HERITAGE HAVEN

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.. tools, sharp objects.. could pose a danger to residents.. This requirement is not met as evidenced by: Based on observation and interview, the licensee did not comply with the section cited above drill bits, screwdriver bits, Ez Patch Spackling Compound, Paint and Joint Compound, WD Spray, Clorox bleach and detergent unlocked which poses an immediate health and safety risk to persons in care.

Official plan of correction

By POC date, Licensee agrees to remove and put them in a locked cabinet and submit a self certification letter stating that this was completed to CCLD.

Deadline recorded: Jul 2, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87303(1)

Regulation authority

CCR

What the official deficiency says

87303 Maintenance and Operation (1) Floor surfaces in bath, laundry and kitchen areas shall be maintained in a clean, sanitary, and odorless condition. This requirement is not met as evidenced by: Based on observation and interview, the licensee did not comply with the section cited above in that the residents bathtub, showers and toilet had mold which poses a potential health and safety risk to persons in care

Official plan of correction

By POC date, Licensee agrees to have shower, bathtub and toilets deeply cleaned and the mold removed and submit photo proof that this was completed to CCLD.

Deadline recorded: Jul 8, 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 Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times... This requirement is not met as evidenced by: Based on observation and interview, the licensee did not comply with the section cited above in that the construction contract does not have a concrete timeline of completion and the light bulbs upstairs are non operable which poses a potential health and safety risk to persons in care.

Official plan of correction

By POC date, Licensee agrees to complete a detailed construction timeline with a completetion date and change the non operable lightbulbs and replace them with new lightbulbs and submit a copy of the construction timeline and self-certification letter stating that the light bulbs were changed to CCLD.

Deadline recorded: Jul 8, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87303(d)

Regulation authority

CCR

What the official deficiency says

87303 Maintenance and Operation (d) There shall be lamps or light appropriate for the use of each room and sufficient to ensure the comfort and safety of all persons in the facility This requirement is not met as evidenced by: Based on observation and interview, the licensee did not comply with the section cited above in that the facility is using a single light strip in the resident hallway and multiple light fixtures are non operable which poses a potential health and safety risk to persons in care.

Official plan of correction

By POC date, Licensee agrees to remove the single light strip and replace the light fixtures and submit photo proof that this was completed to CCLD.

Deadline recorded: Jul 8, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87506(d)

Regulation authority

CCR

What the official deficiency says

87506 Resident Records (d) All resident records shall be available to the licensing agency to inspect, audit, and copy upon demand during normal business hours.. This requirement is not met as evidenced by: Based on interview, the licensee did not comply with the section cited above in not having residents files available for licensing to review which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

By POC date, the Administrator agreed to review section 87506 and assign at least one staff member on shift to have access to resident files and submit a self certification letter to CCLD.

Deadline recorded: Jul 8, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

1569.17(c)(1)(A)

Regulation authority

CCR

What the official deficiency says

(c)(1)(A) Subsequent to initial licensure, a person.. (b) who is not exempted from fingerprinting shall obtain.. (f) of this section or Section 1522.7, from the State Department of Social Services prior to employment.. This requirement is not met as evidenced by: Based on observation, interview, the licensee did not comply with the section cited above in not having S1 fingerprinted and associated to the facility which poses an immediate health and safety risk to persons in care

Official plan of correction

By POC date, Licensee agreed to have S1 fingerprinted and associated to the facility and submit copy of fingerprint document to CCLD.

Deadline recorded: May 28, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87412(a)(11)

Regulation authority

CCR

What the official deficiency says

(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: (11) A health screening as specified in Section 87411, Personnel Requirements - General. 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 by not having health screening and negative TB results for S3 on file which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 02/24/2026 Plan of Correction By POC date, the administrator agrees submit the health screening and TB results to CCLD.

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 in that S2, S3, S4, and S5 had missing required 20 hr annual training which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 02/24/2026 Plan of Correction By POC date, the Administrator agrees to submit documentation of completed 20 hr annual training to CCLD.

Official classification

Type B

Official code

87463(b)

Regulation authority

CCR

What the official deficiency says

(b) The reappraisal shall document significant changes in the resident's physical, mental, cognitive, behavioral, or functional condition, including those required to be documented as specified in Section 87466, Observation of the Resident. This requirement is not met as evidenced by: Deficient Practice Statement Based on records review, the licensee did not comply with section above in R1, R3, and R4 did not have updated Appraisal Needs and Services Plans which poses a potential health and safety risks to persons in care.

Official plan of correction

POC Due Date: 02/24/2026 Plan of Correction By POC date, The Administrator agrees to complete updated Appraisal Needs and Services plans for R1, R3, and R4 to CCLD.

Official classification

Type B

Official code

87203

Regulation authority

CCR

What the official deficiency says

87203 Fire Safety All facilities shall be maintained in conformity with the regulations adopted by the State Fire Marshal for the protection of life and property against fire and panic. 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 that 2 out of 2 fire extinguishers were expired, which poses a potential safety risk to persons in care.

Official plan of correction

POC Due Date: 02/24/2026 Plan of Correction By POC date, the Administrator agrees to replace or service all fire extinguishers and send photo proof to CCLD.

