ROSELEAF GARDENS

Official classification

Type A

Official code

87307(d)(6)

Regulation authority

CCR

What the official deficiency says

(6) All outdoor and indoor passageways and stairways shall be kept free of obstruction. 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 (1) one exterior exit was blocked by a hoyer life and a resident wheelchair which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/09/2026 Plan of Correction Licensee/Administrator shall ensure all exits are free of obstruction immedaitely. LPA shall return at a later date to complete this Plan of Correction.

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 observation, the licensee did not comply with the section cited above in that two (2) bathrooms were dirty with dirt in unused showers, visable dirty floors in walk-in showers, and dirty fingerprints on doors/doorjams. Additionally, one (1) exterior door alarm was not sounding and needed the batteries to be replaced, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/22/2026 Plan of Correction Licensee/Administrator shall ensure the facility is clean and in good repair at all times. LPA shall return at a later day to complete this Plan of Correction (POC)

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 observation and record review, the licensee did not comply with the section cited above in one (1) out of six (6) staff files did not contain proof of a negative tuberculosis test which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/29/2026 Plan of Correction Licensee/Administrator shall have staff member complete a tuberculosis exam and submit negative results to LPA via email by end of busines on April 29, 2026

Official classification

Type B

Official code

87458(c)(1)(A)

Regulation authority

CCR

What the official deficiency says

(c) The medical assessment shall include, but not be limited to: (1) A physical examination of the resident indicating the licensed medical professional's diagnosis or diagnoses and results of an examination for all of the following: (A) Communicable tuberculosis. 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 one (1) out ofsix (6) resident files did not have record of a negative tuberculosis exam which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/29/2026 Plan of Correction Licensee/Administrator shall submit proof of residents negative tb test to LPA via email by end of business on APril 29, 2026.

Official classification

Type A

Official code

87468.1(a)(2)

Regulation authority

CCR

What the official deficiency says

This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and interview, the licensee did not comply with the section cited above in that LPA observed (2) two resdient beds positioned away from room pull cords so that residents were unable to reach them in case of an emergency which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/10/2026 Plan of Correction LIcensee/Administrator shall submit a plan of how staff shall ensure all residents have access to pull cords in resident rooms. Plan shall be submitted to Licensing by end of business 04/10/2025

Official classification

Type B

Official code

87411(a)

Regulation authority

CCR

What the official deficiency says

87411 Personnel Requirements – General (a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs….The licensing agency may require any facility to provide additional staff whenever it determines through documentation that the needs of the particular residents, the extent of services provided, or the physical arrangements of the facility require such additional staff for the provision of adequate services. This is evidenced by: Based on observation and interview, the licensee did not ensure that facility staff was sufficient in numbers in that (2) two of (2) residents interviewed stated they had been left unattended after requesting assistance from staff. Additionally, (5) of five (5) staff agreed that the facility did not have enough staff on each shift to properly care for residents, which poses a potential health, safety, or personal rights risk to residents in care.

Official plan of correction

Administrator agrees to submit a LIC 9098 ensuring their understanding of the regulation. Administrator shall submit the form to LPA by end of business on March 30th, 2026. Previous Administrator has provided proof of in-service training conducted on February 19, 2026, addressing this deficiency.

Deadline recorded: Mar 30, 2026. 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 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 is evidenced by: Based on observation and record review, the licensee did not comply with the regulation stated in that one (1) of three (3) staff files reviewed did not have current First Aid training, which poses a potential health, safety, or personal rights risk to residents in care.

Official plan of correction

Administrator agrees to fill out a LIC 9098 ensuring their understanding of the regulation. Administrator shall submit the form to LPA by end of business on March 30th, 2026. Administrator provided proof of staff’s current First Aid training on November 5, 2026. Additionally, Administrator conducted an in-house CPR training for all staff on November 6, 2025 provided by Kiser CPR.

