MERISOL CARE

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 zinc oxide ointment and Thick-It powder which posed an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 06/04/2026 Plan of Correction Administrator locked the items during the visit. Deficiency cleared.

Official classification

Type B

Official code

1569.605

Regulation authority

HSC

What the official deficiency says

On and after July 1, 2015, all residential care facilities for the elderly, except those facilities that are an integral part of a continuing care retirement community, shall maintain liability insurance covering injury to residents and guests in the amount of at least one million dollars ($1,000,000) per occurrence and three million dollars ($3,000,000) in the total annual aggregate, caused by the negligent acts or omissions to act of, or neglect by, the licensee or its employees. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, licensee did not comply with the section cited above by not having sufficient coverage on the liability insurance which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 06/11/2026 Plan of Correction By POC date, the Administrator agrees to send proof of liability insurance to CCLD.

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 by having a commode in the backyard, multiple light bulbs missing in R5's room and living room, and a handle missing in R3's bathroom drawer which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/12/2026 Plan of Correction By POC date, the Administrator agrees to schedule a bulk pick up, install light bulbs, and repair the handle. Proof of correction will be sent to CCLD.

Official classification

Type B

Official code

87463(h)

Regulation authority

CCR

What the official deficiency says

(h) The licensee shall request that all residents receive an annual routine visit with a licensed medical professional once every twelve months, either in person or by video appointment. 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. R2 and R5 does not have an updated medical assessment and R2 and R5's current medical assessment does not have ambulatory status which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/17/2026 Plan of Correction By POC date, the Administrator agrees to obtain updated medical assessment and send proof to CCLD.

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 half bed rail doctor's order for R2 which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/17/2026 Plan of Correction By POC date, the Administrator agrees to obtain the half bed rail doctor's order and send proof to CCLD.

Official classification

Type B

Official code

87465(h)(6)

Regulation authority

CCR

What the official deficiency says

(6) The licensee shall be responsible for assuring that a record of centrally stored prescription medications for each resident is maintained for at least one year and includes: This requirement is not met as evidenced by: Deficient Practice Statement Based on record review and interview, the licensee did not comply with the section cited above by not having doctor’s order for R2 and R4’s medication and by having R2’s record Centrally Stored Medication and Destruction Record (LIC622) not updated which poses a potential safety risk to persons in care.

Official plan of correction

POC Due Date: 06/17/2026 Plan of Correction By POC date, the Administrator agrees to obtain doctor’s order for the medications and ensures that the LIC622 is updated. Proof of correction will be sent to CCLD by POC date.

Official classification

Type A

Official code

87465(h)(2)

Regulation authority

CCR

What the official deficiency says

87465(h)(2)Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. This requirement is not met as evidenced by: Based on observation, the licensee did not comply by having unlocked medication of Peridex in the bathroom which posed an immediate safety risk to persons in care.

Official plan of correction

The Administrator locked the item during the visit. Deficiency cleared.

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

Official classification

Type B

Official code

87211(a)(1)(A)

Regulation authority

CCR

What the official deficiency says

87211(a)(1)(A)Death of any resident from any cause regardless of where the death occurred, including but not limited to a day program, a hospital, en route to or from a hospital, or visiting away from the facility. 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 reporting the death of R1 within seven days of occurrence which poses a potential safety risk to persons in care.

Official plan of correction

The Administrator agrees to review the regulation and self-certify. Proof of correction will be sent to CCLD by POC date.

Deadline recorded: Mar 4, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87211(a)(1)

Regulation authority

HSC

What the official deficiency says

87211(a)(1) Reporting Requirements (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, the licensee did not comply with the section cited above by not sending a report to licensing that R1 was on hospice when admitted to the facility which posed a potential safety risk to person in care.

Official plan of correction

The Administrator agrees to self certify the regulation, send a hospice notification to licensing, and send proof to CCLD by POC date.

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

Official classification

Type B

Official code

87611(a)

Regulation authority

CCR

What the official deficiency says

87611(a) (a) Prior to accepting or retaining a resident with an allowable health condition as specified...Contractures; or Section 87631, Healing Wounds; licensees who have, or have had, any of the following within the last two years, shall obtain Department approval: This requirement is not met as evidenced by: Based on record review, the licensee did not comply with the section cited above by admitting R1 with a health condition without prior approval from the department which poses a potential safety risk to person in care.

Official plan of correction

The Administrator agrees to request an exception to retain R1 and send the following documents including but not limited to appraisal needs and services plan, physician's report, doctor's order for hospice, proof of staff training, and hospice care plan/assessment. Proof of correction will be sent to CCLD by POC date.

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

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: Based on record review, the licensee did not comply with the section cited above by not having R1's complete hospice binder at the facility available for review which poses a potential safety risk to persons in care.

Official plan of correction

The Administrator agrees to obtain and maintained R1's files including hospice binder and send proof to CCLD by POC date.

Deadline recorded: Oct 17, 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 the facility's side gate is locked. Staff interview indicated that the staff locks the gate at night which poses an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 05/29/2025 Plan of Correction The Administrator agrees to remove the lock and send proof to CCLD by POC date.

