ANDRE ALEXIS GUEST HOME

Official classification

Type A

Official code

87355(e)(3)

Regulation authority

CCR

What the official deficiency says

(e) All individuals subject to a criminal record review... shall prior to working.. in a licensed facility: (3) Request a transfer of a criminal record clearance... This requirement was not met as evidence by: Based on record review the Licensee did not comply with the section cited above in having S1 associated to the facility, which poses an immediate health and safety risk to person in care.

Official plan of correction

By POC date, the Administrator agreed to send a copy of S1's LIC9182 and identification card to CCLD.

Deadline recorded: Mar 13, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87411(c)(1)

Regulation authority

CCR

What the official deficiency says

(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 in that S1, S2, and S3 did not have first aid certification on file which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 12/23/2025 Plan of Correction By POC date, The Administrator agrees to schedule all staff members to recieve first aid training and submit documentation of scheduled training to CCLD. Administrator agreed to also send the completion of the training on 12/23/2025.

Official classification

Type B

Official code

87463(c)

Regulation authority

CCR

What the official deficiency says

(c) If the licensee observes or is made aware of behavioral expression, as defined in Section 87101, that has caused or may cause harm to the resident or others, the licensee shall document all of the following in the resident’s reappraisal: This requirement is not met as evidenced by: Deficient Practice Statement Based on file review, the licensee did not comply with the section cited above by not having R2, R3, R4, R5 or R6's Appraisal Needs and Service Plan which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 12/23/2025 Plan of Correction By POC date, the Administrator agrees to have an Appraisals Needs and Service Plan for all residents and send proof to CCLD.

Official classification

Type A

Official code

87202(a)

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: 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 a second bolt which poses an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 12/27/2024 Plan of Correction The Administrator agrees to remove the second bold from the gate and send proof to CCLD by POC date. Civil Penalty of $500 is assessed.

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

Official plan of correction

POC Due Date: 12/27/2024 Plan of Correction Administrator locked the medication cabinet during the visit. Deficiency cleared.

Official classification

Type B

Official code

1569.311

Regulation authority

HSC

What the official deficiency says

Every residential care facility for the elderly shall have one or more carbon monoxide detectors in the facility that meet the standards established in Chapter 8 (commencing with Section 13260) of Part 2 of Division 12. The department shall account for the presence of these detectors during inspections. 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 a carbon monoxide detector not operating which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 01/03/2025 Plan of Correction Administrator agrees to buy a new carbon monoxide and send proof to CCLD by POC date.

Official classification

Type B

Official code

87463(c)

Regulation authority

CCR

What the official deficiency says

(c)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, when there is significant change in the resident’s condition, or once every 12 months, whichever occurs first, as specified in Section 87467, Resident Participation in Decision Making. 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 havig R1, R2, R3, R4, and R5 Appraisal Needs and Service Plan which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 01/10/2025 Plan of Correction Administrator agrees to have an Appraisals Needs and Service Plan for all residents and send proof to CCLD by POC date.