Deadline recorded: Mar 30, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87211(a)(1)(A)

Regulation authority

CCR

What the official deficiency says

87211 Reporting Requirements (a)Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: (1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any….(A) Death of any resident from any cause regardless of where the death occurred, including but not limited to a day program, a hospital, en route to or from a hospital, or visiting away from the facility. This is evidenced by: Based on observation and record review, the licensee did not comply with the regulation stated in that one (1) resident passed away and the facility failed to inform CCL within seven (7) days, which poses a potential health, safety, or personal rights risk to residents in care.

Official plan of correction

Administrator agrees to fill out a LIC 9098 ensuring their understanding of the regulation. Administrator shall submit the form to LPA by end of business on March 30th, 2026. Administrator has provided LPA with an LIC 624A documenting this resident’s death and has been sending incident reports sufficiently to CCL since being notified of the deficiency in October 2025.

Deadline recorded: Mar 30, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.1(a)(14)

Regulation authority

CCR

What the official deficiency says

87468.1 Personal Rights of Residents in All Facilities(a) Residents in all residential care facilities for the elderly shall have all of the following personal rights:(14) To have reasonable access to telephones, to both make and receive confidential calls. This is evidenced by: Based on observation and record review, the licensee failed to ensure that the facility had reliable and correctly functioning telephone service which prevented families from being able to contact residents. This poses a potential health, safety, and/or personal rights risk to residents in care.

Official plan of correction

The licensee agrees to arrange to have a functioning telephone number that can be answered at all times. The licensee shall update their website and Google profile to reflect a current, working, telephone number. Licensee shall infom family/POA of each resident of the new phone number, if deemed necessary. POC shall be completed and licensee/administrator shall inform LPA of changes made by end of business April 20, 2026.

Deadline recorded: Apr 20, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87411(a)

Regulation authority

CCR

What the official deficiency says

87411 Personnel Requirements - General (a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. This violation is evidenced by: Based on interview and record review, the licensee failed to meet the residents needs in that they did not follow the resident's care plan to provide hands on toileting asisitance and they left the resident unattended for approximately 1.5 hours, resulting in R1 sustaining a fall and injury, which poses a potential health, safety, or personal rights risk to resident's in care.

Official plan of correction

Administrator agrees to fill out a LIC 9098 ensuring their understanding of the regulation. Administrator shall submit the form to LPA by end of busness on February 2, 2026. Administrator agrees to conduct/provide training pertinent to the regulation. Administrator shall submit an agenda of this training and a signed staff attendance to LPA by end of busness on February 20, 2026.

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

Official classification

Type B

Official code

87468.1(a)(2)

Regulation authority

CCR

What the official deficiency says

87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights:(2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This is evidenced by: Based on observation, interview, and record review, the licensee failed to provide safe accomodations for the resident in that staff did not follow the resident's care plan to have only bed baths resulting in a fall while in the care of staff, which poses a potential health, safety, or personal rights risk to persons in care

Official plan of correction

Administrator agrees to conduct/provide training pertinent to the regulation. Administrator shall submit a signed staff attendance to LPA by end of busness on February 20, 2026.

Deadline recorded: Feb 20, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87465(g)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care (g) The licensee shall immediately telephone 9-1-1 if an injury or other circumstance has resulted in an imminent threat to a resident’s health... This is evidenced by: Based on observation, interview, and record review, the licensee failed to seek medical assistance for the resdient after a fall and sustained injury,

Official plan of correction

Administrator agrees to conduct/provide training pertinent to the regulation. Administrator shall submit a signed staff attendance to LPA by end of busness on February 20, 2026.

Deadline recorded: Feb 20, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87211(a)(1)(D)

Regulation authority

CCR

What the official deficiency says

87211 Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: (1)A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below (D) Any incident which threatens the welfare, safety or health of any resident. This is evidenced by: Based on Observation, Interview, and Record Review, the licensee/administrator failed to report an incident in which R1's welfare was threatened, which poses a potential health, safety, or personal rights risk to persons in care

Official plan of correction

Administrator agrees to conduct/provide training pertinent to the regulation. Administrator shall submit an agenda of this training and a signed staff attendance to LPA by end of busness on February 20, 2026.

