GOLDEN LIVING GUEST HOME

Official classification

Type A

Official code

87202(a)

Regulation authority

CCR

What the official deficiency says

87202 Fire Clearance (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. This requirement is not met as evidence by: Based on observation, file review, interview, the licensee did not comply with the section cited above by not having an approved fire clearance upstairs before letting residents (R2) go upstairs, sleeping in bedroom in which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

Administrator will redirect resident(s) to first floor licensed area for sleeping and taking space. Administrator will self-certify that they have read the regulation and will comply moving forward. Administrator will send self-certification to CCLD by POC due date. Immediate Civil Penalty $500.00

Deadline recorded: May 27, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87309(a)

Regulation authority

CCR

What the official deficiency says

87309 Storage Space and Access (a) 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 evidence by: Based on observation the licensee did not comply with the section cited above by not having the laundry room door locked upstairs which toxic chemicals: Laundry detergent, Downy Softener, multi-purpose disinfectant, drain cleanser were unlocked in laundry room. In which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

Administrator agreed to conduct an In-Service Training with staff and send sign-in sheet to CCLD by POC due date.

Deadline recorded: May 27, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

87303 Maintenance and Operations (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 evidence by: Based on observation, the licensee did not comply with the section cited above by not having piles of wood debris cleared from front yard which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Administrator agreed to clean up piles of wooden debris from front yard/sidewalk and send a photo to CCLD by POC due date.

Deadline recorded: Jun 9, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87632(d)(2)

Regulation authority

CCR

What the official deficiency says

CCR 87632 Hospice Care Waiver (d) If the Department grants a hospice care waiver it shall stipulate terms and conditions of the waiver as necessary to ensure the well-being of terminally ill residents and of all other facility residents, which shall include, but not be limited to, the following requirements: (2) The licensee shall notify the Department in writing within five working days of the initiation of hospice care services for any terminally ill resident in the facility or within five working days of admitting a resident already receiving hospice care services. The notice shall include the resident's name and date of admission to the facility and the name and address of the hospice. Based on observation, record review and interview the licensee did not comply with the section cited above by not notifying CCLD of R5 hospice care which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Administrator sent hospice notification to CCLD for R5 during visit. Deficiency cleared during visit.

Deadline recorded: Jun 9, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87633(b)

Regulation authority

CCR

What the official deficiency says

87633 Hospice Care of Terminally Ill Residents (b) A current and complete hospice care plan shall be maintained in the facility for each hospice resident and include the following: Based on record review and interview the licensee did not comply with the section cited above by not having a signed hospice care plan on file for R5 which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Administrator agreed to submit an signed hospice care plan for R5 to CCLD by POC due date.

Deadline recorded: Jun 9, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87633(h)(5)

Regulation authority

CCR

What the official deficiency says

87633 HospiceCare of Terminally Ill Residents (h) For each terminally ill resident receiving hospice services in the facility, the licensee shall maintain the following in the resident’s record: (5) A statement signed by the resident's roommate, if any, or any resident who will share a room with a person who is terminally ill to be accepted or retained as a resident, indicating his or her acknowledgment that the resident intends to receive hospice care in the facility for the remainder of the resident's life, and the roommate's voluntary agreement to grant access to the shared living space to hospice caregivers, and the resident's support network of family members, friends, clergy, and others. Based on record review and interview the licensee did not comply with the section cited above by not having a signed statement agreement on file for R4 whom shares room with R5 which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Administrator agreed to get a signed statement from R4's responsible party and send to CCLD by POC due date.

Deadline recorded: Jun 9, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87463(a)

Regulation authority

CCR

What the official deficiency says

87463 Reappraisals (a) The pre-admission appraisal, as specified in Section 87457, Pre-Admission Appraisal, shall be updated in writing as frequently as necessary or once every 12 months, whichever occurs first, to note significant changes in condition, as defined in Section 87101, Definitions, and to keep the appraisal accurate. For the purposes of this section, the updated pre-admission appraisal shall be referred to as the reappraisal. This requirement is not met as evidence by: Based on record review and interview, the licensee did not comply with the section cited above by having completed Appraisal Needs and Services (ANS) on file for R4 and R5 which poses an health, safety or personal rights risk to persons in care.

