ST. LOURDES HOME

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 the following which pose an immediate health, safety and/or personal rights risks to persons in care: lighter and resident's medication unlocked in kitchen drawers; Ca-Rezz incontinent wash unlocked in resident's room

Official plan of correction

POC Due Date: 08/21/2026 Plan of Correction Licensee locked the items. In addition, licensee to in-service the staff and submit copy of training topics with attendees signatures by 8/21/26.

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: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above in smoke detectors in living room and hallway have wiring exposed due to covers were missing which pose an immediate safety and/or personal rights risks to persons in care.

Official plan of correction

POC Due Date: 08/21/2026 Plan of Correction Licensee stated he'll have smoke detectors covered. Pictures to be submitted by 8/21/26.

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 rusty towel holder in residents' ensuite bathroom and cobwebs on the living room and kitchen ceiling which pose potential personal rights risks to persons in care.

Official plan of correction

POC Due Date: 09/03/2026 Plan of Correction Licensee stated he'll have the paper towel holder replaced. In addition, licensee to have ceiling cleaned. Pictures to be submitted by 9/03/26.

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

Official plan of correction

POC Due Date: 09/03/2026 Plan of Correction Licensee stated he'll have the shower room/bathroom cleaned. Picture to be submitted by 9/03/26.

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 records review, the licensee did not comply with the section cited above in Staff (S2, S3, S4 and S5) not having hospice care training on file which pose a potential health, safety and/or personal rights risks to persons in care.

Official plan of correction

POC Due Date: 09/03/2026 Plan of Correction Licensee stated he'll have the staff trained. Proof to be submitted by 9/03/26.

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 5 out of 5 residents have no LIC9172 on file which pose a potential health, safety and/or personal rights risks to persons in care.

Official plan of correction

POC Due Date: 09/03/2026 Plan of Correction Licensee to complete the LIC9172 and submit copies by 9/03/26.

Official classification

Type B

Official code

87463(h)

Regulation authority

CCR

What the official deficiency says

(h) The licensee shall request that all residents receive an annual routine visit with a licensed medical professional once every twelve months, either in person or by video appointment. 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 Resident R2 and R5's medical assessment (LIC602A) on file over a year old which poses a potential health and/or personal rights risks to persons in care.

Official plan of correction

POC Due Date: 09/03/2026 Plan of Correction Licensee to have R2 and R5 scheduled for medical assessment. Copies of LIC602A to be submitted by 9/03/26.

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 record review, the licensee did not comply with the section cited above in not having doctor's order on file for R2's half bed rails which poses a potential safety and/or personal rights risks to person in care.

Official plan of correction

POC Due Date: 09/03/2026 Plan of Correction Licensee stated he'll obtain doctor's order and submit copy by 9/03/26.

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 following which pose an immediate health, safety andor personal rights risks to persons in care: Ca-Rezz incontinent wash, Hydrocortisone cream, lighter in unlocked closet in the hallway; scissors, mallet, hammer. screw drivers, lubricant in a plastic storage container in the backyard; Ca-Rezz in common bathroom; scissors in one of the residents' rooms. A $250.00 civil penalty is assessed.

Official plan of correction

POC Due Date: 08/14/2025 Plan of Correction Staff locked the items. In addition, administrator to in-service the staff and submit proof by 8/14/25.

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, the licensee did not comply with the section cited above in medications in kitchen drawer without lock which poses an immediate health and/or personal rights risks to persons in care.

Official plan of correction

POC Due Date: 08/14/2025 Plan of Correction Staff locked the medications. In addition, administrator to in-service the staff and submit proof by 8/14/25.

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 observation and records review, the licensee did not comply with the section cited above in the following which pose immediate health and/or personal rights risks to persons in care: R3 has 1 medication on listed on After Visit Summary dated 8/05/25 but facility does not have medication; facility does not have 3 of R4's prescribed medications; R4's doctor's order for Tylenol (Acetaminophen) order is 325 mg but the one in facility's hand is 500 mg

Official plan of correction

POC Due Date: 08/14/2025 Plan of Correction Administrator to do the following and submit proof by 8/14/25. 1. Check with the doctor if the medications are no longer needed and obtain discontinued orders; otherwise, obtain the medications. 2. Obtain correct dosage for Tylenol.

