A AND M BOARD&CARE,INNOVATIVE ASSIS.HOME FOR ELDER

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 observations, the licensee did not comply with the section cited above by having foul odor coming in Room # 2, hoyer lift in the living room, two hoyer lift in the backyard, flies all around the facility, fridge and freezer not clean, etc. which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 10/02/2025 Plan of Correction Staff agrees to removed hoyer lift, organize fridge/ freezer, and clean resident room.

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 a TB test for S2 which poses a potential safety risk to persons in care.

Official plan of correction

POC Due Date: 10/02/2025 Plan of Correction Administrator will obtain a TB test for S1 and send results to CCLD by POC date.

Official classification

Type A

Official code

87555(b)

Regulation authority

CCR

What the official deficiency says

(b) The following food service requirements shall apply: 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 expired food in the refrigerator and spoiled/molded fruits in the basket which poses an immediate safety risk to persons in care.

Official plan of correction

POC Due Date: 09/26/2025 Plan of Correction Administrator agrees to self-certify the regulation, throw away the expired food, and send proof to CCLD by POC date.

Official classification

Type A

Official code

87309(c)

Regulation authority

CCR

What the official deficiency says

(c) Except as specified in subsection (d), the licensee shall implement reasonable interventions in order to ensure that nutritional supplements, vitamins, alcohol, cigarettes and other potentially toxic substances, such as certain plants, gardening supplies, and auto supplies, are stored so as not to pose a hazard to residents. 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 resident's room and medication in the staff lounge area which posed an immediate safety risk to persons in care.

Official plan of correction

POC Due Date: 09/26/2025 Plan of Correction Administrator agrees to self-certify the regulation with staff and send proof to CCLD by POC date.

Official classification

Type B

Official code

1569.618(c)(3)

Regulation authority

HSC

What the official deficiency says

(c)The facility shall employ, and the administrator shall schedule, a sufficient number of staff members to do all of the following: (3) Ensure that at least one staff member who has cardiopulmonary resuscitation (CPR) training and first aid training is on duty and on the premises at all times. This paragraph shall not be construed to require staff to provide CPR. 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 a valid CPR certificate for S1 which poses a potential safety risk to persons in care.

Official plan of correction

POC Due Date: 10/02/2025 Plan of Correction Administrator will obtain a CPR certification for S1 and send proof to CCLD by POC date.

Official classification

Type B

Official code

87456(a)(3)

Regulation authority

CCR

What the official deficiency says

(a) Prior to accepting a resident for care and in order to evaluate his/her suitability, the facility shall, as specified in this article 8: (3) Obtain and evaluate a recent medical assessment. 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 medical assessment for 3 of 3 residents which poses a potential health and personal risk to persons in care.

Official plan of correction

POC Due Date: 10/16/2025 Plan of Correction Administrator agrees to obtain a new medical assessment for all 3 residents and send proof to CCLD by POC date.

Official classification

Type A

Official code

87411(g)(3)

Regulation authority

CCR

What the official deficiency says

Personnel Requirements - General. Request and be approved for a background, and criminal record exemption... This requirement is not met as evidence by: Based on record review, licensee did not comply with the section cited above by not having background, and criminal record which poses an immediate health and safety risk to the persons in care.

Official plan of correction

Facility has agreed to obtain background and criminal record for any induvial that are assisting residents moving forward. Civil penalty of $100 is being assessed.

Deadline recorded: Oct 8, 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 LPA observation hot water temperature measured at 140.2-degree Fahrenheit, the licensee did not comply with the section cited above in, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/09/2024 Plan of Correction LIcensee agree to fix water temp. and send photo of hot water temp under 125 degree F to CCLD by POC date.

Official classification

Type A

Official code

87309(b)

Regulation authority

CCR

What the official deficiency says

(b) Medicines shall be stored as specified in Section 87465(c) and separately from other items specified in (a) above. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA observation medication were left in the Ziplock bag on the couch, and mediation in resident room 1 is on the counter., the licensee did not comply with the section cited above, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/09/2024 Plan of Correction LIcensee agree to remove medication from residents room, and lock them and submit photo to CCLD by POC date

Official classification

Type A

Official code

87555(b)(8)

Regulation authority

CCR

What the official deficiency says

(b) The following food service requirements shall apply: (8) All food shall be of good quality. Commercial foods shall be approved by appropriate federal, state and local authorities. Food in damaged containers shall not be accepted, used or retained. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA observation expired food in the refrigerator and molded fruits in the basket, the licensee did not comply with the section cited above, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/10/2024 Plan of Correction LIcensee agree to remove all expired food/fruti from refrigerator and basket, and submit submit photo to CCLD by POC date.

Official classification

Type A

Official code

87555(b)(27)

Regulation authority

CCR

What the official deficiency says

(b) The following food service requirements shall apply: (27) All kitchen areas shall be kept clean and free of litter, rodents, vermin and insects. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA observation multiples cockroach in the kitchen cabinet, countertop, and in the garage food pantry, the licensee did not comply with the section cited above, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/10/2024 Plan of Correction LIcensee agree to contact professional to consult on how to eleminate the roaches. Licensee will send confirmation of communiation and photo roaches free to CCLD by POC date.

Official classification

Type A

Official code

87307(a)(2)(B)

Regulation authority

CCR

What the official deficiency says

(2) Resident bedrooms shall be provided which meet, at a minimum, the following requirements: (B) No room commonly used for other purposes shall be used as a sleeping room for any resident. This includes any hall, stairway, unfinished attic, garage, storage area, shed or similar detached building. 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 a resident living in a room that is not a dedicated bedroom which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/01/2022 Plan of Correction The facility will move the resident into one of the bedrooms. Proof of correction will be sent to CCLD by POC date.

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 by having one of the sinks in the bathroom not working properly which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/08/2022 Plan of Correction The facility will have the sink repaired. Proof of correction will be sent to CCLD by POC date.

Official classification

Type B

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 by having a fire extinguisher service tags dated 06/03/2021 which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/08/2022 Plan of Correction Facility will either have fire extinguisher serviced or purchase a new fire extinguisher and tape receipt to fire extinguisher. A photo will be sent to CCLD by POC date.