ABOVE & BEYOND RCFE, INC.

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 unlocked scissors in kitchen drawer, and bleach and Lysol spray in in unlocked cabinet in residents' ensuite bathroom which pose an immediate health, safety and/or personal rights risk to persons in care. This is a repeat violation within 12 month period.

Official plan of correction

POC Due Date: 03/27/2026 Plan of Correction Staff locked the scissors and ensuite bathroom cabinet. In addition, licensee and/or administrator to in-service the staff and submit copy of training topic with attendees signatures by 3/27/26.

Official classification

Type A

Official code

87309(c)

Regulation authority

CCR

What the official deficiency says

(c) Except as specified in subsection (d), the licensee shall implement reasonable interventions in order to ensure that nutritional supplements, vitamins, alcohol, cigarettes and other potentially toxic substances, such as certain plants, gardening supplies, and auto supplies, are stored so as not to pose a hazard to residents. 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 Cortisone ointments in unlocked staff room which poses an immediate safety and/or personal rights risks to persons in care. This is a repeat violation within 12 month period.

Official plan of correction

POC Due Date: 03/27/2026 Plan of Correction Staff locked the room. In addition, licensee and/or administrator to in-service the staff and submit copy of training topic with attendees signatures by 3/27/26.

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 inunlocked central storage for medications which poses an immediate health, safety and/or personal rights risks to persons in care.

Official plan of correction

POC Due Date: 03/27/2026 Plan of Correction Staff locked medication central storage. In addition, licensee and/or administrator to in-service the staff and submit copy of training topic with attendees signatures by 3/27/26.

Official classification

Type A

Official code

87355(e)(2)

Regulation authority

CCR

What the official deficiency says

87355 Criminal Record Clearance (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) Obtain a California clearance or a criminal record exemption as required by the Department 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 in a staff not fingerprint cleared which poses an immediate safety and/or personal rights risks to persons in care.

Official plan of correction

POC Due Date: 03/27/2026 Plan of Correction Staff left the facility while at the facility. Administrator to have the staff fingerprinted and cleared. Proof to be submitted by 3/27/26.

Official classification

Type B

Official code

87303(a)(1)

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. (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 shower room in ensuite bathroom with mildew which poses a potential health and/or personal rights risks to persons in care.

Official plan of correction

POC Due Date: 04/09/2026 Plan of Correction Licensee and/or administrator to have the shower room cleaned and submit picture by 4/09/26.

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 in S4 not associated which poses a potential safety and/or personal rights risks to persons in care.

Official plan of correction

POC Due Date: 04/22/2025 Plan of Correction Administrator provided a copy of LIC9182 transfer request while LPA is at the facility. In addition, administrator to submit the documents via email to the Oakland Regional Office by POC date.

Official classification

Type B

Official code

87412(a)

Regulation authority

CCR

What the official deficiency says

87412 Personnel Records (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 S2 does not having LIC501 Personnel Record on file which poses a potential safety and/or personal rights risks to persons in care.

Official plan of correction

POC Due Date: 04/22/2025 Plan of Correction Administrator to have the LIC501 completed and submit proof by 4/22/25.

Official classification

Type B

Official code

87456(a)(2)

Regulation authority

CCR

What the official deficiency says

(a) Prior to accepting a resident for care and in order to evaluate his/her suitability, the facility shall, as specified in this article 8: (2) Perform a pre-admission appraisal. 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 R4 not having Pre-Admission Appraisal which poses a potential health, safety and/or personal rights risks to persons in care.

Official plan of correction

POC Due Date: 04/22/2025 Plan of Correction Administrator to complete the Pre-Admission Appraisal and submit copy by 4/22/25.

Official classification

Type B

Official code

87457(c)

Regulation authority

CCR

What the official deficiency says

(c) Prior to admission a determination of the prospective resident's suitability for admission shall be completed and shall include an appraisal of their individual service needs in comparison with the admission criteria specified in Section 87455, Acceptance and Retention Limitations. 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 R4 not having LIC625 Appraisal/Needs and Services Plan which poses a potential health, safety and/or personal rights risks to persons in care.

Official plan of correction

POC Due Date: 04/22/2025 Plan of Correction Administrator to complete the LIC625 and submit copy by 4/22/25.

