TRI CITY CARE HOME II

Official classification

Type B

Official code

87303(e)(2)

Regulation authority

CCR

What the official deficiency says

(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 hot water temperature measured at 100.7 degrees Fahrenehit 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 The Administrator agrees to have the water temperature measured within range and send proof to CCLD by POC date.

Official classification

Type B

Official code

87555(b)(8)

Regulation authority

CCR

What the official deficiency says

(8) All food shall be of good quality. Commercial foods shall be approved by appropriate federal, state and local authorities. Food in damaged containers shall not be accepted, used or retained. 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 spoiled bananas in the fridge which posed a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 03/20/2026 Plan of Correction Staff threw away the bananas during the visit. Deficiency cleared.

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 perishable food for the residents' in care which poses a potential health, safety or personal rights 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 purchase more food and send proof to CCLD.

Official classification

Type B

Official code

87463(b)

Regulation authority

CCR

What the official deficiency says

(b) The reappraisal shall document significant changes in the resident's physical, mental, cognitive, behavioral, or functional condition, including those required to be documented as specified in Section 87466, Observation of the Resident. 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 Appraisal Needs and Services Plan (LIC625) for 6 of 6 residents which poses a potential safety risk to persons in care.

Official plan of correction

POC Due Date: 03/31/2026 Plan of Correction By POC date, the Administrator agrees to complete the LIC625 and send proof 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 eyedrops in the linen closet and unlocked cleaning chemicals in the laundry machine room which posed an immediate safety risk to persons in care.

Official plan of correction

POC Due Date: 03/18/2026 Plan of Correction Staff locked the items 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 interview and observation, the licensee did not comply with the section cited above by not having one of the medications for R5 in the facility, missing doctor’s order for R5’s medications, and R5’s dosage for two of the medications does not match the doctor’s order 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 have the medications in the facility, obtain the doctor's order for R5, and follow up with R5's physician regarding the dosage for medication. Proof of correction will be sent to CCLD.

Official classification

Type A

Official code

87468.1(a)(3)

Regulation authority

CCR

What the official deficiency says

87468.1(a)(3)Personal Rights of Residents in All Facilities (a) ...(3) To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive...daily living functions such as eating, sleeping, or elimination. This requirement is not met as evidenced by: Based on observation and interview, the licensee did not comply with the regulation cited above in having the kitchen cabinet and kitchen fridge locked which poses a potential health and safety risk to the residents in care.

Official plan of correction

The licensee agrees to unlock the the cabinet, fridge, submit a waiver request with the dementia plan of operation, and submit proof to CCLD by POC date.

Deadline recorded: Apr 3, 2025. A deadline is not proof that correction was completed.

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 in having an incomplete file for S4 and S5 which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 03/17/2025 Plan of Correction The Administrator agrees to obtain the documents for the staffs' file 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 in having an incomplete file for R2 to R6 which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/17/2025 Plan of Correction The Administrator agrees to obtain all the documents for the residents' and send proof to CCLD by POC date.

Official classification

Type A

Official code

87204(a)

Regulation authority

CCR

What the official deficiency says

(a) A licensee shall not operate a facility beyond the conditions and limitations specified on the license, including specification of the maximum number of persons who may receive services at any one time. An exception may be made in the case of catastrophic emergency when the licensing agency may make temporary exceptions to the approved capacity. 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 retained a resident who is bedridden but facility does not have an approved bedridden fire clearance which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/25/2024 Plan of Correction The Administrator will notify local fire department within 24 hours about the bedridden resident and by POC date, she will submit a request for bedridden clearance to CCL.

Official classification

Type A

Official code

87615(a)(1)

Regulation authority

CCR

What the official deficiency says

(a) Persons who require health services for or have a health condition including, but not limited to, those specified below shall not be admitted or retained in a residential care facility for the elderly: (1) Stage 3 and 4 pressure sores (dermal ulcers). 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 resident with stage 2 and unstageable pressure injury 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 During the visit, the resident was admitted to hospice care.

Official classification

Type B

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 file review], the licensee did not comply with the section cited above in having 4 out of 5 residents with dementia but without an uodated medical assessment which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/04/2024 Plan of Correction By POC date, Administrator will submit to CCL updated medical assessment of the 4 residents with dementia.

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 side gate was locked which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/07/2022 Plan of Correction Staff unlock side gate Corrected during the visit. Administrator will train all staff regarding the citation, proof of training needs to be submitted on CCL office on 3/11/2022.

Official classification

Type A

Official code

87705(f)(2)

Regulation authority

CCR

What the official deficiency says

87705 Care of 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 medicaition was accesible to residents in care, disinfectant cleaner accessible to resident in care which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/07/2022 Plan of Correction Staff locked the disinfectant supplies and medications supplies. Corrected during the visit.

Official classification

Type B

Official code

80087(c)

Regulation authority

CCR

What the official deficiency says

80087 Buildings and Grounds (c) All outdoor and indoor passageways, stairways, inclines, ramps, open porches and other areas of potential hazard 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 deck flooring has obstruction which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/14/2022 Plan of Correction Administrator agreed to fix the deck flooring and replace the wood that has temporary wood patch, Administrator will need to send proof of correction to CCL by POC date.

Official classification

Type B

Official code

87411(d)(5)

Regulation authority

CCR

What the official deficiency says

(d) All personnel shall be given on the job training or have related experience in the job assigned to them. This training and/or related experience shall provide knowledge of and skill in the following, as appropriate for the job assigned and as evidenced by safe and effective job performance: (5) Knowledge necessary in order to recognize early signs of illness and the need for professional help. 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 staff has not conducted staff training on infection prevention, symptoms, transmission and PPE usewhich poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/11/2022 Plan of Correction Administrator agreed to train all staff regarding infection prevention, symptoms, transmission and PPE use, proof traning need to be submitted to CCL on the POC date.