Official classification

Type B

Official code

1569.69(b)

Regulation authority

HSC

What the official deficiency says

(b) Each employee who received training and passed the examination required in paragraph (5) of subdivision (a), and who continues to assist with the self-administration of medicines, shall also complete eight hours of in-service training on medication-related issues in each succeeding 12-month period. 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. 0 of 5 staff had a record of 8 hours of training on medications within the past 12 months, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/26/2025 Plan of Correction On or before the due date the Licensee will submit proof to LPA that ALL staff members have completed 8 hours of medication training and proof of training has been added to their records.

Official classification

Type B

Official code

87466

Regulation authority

CCR

What the official deficiency says

87466 Observation of the Resident..The licensee shall ensure that residents are regularly observed...the licensee shall ensure that such changes are documented and brought to the attention of the resident's physician and the resident's responsible person, if any. This requirement is not met as evidenced by: Based on interview, the licensee did not comply with the section above for not doing an updated reappraisal with the changes in R1 getting lost when leaving the facility. This posed a potential health and safety risk to person in care.

Official plan of correction

Administrator will do an reappraisal with R1's physician and submit an updated re-appraisal and Physician's Report to CCLD by POC date.

Deadline recorded: Oct 8, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87203

Regulation authority

CCR

What the official deficiency says

All facilities shall be maintained in conformity with the regulations adopted by the State Fire Marshal for the protection of life and property against fire and panic. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above with non-operational smoke detectors, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/14/2024 Plan of Correction Licensee shall replace all smoke detectors with new fully operational smoke detectors.

Official classification

Type B

Official code

87470(a)(2)(A)

Regulation authority

CCR

What the official deficiency says

(a) A licensee shall ensure that infection control practices are maintained as follows: (2) Environmental cleaning and disinfection activities shall be performed following the manufacturers' instructions for proper use of the cleaning and disinfecting products. These activities shall be completed, at a minimum, as follows: (A) Surfaces such as floors, chairs, toilets, sinks, counters and tabletops shall be cleaned and disinfected on a regular basis to ensure they are safe and sanitary. These surfaces shall also be disinfected when these surfaces are contaminated and visibly soiled with blood or body fluids or other potentially infectious material. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above throughout the facility, with flooring that is in disrepair: the vinyl and/or linoleum flooring is chipped, the carpeting has holes, dirty, frayed on the edges, and littered with gum and/or other substances stuck to it, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/14/2024 Plan of Correction Licensee shall replace all flooring in disrepair with commercial grade vinyl or linoleum.

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 with a window cracked in room 21, kitchen cabinets and drawers in disrepair, broken garbage disposal in kitchen sink, a broken sink in room #2, which pose a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/14/2024 Plan of Correction Licensee shall replace or repair to full function all items in disrepair within the facility including all listed above and any others not listed above.

Official classification

Type B

Official code

87303(c)

Regulation authority

CCR

What the official deficiency says

(c) All window screens shall be clean and maintained in good repair. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above the window screens in rooms 2 and 10 in disrepair, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/14/2024 Plan of Correction All window screens must be inspected, repaired, or replaced by the Licensee.

Official classification

Type B

Official code

87303(e)(6)

Regulation authority

CCR

What the official deficiency says

(e) Water supplies and plumbing fixtures shall be maintained as follows: (6) Toilet, handwashing and bathing facilities shall be maintained in operating condition. Additional equipment shall be provided in facilities accommodating physically handicapped and/or nonambulatory residents, based on the residents' needs. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above with bathroom #12 sink broken and leaking faucets in Administrator room, Staff room, and Basement, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/14/2024 Plan of Correction All broken plumbing fixtures must be inspected, repaired, or replaced by the Licensee.

Official classification

Type B

Official code

87303(g)(1)

Regulation authority

CCR

What the official deficiency says

(g) Facilities which have machines and do their own laundry shall: (1) Have adequate supplies available and equipment maintained in good repair. Space used to sort soiled linen shall be separate from the clean linen storage and handling area. Except for facilities licensed for fifteen (15) residents or less, the space used to do laundry shall not be part of an area used for storage of anything other than clean linens and/or other supplies normally associated with laundry activities. Steam, odors, lint and objectionable laundry noise shall not reach resident or employee areas. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above with washer in disrepair, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/14/2024 Plan of Correction Licensee shall replace clothes washer with a commercial washer.

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 with second floor patio in disrepair, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/14/2024 Plan of Correction The Licensee shall permanently repair the second-floor patio, including the siding and flashing and a concrete walking surface, and the damage done to the first floor exterior of the building siding and ceiling of the patio cover.

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 was not met as evidence by: Based on LPA observation the Licensee did not comply with the section cited above in having the in good repair and free of unexplainable amount of flies, which poses a potential health and safety risk to persons in care.

Official plan of correction

Administrator agreed to have window, door, cabinet fixed, and rid excesive amount of flies. Administrator will submit photo for all, and either purchase insect kill or hire an exterminator. Send photos to CCLD by POC date.

