JACKSON HILLS ASSISTED LIVING LLC

Official classification

Type B

Official code

1569.157(c)

Regulation authority

HSC

What the official deficiency says

If a resident council submits written concerns or recommendations, the facility shall respond in writing regarding any action or inaction taken in response to those concerns or recommendations within 14 calendar days. This requirement is not met as evideced by: based on interviews and record reivews, facility do not provide written responses to the residents within 14 days. This poses a potential health, safety, and/or personal rights risks to persons in care

Official plan of correction

Per discussion, the administrator will submit a written statement of understanding of the regulation HSC 1569.157 relating to the regulatory requirement regarding resident council by POC due date.

Deadline recorded: Jun 11, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87555(a)

Regulation authority

CCR

What the official deficiency says

The total daily diet shall be of the quality and in the quantity necessary to meet the needs of the residents... This is not met as evidenced by: Based on interviews, record reviews and observation, evidence showed that facility were not consistent in meeting resident food service needs. This poses a potential health, safety, and/or personal rights risks to persons in care.

Official plan of correction

Per discussion, the administrator will submit a written statement of understanding of the regulation cited relating to the regulatory requirement for food service by POC due date. Per interview, facility is currently addressing the ongoing concerns of their residents and will continue to do so.

Deadline recorded: Jun 11, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87206(a)

Regulation authority

CCR

What the official deficiency says

In accordance with Health and Safety Code Sections 1569.68 and 1569.681, licensees shall reveal each facility license number in all public advertisements, including Internet, or correspondence. This requirement is not met as evidenced by: Base on observation, interviews and review of facility's website, the licensee did not ensure their facility license number was included in their website. This poses a potential health, safety, and personal rights risks to persons in care.

Official plan of correction

Per discussion, the licensee will include the facility license number in the facility's website. Photo of the website showing the license number will be submitted to the Department by POC due date.

Deadline recorded: Dec 31, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468(c)(2)(A)

Regulation authority

CCR

What the official deficiency says

Licensees may use the Residential Care Facility for the Elderly (RCFE) Complaint Poster (PUB 475) or may develop their own poster as provided in this section. A poster developed by the licensee shall contain the same content as the PUB 475. The poster that is posted shall be 20” x 26” in size and be posted in the main entryway of the facility. PUB 475 may be accessed, downloaded, and printed from the www.ccld.ca.gov website. This requirement is not met as evidenced by: Through observation and interviews, the licensee did not ensure their complaint poster is posted at all times. This poses a potential health, safety, and personal rights risks to persons in care.

Official plan of correction

Per discussion, Administrator agreed that photo of the require poster, posted on the facility wall, will be submitted to the Department by POC due date.

Deadline recorded: Dec 31, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(h)(5)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care (h) The following requirements shall apply to medications...:(5) Each resident's medication shall be stored in its originally received container. No medications shall be t ansferred between containers.This requirement was not met as evidenced by: Observationby the LPA of (10+) clients medicaitons being prepared for the mid day pass outside of the immedate presence of the clients in seperate contatiners from the orignial, and 1(warfrin) being stored outside its orignal container for the evening pass. This poses a health, safety, personal rights risk to the clients in care.

Official plan of correction

The facility is going to stop it's practice of prepoured medications immediately, and submit a plan to the LPA as to how a timely med pass procedure will occur without prepouring the medications. The plan can be submitted to the LPA in a week, 10/17/25.

Deadline recorded: Oct 11, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

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, the licensee did not comply with the section cited above in 45 out of 60 med containers which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/29/2025 Plan of Correction No POC Required, facility will convince as many people as possible to switch to blister, otherwise pour medications in the immediate presence of the person reciving the med.

Official classification

Type A

Official code

87465(c)(2)

Regulation authority

CCR

What the official deficiency says

87465 Incidential Medical and dental Services (c) ...facility staff designated by the licensee shall be permitted to assist the resident with self-administration, provided...: (2) Once ordered by the physician the medication is given according to the physician's directions. The requirement was not met as the result of: record review of the mar showing a period of 3 days where neither of the perscribed heart medications were not availible to the resident for reasons unknown This poses an immediate health and saftey risk to persons in care.

Official plan of correction

The Facility will make sure medication is availible to the residents as perscribed, including having detailed records that reflect a status the medication is in if it's not in the care of the facility, including what will be done to keep the resident safe when medication is in a nondeliverable state. a sample Copy of the new record keeping process, a detailed documentation for the refusal process, a detailed documentation for the prn process, will be given to the LPA end of buisness friday, 8/29/25.

Deadline recorded: Aug 29, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87555(a)

Regulation authority

CCR

What the official deficiency says

87555 General Food service requirements (a) the total daily diet shall be of the quality and in the quantity necessary to meet the needs of the residents... All food shall be selected, stored, prepared and served in a safe and healthful manner. The requirement Was not met as evidenced by: LPA's observation of the kitchen in a state of renovation where particles and workers could travel into the food served during meal preperation. This poses an immedate risk to health to persons in care

Official plan of correction

No plan of correction needed. The Facility set up a barrier between the two work areas. The barrier shall be maintained for the period of the work being done, the facility will invest resources in its maintaince, and the maintanience in a pest free envionment during the work period.

Deadline recorded: Aug 29, 2025. A deadline is not proof that correction was completed.