HRS CARE HOME

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: 03/14/2026 Plan of Correction Administrator has agreed to obtain a lock box to lock the medications in the refrigerator and will 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 health screening and TB test for S4 which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 03/23/2026 Plan of Correction Administrator has agreed to obtain S4's health screening and TB test. Administrator will submit a copy to CCLD by POC date.

Official classification

Type B

Official code

87355(e)(3)

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: (3) Request a transfer of a criminal record clearance as specified in Section 87355(c) or 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 S4 associated to the facility which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 03/30/2026 Plan of Correction Administrator has agreed to associate S4 to the facility and provide documentation proof to CCLD by POC date.

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 record review, the licensee did not comply with the section cited above by not having initial training completed for staff which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 04/03/2026 Plan of Correction Administrator has agreed to obtain initial training for S3 and S4. Administrator will submit training completion to CCLD by POC date.

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 paints, fertilizer, and gardening tools in the backyard which poses an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 03/08/2025 Plan of Correction Staff locked up the items during inspection. Civil penalty of $250 is being assessed for a repeat violation. Deficiency cleared.

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 record review, the licensee did not comply with the section cited above by having incomplete resident files which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 03/31/2025 Plan of Correction Administrator has agreed to obtained signed documents for all residents for future reviews. Administrator will submit self-certification to CCLD by POC date.

Official classification

Type B

Official code

87465(a)(4)

Regulation authority

CCR

What the official deficiency says

(a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following: (4) The licensee shall assist residents with self-administered medications as needed. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and record review, the licensee did not comply with the section cited above by not having PRN medications available and preparing medications a week in advance which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 03/31/2025 Plan of Correction Administrator has agreed to obtain R3's PRN medication or a discontinue order for Lactulose Solution. Administrator has agreed to conduct training regarding preparing medications and obtaining PRN medications. Administrator will submit picture proof or discontinue order and staff sign-in sheet to CCLD by POC date.

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

Maintenance and Operation. The facility shall be clean, safe, sanitary and in good repair at all times... This requirement is not met as evidence by: Based on investigation, licensee did not comply with the section cited above by having broken furniture, bed and other items in the passageways of the backyard which poses a potential health and safety risk to the persons in care.

Official plan of correction

Administrator has agreed to remove the broken item and storage items out of the passageway. Administrator will submit picture proof to CCLD by POC date.

Deadline recorded: Aug 16, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87705(c)(7)

Regulation authority

CCR

What the official deficiency says

Care of Persons with Dementia. An activity program shall address the needs and limitations of residents with dementia... This requirement is not met as evidence by: Based on investigation, licensee did not comply with the section cited above by not having an activity program to address the needs of residents with dementia which poses a potential health and safety risk to the persons in care.

Official plan of correction

Administrator has agreed to create an activity program to address the needs of each residents with dementia. Administrator will submit the activity program to CCLD by POC date.

Deadline recorded: Aug 16, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87307(a)(2)(C)

Regulation authority

CCR

What the official deficiency says

Personal Accommodations and Services. No bedroom of a resident shall be used as a passageway to another room, bath or toilet. This requirement is not met as evidence by: Based on investigation, licensee did not comply with the section cited above by using R1's room as passageway to the bathroom which poses a potential personal rights violation to the persons in care.

Official plan of correction

Administrator has agreed to conduct training to all staff on not using resident's room as passageway to the bathroom and submit staff sign in sheet to CCLD by POC date.

Deadline recorded: Aug 16, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87555(b)(6)

Regulation authority

CCR

What the official deficiency says

General Food Service Requirements. Facilities licensed for less than sixteen (16) residents shall maintain a sample menu... This requirement is not met as evidence by: Based on investigation, licensee did not comply with the section cited above by not having a sample menu which poses a potential health and safety risk to the persons in care.

Official plan of correction

Administrator has agreed to create a facility sample menu and submit a copy to CCLD by POC date.

Deadline recorded: Aug 16, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87303(e)(2)

Regulation authority

CCR

What the official deficiency says

(e) Water supplies and plumbing fixtures shall be maintained as follows: (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 having hot water at 131.9 degrees F which poses an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 03/26/2024 Plan of Correction Staff lowered hot water temperature and LPA re-measured hot water at 107.1 degrees F. Deficiency cleared.

Official classification

Type A

Official code

87307(e)

Regulation authority

CCR

What the official deficiency says

(e) Facilities providing services to residents who have physical or mental disabilities shall assure the inaccessibility of fishponds, wading pools, hot tubs, swimming pools or similar bodies of water, when not in active use by residents, through fencing, covering or other means. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above having pool gate unlocked during inspection which poses an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 03/26/2024 Plan of Correction Staff locked the pool gate during inspection. Civil penalty of $500 is being assessed. Deficiency cleared.

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 having unlocked knives in the kitchen which poses an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 03/26/2024 Plan of Correction Staff locked up the knives during inspection. Deficiency cleared.

Official classification

Type A

Official code

87355(e)(1)

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: (1) 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 record review, the licensee did not comply with the section cited above having uncleared staff work at the facility which poses an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 03/26/2024 Plan of Correction Uncleared staff left the facility and will not return to the facility until fingerprint clearance. Administrator will follow up with Guardian regarding fingerprint clearance for S4 and submit communication to CCLD by POC date. Civil penalty of $100 is being assessed.

Official classification

Type B

Official code

1569.625(b)(2)

Regulation authority

HSC

What the official deficiency says

(2) In addition to paragraph (1), training requirements shall also include an additional 20 hours annually, eight hours of which shall be dementia care training, as required by subdivision (a) of Section 1569.626, and four hours of which shall be specific to postural supports, restricted health conditions, and hospice care, as required by subdivision (a) of Section 1569.696. This training shall be administered on the job, or in a classroom setting, or both, and may include online training. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, the licensee did not comply with the section cited above not having current annual training for staff which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 04/19/2024 Plan of Correction Administrator has agreed to obtain current annual training for staff and provide training documents to CCLD by POC date.

Official classification

Type B

Official code

87705(c)(5)

Regulation authority

CCR

What the official deficiency says

(c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following: (5) Each resident with dementia shall have an annual medical assessment as specified in Section 87458, Medical Assessment, and a reappraisal done at least annually, both of which shall include a reassessment of the resident’s dementia care needs. 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 not having current medical assessment for three residents which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 04/19/2024 Plan of Correction Administrator has agreed to obtain current medical assessments for R1, R2, and R3 and will submit copies 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 under the sink which poses an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 03/11/2022 Plan of Correction Staff lock up the cleaning supplies during inspection. Deficiency cleared during inspection.

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 on dining table and in hallway closet which poses an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 03/11/2022 Plan of Correction Staff locked up medications during inspection. Deficiency cleared during inspection.

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 TB test results which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 03/28/2022 Plan of Correction Administrator will submit TB test results for the two staff to CCLD by POC date.