C & L HOME FOR THE ELDERLY

Official classification

Type A

Official code

87309(a)

Regulation authority

CCR

What the official deficiency says

(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 evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above by having unlocked knives and laundry detergents which poses an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 11/20/2025 Plan of Correction Staff locked up the items during inspection. Defiency cleared.

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 health screening and TB test for S1 which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 12/08/2025 Plan of Correction Facility has agreed to obtain TB test result and health screening for S1. Facility will submit documents 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 not having current annual training for S2 and S3 which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 12/08/2025 Plan of Correction Facility has agreed to obtain annual training for S2 and S3. Facility will submit training documents to CCLD by POC date.

Official classification

Type B

Official code

1569.695(c)

Regulation authority

HSC

What the official deficiency says

(c) A facility shall conduct a drill at least quarterly for each shift. The type of emergency covered in a drill shall vary from quarter to quarter, taking into account different emergency scenarios. An actual evacuation of residents is not required during a drill. While a facility may provide an opportunity for residents to participate in a drill, it shall not require any resident participation. Documentation of the drills shall include the date, the type of emergency covered by the drill, and the names of staff participating in the drill. 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 conducting disaster drill quarterly or every 3 months which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 12/08/2025 Plan of Correction Facility has agreed to conduct a disaster drill and submit documents to CCLD by POC date.

Official classification

Type B

Official code

87506(a)

Regulation authority

CCR

What the official deficiency says

(a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff. 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 having incomplete records for R1, R2, R3, R4, and R6 which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 12/08/2025 Plan of Correction Facility has agreed to obtain all records for R1, R2, R3, R4, and R6 at the facility for any future reviews. Facility will submit self-certification by POC date. Civil penalty of $250 is being assessed for a repeat violation.

Official classification

Type B

Official code

87411(c)(1)

Regulation authority

CCR

What the official deficiency says

(c) All RCFE staff who assist residents with personal activities of daily living shall receive initial and annual training as specified in Health and Safety Code sections 1569.625 and 1569.69 (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 not having first aid training for S1 which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 12/08/2025 Plan of Correction Facility has agreed to obtain current first aid training for S1 and submit completion documents to CCLD by POC date.

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 sufficient non-perishiable food supplies for 6 residents which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 12/08/2025 Plan of Correction Facility has agreed to purchase additional non-perishable food supplies and submit picture proof to CCLD by POC date.

Official classification

Type B

Official code

87465(a)(4)

Regulation authority

CCR

What the official deficiency says

(a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following: (4) The licensee shall assist residents with self-administered medications as needed. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and record review, the licensee did not comply with the section cited above by not providing adequate medication administration assistance to R6 in including a mediation that was not in the bubble pack which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 12/12/2025 Plan of Correction Facility has agreed to obtain a current medication list from the doctors and update MAR as needed. Facility will submit documents to CCLD by POC date.

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 observation, the licensee did not comply with the section cited above in having the water temperature is measured at 98.3 degrees Fahrenheit which poses an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 12/04/2024 Plan of Correction By POC due date, Administrator agreed to correct hot water temperature and submit proof of correction to CCLD.

Official classification

Type A

Official code

87506(a)

Regulation authority

CCR

What the official deficiency says

(a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff. 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 documentations for R1, R2, R3, R4 which poses an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 12/17/2024 Plan of Correction By POC date, Administrator agrees to obtain the following documents for R1, R2, R3, and R4: Consent Form, Safeguards for Property/ Valuables, Medical Assessment, TB test, Appraisal Needs and Services, LIC613C, and ID and Emergency Information

Official classification

Type A

Official code

87705(f)(1)

Regulation authority

CCR

What the official deficiency says

(f) The following shall be stored inaccessible to residents with dementia: (1) Knives, matches, firearms, tools and other items that could constitute a danger to the resident(s). 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 knives and cleaning chemicals found unlocked and accessible to residents in the kitchen. Medication and paint was observed to be unlocked and accessible to residents in the bathroom which poses an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 12/04/2024 Plan of Correction Administrator agree to self certify that they read and understand the regulation and submit self-certification to CCLD by POC due date. Staff locked the items during the visit.

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 in having a Liability Insurance that expired on 2020 in file which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 12/10/2024 Plan of Correction Administrator showed proof of liability insurance on today's visit. Deficiency cleared.