Official plan of correction

Administrator to send ANS for R4 and R5 updated with change of condition (hospice and bedridden) and signed to CCLD by POC due date. Repeat Civil Penalty $250.00

Deadline recorded: Jun 9, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87507(e)

Regulation authority

CCR

What the official deficiency says

87507 Admission Agreements (e) The licensee shall provide a copy of the signed and dated current admission agreement, and all subsequent signed and dated modifications, to the resident or the resident's representative, if any, immediately upon signing the admission agreement or modification. This requirement is not met as evidence by: Based on record review and interview, the licensee did not comply with the section cited above by not having an signed Admissions Agreement on file for R4 and R5 who were transferred from another facility which poses an health, safety or personal rights risk to persons in care.

Official plan of correction

Administrator agreed to send a copy of signed Admission Agreements for R4 and R5 to CCLD by POC due date. Repeat Civil Penalty $250.00

Deadline recorded: Jun 9, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87608(a)(3)

Regulation authority

CCR

What the official deficiency says

87608 Postural Supports (3) A written order from a physician indicating the need for the postural support shall be maintained in the resident’s record. This requirement is not met as evidence by: Based on observation, record review and interview, the licensee did not comply with the section cited above by not having an doctor's orders on file for R1, R2 and R3 which poses an health, safety or personal rights risk to persons in care. This requirement is not met as evidence by:

Official plan of correction

Administrator agreed to submit doctor's orders for postural/mobility support for R1, R4 and R5 to CCLD by POC due date. Repeat Civil Penalty $250.00

Deadline recorded: Jun 9, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87507(a)

Regulation authority

CCR

What the official deficiency says

(a) The licensee shall complete an individual written admission agreement, as defined in Section 87101(a), with each resident or the resident's representative, if any. 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 5 persons which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/15/2026 Plan of Correction An updated signed copy of the admission agreement for 3 residents will be submitted to LPA by POC date.

Official classification

Type A

Official code

87202(a)(2)

Regulation authority

CCR

What the official deficiency says

87202 Fire Clearance (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 evidence by: Based on observation, file review, interview, the licensee did not comply with the section cited above by not having a fire clearance for bedridden (R1) in a room that wasn't cleared as a bedroom per facility sketch and current fire clearance dated 10/24/22 which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

Administrator agreed to submit an updated facility sketch that will include all bedrooms and bedridden. In addition, Administrator will submit notification to local fire district of bedridden resident in facility. All copies of documents will be submitted to CCLD by POC due date. Immediated Civil Penalty $500.00 assessed.

Deadline recorded: Feb 12, 2026. 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

87307 Personal Accommodations and Services (a) Living accommodations...shall be related to the facility's function. ... provide comfortable living accommodations and privacy for the residents... The following provisions shall apply: (2) Resident bedrooms shall be provided which meet... (C) 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 observation, the licensee did not comply with the section cited above by allowing the use of R2's and R3's bedroom as a passageway to another room for R1 which poses an health, safety or personal rights risk to persons in care.

Official plan of correction

Administrator agreed to read the regulation and self certify understanding the regulation. Administrator stated that they will lock the sliding glass window that is connected between Bedroom #3 and adjacent room. Documents will be sent to CCLD by POC due date.

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

Official classification

Type B

Official code

87463(a)

Regulation authority

CCR

What the official deficiency says

87463 Reappraisals (a) The pre-admission appraisal, as specified in Section 87457, Pre-Admission Appraisal, shall be updated in writing as frequently as necessary or once every 12 months, whichever occurs first, to note significant changes in condition, as defined in Section 87101, Definitions, and to keep the appraisal accurate. For the purposes of this section, the updated pre-admission appraisal shall be referred to as the reappraisal. This requirement is not met as evidence by: Based on record review and interview, the licensee did not comply with the section cited above by having completed Appraisal Needs and Services (ANS) on file for R1-R6 which poses an health, safety or personal rights risk to persons in care.