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 administering multi Vitamins and Ferrous sulfate to R2 but these are not included on the medications/supplements listed on LIC602A dated 5/27/25 which pose an immediate health and/or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/14/2025 Plan of Correction Administrator to check with the doctor if the medication/supplements are needed by R2. If so, obtain doctor's order. Otherwise, stop the administration. Proof to be submitted by 8/14/25.

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 records review, the licensee did not comply with the section cited above in staff, S2 and S4, not having required postural support training for 2024 which posed a potential safety and/or personal rights risks to persons in care.

Official plan of correction

POC Due Date: 08/27/2025 Plan of Correction Administrator to have the staff trained and submit proof by 8/27/25.

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. 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 S3 & S5 not having the complete required 40 hours of training which poses a potential health, safety and/or personal rights risks to persons in care.

Official plan of correction

POC Due Date: 08/27/2025 Plan of Correction Administrator to have the staff complete the training. Proof to be submitted by 8/27/25.

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 R4's two prescribed medications filled on 6/18/25 & one filled on 7/18/25 not listed on LIC622 Centrally Stored Medication and Destruction Record which pose a potential personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/27/2025 Plan of Correction Administrator to record the medications and submit copy of the LIC622 by 8/27/25.

Official classification

Type A

Official code

87705(d)

Regulation authority

CCR

What the official deficiency says

87705 Care of Persons with Dementia (d) The licensee shall ensure that the facility has an auditory device or other staff alert feature to monitor exits on exterior doors and perimeter fence gates accessible to those residents who may be at risk for elopement.. -This requirement is not met as evidenced by: -Based on observation , record review and interview, the licensee did not comply in R1 able to leave unnoticed and the auditory signals of all exit doors disarmed which posed an immediate risk to the person in care. R1 sustained injuries. Civil penalty is assessed.

Official plan of correction

Licensee installed auditory signals on fence gates. Licensee tumed on the auditory signals on exit doors while LPA was at the facility. In addition, licensee to in-service the staff and submit proof by 3/01/25. A $500.00 civil penalty is assessed.

Deadline recorded: Mar 1, 2025. 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) 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...... --This requirement is not met as evidenced by: -Based on observation, the licensee did not comply with the section above in unlocked staff medications and disinfectant spray which posed immediate risks to persons in care. This is a repeat violation

Official plan of correction

Staff and licensee locked the items while LPA was at the facility. In addition, licensee to in-service the staff and submit proof by 3/01/25. A $250.00 civil penalty is assessed

Deadline recorded: Mar 1, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87202(a)(2)

Regulation authority

CCR

What the official deficiency says

(a) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, or the State Fire Marshal. Prior to accepting or retaining any of the following types of persons, the applicant or licensee shall notify the licensing agency and obtain an appropriate fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, or the State Fire Marshal: (2) Bedridden persons 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 bedridden resident (R2) but facility is not licensed nor have bedridden fire clearance which poses an immediate safety and/or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/08/2024 Plan of Correction Administrator stated will have the resident move out. Proof to be submitted by 8/08/24.

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 in the following which poses an immediate health, safety and/or personal rights risk to persons in care: Raid insect killer, gallons of liquid sanitizer in unlocked storage in the backyard; automotive agents, bug and windshield cleaner, stain remover in the backyard; staff's medications in the living room; razors in the bathroom; ointments and peritoneal cleanser in resident's room

Official plan of correction

POC Due Date: 08/08/2024 Plan of Correction Staff locked the items. In addition, administrator in-service the staff and submit copy of training topic with attendees signatures by 8/08/24.

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 risk to persons in care: rotten bitten melon leaves, asparagus, lettuce and cauliflower; expired canned good.

Official plan of correction

POC Due Date: 08/08/2024 Plan of Correction Staff threw the items. In addition, administrator in-service the staff and submit copy of training topic with attendees signatures by 8/08/24.

