GRACE HOME CARE - LLOYD

Official classification

Type A

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 by having hot water temperature at 131.5 degrees F at the hallway bathroom sink and shared residents' bathroom. which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/19/2026 Plan of Correction The licensee agrees to immediately adjust and maintain the hot water temperature at the hallway bathroom sink and shared residents’ bathroom within the required regulatory temperature range. The Administrator will conduct and document daily checks of the hot water temperature for 7 consecutive days and weekly thereafter for 30 days to ensure continued compliance. The Administrator will provide staff with in-service training regarding the required hot water temperature and submit documentation of correction and training to CCLD by the POC due date 8/25/26

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 by having unlocked chemicals in the shared resident bathroom, RM 3, and the backyard. which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/19/2026 Plan of Correction The licensee agrees to immediately secure all chemicals and cleaning products in locked storage areas inaccessible to residents. The Administrator will conduct a facility-wide inspection to ensure all chemicals are properly stored and locked. Staff will be reminded of the facility’s chemical storage procedures, and the Administrator will conduct and document weekly checks for 30 days to ensure continued compliance. Documentation of correction and staff training will be submitted to CCLD by the POC due date 8/25/26

Official classification

Type A

Official code

87465(h)(2)

Regulation authority

CCR

What the official deficiency says

(h) The following requirements shall apply to medications which are centrally stored: (2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above by having unlocked medications in residents' RMs 1, 2, 3, and 4. which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/19/2026 Plan of Correction The licensee agrees to immediately secure all medication in locked storage areas inaccessible to residents. The Administrator will conduct a facility-wide inspection to ensure all medication are properly stored and locked. Administrator will conduct and document weekly checks for 30 days to ensure continued compliance. Documentation of correction and staff training will be submitted to CCLD by the POC due date 8/25/26

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 by having multiple trash bags and containers in the backyard and along the side of the facility. which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/28/2026 Plan of Correction The licensee agrees to immediately remove all trash bags and containers from the backyard and along the side of the facility and properly dispose of the waste. The Administrator will conduct a facility-wide inspection to ensure the premises are maintained in a clean, safe, and sanitary condition. Staff will be reminded of proper trash disposal procedures, and the Administrator will conduct and document weekly inspections for 30 days to ensure continued compliance. Documentation of correction will be submitted to CCLD.

Official classification

Type B

Official code

87307(a)(2)(B)

Regulation authority

CCR

What the official deficiency says

(a) Living accommodations and grounds shall be related to the facility's function. The facility shall be large enough to provide comfortable living accommodations and privacy for the residents, staff, and others who may reside in the facility. The following provisions shall apply: (2) Resident bedrooms shall be provided which meet, at a minimum, the following requirements: (B) No room commonly used for other purposes shall be used as a sleeping room for any resident. This includes any hall, stairway, unfinished attic, garage, storage area, shed or similar detached building. 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 by having the garage is being used as a sleeping area, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/28/2026 Plan of Correction The licensee agrees to immediately discontinue the use of the garage as a sleeping area and ensure that all residents are provided with appropriate, approved sleeping accommodations. The Administrator will inspect the facility to ensure that no unapproved areas are being used for resident sleeping or living purposes. Staff will be informed of the requirement to use only designated and approved resident areas. The Administrator will monitor compliance and document the corrective action. Documentation of the correction will be submitted to CCLD by the POC due date.

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 by not having no S3 TB or Health Screen on file on today's date, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/21/2026 Plan of Correction The licensee agrees to immediately obtain and maintain the required TB clearance and health screening documentation for S3 in the personnel file. The Administrator will review all staff personnel files to ensure required TB and health screening documentation is complete and current. Staff will be reminded of the facility’s requirements for maintaining these records. The Administrator will monitor personnel files for compliance and submit documentation of correction to CCLD by the POC due date.