Official classification

Type B

Official code

87458(c)(5)

Regulation authority

CCR

What the official deficiency says

(c) The medical assessment shall include, but not be limited to: (5) The determination whether the person is ambulatory or nonambulatory as defined in Section 87101, Definitions, or bedridden as defined in Health and Safety Code section 1569.72. The assessment shall indicate whether nonambulatory status is based upon the resident's physical condition, mental condition, or both. This requirement is not met as evidenced by: Deficient Practice Statement Based on records review, , the licensee did not comply with the section cited above in the following which pose a potential health, safety and/or personal rights risks to persons in care: R1's LIC602A indicated ambulatory but resident has major neurocognitive disorder. R2's LIC602A indicated bedridden but R2 was observed able to ambulate using walker.

Official plan of correction

POC Due Date: 04/22/2025 Plan of Correction Administator to have the LIC602As corrected and submit proof by 4/22/25.

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 records review, the licensee did not comply with the section cited above in the following which pose a potential health, safety and/or personal rights risks to persons in care: R1 and R2's LIC625 over a year old; R3's LIC625 not properly filled-up.

Official plan of correction

POC Due Date: 04/22/2025 Plan of Correction Administrator to do re-appraisal and properly fill-up the LIC625. Self-certification to be submitted by 4/22/25.

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 records review, the licensee did not comply with the section cited above in not having records showing drills were conducted on previous quarters which pose a potential safety and/or personal rights risks to persons in care.

Official plan of correction

POC Due Date: 04/22/2025 Plan of Correction Administrator to read the Regulations and submit self-certification ensuring drills are conducted at least quarterly.

Official classification

Type B

Official code

87411(c)(1)

Regulation authority

CCR

What the official deficiency says

87411 Personnel Requirements - General (c) All RCFE staff who assist residents with personal activities of daily living shall receive initial and annual training as specified in Health and Safety Code sections 1569.625 and 1569.69 (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 S4 and S5 not having first aid certificate on file which pose a potential safety and/or personal rights risks to persons in care.

Official plan of correction

POC Due Date: 04/22/2025 Plan of Correction Administrator to have the staff reqistered for training and submit copies of certificates by 4/22/25.

Official classification

Type B

Official code

87412(a)(11)

Regulation authority

CCR

What the official deficiency says

87412 Personnel Records (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: (11) A health screening as specified in Section 87411, Personnel Requirements - General. This requirement is not met as evidenced by: Deficient Practice Statement Based on records review, the licensee did not comply with the section cited above in S2, S4 and S5 not having LIC503 on file which pose a potential health and/or personal rights risks to persons in care.

Official plan of correction

POC Due Date: 04/22/2025 Plan of Correction Administrator to have the staff health screened and submit proof by 4/22/25.

Official classification

Type B

Official code

87411(f)

Regulation authority

CCR

What the official deficiency says

87411 Personnel Requirements - General (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…… This requirement is not met as evidenced by: Deficient Practice Statement Based on records review, the licensee did not comply with the section cited above in S2, S4 and S5 not having TB test on file which pose a potential health and/or personal rights risks to persons in care.

Official plan of correction

POC Due Date: 04/22/2025 Plan of Correction Administrator to have the staff TB tested and submit copies of test results by 4/22/25.

Official classification

Type B

Official code

1569.625(b)(1)

Regulation authority

CCR

What the official deficiency says

§1569.625 Staff training; legislative findings; contents: (b) (1) The department shall adopt regulations to require staff members of residential care facilities for the elderly who assist residents with personal activities of daily living to receive appropriate training. This training shall consist of 40 hours of training. A staff member shall complete 20 hours, including six hours specific to dementia care, as required by subdivision (a) of Section 1569.626 and four hours specific to postural supports, restricted health conditions, and hospice care, as required by subdivision (a) of Section 1569.696, before working independently with residents. The remaining 20 hours shall include six hours specific to dementia care and shall be completed within the first four weeks of employment.......................This requirement is not met as evidenced by: Deficient Practice Statement Based on records review, the licensee did not comply with the section cited above in S2, S4 and S5 not having the 40 hours required training on file which pose a potential health, safety and/or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/22/2025 Plan of Correction Administrator to have the staff complete the training and submit proof by 4/22/25.