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 in having cluttered such as bed spring, bed frame, bikes, cardboard, headboard, crates, and etc. in the side backyard which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 12/11/2024 Plan of Correction By POC date, Administrator agrees to remove the items such as bed spring, bed frame, bikes, cardboard, headboard, crates, and etc. 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 having an expired CPR certificate for S4 which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 12/10/2024 Plan of Correction By POC date, the Administrator agrees to obtain a new CPR certificate for S4 and send proof to CCLD.

Official classification

Type B

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 observation, the licensee did not comply with the section cited above in having food that is not properly stored and expired canned goods found in the cabinet which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 12/05/2024 Plan of Correction Administrator removed expired canned goods and properly labeled and stored food during the visit. Deficiency cleared during the visit.

Official classification

Type B

Official code

87608(a)(5)(A)

Regulation authority

CCR

What the official deficiency says

(A) A bed rail that extends from the head half the length of the bed and used only for assistance with mobility shall be allowed. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and record review, the licensee did not comply with the section cited above by having half bed rail with no doctor's order for R4 in Room #2 which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 12/13/2024 Plan of Correction Administrator agrees to obtain a doctor's order for the half bed rail for R4 and send proof of document to CCLD by POC date.

Official classification

Type B

Official code

87412(a)

Regulation authority

CCR

What the official deficiency says

87412(a) Personnel Records (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: 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 Administrator records in the facility which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 12/18/2024 Plan of Correction Administrator agrees to obtain their file that includes LIC 501, LIC 503, TB test, Administrator Certificate, First Aid Certificate, etc. and send to CCLD by POC date.

Official classification

Type A

Official code

87303(e)(2)

Regulation authority

CCR

What the official deficiency says

87303 Maintenance and Operation (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 degree C) and not more than 120 degree F (49 degree C). 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 hot water between 105 - 120 degrees F which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/24/2022 Plan of Correction Administrator agreed to adjust water to meet requirements and submit a photo copy of measurement while running water to CCLD by POC date.

Official classification

Type B

Official code

87608(a)(3)

Regulation authority

CCR

What the official deficiency says

87608 Postural Supports (a) Based on the individual's preadmission appraisal, and subsequent changes to that appraisal, the facility shall provide assistance and care for the resident in those activities of daily living which the resident is unable to do for himself/herself. Postural supports may be used under the following conditions. (3) A written order from a physician indicating the need for the postural support shall be maintained in the resident’s record. The licensing agency shall be authorized to require other additional documentation if needed to verify the order. This requirement is not met as evidenced by: This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and record review, the licensee did not comply with the section cited above in having a doctor's order for a hospital bed for R1 which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/31/2022 Plan of Correction Administrator agreed to obtain a doctor's order for R1's hospital bed and submit a copy to CCLD by POC date.

Official classification

Type B

Official code

87305(b)

Regulation authority

CCR

What the official deficiency says

87305 Alterations to Existing Building or New Facilities (b) The licensing agency may require the facility to acquire a local building inspection where the agency determines that a suspected hazard to health and safety exists. This requirement is not met as evidenced by: This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and record review, the licensee did not comply with the section cited above in having a new facility sketch and permit for alterations to garage which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/31/2022 Plan of Correction Administrator agreed to submit a new facility sketch and permit to CCLD by POC date.

Official classification

Type B

Official code

873039(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: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above in having sinks leaking water which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/31/2022 Plan of Correction Administrator agreed to fix sink in shared and master bathrooms and submit photo to CCLD by POC date.

Official classification

Type B

Official code

87303(a)(1)

Regulation authority

CCR

What the official deficiency says

Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include…. (1) Floor surfaces in bath, laundry….. This requirement is not met as evidenced by: Based on observation and interview, Licensee failed to maintain an operational dryer so that clothes would not have to be dried on a rope in the back yard which poses a potential health and safety risk to residents in care.

Official plan of correction

Administrator stated he already ordered parts of the dryer from Amazon, Adminsitrator stated that order will arrived today and he will replace the part of the broken machine. LPA requested from Administrator to submitted proof of receipt to be submitted by POC date.

Deadline recorded: Oct 14, 2022. A deadline is not proof that correction was completed.