Deadline recorded: Feb 20, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87625(b)(3)

Regulation authority

CCR

What the official deficiency says

87625 Managed Incontinence (b) In addition to Section 87611... the licensee shall be responsible for the following: (3) Ensuring that incontinent residents are kept clean and dry and that the facility remains free of odors from incontinence. This is evidenced by: Based on observation, record review, and interviews, the licensee did not ensure that incontinence needs of residents were being met in that resdients were found soaked through their bedding at shift changes on more than one occasion and the facility has been observed to smell of urine which poses a potential health, safety, or personal rights risk to persons in care.

Official plan of correction

Administrator agrees to fill out a LIC 9098 ensuring their understanding of the regulation. Administrator shall submit the form to LPA by end of busness on February 6, 2026.

Deadline recorded: Feb 6, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87303

Regulation authority

CCR

What the official deficiency says

87303 Maintenance and Operation (i) Facilities shall have signal systems which shall meet the following criteria: (1) All facilities licensed for 16 or more... shall have a signal system which shall:(B)Transmit a visual and/or auditory signal to a central staffed location or produce an auditory signal at the living unit loud enough to summon staff. Based on observations and interviews conducted, the licensee did not ensure the facility's emergency signal system was operable, which poses an immediate health, safety or personal rights violation.

Official plan of correction

The LIcensee/Administrator agrees to have the signall system repaired and operable by end of business on 10/24/25. Licensee/Administrator shall submit video proof to LPA of working pagers by end of business 10/24/25. Until the pagers have been received and programmed, the licensee/administrator agrees to have staff check on residents hourly and staff shall sign off on a physical log of these checks.

Deadline recorded: Oct 23, 2025. 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 was not met as evidenced by: Based on observations and interviews conducted, the licensee did not ensure that R1's room was clean, safe, and sanitary on at least three (3) seperate dates, which poses a potential health, safety or personal rights violation.

Official plan of correction

Licensee/Administrator shall ensure resident's rooms and belongings are kept sanitary and remain odor free. Licensee/Administrator shall create and submit a plan to licensing to address the consistent unsanitary conditions by end of business October 31, 2025.

Deadline recorded: Nov 4, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87312

Regulation authority

CCR

What the official deficiency says

87312 Motor Vehicles Used in Transporting Residents ....Any vehicle used by the facility to transport residents shall be maintained in a safe operating condition. This requirement was not met as evidenced by: Based on observation, interviews, and records reviewed, the licensee did not ensure that the facility transportation vehicle was in working order which poses a potential health, safety or personal rights violation.

Official plan of correction

Licensee/Administrator agrees to ensure the vehicle is in working order by end of business on October 10, 2025. LIcensee/Administrator shall provide proof of purchase for any parts needed and any addiitonal work done on the vehicle to LPA via email by this date.

Deadline recorded: Oct 10, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87464(f)(4)

Regulation authority

CCR

What the official deficiency says

Basic Services - 87464(f)(4) Basic services shall at a minimum include:(4) Personal assistance and care as needed by the resident and as indicated in the pre-admission appraisal, with those activities of daily living such as dressing, eating, bathing and assistance with taking prescribed medications Based on observation and interview, the licensee did not comply with the section cited above as three residents in the facility are refusing showers, causing specific wings of the facility to be maloderous, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

Administrator/Licensee agrees to create a policy/plan that will be implemented regarding resident refusal of basic services (ADL's) i.e., bathing, dressing, etc. This will be submitted to licensing by end of business on Jully 31, 2025.