Official classification

Type B

Official code

87506(a)

Regulation authority

CCR

What the official deficiency says

87506 Resident Records (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 in R5’s 2 medications received by the facility not properly recorded on LIC622 which posed a potential personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/22/2025 Plan of Correction Administrator to correct the LIC622 and submit proof by 4/22/25.

Official classification

Type B

Official code

87608(a)(3)

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. (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 records review, the licensee did not comply with the section cited above in R3 and R4’s half bed rails not having doctor's order on file which pose a potential safety and/or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/22/2025 Plan of Correction Administrator to obtain doctor's order and submit copies by 4/22/25.

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 hot water at 134.1 degrees Fahrenheit which poses an immediate health and/or personal rights risks to persons in care.

Official plan of correction

POC Due Date: 03/29/2025 Plan of Correction Administrator to have the temperature adjusted within Regulations range and submit proof by 3/29/25.

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 the following which pose an immediate health, safety and/or personal rights risks to persons in care: medications in unlocked garage; unlocked kitchen shears and medication (Aspirin) in the kitchen cabinet; kitchen cabinets where sharps and cleaning supplies are kept do not have an appropriate lock; unlocked Vitamins and perineal skin protector; shaving cream, Isopropyl alcohol, UTI pain reliever and razor in residents' rooms; disinfectant and sanitizing sprays in the common bathroom

Official plan of correction

POC Due Date: 03/29/2025 Plan of Correction Staff put the items in the garage then locked the garage. In additon, administrator to do the following and submit proof by 3/29/25: 1. Install lock in the cabinets. 2. In-service the staff and submit copy of training topic with attendees signatures.

Official classification

Type A

Official code

87309(c)

Regulation authority

CCR

What the official deficiency says

(c) Except as specified in subsection (d), the licensee shall implement reasonable interventions in order to ensure that nutritional supplements, vitamins, alcohol, cigarettes and other potentially toxic substances, such as certain plants, gardening supplies, and auto supplies, are stored so as not to pose a hazard to residents. 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 a rake outside the storage in the backyard which poses an immediate safety and/or personal rights risks to persons in care.

Official plan of correction

POC Due Date: 03/29/2025 Plan of Correction Staff temporarily locked the rake in the garage. Administrator to do the following and submit proof by 3/29/25: 1. Put the rake in the storage. 2 In-service the staff and submit copy of training topic with attendees signatures.

Official classification

Type A

Official code

87555(b)(8)

Regulation authority

CCR

What the official deficiency says

(b) The following food service requirements shall apply: (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 in rotten broccoli which poses an immediate health and/or personal rights risks to persons in care.

Official plan of correction

POC Due Date: 03/29/2025 Plan of Correction Staff discarded the item. Administrator to in-service the staff and submit copy of training topic with attendees signatures by 3/29/25.

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 the following pose a potential safety and/or personal rights risks to persons in care: piece of metal, mattress, bed frame and bed rail in the backyard.

Official plan of correction

POC Due Date: 04/11/2025 Plan of Correction Administrator to have the yard cleaned and submit pictures by 4/11/25.

Official classification

Type B

Official code

87355(e)(3)

Regulation authority

CCR

What the official deficiency says

87355 Criminal Record Clearance (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) This requirement is not met as evidenced by: Deficient Practice Statement Based on interview and review of facility roster in Guardian, the licensee did not comply with the section cited above in S1 not associated which poses a potential safety and/or personal rights risks to persons in care.

Official plan of correction

POC Due Date: 04/11/2025 Plan of Correction Administrator to have the staff associated and submit proof by 4/11/25.

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 hot water at 125.1 degrees Fahrenheit.which poses an immediate health, safety and/or personal rights risks to persons in care.

Official plan of correction

POC Due Date: 03/24/2024 Plan of Correction Corrected. Administrator adjusted the water temperature to 110 degrees Fahrenheit.

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 which pose an immediate health, safety and/or personal rights risk to persons in care. LPA observed the following: knives in unlocked kitchen cabinet; scissors and pizza cutter in drawers without lock; Lysol, Windex, Barbasol in cabinet without lock in the ensuite bathroom; peritoneal cleansers and ointments, lighter, scissors in one of the residents rooms; peritnoeal cleaner in the common bathroom

Official plan of correction

POC Due Date: 03/24/2024 Plan of Correction Administrator and staff lock the items. In addition, administrator to in-service the staff and submit copy of training topic with attendees signatures by 3/24/24.