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, 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 records review, the licensee did not comply with the section cited above in R1's Vitamins, ointments and stool softener, and R5's Quetiapine with no doctor's orders which pose an immediate health and/or personal rights risks to persons in care.

Official plan of correction

POC Due Date: 08/08/2024 Plan of Correction Administrator to obtain doctor's orders and submit copies; otherwise, stop the administration and submit proof by 8/08/24.

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 in the following which pose a potential health, safety and/ or personal rights risks to persons in care: ensuite bathroom's shower door with mildew; cabinets with heavily peeled varnish and soiled bathtub in the common bathroom; refrigerator's vegetable crispers with mold; broken drawer knobs in 2 resident rooms and missing drawer knob in the drawer by the hallway; rusted metal cart in the yard

Official plan of correction

POC Due Date: 08/21/2024 Plan of Correction Staff cleaned the vegetable crispers. In addition, administrator to do the following and submit pictures by 8/21/24: (1) Have the shower door and bathtub cleaned.; (2) Have the cabinets re-varnished.; (3) Replace the drawer knobs.; (4) Dispose the metal cart.

Official classification

Type B

Official code

87615(a)(5)

Regulation authority

CCR

What the official deficiency says

87615 Prohibited Health Conditions (a) Persons who require health services for or have a health condition including, but not limited to, those specified below shall not be admitted or retained in a residential care facility for the elderly: (5) Residents who depend on others to perform all activities of daily living for them as set forth in Section 87459, Functional Capabilities. 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 R2 who is dependent on staff with all ADLs which poses potential health, safety and/or personal rights risks to person in care.

Official plan of correction

POC Due Date: 08/21/2024 Plan of Correction Administrator stated he'll have R2 move out and submit proof.

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…… (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 and records review, 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: R1 has doctor's order for 3 medications but facility does not have them; some of R1's medication dosages and frequency of adminstration on the labels do not match the doctor's orders; R4 has order for 1 medication which facility does not have on hand; R5 has discontinued order for Lisinopril and facility administering this medication; R5 has order for Albuterol 2.5 mg but facility does not have this medication

Official plan of correction

POC Due Date: 08/09/2024 Plan of Correction Administrator to obtain correct doctor's orders, obtain the medications and/or discontinued orders, and submit copies by 8/08/24.

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 unlocked cleaning agents, disinfectants, wound & peritoneal cleansers which pose an immediate health abd safety risks to persons in care.

Official plan of correction

POC Due Date: 08/03/2023 Plan of Correction Licensee and staff locked all the items. In addition, licensee to in-service the staff, and submit copy of training topic with attendees signatures by 8/03/23.

Official classification

Type A

Official code

87565(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..... This requirement is not met as evidenced by: Deficient Practice Statement Based on interview and record review, tthe licensee did not comply with the section cited above for having medication for R5 which is not listed on the most current list of doctor's order of medication which poses an immediate health and/or personal rights risks to person in care.

Official plan of correction

POC Due Date: 08/03/2023 Plan of Correction Licensee to check with the resident's physician, and obtain doctor's order if medication is needed. Proof to be submitted by 8/03/23.

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 the transition metal plate and wood plank detached from the flooring which pose potential safety riisks to persons in care.

Official plan of correction

POC Due Date: 08/16/2023 Plan of Correction Licensee to have the plank and plate attached back to the flooring, and submit picture by 8/16/23.

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 4 staff not having the required annual training which poses potential safety and/or ersonal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/16/2023 Plan of Correction Licensee stated he'll have the staff complete the training. Proof to be submitted by 8/16/23.

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 for bleach, Great Value All Purpose Cleaner with Bleach, ant & roach killer and Comet in unlocked kirchen cabinet which pose immediate safety risks to persons in care.

Official plan of correction

POC Due Date: 08/09/2022 Plan of Correction Licensee locked the cabinet while LPA was at the facility. In addition, licensee to in-service the staff and submit copy of in-service training with attendees signatures by 8/09/2022.