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

Official classification

Type A

Official code

87468.1(a)(6)

Regulation authority

CCR

What the official deficiency says

Residents in all residential care facilities for the elderly shall have all of the following personal rights...To leave or depart the facility at any time and to not be locked into any room, building, or on facility premises by day or night. This is not evidence by: Based on observation and interview, the licensee did not comply with the section cited above as the exit doors are all locked with codes rendering them inoperable which poses an immediate health, safety or personll rights risk to persons in care.

Official plan of correction

By COB tomorrow, 5/29/25 the locks on the exits shall be removed or turned off so that they are operable for residents to exit. As additional safety measures all exits shall be alarmed to alert staff. Send proof of correction to LPA by 5/29/25

Deadline recorded: May 28, 2025. A deadline is not proof that correction was completed.

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... which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage. This is evidenced by: Based on observation and interview, the licensee did not comply with the section cited above in that 1 of 1 cleaning solutions was left in a bathroom cabinet accessible to residents which poses an immediate health, safety or personll rights risk to persons in care.

Official plan of correction

By COB tomorrow, 5/29/25 the cleaning solution shall be removed from the bathroom and rendered inaccessible to residents. Send proof of correction to LPA by 5/29/25. Licensee shall provide additional training to staff regarding storage of cleansers and toxins. Proof of this training provided to all staff shall be submitted to LPA by 06/03/2025.

Deadline recorded: May 28, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87303(a)(d)

Regulation authority

CCR

What the official deficiency says

(a) The facility shall be clean, safe, sanitary and in good repair at all times...(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 is not evidenced by: Based on observation and interview, the licensee did not comply with the section cited above in that 1 of 1 lamp was missing a lightbulb and lampshade. the missing lightbulb poses an immediate health, safety or personll rights risk to persons in care.

Official plan of correction

Ensure that all lights are functioning, If lights burn out or are removed they need to be replaced immediately. Prepare a system for staff checking and replacing lights on a regular basis.

Deadline recorded: May 28, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87303(a)(1)

Regulation authority

CCR

What the official deficiency says

The facility shall be clean, safe, sanitary and in good repair at all times...Floor surfaces in bath, laundry and kitchen areas shall be maintained in a clean, sanitary, and odorless condition. Based on observations the licensee did not comply with the section as there were multiple rooms that smelled bad.

Official plan of correction

By 5/28/25 the licensee shall identify the rooms (including but not limited to rooms 720, 610, 420, 410, 310, 110, etc.) that need to be deep cleaned and send a plan on who, how, and when the rooms will be cleaned. The facility shall be odor free by 6/27/25.

Deadline recorded: May 28, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87355(e)(3)

Regulation authority

CCR

What the official deficiency says

(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (3) Request a transfer of a criminal record clearance as specified in Section 87355(c) or 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 one out of five files which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/23/2025 Plan of Correction Provider shall send a transfer request form to associate med tech by COB 4/23/25. All staff present must be cleared and associated prior to their presence in the facility.

Official classification

Type B

Official code

87412(g)

Regulation authority

CCR

What the official deficiency says

(g) All personnel records shall be maintained at the facility. 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 one out of five files which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/23/2025 Plan of Correction Provider shall retain personnel files at the facility for all staff at all times. A copy of med tech's file shall be brought and retained on campus. Send confirmation to LPA by COB 4/23/25.

Official classification

Type B

Official code

87608(a)(1)

Regulation authority

CCR

What the official deficiency says

(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: (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: (1) Postural supports shall be limited to appliances or devices such as braces, spring release trays, or soft ties, used to achieve proper body position and balance, to improve a resident's mobility and independent functioning, or to position rather than restrict movement including, but not limited to, preventing a resident from falling out of bed, a chair, etc. 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 2 out of 5 rooms which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/06/2025 Plan of Correction All residents with 1/2 rails shall have MD orders on file for use as postural supports - provider shall supply the orders for residents who use 1/2 rails to their files or shall remove the rails by 5/6/25.

