statement Based on file review, the licensee did not comply with the section cited above in not conducting fire drill which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/29/2024 Plan of Correction Administrator will conduct emergency drill and submit proof to CCL.

Official classification

Type A

Official code

87705(f)(1)

Regulation authority

CCR

What the official deficiency says

87705(f0(1): Care of Persons with Dementia- (f) The following shall be stored inaccessible to residents with dementia: (1) Knives, matches, firearms, tools and other items that could constitute a danger to the resident(s). 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 Scissors in the drawer and knifes in the kitcken pantry unlocked and accessible to residents which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/21/2023 Plan of Correction Licensee agreed to lock up all scissors and knifes in the pantry in the kitchen. Deficiency cleared.

Official classification

Type B

Official code

87608(a)(5)(B)

Regulation authority

CCR

What the official deficiency says

87608: Postural Supports- (a) Based on the individual's preadmission appraisal, and subsequent changes to that appraisal, the facility shall provide assistance and care for the resident in those activities of daily living which the resident is unable to do for himself/herself. Postural supports may be used under the following conditions. (5) Under no circumstances shall postural supports include tying, depriving, or limiting the use of a resident's hands or feet. (B) Bed rails that extend the entire length of the bed are prohibited except for residents who are currently receiving hospice care and have a hospice care plan that specifies the need for full bed rails. 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 requesting an order from R5's physician to get approval for a full bed rail which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/03/2023 Plan of Correction Licensee agreed to obtain a physicians order for a full bed rail and to submit proof of the order to CCL by POC due date.

Official classification

Type B

Official code

87608(a)(5)(A)

Regulation authority

CCR

What the official deficiency says

87608: Postural Supports-(a) Based on the individual's preadmission appraisal, and subsequent changes to that appraisal, the facility shall provide assistance and care for the resident in those activities of daily living which the resident is unable to do for himself/herself. Postural supports may be used under the following conditions. (5) Under no circumstances shall postural supports include tying, depriving, or limiting the use of a resident's hands or feet. (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, the licensee did not comply with the section cited above by not obtaining physicians order(s) for R1, R2, R3, and R4 for approval for Half bed rails which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/03/2023 Plan of Correction Licensee agree to obtain physicians orders for half bed rails for all residents and to submit to CCL by POC due date.

Official classification

Type B

Official code

87555(b)(27)

Regulation authority

CCR

What the official deficiency says

87555(b)(27): General Food Service Requirements- (b) The following food service requirements shall apply: (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 not keeping the facility clean from cockroaches and making sure there are no insects walking around the kitchen which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/27/2023 Plan of Correction Licensee agreed to remove and keep facility cleared from all insects and to submit a self-certification on General food service requirements on keeping the kitchen clean and sanitized and to submit to CCL by POC due date.

Official classification

Type A

Official code

80087(g)

Regulation authority

CCR

What the official deficiency says

Buildings and Grounds Disinfectants, cleaning solutions, poisons, firearms and other items that could pose a danger if readily available to clients shall be stored where inaccessible to clients.. This requirement is not met as evidence by: Based on observation the licensee did not comply with the section cited above disinfectant solution was observed accesible to residents in care which poses a potential health and safety risk to the residents in care.

Official plan of correction

Cleared during the visit.

Deadline recorded: Dec 22, 2021. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87355(e)

Regulation authority

CCR

What the official deficiency says

Criminal Record Clearance. All individuals subject to a criminal record review...prior to working, residing or volunteering in a licensed facility: Obtain a California clearance... This requirement is not met as evidence by: Based on interview and records review licensee failed to have criminal record clearance for S2 which poses an immediate health and safety risk to the residents in care.

Official plan of correction

Administrator will obtain criminal record clearance for S2. S2 cannot assist residents ADL if a fingerprint staff is not present. Administrator will submit a copy of S1's criminal record clearance to CCLD. LPA provided technical assistance to Administrator about using guardian system for easier access of fingerprint clearance for the facility.

Deadline recorded: Dec 22, 2021. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87355(e)(2)

Regulation authority

CCR

What the official deficiency says

Criminal Record Clearance Request a transfer of a criminal record clearance as specified in Section… This requirement is not met as evidence by: Based on investigation, the licensee did not comply with the section cited above S3 is not associated with the facility which poses a potential health and safety risk to the residents in care.

Official plan of correction

Cleared. Adminsitrator associated S3.

Deadline recorded: Dec 22, 2021. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

80065(g)(1)

Regulation authority

CCR

What the official deficiency says

Personnel Requirements. Good physical health shall be verified by a health screening, including a test for tuberculosis, performed under the supervision of a physician not more than one year prior to or seven days . This requirement is not met as evidence by: Based on interview with Adminsitrator and records review, LPA observed no health screening and TB test results for Staff 1 (S2 & S3) which poses a potential health and safety risk to the residents in care.

Official plan of correction

Administrator/Licensee needs to send staff s2 & S3 for health screening and TB testing, Adminsitrator needs to send proof of health screening and TB test to CCL office by POC date.

Deadline recorded: Jan 7, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87303(e)(4)

Regulation authority

CCR

What the official deficiency says

Maintenance and Operation. Grab bars shall be in each toilet used by residents. This requirement is not met as evidenced by Based upon observation, the licensee does not have grab bars near the toilet for client use.

Official plan of correction

The licensee/Administrator shall purchase and install appropriate grab bar on all toilet use by residents, Administrator/Licensee shall take picture and send to CCL as proof of correction by POC date.

Deadline recorded: Jan 7, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87211(a)(1)(D)

Regulation authority

CCR

What the official deficiency says

Reporting Requirements:(a) Each licensee shall furnish to the licensing agency...(1)A written report shall be submitted to the licensing agency...(D) Any incident which threatens the welfare, safety or health of any resident.. This requirement was not met as evidence by: Based on record review and interview, Licensee did not comply with the regulation cited above, Administrator admitted that she did not submit unusual incident report for R1’s hospitalization, administrator also mentioned that she “does not know” that she needs to submit such report.

Official plan of correction

The licensee will submit a written plan which describes what steps will be taken in order to ensure that unusual incidents are reported to CCL per Title 22 regulations, by the POC date

Deadline recorded: Jan 3, 2022. A deadline is not proof that correction was completed.