ESCUETA CARE HOME 3, 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 scissors in a tray in the dining area and unlocked closet were manicure set and acetone were kept which pose an immediate safety and/or personal rights risks to persons in care.

Official plan of correction

POC Due Date: 05/23/2026 Plan of Correction Administrator to in-service the staff and submit copy of training topic with attendees signatures by 5/23/26.

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 in hot water temperature at 102.8 degrees Fahrenheit which poses a potential health an/or personal rights risks to persons in care.

Official plan of correction

POC Due Date: 06/05/2026 Plan of Correction Administrator to have the temperature adjusted within Regulation range and submit proof by 6/05/26.

Official classification

Type B

Official code

87463(a)

Regulation authority

CCR

What the official deficiency says

(a) The pre-admission appraisal, as specified in Section 87457, Pre-Admission Appraisal, shall be updated, in writing as frequently as necessary or once every 12 months, whichever occurs first, to note significant changes in condition, as defined in Section 87101, Definitions, and to keep the appraisal accurate. For the purposes of this section, the updated pre-admission appraisal shall be referred to as the reappraisal. 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 R1 and R2's LIC625 Appraisal/Needs and Services Plan over a year old which pose a potential health, safety and/or personal rights risks to persons in care.

Official plan of correction

POC Due Date: 06/05/2026 Plan of Correction Administrator to update the LIC625 and submit copies by 6/05/26.

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 records review, the licensee did not comply with the section cited above in R1 and R2's quantities of medications on labels do not match the quantities received by the facility which poses a potential personal rights risks to persons in care.

Official plan of correction

POC Due Date: 05/29/2025 Plan of Correction Administrator to obtain correct labels and submit proof by 5/29/25.

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 not having LIC601 Identification and Emergency Contact Information for R2 which poses potential health, safety and/or personal rights risks to person in care.

Official plan of correction

POC Due Date: 05/29/2025 Plan of Correction Administrator to complete the LIC601 and submit copy by 5/29/25.

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 record review, the licensee did not comply with the section cited above in R3's half bed rails and hoyer lift not having doctor's orders which pose a potential health, safety and/or personal rights risks to persons in care.

Official plan of correction

POC Due Date: 05/29/2025 Plan of Correction Administrator to obtain doctor's orders and submit copies by 5/29/25.

Official classification

Type B

Official code

1569.625(b)(2)

Regulation authority

CCR

What the official deficiency says

§1569.625 Staff training; legislative findings; contents (b) (2) In addition to paragraph (1), training requirements shall also include an additional 20 hours annually, eight hours of which shall be dementia care training, as required by subdivision (a) of Section 1569.626, and four hours of which shall be specific to postural supports, restricted health conditions, and hospice care, as required by subdivision (a) of Section 1569.696. This 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 not having the required 4 hrs training and S3 only have 2 hours of the required 4 hours required postural support, restricted health condition & hospice care training for 2024 which pose a potential health, safety and/or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/28/2025 Plan of Correction Administrator to have the training completed and submit self-certification that the required training will be completed annually thereafter.

Official classification

Type B

Official code

87463(c)

Regulation authority

CCR

What the official deficiency says

(c) The licensee shall arrange a meeting with the resident, the resident's representative, if any, appropriate facility staff, and a representative of the resident's home health agency, if any, when there is significant change in the resident's condition, or once every 12 months, whichever occurs first, 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 3 out of 3 residents' LIC625 over a year old which pose a potential health risk to persons in care.

Official plan of correction

POC Due Date: 06/13/2024 Plan of Correction Administrator to update the LIC625 and submit self-certifcation by 6/13/24.

Official classification

Type B

Official code

1569.625(b)(1)

Regulation authority

HSC

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. The training coursework may utilize various methods of instruction, including, but not limited to, lectures, instructional videos, and interactive online courses.......... 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’s required 40 hours of training not completed within 4 weeks of employment which posed a potential health, safety and/or personal rights risks to persons in care.

Official plan of correction

POC Due Date: 06/13/2024 Plan of Correction Administrator to have the staff complete the training and submit self-certification by 6/13/24.