Official classification

Type A

Official code

87464(d)

Regulation authority

CCR

What the official deficiency says

87464 Basic Services - A facility need not accept a particular resident for care. However, if a facility chooses to accept a particular resident for care, the facility shall be responsible for meeting the resident's needs as identified in the pre-admission appraisal specified in Section 87457, Pre-admission Appraisal and providing the other basic services specified below, either directly or through outside resources. This requirement was not met as evidenced by: Based on interviews and a review of the resident’s observation log the licensee/administrator did not send the resident out for emergency services. This poses an immediate risk to residents in care.

Official plan of correction

The administrator agrees to write a plan of correction advising how she will avoid this type of citation in the future.

Deadline recorded: Mar 19, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87466

Regulation authority

CCR

What the official deficiency says

Observation of the Resident - The licensee shall ensure that residents are regularly observed for changes in physical, mental, emotional and social functioning and that appropriate assistance is provided when such observation reveals unmet needs. When changes such as unusual weight gains or losses or deterioration of mental ability or a physical health condition are 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 was not met as evidenced by: Based on interviews and a review of the resident’s observation log the licensee/administrator did not notify the resident’s responsible party, as required. This poses a immediate risk to residents in care.

Official plan of correction

The administrator agrees to write a plan of correction advising how she will avoid this type of citation in the future. Repeat violation, $250. civil penalty.

Deadline recorded: Mar 19, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87464(f)

Regulation authority

CCR

What the official deficiency says

Basic Services - Basic services shall at a minimum include: Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code Section 1569.2(c). This requirement was not met as evidenced by: Based on interviews and a review of the records, the licensee/administrator did not ensure that residents were receiving their showers as required. This poses a potential risk to residents in care.

Official plan of correction

The administrator agrees to submit to the licensing agency the Personnel Report (LIC 500) advising how she will meet the needs of the residents by increasing staffing.

Deadline recorded: Mar 25, 2025. 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

Maintenance and Operation - 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 evidenced by: Based on interviews, the licensee/administrator did not ensure that the facility was without clogged toilets and an odor throughout the facility. This poses a potential risk to residents in care.

Official plan of correction

The administrator agrees to write a plan of correction advising how she will avoid this type of citation in the future.

Deadline recorded: Mar 25, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

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 for changes in physical, mental, emotional and social functioning and that appropriate assistance is provided when such observation reveals unmet needs. When changes such as unusual weight gains or losses or deterioration of mental ability or a physical health condition are 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 was not met as evidenced by: Based on observation of records and interviews that were conducted by the Department of Social Services-Community Care Licensing Division-Investigations Branch, Investigator Blatnick, the facility did not seek any other medical options or communicate with the doctor regarding the resident’s condition which presents an immediate health, safety, and personal rights risk to the residents in care.

Official plan of correction

Licensee/Administrator shall conduct staff training and provide proof of that training to Community Care Licensing. In addition, Licensee/Administrator shall fill out an LIC 9098-Self-Certification understanding of the regulation. Licensee/Administrator shall also provide a statement on how future compliance will be met. POC due date February 13, 2025

Deadline recorded: Feb 13, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

1569.2

Regulation authority

HSC

What the official deficiency says

Health and Safety Code §1569.2 (c) “Care and supervision” means the facility assumes responsibility for, or provides or promises to provide in the future, ongoing assistance with activities of daily living without which the resident’s physical health, mental health, safety, or welfare would be endangered. Assistance includes assistance with taking medications, money management, or personal care. This requirement was not met as evidenced by: Based on an observation of facility records and an interview with the Administrator, the facility Care Notes reflected that the bathing was not documented as being completed with no proof that the resident ever denied the showers. LPA conducted an interview with the Administrator via email and learned that the facility has no corroborating evidence to support that the resident denied the showers during said dates which is an immeidate health, safety and personal rights risk to the residents in care.