Official classification

Type A

Official code

87303(f)

Regulation authority

CCR

What the official deficiency says

(f) All waste shall be located, stored, and disposed of in a manner that will not transmit communicable diseases or odors, pose a risk to health and safety, or provide a breeding place or food source for insects or rodents. 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 trash bags filled with diapers outside the trash bin in the backyard side gate area which poses an immediate health and risk to persons in care.

Official plan of correction

POC Due Date: 05/29/2025 Plan of Correction The Administrator agrees to remove the trash bags and send proof to CCLD by POC date.

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 record review, the licensee did not comply with the section cited above by not having CPR Certification for S2 and S3 which poses an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 05/29/2025 Plan of Correction The Administrator agrees to obtain CPR certification for both staff and send proof to CCLD by POC date.

Official classification

Type A

Official code

87465(h)(2)

Regulation authority

CCR

What the official deficiency says

(h) The following requirements shall apply to medications which are centrally stored: (2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. 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 Robitussin Cough Medicine unlocked in the fridge which poses an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 05/29/2025 Plan of Correction Administrator removed the medication from the fridge during the visit. Deficiency cleared.

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 by having uneven pavement towards the side gate exit from the ramp which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 06/11/2025 Plan of Correction The Administrator agrees fix the uneven pavement and send proof to CCLD by POC date.

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 all 3 files incomplete which poses a potential health risk to persons in care.

Official plan of correction

POC Due Date: 06/11/2025 Plan of Correction The Administrator agrees to make sure each staff has LIC501, LIC503, TB Test, and First Aid/ CPR Certification. Proof of correction will be sent to CCLD by POC date.

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 by not having trainings conducted for all the staff which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 06/18/2025 Plan of Correction The Administrator agrees to have staff trainings conducted and send proof to CCLD by POC date.

Official classification

Type B

Official code

87468(d)

Regulation authority

CCR

What the official deficiency says

(d) Licensees shall post the personal rights, nondiscrimination notice, and complaint information specified above in English, and, in any other language in which at least five (5) percent of the residents can only read that other language. 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 Personal Rights Poster and Ombudsman poster which poses personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/18/2025 Plan of Correction The Administrator agrees to obtain the posters and send proof to CCLD by POC date.

Official classification

Type B

Official code

87465(a)(8)

Regulation authority

CCR

What the official deficiency says

(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 by not having a complete First Aid Kit which poses a potential safety risk to persons in care.

Official plan of correction

POC Due Date: 06/04/2025 Plan of Correction The Administrator agrees to purchase a new First Aid Kit and send proof to CCLD by POC date.

Official classification

Type B

Official code

87465(c)(1)

Regulation authority

CCR

What the official deficiency says

(c) If the resident's physician has stated in writing that the resident is unable to determine his/her own need for nonprescription PRN medication, but can communicate his/her symptoms clearly, facility staff designated by the licensee shall be permitted to assist the resident with self-administration, provided all of the following requirements are met: (1) There is written direction from a physician, on a prescription blank, specifying the name of the resident, the name of the medication, all of the information specified in Section 87465(e), instructions regarding a time or circumstance (if any) when it should be discontinued, and an indication of when the physician should be contacted for a medication reevaluation. 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 PRN medications which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 06/18/2025 Plan of Correction The Administrator agrees to obtain doctor's order for the PRN medications and send proof to CCLD 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 by not having a complete file for each residents which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 06/18/2025 Plan of Correction The Administrator agrees to complete the residents' files including the Appraisal Needs and Services, Physician's Report, Emergency ID form, Consent Form etc. 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 emergency drills which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 06/11/2025 Plan of Correction The Administrator agrees to conduct emergency drills 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 *****THIS IS AN AMENDED REPORT FROM VISIT 05/28/2025**** Based on record review, the licensee did not comply with the section cited above by not having half bed rail orders for R1, R2, R4, and R6 which poses a potential 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 send proof of the half bed rail orders for the residents 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 *****THIS IS AN AMENDED REPORT FROM VISIT 05/28/2025***** Based on record review, the licensee did not comply with the section cited above in having a full bed rail orders for R3 and R5 which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 06/25/2025 Plan of Correction The Administrator will request an exception for R3 for the full bed rail and will obtain a full bed rail order for R5 from hospice. Proof of correction will be sent to CCLD by POC date.

Official classification

Type B

Official code

87555(b)(26)

Regulation authority

CCR

What the official deficiency says

(26) Supplies of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days shall be maintained on the premises. 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 enough canned goods for the facility which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 06/04/2025 Plan of Correction The Administrator agrees to buy more canned goods and send proof to CCLD by POC date.

Official classification

Type B

Official code

87632(a)

Regulation authority

CCR

What the official deficiency says

(a) ...The licensee shall have obtained a facility hospice care waiver from the Department. To obtain this waiver the licensee shall submit a written request for a waiver to the Department on behalf of any residents who may request retention, and any future residents who may request acceptance, along with the provision of hospice services in the facility. The request shall include, but not be limited to 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 by having two residents in hospice and only approved for one hospice waiver which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 06/11/2025 Plan of Correction The Administrator will request for an increase of hospice waiver and send proof to CCLD by POC date.

