TRI CITY CARE HOME

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 Clorox and Lysol spray in basket near front entrance. Chemical left underneath the sink. Disinfected wipes left in bathroom. LPA observed knives on table near front door. which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/17/2025 Plan of Correction Administrator agrees to put all disinfected and sharps in a locks area. Administrator agrees to conduct training for all staff and submit proof to CCLD by POC date.

Official classification

Type A

Official code

87555(b)(23)

Regulation authority

CCR

What the official deficiency says

(b) The following food service requirements shall apply: (23) All readily perishable foods or beverages capable of supporting rapid and progressive growth of micro-organisms which can cause food infections or food intoxications shall be stored in covered containers at appropriate temperatures. 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 by having multiple expired and mold food including but not limited to salad dressing, cheese, salad, bell pepper, cans good, and ect, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/17/2025 Plan of Correction Administrator agrees toss out all food that is expired. Administrator agrees to conduct training for all staff and submit proof to CCLD by POC date.

Official classification

Type A

Official code

87465(h)

Regulation authority

CCR

What the official deficiency says

(h) The following requirements shall apply to medications which are centrally stored: 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 prescribe medication including but not limited to cream, in resident rooms. which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/17/2025 Plan of Correction Administrator agrees to check all residents’ rooms and locks all medication in a lock area. Administrator agrees to conduct training for all staff and submit proof to CCLD by POC date.

Official classification

Type B

Official code

87309(a)(2)

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. (2) Any items in subsection (a)(1) that are transferred from their original container to another container shall have a legible label that indicates: 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 by not having containers with food are not labeled properly. which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/23/2025 Plan of Correction Administrator agrees to label all food containers with open date and expired date. Administrator agrees to conduct training for all staff and submit proof to CCLD by POC date.

Official classification

Type A

Official code

87309(a)

Regulation authority

CCR

What the official deficiency says

(a) Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients. 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 ant, roach, and spider (hot shot) spray inside room 4 bathroom. which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/06/2024 Plan of Correction Administrator remove ant, roach, and spider (hot shot) spray inside room 4 bathroom during inspection. Deficency Cleared

Official classification

Type A

Official code

87555(b)(23)

Regulation authority

CCR

What the official deficiency says

(b) The following food service requirements shall apply: (23) All readily perishable foods or beverages capable of supporting rapid and progressive growth of micro-organisms which can cause food infections or food intoxications shall be stored in covered containers at appropriate temperatures. 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 cheese, and tomato have mold in the refrigerator.which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/06/2024 Plan of Correction Administrator remove the cheese, and tomato contained mold during inspection. Deficency Cleared

Official classification

Type B

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: Deficient Practice Statement Based on observation, and record review, the licensee did not comply with the section cited above in by having residents’ medication that are not in its original container. which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/13/2024 Plan of Correction Administrator agree to send in proof of med trainging, MAR logs, orgraize original medication of residents containers to CCLD by POC date.

Official classification

Type A

Official code

87628(a)

Regulation authority

CCR

What the official deficiency says

87628 Diabetes (a) The licensee shall be permitted to accept or retain a resident who has diabetes if the resident is able to perform his/her own glucose testing with blood or urine specimens, and is able to administer his/her own medication including medication administered orally or through injection, or has it administered by an appropriately skilled professional This requirement is not met as evidenced by: Based on interview conducted, R1 is diabetic and needs FBS check 2x a day. However, R1 is unable to check own blood sugar. Staff check R1's FBS and facility does not have an approved exception.

Official plan of correction

By POC date, the Administrator will provide CCL plans on how to address R1's diabetes and submit to CCL.

Deadline recorded: Apr 15, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87204(a)

Regulation authority

CCR

What the official deficiency says

87204(a) Limitations - Capacity and Ambulatory Status (a)(a) A licensee shall not operate a facility beyond the conditions and limitations specified on the license, including specification of the maximum number of persons who may receive services at any one time. An exception may be made in the case of catastrophic emergency when the licensing agency may make temporary exceptions to the approved capacity. This requirement is not met as evidenced by: The facility admitted W1 temporarily while recovering from surgery despite at full capacity which poses an immediate risk to the health and safety of clients.

Official plan of correction

During the visit, LPA was informed by the Administrator that W1 has moved out of the facility on 3/29/2024. Civil penalty of $500 is assessed for today's visit.

Deadline recorded: Apr 9, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

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: Based on interviews conducted, the facility failed to comply with State Fire Marshall regulations when the facility admitted W1 who was recovering from surgery and stayed in one of the caregivers' room which poses an immediate risk to the health and safety of clients under care.

Official plan of correction

The Administrator states W1 moved out of the facility on 3/29/2024. The Administrator will submit self-certification of understanding of Sections cited and submit to CCL by POC date.

Deadline recorded: Apr 10, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87615(a)(1)

Regulation authority

CCR

What the official deficiency says

(a) Persons who require health services for or have a health condition including, but not limited to, those specified below shall not be admitted or retained in a residential care facility for the elderly: (1) Stage 3 and 4 pressure sores (dermal ulcers). This requirement is not met as evidenced by: Deficient Practice Statement Based on interviews conducted, the licensee did not comply with the section cited above in having a resident with stage 2, unstageable pressure injury on the right hip and using a wound vacuum which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/21/2024 Plan of Correction R1 was admitted to hospice care by Anodine Hospice during the visit.

Official classification

Type A

Official code

87606(c)

Regulation authority

CCR

What the official deficiency says

This requirement is not met as evidenced by: Deficient Practice Statement Based on interviews conducted, the licensee did not comply with the section cited above in having R1 who is unable to turn from side to side (bedridden) without an approved bedridden fire clearance which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/25/2024 Plan of Correction Within 24 hours, Administrator will notify fire department about R1's bedridden status. By POC date, Administrator will submit to CCL documents to apply for bedridden fire clearance.

Official classification

Type B

Official code

87705(c)(5)

Regulation authority

CCR

What the official deficiency says

(c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following: (5) Each resident with dementia shall have an annual medical assessment as specified in Section 87458, Medical Assessment, and a reappraisal done at least annually, both of which shall include a reassessment of the resident's dementia care needs. This requirement is not met as evidenced by: Deficient Practice Statement Based on file review conducted, the licensee did not comply with the section cited above in not having updated medical assessment for 4 out of 5 residents who have Dementia which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/04/2024 Plan of Correction By POC date, Administrator will send CCL updated medical assessment of the 4 residents who have Dementia.

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 which poses an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 12/20/2021 Plan of Correction Caregiver corrected deficiency during inspection. Knife was removed from kitchen dish drain and locked inside the locked sharps drawer. Licensee corrected deficiency during visit. Licensee locked shed in the backyard.

Official classification

Type A

Official code

87465(h)(2)

Regulation authority

CCR

What the official deficiency says

Incidental Medical and Dental Care Services. Centrally stored medications shall be kept in a safe locked place that is not accessible to persons other than employees responsible for the supervsiion of the 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 which poses an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 12/20/2021 Plan of Correction Licensee corrected deficiency during the inspection. Observed cargiver lock the medication in the hallway medication closet on 12/20/21.

Official classification

Type A

Official code

80087(g)(1)

Regulation authority

CCR

What the official deficiency says

(g) Disinfectants, cleaning solutions, poisons, firearms and other items that could pose a danger if readily available to clients shall be stored where inaccessible to clients. (1) Storage areas for poisons, and firearms and other dangerous weapons shall be locked. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above which poses an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 12/20/2021 Plan of Correction Caregiver corrected deficiency during the inspection. Observed cargiver lock the cleaning supplies in garage cabinet on 12/20/21.