ALONDRA CARE HOME 3

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 record review, the licensee did not comply with the section cited above in all of R3's 13 medications with no doctor's orders on file which poses an immediate health and/or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/28/2026 Plan of Correction Administrator stated she'll obtain doctor's order. Copy to be submitted by 5/28/26.

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 record review, the licensee did not comply with the section cited above in S4 not having valid TB test which poses a potential health and/or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/10/2026 Plan of Correction Administrator stated she'll have the staff TB tested. Result to be submitted by 6/10/26.

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 records review, the licensee did not comply with the section cited above in S2 & S4 not having LIC503 Health Screening records on file which poses a potential health and/or personal rights risks to persons in care.

Official plan of correction

POC Due Date: 06/10/2026 Plan of Correction Administrator stated she'll have the staff health screened. Copies of LIC503 to be submitted by 6/10/26.

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 records review, the licensee did not comply with the section cited above in 3 staff (S2, S3 and S4) not completed the required 40 hours of training which pose a potential health, safety and/or personal rights risks to persons in care.

Official plan of correction

POC Due Date: 06/10/2026 Plan of Correction Admistrator stated she'll have the staff complete the training. Self-certication to be submitted by 6/10/26.

Official classification

Type B

Official code

1569.696(a)

Regulation authority

HSC

What the official deficiency says

(a) All residential care facilities for the elderly shall provide training to direct care staff on postural supports, restricted conditions or health services, and hospice care as a component of the training requirements specified in Section 1569.625. The training shall include all of the following: This requirement is not met as evidenced by: Deficient Practice Statement Based on record reviews, the licensee did not comply with the section cited above in S2, S3 and S4 do not having restricted health and hospice care trainings which pose a potential health, safety and/or personal rights risks to persons in care.

Official plan of correction

POC Due Date: 06/10/2026 Plan of Correction Administrator stated she'll have the staff complete the training. Proof to be submitted by 6/10/26.

Official classification

Type B

Official code

87506(b)(17)(B)

Regulation authority

CCR

What the official deficiency says

(b) Each resident's record shall contain at least the following information: (17) Documents and information required by the following: (B) Section 87459, Functional Capabilities; 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 all 5 residents not having LIC9172 Functional Capability Assessments on file which pose a potential health, safety and/or personal rights risks to persons in care.

Official plan of correction

POC Due Date: 06/10/2026 Plan of Correction Administrator to complete the LIC9172 and submit copies by 6/10/26.

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 record review, the licensee did not comply with the section cited above inresident's (R1) LIC602A Physician's Report not consistent with R1's current ambulatory status which poses a potential health, safety and/or personal rights risks to person in care.

Official plan of correction

POC Due Date: 06/10/2026 Plan of Correction Administrator stated she'll have R1 medically assessed. Copy of updated LIC602A to be submitted by 6/10/26.

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 records review, the licensee did not comply with the section cited above in residents' (R1, R4 and R5) half bed rails not having doctor's orders on file which pose a potential safety and/or personal rights risks to persons in care.

Official plan of correction

POC Due Date: 06/10/2026 Plan of Correction Administrator stated she'll obtain doctor's orders. Copies to be submitted by 6/10/26.

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 cleaning agents in unlocked kitchen cabinet; unlocked Fabuloso, Voltaren ointment, CA-Rezz cream, Comet, shovel, staff medications which pose an immediate health, safety and/or personal rights risks to persons in care.

Official plan of correction

POC Due Date: 05/27/2026 Plan of Correction Administrator locked all the items. In addition, administrator to in-service the staff and submit copy of training topic with attendees signatures by 5/27/26.

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 observation and interview, the licensee did not comply with the section cited above in staff (S1) not fingerprinted which poses an immediate safety and/or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/27/2026 Plan of Correction Administrator stated she'll have the staff fingerprinted and will not allow to work until cleared. Proof to be submitted by 5/27/26.

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 at 123.3 degrees Fahrenheit which poses a potential health, safety and/or personal rights risks to persons in care.

Official plan of correction

POC Due Date: 06/09/2026 Plan of Correction Administrator to have the water temperature adjusted within Regulations range. Proof to be submitted by 6/09/26.

Official classification

Type A

Official code

87411(a)

Regulation authority

CCR

What the official deficiency says

87411 Personnel Requirements - General: (a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs.......... -This requirement is not met as evidenced by: -Based on records review and interviews, the licensee did not comply with the section when R2 fell and no staff present which posed and immediate safety, health and/or personal rights risks to person in care.

Official plan of correction

Administrator to ensure staff coverage and submit updated copy of LIC500 Personnel Report by 1/23/26. A $500.00 civil penalty is assessed.

Deadline recorded: Jan 23, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87455(e)(2)

Regulation authority

CCR

What the official deficiency says

87355 Criminal Record Clearance (e) All individuals....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. -This requirement is not met as evidenced by: -Based on interview and record review, the licensee did not comply with the section above in allowing S1 worked without fingerprint clearance which posed an immediate safety and/or personal rights risks to persons in care.