Official classification

Type B

Official code

87208(a)(7)(B)

Regulation authority

CCR

What the official deficiency says

(B) The grounds showing buildings, driveways, fences, storage areas, pools, gardens, recreation area and other space used by the residents. (7) Sketches, showing dimensions, of 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 by not having the facility sketch not matching the physical plant which poses a potential safety risk to persons in care.

Official plan of correction

POC Due Date: 06/04/2025 Plan of Correction The facility agrees to submit a LIC200, updated facility sketch, and have the fire inspectors inspect the facility. Proof of correction will be sent to CCLD by POC date.

Official classification

Type A

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 interview record review, the licensee did not comply with the section cited aboveby not having a staff record for S2 which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/14/2024 Plan of Correction Licensee agrees to complete a staff record for S2. Proof of correction will be sent to CCLD by POC date.

Official classification

Type A

Official code

87465(h)(2)

Regulation authority

CCR

What the official deficiency says

(h) The following requirements shall apply to medications which are centrally stored: (2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. 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 leaving the medication cabinet unlocked which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/14/2024 Plan of Correction Licensee agrees to lock the medication cabinet and review the regulation. Proof of correction will be sent to CCLD by POC date.

Official classification

Type A

Official code

87458(a)

Regulation authority

CCR

What the official deficiency says

(a) Prior to a person's acceptance as a resident, the licensee shall obtain and keep on file, documentation of a medical assessment, signed by a physician, made within the last year. The licensee shall be permitted to use the form LIC 602 (Rev. 9/89), Physician's Report, to obtain the medical assessment. 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 medical assessments done for R2 which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/26/2024 Plan of Correction Licensee agrees to get medical assessments for all residents. Proof of correction will be sent to CCLD by POC date.

Official classification

Type A

Official code

87705(c)(5)

Regulation authority

CCR

What the official deficiency says

(c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following: (5) Each resident with dementia shall have an annual medical assessment as specified in Section 87458, Medical Assessment, and a reappraisal done at least annually, both of which shall include a reassessment of the resident's dementia care needs. 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 updated medical assessment for R5 which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/26/2024 Plan of Correction Licensee agrees to get medical assessment for resident 5. Proof of correction will be sent to CCLD by POC date.

Official classification

Type B

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 because the Fire Extinguisher has not been serviced or replaced since May 9th 2023 which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/26/2024 Plan of Correction Licensee agrees to get the Fire Extinguisher serviced. Proof of correction will be sent to CCLD by POC date.

Official classification

Type B

Official code

87412(d)

Regulation authority

CCR

What the official deficiency says

(d) The licensee shall maintain documentation that an administrator has met the certification requirements specified in Section 87406, Administrator Certification Requirements or the recertification requirements in Section 87407, Administrator Recertification 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 by having expired administrator certificates for both the licensee and the administrator which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/26/2024 Plan of Correction Licensee agrees to hire a licensed administrator. Proof of correction will be sent 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 by having the PUB 475 the wrong size which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/03/2024 Plan of Correction Licensee agrees to get a new poster in the correct size of 20” x 26” inches. Proof of correction will be sent to CCLD by POC date.

Official classification

Type A

Official code

87202(a)(1)

Regulation authority

CCR

What the official deficiency says

87202 Fire Clearance (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. (1) Nonambulatory persons 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 R2.resident in bedroom #7 that shows on facility sketch bedroom #7 was designated for staff only. Staff now residing in bedroom #2. This poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/02/2022 Plan of Correction Licensee agreed to submit and LIC200 and updated copy of facility sketch to CCLD by POC date for new fire clearance.

Official classification

Type A

Official code

87705(f)(2)

Regulation authority

CCR

What the official deficiency says

87705 Care persons with Dementia (f) The following shall be stored inaccessible to residents with dementia: (2) Over-the-counter medication, nutritional supplements or vitamins, alcohol, cigarettes, and toxic substances such as certain plants, gardening supplies, cleaning supplies and disinfectants. 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 detergents, disinfectants, and solutions, and cleaners inaccessible to residents which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/02/2022 Plan of Correction Licensee agreed to reserve the door knobs where it's inaccessible to person in care by submitting a photo copy to CCL by POC date.

Official classification

Type B

Official code

87608(5)(A)

Regulation authority

CCR

What the official deficiency says

87608 Postural Support (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 and record review, the licensee did not comply with the section cited above by not having a doctors order for half bed rail for R1. Which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/06/2022 Plan of Correction Licensee agreed to submit a copy of a doctors order for half bed for R1 to CCL by POC date.

Official classification

Type B

Official code

87305(a)

Regulation authority

CCR

What the official deficiency says

87305 Alterations to Existing Building or New Facilities (a) Prior to construction or alterations, all facilities shall obtain a building permit. 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 obtaining a permit for shed located in backyard using to reside staff member which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/06/2022 Plan of Correction Licensee agrees to submit a copy of a permit for the shed located in the backyard by POC date.