Official plan of correction

Licensee/Administrator to submit an LIC 9098 understanding of the Health and Safety Code Regulation. In addition, Licensee and Administrator shall conduct staff training outlining the regulations surrounding Care and Supervision. Licensee/Administrator shall provide a statement on how future compliance will be met. POC due date: November 14, 2024

Deadline recorded: Nov 14, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87411(a)

Regulation authority

CCR

What the official deficiency says

Personnel Requirements – Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs or the physical arrangements of the facility require such additional staff for the provision of adequate services. The requirement is not met as evidence by: Based on record review, the licensee did not provide adequate care and supervision by leaving a dementia resident unsupervised outside for an extended period which poses an immediate Health, Safety, Personal Rights risk to persons in care.

Official plan of correction

The licensee/administrator agrees to submit to the licensing agency a plan for each resident that is a fall risk. Advise the type of prevention, escort services needed, and training materials that will be used to inform the staff. A civil penalty in the amount of $1000.00 will be served this date, as the facility has been cited two times; dates 07/10/24 and 10/29/24.

Deadline recorded: Oct 30, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87705(c)(3)(A)

Regulation authority

CCR

What the official deficiency says

Care of Persons with Dementia – Licensees who accept and retain residents with dementia shall be responsible for ensuring the following: In addition to the on-the-job training requirements in Section 87411(d), staff who provide direct care to residents with dementia shall receive the following training as appropriate for the job assigned and as evidenced by safe and effective job performance: Dementia care including, but not limited to, knowledge about hydration, skin care, communication, therapeutic activities, behavioral challenges, the environment, and assisting with activities of daily living. Based on record review, the licensee did not provide adequate care and supervision by leaving a dementia resident unsupervised outside for an extended period which poses an immediate Health, Safety, Personal Rights risk to persons in care.

Official plan of correction

The licensee/administrator agrees to submit to the licensing agency what plan is in place to ensure that the residents are being hydrated each day.

Deadline recorded: Oct 30, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(d)(1)(2)

Regulation authority

CCR

What the official deficiency says

If the resident is unable to determine his/her own need for a prescription or nonprescription PRN medication, and is unable to communicate his/her symptoms clearly, facility staff designated by the licensee, shall be permitted to assist the resident with self-administration provided all of the following requirements are met: Facility staff shall contact the resident's physician prior to each dose, describe the resident's symptoms, and receive direction to assist the resident in self-administration of that dose of medication. The date and time of each contact with the physician, and the physician's directions, shall be documented and maintained in the resident's facility record. This requirement was not met as evidenced by: Based on interviews and records reviewed, the licensee did not ensure that a document indicating the date and time of each contact with the physician (hospice) and the physician’s (hospice) directions were documented and maintained in the resident’s file.

Official plan of correction

The administrator agrees to have a document in each resident’s file that indicates when the physician/hospice is called to give a PRN. This does not include the standard PRN letter related to over-the-counter meds. The administrator shall develop a document for each resident and shall submit a copy of what the document contains that the facility staff will use. A skilled medical professional shall provide training to the staff in regards to the citation.

Deadline recorded: Aug 7, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87411(a)

Regulation authority

CCR

What the official deficiency says

87411(a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs or the physical arrangements of the facility require such additional staff for the provision of adequate services. The requirement is not met as evidence by: Based on record review, the licensee did not provide adequate care and supervision by leaving a dementia resident unsupervised outside for an extended period of time which poses an immediate Health, Safety, Personal Rights risk to persons in care.

Official plan of correction

Licensee/Administrator will submit a Plan of Correction on how future compliance will be met. Civil Penalties were assessed today for the amount of $250.00 Plan of Correction due on July 11, 2024.

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

Official classification

Type B

Official code

87705(c)(5)

Regulation authority

CCR

What the official deficiency says

Licensees who accept and retain residents with dementia shall be responsible for ensuring the following: 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. The requirement is not met as evidence by: Based on record review, the licensee did not provide provide an updated medical assessment for a dementia resident which poses a potential Health, Safety, Personal Rights risk to persons in care.

