A & P CARE HOME FOR SENIORS

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 by not having the Medication Administration Record (MAR) completed for R5 which poses a potential safety rights risk to persons in care.

Official plan of correction

POC Due Date: 01/16/2026 Plan of Correction The Administrator agrees to have an in-service on recordkeeping for MAR 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 and interview, the licensee did not comply with the section cited above by having a full bed rail for R1 and is not on hospice which poses a potential safety risk to persons in care.

Official plan of correction

POC Due Date: 01/22/2026 Plan of Correction The Administrator agrees to request for an exception for the full bed rail. Proof of correction will be sent to CCLD by POC date.

Official classification

Type A

Official code

87309(a)

Regulation authority

CCR

What the official deficiency says

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

Official plan of correction

POC Due Date: 01/09/2026 Plan of Correction The Administrator agrees to lock the items and send proof to CCLD by POC date.

Official classification

Type B

Official code

87303(i)(1)(B)

Regulation authority

CCR

What the official deficiency says

(i) Facilities shall have signal systems which shall meet the following criteria: (1) All facilities licensed for 16 or more and all residential facilities having separate floors or buildings shall have a signal system which shall: (B) Transmit a visual and/or auditory signal to a central staffed location or produce an auditory signal at the living unit loud enough to summon staff. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and interview, the licensee did not comply with the section cited above by having the door alarm in room #3 not working which posed a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 01/16/2026 Plan of Correction Staff changed the alarm battery. Deficiency cleared during the visit.

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 by having a plant, wheelcair, and a bedside table in front of the sliding door in Room #6 which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/16/2026 Plan of Correction The Administrator agrees to remove the items from the passageway and send proof to CCLD by POC date.

Official classification

Type B

Official code

87555(b)(23)

Regulation authority

CCR

What the official deficiency says

(b) The following food service requirements shall apply: (23) All readily perishable foods or beverages capable of supporting rapid and progressive growth of micro-organisms which can cause food infections or food intoxications shall be stored in covered containers at appropriate temperatures. 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 rotten cauliflower, wilted cabbage, wilted bean sprouts, and eggs left in the garage which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 01/16/2026 Plan of Correction Staff threw the items away. Deficiency cleared during the visit.

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 by not having a First aid certification for S2 which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 01/16/2026 Plan of Correction The Administrator agrees to obtain first aid certification for S2 and send proof to CCLD by POC date.

Official classification

Type A

Official code

87465(h)(1)

Regulation authority

CCR

What the official deficiency says

Medications shall be centrally stored under the following circumstances: 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 Freestyle Lancets, A & D Ointment, Hydrophilic Wound Dressing, Thick It, and Milk of Magnesia unlocked which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/09/2026 Plan of Correction The Administrator agrees to lock the items and send proof to CCLD by POC date.

Official classification

Type B

Official code

87628(a)

Regulation authority

CCR

What the official deficiency says

(a) The licensee shall be permitted to accept or retain a resident who has diabetes if the resident is able to perform his/her own glucose testing with blood or urine specimens, and is able to administer his/her own medication including medication administered orally or through injection, or has it administered by an appropriately skilled professional. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and interview, the licensee did not comply with the section cited above. R5 is unable to perform their own glucose test by themselves which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/22/2026 Plan of Correction The Administrator agrees to send an exception request for the family to perform R5's glucose test and send proof to CCLD by POC date.

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 temperature measured at 129.2 degrees Fahrenheit which poses/posed a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 01/17/2025 Plan of Correction Administrator agrees to send proof to CCLD by POC date of the hot water temperature measured between 105 and 120 degrees Fahrenhet.

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 screwdriver accessible to residents in the backyard which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 01/17/2025 Plan of Correction Administrator agrees to lock the screwdriver so that it's inaccessible to residents 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 unlocked insulin in the fridge and medication found in R5’s room poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 01/17/2025 Plan of Correction Administrator agrees lock the insulin and the medication in R5’s room 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 pieces of wood in the backyard that needs to be removed, a hole in the window screen in R5’s room and the fire extinguisher that was last serviced on 11/22/2022 which poses/posed a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 01/30/2025 Plan of Correction By POC date, Administrator agrees to remove the pieces of wood in the backyard, fix the hole in the window screen, service the fire extinguisher, and send proof to CCLD.

Official classification

Type B

Official code

1569.618(c)(3)

Regulation authority

HSC

What the official deficiency says

(c)The facility shall employ, and the administrator shall schedule, a sufficient number of staff members to do all of the following: (3) Ensure that at least one staff member who has cardiopulmonary resuscitation (CPR) training and first aid training is on duty and on the premises at all times. This paragraph shall not be construed to require staff to provide CPR. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, the licensee did not comply with the section cited above by not having First Aid Certification for S2 and S3 which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 01/17/2025 Plan of Correction By POC date, staff agrees to obtain their First Aid Certfication and send proof to CCLD.

Official classification

Type B

Official code

87463(i)

Regulation authority

CCR

What the official deficiency says

(i) When there is significant change in condition, as defined in Section 87101, Definitions, or once every 12 months, whichever occurs first, the licensee shall arrange an in-person or virtual meeting or conference call to share the reappraisal with the resident, the resident's representative, if applicable, and appropriate facility staff, as specified in Section 87467, Resident Participation in Decision Making. 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 by not having an updated Appraisal Needs and Service Plan for R1 to R5 which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 01/30/2025 Plan of Correction By POC date, Administrator agrees to update all the residents Appraisal Needs and Service Plan 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 conducting Emergency Disaster Drills quarterly which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 01/30/2025 Plan of Correction By the POC date, Administrator agrees to conduct an Emergency Disaster Drill and send proof to CCLD.

