H & M HOMES STANDISH

Official classification

Type A

Official code

87309(a)(1)

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. (1) Disinfectants, cleaning solutions, and poisonous substances shall be stored in areas separate from food supplies as specified in Section 87555, General Food Service Requirements. 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: unlocked CA-Rezz incontinent wash and wound cleanser; peeler and can opener in kitchen cabinets without locks; unlocked screw driver in the laundry area

Official plan of correction

POC Due Date: 12/19/2025 Plan of Correction Staff locked the items. In addition, administrator stated she'll in-service the staff. Copy of training topic with attendees signature to be submitted by 12/19/25.

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 which pose a potential health, safety and/or personal rights risks to persons in care: heavily scratched kitchen island; dusty and soiled upright kitchen cabinets; greasy and rusty cooking range; refrigerator dirty; rotten dining bench in the backyard.

Official plan of correction

POC Due Date: 01/02/2026 Plan of Correction Saff cleaned the cooking range while LPA was at the facilty: In addition, administrator stated she'll have the refrigerator, kitchen island and cabinets cleaned, discard and replace the dining bench. Pictures to be submitted by 1/02/26.

Official classification

Type B

Official code

1569.625(b)(2)

Regulation authority

HSC

What the official deficiency says

(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 training shall be administered on the job, or in a classroom setting, or both, and may include online 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 S5 not having the required 4 hours postural support, restricted health condition and hospice care training which poses a potential health, safety and/or personal rights risks to persons in care.

Official plan of correction

POC Due Date: 01/02/2026 Plan of Correction Administrator to have the staff complete the training and submit proof by 1/02/26.

Official classification

Type B

Official code

87618(b)(3)(B)

Regulation authority

CCR

What the official deficiency says

(3) Ensuring that the use of oxygen equipment meets the following requirements: (B) “No Smoking-Oxygen in Use” signs shall be posted in the appropriate areas. 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 not having signs posted for Oxygen which pose a potential safety and/or personal rights risks to persons in care.

Official plan of correction

POC Due Date: 01/02/2026 Plan of Correction Corrected. Administrator posted signs.

Official classification

Type B

Official code

1569.625(b)(2)

Regulation authority

HSC

What the official deficiency says

(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 training shall be administered on the job, or in a classroom setting, or both, and may include online training. 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 staff not having the 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: 12/22/2023 Plan of Correction Administrator to have the training completed and submit proof by 12/22/23.

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 his/her 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 records review, the licensee did not comply with the section cited above in 5 out 5 residents not having Pre-Admission Appraisal which pose a potential health and/or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/22/2023 Plan of Correction Administrator to complete the Pre-admission Appraisal and submit copies by 12/22/23.

Official classification

Type A

Official code

87465(e)(2)

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, and a label on the medication. Both the physician's order and the label shall contain at least all of the following information. (2) The exact dosage. 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 not having doctor’s order for R1’s two medications and the medication on hand of for 1 does not match the order.which poses an immediate health risk to person in care.

Official plan of correction

POC Due Date: 12/09/2023 Plan of Correction Administrator stated she'll obtain doctor's order. Copy to be submitted by 12/09/23.

Official classification

Type A

Official code

87465(a)(4)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following: (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 record review, the licensee did not comply with the section cited above for not having the 5 medications listed on the doctor's order for R1 which poses an immediate health risk to person in care.

Official plan of correction

POC Due Date: 12/09/2023 Plan of Correction Administrator to call the doctor and check if medications are no longer needed and obtain discontinued order; otherwise obtain the medications. Proof fo be submitted by 12/09/23.

Official classification

Type B

Official code

87463(c)

Regulation authority

CCR

What the official deficiency says

87463 Reappraisals (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 for R1. R4 and R5’s LIC625 Appraisal/Needs and Services Plan over a year old which pose a potential health risks to persons in c are.

Official plan of correction

POC Due Date: 12/22/2023 Plan of Correction Administrator to update the LIC625s and submit self-certification by 12/22/23.

Official classification

Type B

Official code

87458

Regulation authority

CCR

What the official deficiency says

87458 Medical Assessment (c) The licensee shall obtain an updated medical assessment when required by the Department. 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 R1, R3, R4 and R5's LIC602As over a year old which pose a potential health risks to persons in care.

Official plan of correction

POC Due Date: 12/22/2023 Plan of Correction Administrator to call the residents' doctor for appointments and submit by 12/22/23 a self-certification indicating LIC602As are updated.

Official classification

Type A

Official code

1569

Regulation authority

HSC

What the official deficiency says

§1569.312 Basic services requirements Every facility required to be licensed under this chapter shall provide at least the following basic services: (a) Care and supervision as defined in Section 1569.2. -This requirement is not met as evidenced by: -Based on interview and review of records, the licensee did not comply with the section above for R1 and R2 who were able to AWOL which posed immediate risk to persons in care. Civil penalty assessed due to R1 sustaining injuries.

Official plan of correction

Administrator to do the following and submit proof by 8/18/23: 1. Re-assess residents and provide the care needs immediately. 2. In-service staff. 3. Schedule an Interdisciplinary Meeting with Regional Center of East Bay and Behaviorist. $500,00 civil penalty is assessed on this day.

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

Official classification

Type A

Official code

87705(j)

Regulation authority

CCR

What the official deficiency says

87705 Care of Persons with Dementia (j) The licensee shall have an auditory device or other staff alert feature to monitor exits, if exiting presents a hazard to any resident. -This requirement is not met as evidenced by -Based of observation, the licensee did not comply with the section above, for entrance and exit doors not having auditory signals which posed immediate risk to persons in care,

Official plan of correction

Corrected. Administrator had the staff purchased and installed auditory signals while LPA is still at the facility.

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

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 unlocked staff room 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 room immediately. In addition, 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 the following: unlocked storages; scissors in drawer without lock 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 scissors and storage immediately. In addition, administrator to in-service the staff and submit training topic with attendees signatures by 2/21/23.

Official classification

Type B

Official code

87307(a)(3)(C)

Regulation authority

CCR

What the official deficiency says

87307 Personal Accommodations and Services (a) Living accommodations and grounds..... The following provisions shall apply: (3)(C) The use of common wash cloths and towels shall be prohibited. 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 2 out of 2 bathrooms with common towels and hand towels which pose poptential health, safety and personal rights risks to persons in care.

Official plan of correction

POC Due Date: 03/06/2023 Plan of Correction Admnistrator removed the towels and hand towels. In addition, administrator to have paper towel holder installed, and provise paper towel for hand drying and ensure each resident is provided towel. Pictures to be submitted by 3/06/23.