Official classification

Type A

Official code

87355(e)

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: 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 S4 not fingerprint cleared and associated to the facility which poses an immediate safety and/or personal rights risk to persons in care. A $500.00 civil penalty is assessed.

Official plan of correction

POC Due Date: 03/24/2024 Plan of Correction Administrator to have the staff fingerprinted, and will not allow to work until cleared and associated. Proof to be submitted by 3/24/24.

Official classification

Type A

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) (interview) (record review)], the licensee did not comply with the section cited above in [count] out of [total count] [(objects) (persons)] [identifiers] which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: Plan of Correction

Official classification

Type A

Official code

87465(h)(1)(C)

Regulation authority

CCR

What the official deficiency says

(h) The following requirements shall apply to medications which are centrally stored: (1) Medications shall be centrally stored under the following circumstances: (C) Because of potential dangers related to the medication itself, or due to physical arrangements in the facility and the condition or the habits of other persons in the facility, the medications are determined by either a physician, the administrator, or Department to be a safety hazard to others. This requirement is not met as evidenced by: Deficient Practice Statement Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in [count] out of [total count] [(objects) (persons)] [identifiers] which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: Plan of Correction

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 cabinets with residents' medications unlocked which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/24/2024 Plan of Correction Staff locked the cabinets. In addition, administrator to in-service the staff and submit copy of training topic with attendees signatures by 3/24/24.

Official classification

Type A

Official code

87465(c)(2)

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: (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 staff administering R2's multi vitamins twice daily when doctor's order is once daily; Doctor's order for R3's calcium carbonate-Vit D3 (600 mg-12.5 mcg(500 unit) but the medication on facility's hand os 600 mg-10 mg (400 unit).which poses an immediate health and/or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/24/2024 Plan of Correction Administrator to have the medication for R2 administered as ordered and obtain correct medication for R3, and submit proof by 3/24/24.

Official classification

Type A

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 resident's file, and a label on the medication. Both the physician's order and the label shall contain at least all of 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 in having 21 medications on hand for R2 but order on file is only for 18.count which poses an immediate health and/or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/24/2024 Plan of Correction Administrator to check with the doctor if the 3 medications are still needed by R2 and obtain doctor's order. Proof to be submitted by 3/24/24.

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, he licensee did not comply with the section cited above in Aleve, Glucosamine. Bengay in one of the resident's rooms 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 Administrator and staff locked the items. In addition, administrator to in-service the staff and submit copy of training topic with attendees signatures by 3/24/24.

Official classification

Type B

Official code

87303(f)(3)

Regulation authority

CCR

What the official deficiency says

(f) Solid waste shall be stored and disposed of as follows: (3) All containers, except movable bins, used for storage of solid wastes shall have tight-fitting covers on the containers; shall be in good repair; shall have external handles; and shall be leakproof and rodent-proof. 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 trash can without lid which poses a potential health and/or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/06/2024 Plan of Correction Administrator to purchase trash can with foot pedal operated lid, and submit proof of purchase by 4/06/24.

Official classification

Type B

Official code

87412(a)(11)

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: (11) A health screening as specified in Section 87411, Personnel Requirements - General. 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 S3 has not having LIC503 Health Screening & TB test on file which pose a potential health and/or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/06/2024 Plan of Correction Administrator to have the staff health screened and TB tested, Proof to be submitted by 4/06/24,

Official classification

Type B

Official code

1569.625(b)(1)

Regulation authority

HSC

What the official deficiency says

(1) The department shall adopt regulations to require staff members of residential care facilities for the elderly who assist residents with personal activities of daily living to receive appropriate training. This training shall consist of 40 hours of training. A staff member shall complete 20 hours, including six hours specific to dementia care, as required by subdivision (a) of Section 1569.626 and four hours specific to postural supports, restricted health conditions, and hospice care, as required by subdivision (a) of Section 1569.696, before working independently with residents. The remaining 20 hours shall include six hours specific to dementia care and shall be completed within the first four weeks of employment. The training coursework may utilize various methods of instruction, including, but not limited to, lectures, instructional videos, and interactive online courses. The additional 16 hours shall be hands-on 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 in S3 only having total of 22 hours training ofn file which poses a potential health, safety and/or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/06/2024 Plan of Correction Administrator to have the staff complete the training, and submit self-certification by 4/06/24.