Official plan of correction

S1 left while LPA was at the facility. Administrator stated she'll no longer have S1 work. Self-certification to be submitted by 1/23/26. A $200.00 civil penalty is assessed.

Deadline recorded: Jan 23, 2026. 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

87309 Storage Space and Access (a)... 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: -Based on observation, the licensee did not comply with the section above in unlocked Advil and tree trimmer which posed an immediate health, safety and/or personal rights risks to persons in care.

Official plan of correction

Administrator locked the items. In addition, administrator to in-service the staff and submit copy of training topics with attendees signatures by 1/23/26.

Deadline recorded: Jan 23, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

1569.269(a)(1)

Regulation authority

CCR

What the official deficiency says

§1569.269 Enumerated rights; severability (a) Residents of residential care facilities for the elderly shall have all of the following rights: (1) To be accorded dignity in their personal relationships with staff, residents, and other persons. -This requirement is not met as evidenced by: -Based on observation, the licensee did not comply with the section above in engaging in argument with R1 which posed a personal rights risk to person in care.

Official plan of correction

Licensee-administrator to read the Regulation and ensure compliance. Self-certification to be submitted by 2/05/26.

Deadline recorded: Feb 5, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87203

Regulation authority

CCR

What the official deficiency says

87203 Fire Safety All facilities shall be maintained in conformity with the regulations adopted by the State Fire Marshal for the protection of life and property against fire and panic. -This is not met as evidenced by: -Based on observation, the licensee did not comply with the section above in have dividing walls in the garage and beds which pose an immediate risks to the safety risk to persons in care.

Official plan of correction

Administrator had the dividing walls and mattresses removed. In addition, administrator to remove the captain beds and dividing walls removed from the garage. Pictures to be submitted by 10/02/25. A $1,000.00 civil penalty is assessed.

Deadline recorded: Oct 2, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

1569.269(a)(5)

Regulation authority

HSC

What the official deficiency says

§1569.269 Enumerated rights; severability (a) Residents of residential care facilities for the elderly shall have all of the following rights: (5) To be accorded safe, healthful, and comfortable accommodations, furnishings, and equipment. -This is not met as evidenced by: -Based on observation and interviews, the licensee did not comply with the section above when R1 sustained wounds/scratches caused by the dog in the facility.

Official plan of correction

Corrected. Administrator removed the dog while LPA was at the facility.

Deadline recorded: Oct 2, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87608(a)(5)(B)

Regulation authority

CCR

What the official deficiency says

87608 Postural Supports: (a) Postural supports may be used under the following conditions.(5)..(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. -Based observation, the licensee did not comply with the section above in having full bedrails in R2's bed which poses a potential personal rights risk to person in care.

Official plan of correction

Corrected. Administrator removed the other half bed rail.

Deadline recorded: Oct 15, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87203

Regulation authority

CCR

What the official deficiency says

87203 Fire Safety All facilities shall be maintained in conformity with the regulations adopted by the State Fire Marshal for the protection of life and property against fire and panic. -This requirement is not met as evidenced by: -Based on observation, the licensee did not comply with the section above in locking the side fence gate which posed an immediate safety and/or personal rights risks to persons in care.

Official plan of correction

Administrator removed in the lock. In addition, administrator to in-service the staff and submit proof by 8/30/25. A $500.00 civil penalty is assessed.

Deadline recorded: Aug 30, 2025. A deadline is not proof that correction was completed.

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 -Based on record review and interview, the licensee did not comply with the section above in not completing R1's record/file which poses a potential personal rights risk to person in care.

Official plan of correction

Administrator agreed to complete the record and submit self-certfication by 9/12/25.

Deadline recorded: Sep 12, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87508(a)

Regulation authority

CCR

What the official deficiency says

87508 Register of Residents (a) The licensee shall ensure that a current register of all residents in the facility is maintained and contains the following updated information........ -This requirement is not met as evidenced by: -Based on record review and interview, the licensee did not comply with the section above in not having LIC9020 which poses a potential personal rights risk to persons in care..

Official plan of correction

Administrator to complete the LIC9020 and submit copy by 9/12/25.

Deadline recorded: Sep 12, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87211(a)(1)(D)

Regulation authority

CCR

What the official deficiency says

87211 Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following:(D) Any incident which threatens the welfare, safety or health of any resident... -This requirement is not met as evidenced by -Based on record review and interview, the licensee did not comply with the section above in not sending incident reports (LIC624) for R2 and R3 which posed a potential health, safety and/or personal right risks to persons in care.

Official plan of correction

Administrator to complete the LIC624s and submit copies by 9/12/25.

Deadline recorded: Sep 12, 2025. A deadline is not proof that correction was completed.