LAKESHORE RESIDENTIAL CARE

Official classification

Type A

Official code

87465(h)(5)

Regulation authority

CCR

What the official deficiency says

(h) The following requirements shall apply to medications which are centrally stored: (5) Each resident's medication shall be stored in its originally received container. No medications shall be transferred between containers. This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above by having pre-poured medication which poses an immediate health and safety risk to persons in care.

Official plan of correction

Administrator will submit a written statement of having read and understood the regulation and conducted in-service training with all staff, providing CCLD with a copy of all signatures of staff attended no later than the POC date.

Deadline recorded: Apr 16, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87309(a)(b)

Regulation authority

CCR

What the official deficiency says

a) Except as specified in subsection (b)the licensee ... that disinfectants, cleaning solutions, poisonous... objects, and other similar items which ...r to residents are in locked storage and are not left unattended... locked storage. This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above by having unlocked cleaning solution which poses an immediate health and safety risk to persons in care.

Official plan of correction

Staff locked up the items during inspection. Deficiency cleared.

Deadline recorded: Apr 16, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.1(a)(6)

Regulation authority

CCR

What the official deficiency says

(a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: 6) To leave or depart the facility at any time and to not be locked into any room, building, or on facility premises by day or night. This does not prohibit a licensee from establishing house rules, such as locking doors at night to protect residents, or barring windows against intruders, with permission from the Department. This requirement was not met as evidence by: Based on observation the Licensee did not comply with the section cited above in having from entry door unlocked from the inside, which poses a potential safety risk to persons in care.

Official plan of correction

Administrator immediately unlocked front entry door and left it unlocked. Deficiency cleared during visit.

Deadline recorded: Mar 10, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

1569.605

Regulation authority

HSC

What the official deficiency says

On and after July 1, 2015, all residential care facilities for the elderly, except those facilities that are an integral part of a continuing care retirement community, shall maintain liability insurance covering injury to residents and guests in the amount of at least one million dollars ($1,000,000) per occurrence and three million dollars ($3,000,000) in the total annual aggregate, caused by the negligent acts or omissions to act of, or neglect by, the licensee or its employees. 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 the liability insurance cover the enough amount required per occurrence and total annual aggregate which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 12/31/2025 Plan of Correction The Administrator agrees to increase the liability insurance to the sufficient amount and send proof to CCLD by POC date.

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 having the resident's shower room used as a storage room filled with debris which poses a potential safety risk to persons in care.

Official plan of correction

POC Due Date: 12/31/2025 Plan of Correction The Administrator agrees to remove the items from the shower room and send proof to CCLD by POC 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 not having S2 associated with the facility on Guardian which poses a potential safety risk to persons in care.

Official plan of correction

POC Due Date: 12/31/2025 Plan of Correction The Administrator agrees to associate S2 with the facility and send proof to CCLD by POC date.

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 by. Administrator was unable to provide staff training for 2025 which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 01/06/2026 Plan of Correction The Administrator agrees to conduct staff training and send proof to CCLD by POC date.

Official classification

Type B

Official code

87467(a)(3)

Regulation authority

CCR

What the official deficiency says

(a) Prior to, or within two weeks of the resident's admission, the licensee shall arrange a meeting with the resident, the resident's representative, if any, appropriate facility staff, and a representative of the resident's home health agency, if any, and any other appropriate parties, to prepare a written record of the care the resident will receive in the facility, and the resident's preferences regarding the services provided at the facility. (3) The licensee shall arrange a meeting with the resident and appropriate individuals identified in Section 87467(a)(1) to review and revise the written record as specified, when there is a significant change in the resident's condition, or once every 12 months, whichever occurs first. Significant changes shall include, but not be limited to occurrences specified in Section 87463, Reappraisals. 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 an updated appraisal needs and services plan for R2 and R5 which poses a potential personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/06/2026 Plan of Correction Administrator agrees to update the appraisal needs and service plan for the residents and send proof to CCLD by POC date.

Official classification

Type A

Official code

87465(g)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care: (g) The licensee shall immediately telephone 9-1-1 if an injury or other circumstance has resulted in an imminent threat to a resident’s health including, but not limited to, an apparent life-threatening........ -This requirement is not met as evidenced by: -Based on interviews and records review, the licensee did not comply with the section when R1 fell and sustained injury and staff did not call 9-1-1 immediately which posed an immediate health, safety and personal rights risks to person in care.

Official plan of correction

Administrator to in-service the staff and submit copy of training topics with attendees signatures by 5/01/25.

Deadline recorded: May 1, 2025. 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 Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. -This requirement is not met as evidenced by: -Based on interviews, the licensee did not comply with the section above in facility having cockroaches.

Official plan of correction

Corrected. Administrator contracted with pest control company to eradicate the pest problems.

Deadline recorded: May 14, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87217

Regulation authority

CCR

What the official deficiency says

87217 Safeguards for Resident Cash, Personal Property, and Valuables (b) Every facility shall take appropriate measures to safeguard residents... personal property and valuables which have been entrusted to the licensee or facility staff. Based on observation the licensee did not comply with the section cited above. Items were being taked from a resident's room which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Administrator will install a lock on resident closet to protect her belongings

Deadline recorded: Dec 17, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87216(a)

Regulation authority

CCR

What the official deficiency says

87216 Bonding (a) Each licensee, other than a county, who is entrusted to safeguard resident cash resources, shall file or have on file with the licensing agency a copy of a bond issued by a surety company to the State of California as principal. This requirement is not met as evidenced by; Based on records submitted by Administrator to LPA L. Fontanilla, facility is handling resident cash resources but does not have required surety bond issued by a surety company to the State of California as principal which is a potential risk to health and safety of residents under care.

Official plan of correction

Deficiency Cleared. (Facility has provided CCL surety bond on 3/2/22.) On 3/2/2022, Licensee has provided LPA L. Fontanilla a copy of facility’s surety bond in the amount of $50,000 issued by s surety company to the State of California. This deficiency is cleared

Deadline recorded: Mar 15, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87216(d)

Regulation authority

CCR

What the official deficiency says

87216 Bonding (d) No licensee shall either handle money of a resident or handle amounts greater than those stated in the affidavit submitted by him or for which his bond is on file without first notifying the licensing agency and filing a new or revised bond as required by the licensing agency. This requirement is not met as evidenced by; Based on Affidavit Regarding Client/Resident Cash Resources (LIC400) signed by Administrator on 3/1/2022, the amount of money facility will handle for all residents has a maximum of $800.00 per month. A review of the expense logs submitted to LPA L. Fontanilla indicate facility is handling more than what is indicated in LIC400 which is a potential risk to the health and safety of residents under care.

Official plan of correction

Administrator agreed to update LIC400 and indicate the actual maximum amount of resident money facility will handle in a month and submit the form to CCL by the POC due date.

Deadline recorded: Mar 18, 2022. A deadline is not proof that correction was completed.