ELLE'S HOME

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 scissors and medication room which posed an immediate risks to persons in care.

Official plan of correction

Administrator to in-service the staff and submit copy of trainining topic with attendees signatures by 5/08/26. A $250.00 civil penalty is assessed for repeat violation. The first citation was issued on 12/23/25.

Deadline recorded: May 8, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

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 interviews, the licensee did not comply with section above when staff assisted a resident to the bathroom and didn't the other staff to supervise the other residents who were at the common area which posed a potential risk to persons in care,

Official plan of correction

Administrator to in-service the staff and submit copy of trainining topic with attendees signatures by 5/21/26.

Deadline recorded: May 21, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87465(h)(6)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care (h) The following requirements shall apply to medications which are centrally stored: (6) The licensee shall be responsible for assuring that a record of centrally stored prescription medications for each resident is maintained........ -This requirement is not met as evidenced by: -Based on observation and record review, the licensee did not comply with section above in not recording R1's medications on LIC622 which poses a potential rights risk to person in care.

Official plan of correction

Admiinistrator to complete R1's LIC622 and submit copy by 5/21/26.

Deadline recorded: May 21, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

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...... The licensing agency may require any facility to provide additional staff whenever it determines through....... ..... such additional staff for the provision of adequate services. -This requirement is not met as evidenced by: -Based on records review and interviews, the licensee did not comply with the section above in S1's capabilty to provide assistance to resident.

Official plan of correction

Administrator stated she'll adjust her time and come to the facility early and that addtional staff will cover during her days off. In addition, administrator to update the LIC500 and submit copy along with staff's job duties/responsibilities by 4/08/26.

Deadline recorded: Apr 8, 2026. A deadline is not proof that correction was completed.

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... -This requirement is not met as evidenced by: -Based on record review and interviews, the licensee did not comply with the section above in having S1 work without being fingerprinted and cleared which poses an immediate safety and/or personal rights risks to persons in care.

Official plan of correction

Administrator stated she have S1 fingerprinted and submit proof by 3/26/26. In addition, administrator not to allow S1 work until cleared and associated.

Deadline recorded: Mar 26, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87457(c)

Regulation authority

CCR

What the official deficiency says

87457 Pre-Admission Appraisal (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....... -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 the Pre-Admission Appraisal for R1 which poses a potential health, safety and/or personal rights risks to person in care.

Official plan of correction

Admistrator to complete the appraisal and submit copy by 4/08/26.

Deadline recorded: Apr 8, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87465(h)(5)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care (h) The following requirements shall apply to medications which are centrally stored: (5) Each resident's medication shall be stored in its originally received container. No medications shall be transferred between containers. -This requirement is not met as evidenced by: -Based on interviews, the licensee did not comply with the section above in pre-pouring residents' medications which poses a potential health and/or personal rights risks to persons in care.

Official plan of correction

Administrator to stop pre-pouring the medications. Self-certification to be submitted by 4/08/26.

Deadline recorded: Apr 8, 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

(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: unlocked medications in the refrigerators; unlocked cabinet under the sink where Comet and WD-40 were kept; perineal cleanser, scissors, Calmoseptine ointment in unlocked bathroom cabinet; medications in the dining area and resident's room; hammer and Miracle gro fertilizer in the backyard

Official plan of correction

POC Due Date: 12/14/2025 Plan of Correction Administrator locked the items. In addition, administrator to in-service the staff and submit copy of training topic with attendees signatures by 12/24/25.

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 having casseroles and cutting board stored where Comet and WD-40 are kept which poses an immediate health and/or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/14/2025 Plan of Correction Administrator removed the casseroles and cutting board. In addition, administrator to in-service the staff and submit copy of training topic with attendees signatures by 12/24/25.

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 the following which pose an immediate health and/or personal rights risks to persons in care: moldy grapes; expired yogurt and sour cream; rotten cabbage and eggplant; tortilla not properly stored

Official plan of correction

POC Due Date: 12/14/2025 Plan of Correction Administrator have all the items discarded. In addition, administrator to in-service the staff and submit copy of training topics with attendees signatures by 12/24/25

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, 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 not having doctor’s order for R3's Senna medication and not having the other 4 listed on the order which pose an immediate health and/or personal rights risks to person in care.

Official plan of correction

POC Due Date: 12/14/2025 Plan of Correction Administrator stated she'll obtain doctor's order for Senna and check with the doctor and obtain discontinued order for the other 4 if no longer needed. Proof to be submitted by 12/14/25.

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 risk to persons in care: cobwebs and spiders all through out the facility; hole on the wall, dusty lights and air vents in the batrooms; moldy ceiling; broken and dirty closet door in another residents' room; overgrown weeds, rusted metal shelf, crates, piece of metal, moldy chair in the yard

Official plan of correction

POC Due Date: 12/27/2025 Plan of Correction Administrator to do the following and submit pictures by 12/27/25: 1. Have the facility cleaned inside out. 2. Have the closet door fixed and cleaned. 3. Have the wall repaired/fixed.

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 oservation, the licensee did not comply with the section cited above in dirty kitchen floor and moldy shower area/floor which pose a potential health, safety and/or personal rights risks to persons in care.

Official plan of correction

POC Due Date: 12/27/2025 Plan of Correction Administrator to have the kitchen floor and bathrooms thoroughly cleaned and submit pictures by 12/27/25.