Official plan of correction

The facility will develop and implement a strategy to track and monitor annual medical assessments for residents with Dementia, The Facility will inform the LPA of this process, and ensure that all annual medical assessments for residents for Dementia. Plans of Correction due by July 17, 2024

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

Official classification

Type B

Official code

1569.2(c)

Regulation authority

HSC

What the official deficiency says

Care and supervision” means the facility assumes responsibility for, or provides or promises to provide in the future, ongoing assistance with activities of daily living without which the resident’s physical health, mental health, safety, or welfare would be endangered. Assistance includes assistance with taking medications, money management, or personal care. This requirement was not met as evidenced by: The resident was not assisted with dressing as an expressed need outlined in residents medical assessment, preapprasial and care plan from 3/11-3/15/2024, four days without assistance with dressing.

Official plan of correction

Facility agrees to create a plan to ensure that, residents are receiving the care outlined within their needs and services plan. Facility will ensure that staff are documenting the completion of the needs and services outlined in resident care plans. Facility will also conduct a training with staff regarding the importance of resident observation and documentation of ADLs and submit to LPA by the POC due date of 05/02/24.

Deadline recorded: Apr 25, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(a)(6)

Regulation authority

CCR

What the official deficiency says

Incidental Medical - 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: When requested by the prescribing physician or the Department, a record of dosages of medications which are centrally stored shall be maintained by the facility. This requirement was not met as evidenced by interviews and documentation review. The licensee failed to ensure that a prescription order was in place to crush a resident’s medication. This poses an immediate health and safety risk to residents in care.

Official plan of correction

Administrator agrees to ensure that a physician’s order is in place to alter or crush a resident’s medication. The administrator will submit a copy of her understanding to the licensing agency

Deadline recorded: Mar 20, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

1569.269(a)(6)

Regulation authority

HSC

What the official deficiency says

Enumerated rights; severability (a) Residents of residential care facilities for the elderly shall have all of the following rights: (6) To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs. This requirement was not met as evidenced by interviews and documentation review. The licensee failed to comply with the Health and Safety code cited above. A fall risk care plan was not in place. This poses an immediate health and safety risk to residents in care.

Official plan of correction

The administrator agrees to assess all residents that are a fall risk and prepare a plan. Training shall be provided to care providers regarding prevention practices of residents that are a fall risk. The administrator agrees to submit to the licensing agency the materials used to train the care providers and a sign in sheet of those that were trained.

Deadline recorded: Mar 20, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87303(e)(3)

Regulation authority

CCR

What the official deficiency says

(e) Water supplies and plumbing fixtures shall be maintained as follows: (3) Taps delivering water at 125 degree F (52 degrees C) or above shall be prominently identified by warning signs. 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 two out of eight bathrooms in which the water was tested it was above the required 120 degree maximum which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/06/2024 Plan of Correction The administrator will create and implement a process to check the water tempeture to ensure that it remains within regualtion. Administrator will share this plan with the LPA.

Official classification

Type A

Official code

87303(f)(1)

Regulation authority

CCR

What the official deficiency says

(f) Solid waste shall be stored and disposed of as follows: (1) Solid waste shall be stored, located and disposed of in a manner that will not permit the transmission of a communicable disease or of odors, create a nuisance, provide a breeding place or food source for insects or rodents. 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 urine was found in a bucket in the room of a resident with dementia which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/06/2024 Plan of Correction Administrator will develop and implement a plan to ensure that all solid waste is disposed of appropriately. Administrator will share this plan with the LPA.

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 in six of six staff files reviewed did not have the above requirement documented in the file which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/12/2024 Plan of Correction Administrator will develop and implement a plan to ensure that the above regulation completed before the employee begins employment. Adminstrator will share this plan the the LPA.