Official classification

Type B

Official code

87355(e)

Regulation authority

CCR

What the official deficiency says

(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: 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 by S1 and S2, not associated with the facility. LPA checked Gradian on 8/18/26 at 9:25 AM. which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/25/2026 Plan of Correction The licensee agrees to immediately ensure that all staff members are properly associated with the facility in Guardian prior to providing services to residents. The Administrator will review the facility’s current staff roster and verify that each staff member is appropriately associated with the facility in Guardian. The Administrator will also review the association status of S1 and S2 and take corrective action as needed. Staff will be reminded of the requirement to maintain current and accurate personnel association records. Documentation of correction will be submitted to CCLD by the POC due date.

Official classification

Type B

Official code

87468.1(a)(1)

Regulation authority

CCR

What the official deficiency says

Personal Rights of Residents in All Facilities. To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement is not met as evidence by: Based on observation, licensee did not comply with the section cited above by staff speaking inappropriately to residents which poses a potential personal rights violations to the persons in care.

Official plan of correction

Administrator has agreed to conduct training to staff regarding personal rights and submit staff sign in sheet to CCLD by POC date.

Deadline recorded: Sep 5, 2025. A deadline is not proof that correction was completed.

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 by having unlocked gardening shears in the backyard which poses an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 07/26/2025 Plan of Correction Staff locked up the gardening shears during inspection. Deficiency cleared

Official classification

Type A

Official code

87465(h)(2)

Regulation authority

CCR

What the official deficiency says

(h) The following requirements shall apply to medications which are centrally stored: (2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above by having unlocked medication in the refrigerator which poses an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 07/26/2025 Plan of Correction Staff locked up the medications during inspection. Deficiency cleared

Official classification

Type B

Official code

87307(d)(2)

Regulation authority

CCR

What the official deficiency says

(2) The premises shall be maintained in a state of good repair and shall provide a safe and healthful environment. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above by having side fence in disrepair which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 08/15/2025 Plan of Correction Facility will create a plan of action to repair the side fence so that the side gate latch can close. Facility will submit the plan to CCLD by POC date.

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 record review, the licensee did not comply with the section cited above by not following doctor's order for R2's medications which poses an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 07/28/2025 Plan of Correction Facility has agreed to create a plan to obtain the correct medications and/or obtain doctor's orders for R2's calcium, probiotic gummies, and magnesium oxide. Plan should also include additional staff training on medication administration. Facility will submit plan to CCLD by POC date. Civil penalty of $250 is being assessed for repeat violation.

Official classification

Type A

Official code

87705(f)(1)

Regulation authority

CCR

What the official deficiency says

(f) The following shall be stored inaccessible to residents with dementia: (1) Knives, matches, firearms, tools and other items that could constitute a danger to the resident(s). This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above by having unlocked knife, lighter, and cleaning supplies which poses an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 08/09/2024 Plan of Correction Staff locked up the items during inspection. Deficiency cleared.

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, the licensee did not comply with the section cited above by not having the correct Acetaminophen available which poses an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 08/09/2024 Plan of Correction Administrator has agreed to obtain Acetaminophen 325mg and submit picture proof to CCLD by POC date. Civil penalty of $250 is being assessed for repeat violation.

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 by not having written orders from a physician for R1 and R3 which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 08/30/2024 Plan of Correction Facility has agreed to obtain written orders from a physician for R1 and R3's bed rails. Facility will submit a copy to CCLD by POC date.

Official classification

Type B

Official code

87608(a)(5)(B)

Regulation authority

CCR

What the official deficiency says

(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. 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 by having full bed rails for R3 who is not on hospice care which poses a potential personal rights violation to persons in care.

Official plan of correction

POC Due Date: 08/16/2024 Plan of Correction Facility has agreed to remove full bed rails for R3 and submit picture proof to CCLD by POC date.

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 by having unlocked cleaning supplies and gardening tools accessible which poses an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 08/14/2023 Plan of Correction Staff locked up the cleaning supplies and gardening tools during inspection. Deficiency cleared.

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, the licensee did not comply with the section cited above by not having the correct Ferrous Sulfate supplement available which poses an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 08/14/2023 Plan of Correction Administrator has agreed to obtain the Ferrous Sulfate 325mg supplement and submit picture proof to CCLD by POC date.