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 in for not conducting drills at least every quater which poses a potential safety risk to persons in care.

Official plan of correction

POC Due Date: 04/06/2024 Plan of Correction Administrator to have drill conducted, and submit proof by 4/06/24.

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 for not having doctor's orders for R1,R2, R3 and R4's half bed rails which poses a potential health, safety and/or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/06/2024 Plan of Correction Administrator to obtain doctor's order, and submit copies by 4/06/24.

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, the licensee did not comply with the section cited above in R1's LIC602A over a year old & no LIC625 on file which pose a potential health and/or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/06/2024 Plan of Correction Administrator to obtain an updated LIC602A and complete LIC625 for R1, and submit self-certification.

Official classification

Type B

Official code

87506(a)

Regulation authority

CCR

What the official deficiency says

87506 Resident Records (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 This requirement is not met as evidenced by: Deficient Practice Statement Based on records review, the licensee did not comply with the section cited above for the following which poses a potential personal rights risk to persons in care: R1's 3 medications not recorded & other medications not proeprly recorded on LIC622; R2's medications not properly recorded on LIC622.

Official plan of correction

POC Due Date: 04/06/2024 Plan of Correction Administrator to correct the record, and submit self-certification by 4/06/24,

Official classification

Type A

Official code

87465(h)(1)(C)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care (h)(1)(C) Because of potential dangers related to the medication itself, or due to physical arrangements in the facility and the condition or the habits of other persons in the facility, the medications are determined by either a physician, the administrator, or Department to be a safety hazard to others This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above. LPA observed medications in 4 out of 4 residents bedrooms and medication cabinet unlocked which poses an immediate safety risk to persons in care.

Official plan of correction

POC Due Date: 02/21/2023 Plan of Correction Staff locked the medications and medication cabinet while LPA is at the facility. In addition, licensee and/or administrator to in-service the staff and submit training topic with attendees signatures by 2/21/23.

Official classification

Type A

Official code

87309(a)

Regulation authority

CCR

What the official deficiency says

87309 Storage Space (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. LPA observed rusted rake in the backyard and cleaning supplies in unlocked garage and garage cabinets which pose immediate safety risks to persons in care.

Official plan of correction

POC Due Date: 02/21/2023 Plan of Correction Staff locked the rake and medication cabinet, and locked all the cleaning supplies cabinets in the garage. In addition, licesnee and/or administrator to in-service the staff, and submit training topic with attendees’ signatures by 2/21/23.

Official classification

Type A

Official code

87303(e)(2)

Regulation authority

CCR

What the official deficiency says

87303 Maintenance and Operation (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 degree C) and not more than 120 degree F (49 degree 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 for hot water at 134 degrees Fahrenheit which poses an immediate safety risk to persons in care.

Official plan of correction

POC Due Date: 02/21/2023 Plan of Correction Staff adjusted the temperature to 105 degrees while LPA was still at the facility. In addition, licensee and/or administrator to have the temperature regularly checked to ensure temperature is within Regulations range. Proof to be submitted by 2/21/23.

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

87303 Maintenance and Operation (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. LPA observed the following in the backyard: bed frames, used bed, chicken wire. pieces of wood. LPA also observed the doorbell not working.

Official plan of correction

POC Due Date: 03/06/2023 Plan of Correction Staff locked the items in the storage and fixed the doorbell. In addition, license and/or administrator to in-service the staff and submit training topic with attendees’ signatures by 3/06/23.

Official classification

Type B

Official code

87211(g)

Regulation authority

CCR

What the official deficiency says

Reporting Requirements. The licensee shall notify the Department, in writing, within thirty (30) days of the hiring of a new administrator... This requirement is not met as evidence by: Based on interview, licensee did not comply with the section cited above by not notifying the Department of administrator change which poses a potential health and safety risk to the persons in care.

Official plan of correction

The Licensee will submit documents for change of administrator by POC date.

Deadline recorded: Nov 25, 2022. A deadline is not proof that correction was completed.