Official plan of correction

Administrator agreed to complete ANS for R1-R6 and send completed signed copies to CCLD by POC due date.

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

Official classification

Type B

Official code

87507(e)

Regulation authority

CCR

What the official deficiency says

87507 Admission Agreements (e) The licensee shall provide a copy of the signed and dated current admission agreement, and all subsequent signed and dated modifications, to the resident or the resident's representative, if any, immediately upon signing the admission agreement or modification. This requirement is not met as evidence by: Based on record review and interview, the licensee did not comply with the section cited above by not having an updated Admissions Agreement on file for R4 and R6 who were transferred from another facility (same Licensee) which poses an health, safety or personal rights risk to persons in care.

Official plan of correction

Administrator agreed to submit copies of updated signed admission agreements for R4 and R6 and will submit to CCLD by POC due date.

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

Official classification

Type B

Official code

87608(a)(3)

Regulation authority

CCR

What the official deficiency says

87608 Postural Supports (3) A written order from a physician indicating the need for the postural support shall be maintained in the resident’s record. This requirement is not met as evidence by: Based on observation, record review and interview, the licensee did not comply with the section cited above by not having an doctor's orders on file for R1, R2 and R3 which poses an health, safety or personal rights risk to persons in care. This requirement is not met as evidence by:

Official plan of correction

Administrator agreed to submit doctor's orders for postural/mobility support for R1, R2 and R3 to CCLD by POC due date.

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

Official classification

Type B

Official code

87623(b)

Regulation authority

CCR

What the official deficiency says

87623 Indwelling Urinary Catheter (b) In addition to Section 87611, General Requirements for Allowable Health Conditions, the licensee shall be responsible for the following: (1) Ensuring that insertion and irrigation of the catheter shall be performed by an appropriately skilled professional. This requirement is not met as evidence by: Based on observation, record review and interview, the licensee did not comply with the section cited above by not having the home health care plan on file for R2's foley catheter and caregiver training with draining the catheter bag which poses an health, safety or personal rights risk to persons in care.

Official plan of correction

Administrator agreed to submit a copy of home health care plan for R2's foley catheter and training record for staff caregiversby skilled health professional to CCLD by POC due date.

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

Official classification

Type B

Official code

87609(b)(4)

Regulation authority

CCR

What the official deficiency says

87609 Allowable Health Conditions and the Use of Home Health Agencies (b) Incidental medical care may be provided to residents through a licensed home health agency provided the following conditions are met: (4) The licensee and home health agency agree in writing on the responsibilities of the home health agency, and those of the licensee in caring for the resident’s medical condition(s). This requirement is not met as evidence by: Based on record review and interview, the licensee did not comply with the section cited above by not having a home health care plan on file for R1's wound care including but not limited to physical therapy, occupational therapy and nurse aide which poses an health, safety or personal rights risk to persons in care.

Official plan of correction

Administrator agreed to submit a home health care plan for R1's wound care and submit to CCLD by POC due date

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

Official classification

Type B

Official code

87628(a)

Regulation authority

CCR

What the official deficiency says

(a) The licensee shall be permitted to accept or retain a resident who has diabetes if the resident is able to perform his/her own glucose testing with blood or urine specimens, and is able to administer his/her own medication including medication administered orally or through injection, or has it administered by an appropriately skilled professional. This requirement is not met as evidence by: Based on record review and interview, the licensee did not comply with the section cited above by not having an appropriately skilled professional administering insulin injections for R1's diabetes which poses an health, safety or personal rights risk to persons in care.

Official plan of correction

Administrator agreed to submit an updated Physician's Report (LIC602-A) for R1 showing that they can administer their own insulin injections or documentation that an appropriately skilled professional to CCLD by POC due date

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