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 by not having a doctor’s order for R4 which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 01/30/2025 Plan of Correction By POC date, Administrator agrees to obtain a doctor's order for R4 and send proof to CCLD.

Official classification

Type B

Official code

87303(b)(1)

Regulation authority

CCR

What the official deficiency says

(b) A comfortable temperature for residents shall be maintained at all times. (1) The facility shall heat rooms that residents occupy to a minimum of 68 degree F, (20 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 temperature where residents occupy measured at 64 degrees Fahrenheit. which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 01/30/2025 Plan of Correction By POC date, Administrator will self certify the regulation and send proof to CCLD.

Official classification

Type B

Official code

87465(c)(2)

Regulation authority

CCR

What the official deficiency says

(c)(2) Once ordered by the physician the medication is given according to the physician's directions. 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 over the counter medications being given to residents and does not have the right dosage as prescribed by the doctor which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/23/2025 Plan of Correction By POC date, Administrator needs to contact the family members and obtain the medication with the right dose and send proof to CCLD.

Official classification

Type A

Official code

87466

Regulation authority

CCR

What the official deficiency says

87466 Observation of the Resident The licensee shall ensure that residents are regularly observed for changes in physical, mental, emotional and social functioning and that appropriate assistance is provided when such observation reveals unmet needs. This requirement is not met ase evidenced by: R4's discharge paper dated 7/16/23 indicates R4 developed stage 3 pressure injury of left perineal ischial region. R4 was admitted back to the facility without home health nurse following up.

Official plan of correction

A Non compliance conference (NCC) will be scheduled to address plans of correction.

Deadline recorded: Jan 31, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87615(a)

Regulation authority

CCR

What the official deficiency says

87615 Prohibited Health Conditions 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: R4 developed stage 3 pressure injury and was admitted back to the facility without an approved exception which poses an immediate risk to health and safety of clients under care.

Official plan of correction

A Non Compliance Conference (NCC) will be sheduled to address concerns.

Deadline recorded: Jan 31, 2024. 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) Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients. 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 Lysol and comet unlocked which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/31/2024 Plan of Correction Administrator locked all chemicals during the visit. Deficiency is cleared.

Official classification

Type A

Official code

87611(d)

Regulation authority

CCR

What the official deficiency says

(d) In addition to Section 87463, Reappraisals and Section 8, Observation of the Resident, the licensee shall monitor the ability of the resident to provide self care for the allowable health condition and document any change in that ability. 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 in not conducting Reappraisal for R1 who developed pressure injury which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/02/2024 Plan of Correction Administrator will review Sec 87611 and submit certificate of understanding to CCL by POC date.

Official classification

Type A

Official code

87616(b)(1)

Regulation authority

CCR

What the official deficiency says

(b) Written requests shall include, but are not limited to, the following: (1) Documentation of the resident's current health condition including updated medical reports, other documentation of the current health, prognosis, and expected duration of condition. 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 an approved exception for R1 who developed stage 3 in July 2023 which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/02/2024 Plan of Correction Administrator will review Sec 87616 and submit certificate of understanding to CCL by POC date.

Official classification

Type A

Official code

87705(f)(2)

Regulation authority

CCR

What the official deficiency says

(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 in having unlocked insulin in the refrigerator which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/31/2024 Plan of Correction Administrator locked insulin during the visit. Deficiency is cleared.

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

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 ripped screen door, unused DMEs in the backyard which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/14/2024 Plan of Correction By POC date, Administrator will clear the backyard of unused DMEs and fix screen door and submit photo proof to CCL by POC date.

Official classification

Type B

Official code

87303(a)(1)

Regulation authority

CCR

What the official deficiency says

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. (1) Floor surfaces in bath, laundry and kitchen areas shall be maintained in a clean, sanitary, and odorless condition. 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 bathroom that smells urine and unorganized which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/14/2024 Plan of Correction Administrator will get the bathroom cleaned, disinfected and organized and submit photo proof to CCL by POC date.

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 record review, R4 has Alzheimer's Dementia but last Physician's Report is in 2022, the licensee did not comply with section cited which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/21/2024 Plan of Correction Administrator will schedule R4 for the year's medical assessment and submit a copy to CCL by POC date.

Official classification

Type A

Official code

87355(e)(2)

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: (2) 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 and interview, the licensee did not comply with the section cited above by allowing S1 to work in the facility without a tranfer request 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 agrees to make sure all staff members are associated to the facility prior to working. S1 was asked to leave the premises until further and to return when S1 is associated to the facility. Deficiency cleared

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 observation, interview, and record review, the licensee did not comply with the section cited above in 1 out of 3 staff has not completed health screen including TB test since hiring on 4/11/2022 which posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/11/2022 Plan of Correction Administrator agreed to have staff schedule an appointment for health screen and complete it by the POC due date.

Official classification

Type A

Official code

87705(f)(1)

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 (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 and interviewed, the licensee did not comply with the section cited above. LPA observed unlocked knife and scissor in the kitchen drawer which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/28/2022 Plan of Correction Staff locked up the knife and scissor in the medication cabinet during visit. In addition, Administrator agreed to conduct training with staff of regulation and submit a copy of training agenda and sign-in sheet to CCL by the POC due date.