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 in the following which pose an immediiate risks to the safety of persons in care: unlocked scissors; peelers in kitchen cabinet without lock; 2 pails of paint and Hydraulic oil in the backyard; former resident’s medications in unlocked garage

Official plan of correction

POC Due Date: 05/31/2024 Plan of Correction Staff locked the items. In addition, admninistrator to in-service the staff and submit copy of training topics with attendees signatures by 5/31/24.

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 in the following which pose a potential safety and/or personal rights risks to persons in care: pieces of wood, metal grill, rusted cart, missing wood planks fence in the backyard; side fence's wood planks coming off.

Official plan of correction

POC Due Date: 06/13/2024 Plan of Correction Administrator to do the following and submit pictures by 6/13/24: 1. Have the yard cleaned. 2. Have the fence repaired.

Official classification

Type B

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 in hot water at 103.2 degrees Fahrenheit. which poses a potential health and/or personal rights risks to persons in care.

Official plan of correction

POC Due Date: 06/13/2024 Plan of Correction Administrator to have the water temperature adjusted within Regulations range and submit proof by 6/13/24.

Official classification

Type A

Official code

87465(e)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care: (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.,.... -This is not met as evidenced by: -Based on records review, the licensee did not comply with the section above for 4 out of 4 residents not having doctor's orders on file which pose immediate health risks to persons in care.

Official plan of correction

Administrator to obtain copies of doctor's order and submit copies by 5/18/23.

Deadline recorded: May 18, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87463(a)

Regulation authority

CCR

What the official deficiency says

87463 Reappraisals: (a) The pre-admission appraisal shall be updated, in writing as frequently as necessary to note significant changes and to keep the appraisal accurate. The reappraisals shall document changes in the resident's physical, medical, mental, and social condition..... -This is not met as evidenced by: -Based on records review, the licensee did not comply with the section above for 3 out of 4 residents not having a current re-appraisal on file which pose potential health and personal right risks to persons in care.

Official plan of correction

Administrator to do the reappraisals, and submit a self-certification by 5/31/23 indicating it's completed.

Deadline recorded: May 31, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

1569.625(2)

Regulation authority

HSC

What the official deficiency says

§1569.625 Staff training; legislative findings; contents (2).... training requirements shall also include an additional 20 hours annually, 8 hours of which shall be dementia care training, ... and four hours of which shall be specific to postural supports, restricted health conditions, and hospice -This is not met as evidenced by: -Based on records review, the licensee did not comply with the section above for 2 out of 5 staff with incomplete required annual training on file which poses potential safety and personal right risks to persons in care.

Official plan of correction

Administrator to have the staff complete the required training and submit proof by 5/31/23.

Deadline recorded: May 31, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

1569.69(b)

Regulation authority

HSC

What the official deficiency says

§1569.69 Employees assisting residents with self-administration of medication; training requirements: (b) Each employee .... who continues to assist with the self-administration of medicines, shall also complete four hours of in-service training on medication-related issues in each..... .....succeeding 12-month period. -This is not met as evidenced by: -Based on records review, the licensee did not comply with the section above for 2 staff not having the total required number of annnual medication training on file.

Official plan of correction

Administrator to have the staff complete the training and submit proof by 5/31/23.

Deadline recorded: May 31, 2023. A deadline is not proof that correction was completed.

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: -LPA observed the following: collapsed boxes, toilet, mattress and bed frame in the backyard; side fence leaning. These pose potential safety risks to persons in care.

Official plan of correction

Administrator to do the following and submit pictures by 5/24/23: 1. Have the yard cleaned 2. Have the fence repaired/fixed.

Deadline recorded: May 24, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87355(e)

Regulation authority

CCR

What the official deficiency says

87355 Criminal Record Clearance (e) All individuals subject to a criminal record review.. 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) -This requirement is not met as evidenced: -Based on record review,, the licensee did not comply with the section above for a staff not associated to this facility which poses potential safety risk to persons in care.

Official plan of correction

Administrator to have the staff associated by 5/24/23.

Deadline recorded: May 24, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87309

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 staff's medications and supplements stored in unlocked closet which pose immediate heatth and safety risks to persons in care.

Official plan of correction

POC Due Date: 05/12/2022 Plan of Correction Assistant administrator to in-service staff and submit copy with attendees signatures by 5/12/2022.