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 by not having S2's health screening which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 09/01/2023 Plan of Correction Administrator has agreed to obtain S2's health screening and submit a copy to CCLD by POC date.

Official classification

Type B

Official code

1569.69(a)(2)

Regulation authority

HSC

What the official deficiency says

(a) Each residential care facility for the elderly licensed under this chapter shall ensure that each employee of the facility who assists residents with the self-administration of medications meets all of the following training requirements: (2) In facilities licensed to provide care for 15 or fewer persons, the employee shall complete 10 hours of initial training. This training shall consist of 6 hours of hands-on shadowing training, which shall be completed prior to assisting with the self-administration of medications, and 4 hours of other training or instruction, as described in subdivision (f), which shall be completed within the first two weeks of employment. 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 by not having medication training for S2 which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 09/01/2023 Plan of Correction Administrator has agreed to conduct medication training for S2 and submit training document to CCLD by POC date.

Official classification

Type B

Official code

1569.695(c)

Regulation authority

HSC

What the official deficiency says

(c) A facility shall conduct a drill at least quarterly for each shift. The type of emergency covered in a drill shall vary from quarter to quarter, taking into account different emergency scenarios. An actual evacuation of residents is not required during a drill. While a facility may provide an opportunity for residents to participate in a drill, it shall not require any resident participation. Documentation of the drills shall include the date, the type of emergency covered by the drill, and the names of staff participating in the drill. 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 by not conducting an emergency drill every 3 months which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 09/01/2023 Plan of Correction Administrator has agreed to conduct an emergency drill and submit completion document to CCLD by POC date.

Official classification

Type B

Official code

87411(c)(1)

Regulation authority

CCR

What the official deficiency says

(c) All RCFE staff who assist residents with personal activities of daily living shall receive initial and annual training as specified in Health and Safety Code sections 1569.625 and 1569.69 (1) Staff providing care shall receive appropriate training in first aid from persons qualified by such agencies as the American Red Cross. 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 by not having current first aid training for S1 which poses a potential health and safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/01/2023 Plan of Correction Administrator has agreed to obtain current first aid training for S1 and submit completion document to CCLD by POC date.

Official classification

Type B

Official code

87506(d)

Regulation authority

CCR

What the official deficiency says

(d) All resident records shall be available to the licensing agency to inspect, audit, and copy upon demand during normal business hours. Records may be removed if necessary for copying. Removal of records shall be subject to the following 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 by having incomplete files for R2 and R3 which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 09/01/2023 Plan of Correction Administrator has agreed to obtain R2 and R3's complete file and have it available at the facility for any future reviews. Administrator will submit self-certification to CCLD by POC date.

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 by having unlocked cleaning supplies and broken lock for the knives drawer which poses an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 07/14/2022 Plan of Correction Staff locked up cleaning supplies and scissors. Staff will fix the lock and send picture proof to CCLD by POC date.

Official classification

Type A

Official code

87465(h)(2)

Regulation authority

CCR

What the official deficiency says

(h) The following requirements shall apply to medications which are centrally stored: (2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above by having unlocked medication in the refrigerator and unlocked medication cabinet which poses an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 07/14/2022 Plan of Correction Staff locked up the medication in the refrigerator and the medication cabinet during inspection. Deficiency cleared.

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 by having clutter in the backyard on the passageway which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 07/20/2022 Plan of Correction Staff removed clutter from backyard passageways during inspection. Deficiency cleared.

Official classification

Type B

Official code

87555(b)(23)

Regulation authority

CCR

What the official deficiency says

(b) The following food service requirements shall apply: (23) All readily perishable foods or beverages capable of supporting rapid and progressive growth of micro-organisms which can cause food infections or food intoxications shall be stored in covered containers at appropriate temperatures. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above by storing pre-refrigerated eggs on counter top at room temperature for a couple days which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 07/15/2022 Plan of Correction LPA witnessed staff threw away contaminated eggs in the garbage can during inspection. Deficiency cleared.