LUCKY GARDEN CARE HOME

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 by having unlocked Refresh eyedrops in R1 and R2's room, unlocked medication in the living room cabinets, and unlocked medication in the kitchen cabinet which poses an immediate safety risk to persons in care.

Official plan of correction

POC Due Date: 05/27/2026 Plan of Correction By POC date, the Administrator agrees to self-certify the regulation with staff and lock the items. Proof of correction will be sent to CCLD.

Official classification

Type B

Official code

87555(b)(25)

Regulation authority

CCR

What the official deficiency says

(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 the canned goods and emergency water in the same storage space as cleaning products and chemicals.

Official plan of correction

POC Due Date: 06/03/2026 Plan of Correction By POC date, the Administrator agrees to separate the food and water supplies from the cleaning products and chemicals. Proof of correction will be sent to CCLD.

Official classification

Type B

Official code

87203

Regulation authority

CCR

What the official deficiency says

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 interviews and observations, the licensee did not comply with the section cited above by having a staff member sleep in the designated storage room per approved facility sketch.

Official plan of correction

POC Due Date: 05/29/2026 Plan of Correction By POC date, the Administrator agrees to remove the staff belongings such as the bed from the designated storage room. Proof of correction will be sent to CCLD by POC date.

Official classification

Type B

Official code

87465(e)

Regulation authority

CCR

What the official deficiency says

(e) For every prescription and nonprescription PRN medication for which the licensee provides assistance there shall be a signed, dated written order from a physician, on a prescription blank, maintained in the residents file, and a label on the medication... 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 having doctor's order on file for the residents' medications which poses a potential safety risk to persons in care.

Official plan of correction

The Administrator agrees to obtain doctor's order for all the residents' medications and send proof to CCLD by POC date.

Deadline recorded: Jul 31, 2025. A deadline is not proof that correction was completed.

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 scissors, screwdriver, and Lysol wipes unlocked in the kitchen and patio area which poses an immediate health and safety rights risk to persons in care.

Official plan of correction

POC Due Date: 05/09/2025 Plan of Correction The Administrator removed the items and locked it during the visit. Deficiency cleared.

Official classification

Type A

Official code

87202(a)(1)

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: (1) Nonambulatory persons. This requirement is not met as evidenced by: Deficient Practice Statement Based on interviews and records review, the licensee did not comply with the section cited above in 2 out of 4 residents being identifed as non-ambulatory and not approved on the fire clearance which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/18/2024 Plan of Correction The licensee will submit an LIC 200 and an updated facility sketch for a non-ambulatory increase to CCLD for two (2) out of the four (4) residents being identifed as non-ambulatory.

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 observation, the licensee did not comply with the section cited above by not having current CPR training and allowing S2 to work with resident with no First aid and CPR training on file which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/22/2023 Plan of Correction Licensee agreed to obtain a certificate for first aid and CPR for S1 and S2 and to submit a copy to CCL by POC due 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 observation and record review, the licensee did not comply with the section cited above by not maintaining an Lic501 (personnel record) for S2 in staff file which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/28/2023 Plan of Correction Submit a copy to CCL by POC due date, licensee agreed to have S2 fill out an Lic501 (Personnel record) and to maintain it in his file for record review.

Official classification

Type B

Official code

87465(h)(4)

Regulation authority

CCR

What the official deficiency says

(h) The following requirements shall apply to medications which are centrally stored: (4) All centrally stored medications shall be labeled and maintained in compliance with state and federal laws. No persons other than the dispensing pharmacist shall alter a prescription label. 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 MAR fill out for R1, R2, R3, R4, and R5 kept in their file for review which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/28/2023 Plan of Correction Licensee agreed to fill out MAR sheets for all residents and to submit a copy to CCL by POC due date.

Official classification

Type B

Official code

87303(5)

Regulation authority

CCR

What the official deficiency says

87303 Maintenance and Operation (5) Non-skid mats or strips shall be used in all bathtubs and showers 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 non-skid mats in bathtub/shower which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/02/2022 Plan of Correction Administrator agreed to purchase non-skid mats for all three (3) bathrooms and send photo of mats in bathtub/shower to CCLD by POC date.