Official classification

Type B

Official code

87555(b)(29)

Regulation authority

CCR

What the official deficiency says

87555 General Food Service Requirements (b) The following food service requirements shall apply: (29) All equipment, fixed or mobile, and dishes, shall be kept clean and maintained in good repair and free of breaks, open seams, cracks or chips. 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 a potential health, safety and/or personal rights risks to persons in care: dirty and moldy dish drainer; greasy cooking range and range hood; dirty and rusty oven toaster, bread toaster and rice cooker

Official plan of correction

POC Due Date: 12/27/2025 Plan of Correction Administrator stated and will do the following. Pictures to be submitted by 12/27/25: 1. Have the cooking range and range hood cleaned. 2. Discard the dish drainer, oven toaster, bread toaster and rice cooker, and purchase new one.

Official classification

Type B

Official code

87608(a)(3)

Regulation authority

CCR

What the official deficiency says

87608 Postural Supports (a) ... 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 [(observation) (interview) (record review)], the licensee did not comply with the section cited above in not having doctor’s orders for R2, R3 and R4’s half bed rails.which pose a potential health, safety and/or personal rights risks to persons in care.

Official plan of correction

POC Due Date: 12/27/2025 Plan of Correction Administrator stated she'll obtain doctor's order. Copies to be submitted by 12/27/25.

Official classification

Type B

Official code

1569.269(a)(2)

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: (2) To be granted a reasonable level of personal privacy in accommodations, medical treatment, personal care and assistance, visits, communications, telephone conversations, use of the internet, and meetings of resident and family groups. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above in having cameras that capture/ have audio feature which pose a potential personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/27/2025 Plan of Correction Corrected. Administrator removed the cameras.

Official classification

Type B

Official code

87211(a)(1)(A)

Regulation authority

CCR

What the official deficiency says

87211 Reporting Requirements (a) ...(1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events .....(A) Death of any resident from any cause regardless of where the death occurred ... including but not limited to a day program, a hospital, en route to or from a hospital, or visiting away from the facility. -This requirement is not met as evidenced by: -Based on interview, the licensee did not comply with the section above in not submitting Death Report,

Official plan of correction

Administrator to submit Death Report and ensure in the future, report will be submitted in timely manner. Proof to be submitted by 10/04/24.

Deadline recorded: Oct 4, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.1(a)

Regulation authority

CCR

What the official deficiency says

87468.1 Personal Rights of Residents in All Facilities (a) .......(9) To have communications to the licensee from their representatives answered promptly and appropriately. -This requirement is not met as evidenced by: -Based on records review and interviews, the licensee did not comply with the section above in not responding to R1's responsible person.

Official plan of correction

Administrator stated she'll communicate/respond to RP. Proof to be submitted by 10/04/24.

Deadline recorded: Oct 4, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87309(a)

Regulation authority

CCR

What the official deficiency says

(a) Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above for Lysol, glade, scissor and perotoneal cleanser in unlocked bathrooms cabinets which pose an immediate health and safety risks to persons in care.

Official plan of correction

POC Due Date: 12/07/2023 Plan of Correction Administrator locked the items. In addition, administrator to in-service the staff and submit copy of training topic with attendees signatures by 12/07/23.

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above for metal rack, empty pail, dusty commode, rusted metal, styrofoam container, piece of wood in the backyard which pose potential safety and/or personal rights risks to persons in care.

Official plan of correction

POC Due Date: 12/20/2023 Plan of Correction Administrator to have the yard cleaned and submit pictures by 12/20/23.

Official classification

Type B

Official code

1569.618(c)(3)

Regulation authority

HSC

What the official deficiency says

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

Official plan of correction

POC Due Date: 12/20/2023 Plan of Correction Administrator to have the staff and herself complete the training, and submit copies of certificates by 12/20/23.

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 record review, the licensee did not comply with the section cited above in 1 out of 3 staff (S2) not having LIC503 Health Screening and TB test result on file which pose a potential health and/or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/20/2023 Plan of Correction Administrator to have the staff health screened and TB tested, and submit proof by 12/20/23.

Official classification

Type B

Official code

87608(a)(3)

Regulation authority

CCR

What the official deficiency says

87608 Postural Supports (a)….. 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 4 out of 5 residents not having doctor's order on file for half bed rails which pose a potential safety and/or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/20/2023 Plan of Correction Administrator to obtain doctor's order and submit copies by 12/20/23.

Official classification

Type A

Official code

87705(f)(2)

Regulation authority

CCR

What the official deficiency says

87705 Care of Persons with Dementia (f) The following shall be stored inaccessible to residents with dementia: (2) Over-the-counter medication, nutritional supplements or vitamins, alcohol, cigarettes, and toxic substances such as certain plants, gardening supplies, cleaning supplies and disinfectants This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above. LPA obseved the following which pose immediate safety risks to persons in care: cleaning supplies storage without lock; pails of paint and floor cleaner in the backyard; gardening tools in the side yard

Official plan of correction

POC Due Date: 12/09/2021 Plan of Correction Staff installed lock in the storage and lock the gardening tools, pails of paint and cleaning and gardening supplies while LPA is still at the faciliy. Administrator to in-service the staff and submit proof by 12/10/2021.

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 worn out wheelchairs and broken pipes in the backyard which pose a potential safety and personal rights risks to persons in care.

Official plan of correction

POC Due Date: 12/23/2021 Plan of Correction Administrator to have the yard cleaned and submit pictures by December 23, 2021.

Official classification

Type B

Official code

1569.269

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 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 dowel at the bottom of the sliding door in residents' bedroom that prevents the door from opening which poses a potential safety and personal rights risks to persons in care.

Official plan of correction

POC Due Date: 12/23/2021 Plan of Correction Administrator removed the dowel immediately. In addition, administrator to do in-service training and ensure staff does not put back the dowel. Proof to be submitted by December 23, 2021.