Deadline recorded: Aug 17, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87203

Regulation authority

CCR

What the official deficiency says

87203 Fire Safety All facilities shall be maintained in conformity with the regulations adopted by the State Fire Marshal for the protection of life and property against fire and panic. This requirement was not met as evidence by: Based on LPA observation the Licensee did not comply with the section cited above in having the fire extinguishers currently serviced or purchased, which poses a potential health and safety risk to persons in care.

Official plan of correction

Administrator agreed to either purchase or have fire extinguishers serviced and submit a copy of receipt to CCLD by POC date.

Deadline recorded: Aug 10, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87463(c)

Regulation authority

CCR

What the official deficiency says

87463 Reappraisals (c) The licensee shall arrange a meeting with the resident, the resident’s representative, if any,... when there is significant change in the resident’s condition, or once every 12 months, whichever occurs first, This requirement is not met as evidence by: Based on LPAs record review the Licensee did not comply with the section cited above in having current appraisal needs and services or physician's report, which poses potential health and safety risk to persons in care.

Official plan of correction

Administrator agreed to update all appraisal needs and services plan and to obtain a current physician report for the residents that need it and submit a self-certification that it has been completed to CCLD by POC date.

Deadline recorded: Aug 17, 2023. 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

87411 Personnel Requirements - General (c)All RCFE staff... shall receive initial and annual training... (1) Staff... shall receive appropriate training in first aid from persons qualified by such agencies as the American Red Cross. This requirment was not met as evidence by: Based on LPAs record review the LIcensee did not comply with the section cited above in having all staff firs aid certified and at least 1 staff per shift CPR certified, which poses a potential health and safety risk for persons in care.

Official plan of correction

Administrator agreed to have all staff current first aid certification and submit a copy of certification to CCLD by POC date.

Deadline recorded: Aug 17, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

1569.625(b)(2)

Regulation authority

HSC

What the official deficiency says

1569.625 (2) In addition to paragraph (1), training requirements shall also include... 20 hours annually, eight hours of... dementia care training... and four hours.. to postural supports, restricted health conditions, and hospice car.... This training shall be... on the job, or in a classroom, and may include online training. This requirement was not met as evidence by: Based on LPAs record review the Licensee did not comply with the section cited above in having staff currently trained, which poses a potential health and safety risk to persons in care.

Official plan of correction

Administrator agreed to have all staff conduct their annual training and submit self-certification to CCLD that it has been completed by POC date.

Deadline recorded: Aug 17, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87555(b)(26)

Regulation authority

CCR

What the official deficiency says

87555 (b)... food service requirements shall apply: (26)...of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days shall be maintained on the premises. This requirement was not met as evidence by: Based on LPAs observation the Licensee did not comply with the section cited above in having 1 week of nonperishables and 2 days of perishable foods in facility, which poses a potential health and safety risk for persons in care.

Official plan of correction

Administrator agreed to purchase foods and submit photo of food, receipts, and a month menu to CCLD by POC date.

Deadline recorded: Aug 15, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87555(b)(26)

Regulation authority

CCR

What the official deficiency says

(b) The following food service requirements shall apply: (26) Supplies of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days shall be maintained on the premises. 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 a minimum of 7-day non-perishable and 2-day perishable foods available for residents which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/02/2023 Plan of Correction Administartor will buy more non perishable and perishable foods and send photographic proof by POC date.

Official classification

Type A

Official code

87405(d)(1)

Regulation authority

CCR

What the official deficiency says

Administrator - Qualifications and Duties (d) The administrator shall have the qualifications specified in Sections 87405(d)(1) through (7). (1) Knowledge of the requirements for providing care and supervision appropriate to the residents. This requirement is not met as evidenced by: Based on interview conducted, Administrator was not aware that R1 was hospitalized in February 2020 until the phone interview conducted by LPA on 9/23/2021 which poses an immediate risk to health and safety of clients under care.

Official plan of correction

Administrator states he will submit plans to CCL on how to ensure that all residents are provided the appropriate supervision needed by POC date.

Deadline recorded: Dec 31, 2021. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87405(d)(3)

Regulation authority

CCR

What the official deficiency says

Administrator - Qualifications and Duties (d) The administrator shall have the qualifications specified in Sections 87405(d)(1) through (7). (3) Ability to maintain or supervise the maintenance of financial and other records. This requirement is not met as evidenced by: Based on interview conducted on 9/23/2021, Administrator states he does not have R1’s discharge papers from hospitalization on February 2020 which poses a potential risk to the health and safety of client under care.

Official plan of correction

By POC date, Administrator will review Sec 87506 - Resident Records and submit self-certification stating understanding of the requirements of the section.

Deadline recorded: Jan 6, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87303

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. Based on interviews conducted, Administrator failed to maintain facility for the safety and well-being of residents and staff. Residents and staff were infested with bed bugs which poses a potential risk to the health and safety of residents, staff and visitors.

Official plan of correction

Facility has contracted with a pest control company. Administrator will submit to CCL proof of service provided on a regular basis to make sure that there is a continuous pest control service provided to the facility starting with the latest service.

Deadline recorded: Jan 6, 2022. A deadline is not proof that correction was completed.