Official classification

Type B

Official code

87303(e)

Regulation authority

CCR

What the official deficiency says

(e) Water supplies and plumbing fixtures shall be maintained as follows: This requirement is not met as evidenced by: Deficient Practice Statement Based onobservation, the licensee did not comply with the section cited above in one of the eight bathtubs observed was not in working order which poses/posed a potential health, safety or personal righ ts risk to persons in care.

Official plan of correction

POC Due Date: 03/12/2024 Plan of Correction Administrator will repair the broken bathtub and inform the LPA when complete.

Official classification

Type B

Official code

87411(c)(1)

Regulation authority

CCR

What the official deficiency says

(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 in six of the six staff files reviewed did not have the above mentioned requirement within the file which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/12/2024 Plan of Correction Administrator will develop and implement a plan to ensure that all staff are first aid trained before begining employment. Administrator will share this plan with the LPA.

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 interview and record review, the licensee did not comply with the section cited above in no fire drills were conducted in the last 12 months, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/12/2024 Plan of Correction Administrator will develop and implement a plan to ensure that fire drills are conducted as required. Administrator will share this plan with the LPA

Official classification

Type B

Official code

87608(a)(3)

Regulation authority

CCR

What the official deficiency says

(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: Deficient Practice Statement Based on observation record review, the licensee did not comply with the section cited above in two of the three files reviewed of residents to have observed to have bed rails did not have an medical order in the file which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/12/2024 Plan of Correction Administrator will develop and implenet a plan to ensure that all residents with bed rails have a medical order in the file. Admin will share this plan with the LPA.

Official classification

Type B

Official code

87618(b)(3)(B)

Regulation authority

CCR

What the official deficiency says

(3) Ensuring that the use of oxygen equipment meets the following requirements: (B) “No Smoking-Oxygen in Use” signs shall be posted in the appropriate 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 in that a resident who had oxygen in their room but did not have the " No Smoking- Oxygen in Use " sign posted which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/12/2024 Plan of Correction Administrator will ensure that all residents who are in need of Oxygen have the apporpriate postings outside the room to ensure the safety of residents in care. Adminstrator will share this information with the LPA

Official classification

Type A

Official code

87411(a)

Regulation authority

CCR

What the official deficiency says

87411(a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs or the physical arrangements of the facility require such additional staff for the provision of adequate services. The requirement is not met as evidence by: Based on observation, interviews and record review, the licensee did not provide adequate care and supervision by leaving a dementia resident unsupervised outside for an extended period of time which poses an immediate Health, Safety, Personal Rights risk to persons in care.

Official plan of correction

Licensee agrees to provide training for all direct care and administrative staff on the requirement to seek medical attention timely for residents. Licensee will schedule the training and provide CCL with the training content and signed staff attendance sheet as proof of correction.

Deadline recorded: Feb 2, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87213

Regulation authority

CCR

What the official deficiency says

Finances - The licensee shall have a financial plan that conforms to the requirements of Section 87155, Application for License, and that assures sufficient resources to meet operating costs for care of residents; shall maintain adequate financial records; and shall submit such financial reports as may be required upon the written request of the licensing agency… The licensee did not ensure that there were sufficient resources to meet operating costs for the care of residents.

Official plan of correction

The licensee agrees to follow the recommendations that are indicated in the report.

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

Official classification

Type A

Official code

87205(a)(b)

Regulation authority

CCR

What the official deficiency says

Accountability of Licensee Governing Body - The licensee, whether an individual or other entity, shall exercise general supervision over the affairs of the licensed facility and establish policies concerning its operation in conformance with these regulations and the welfare of the individuals it serves. If the licensee is a corporation or an association, the governing body shall be active, and functioning in order to assure accountability. The licensees did not exercise general supervision over the affairs of their licensed facilities.

Official plan of correction

The licensee agrees to follow the recommendations that are indicated in the report.

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

Official classification

Type A

Official code

1569.605

Regulation authority

HSC

What the official deficiency says

Liability Insurance - 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. The licensee did not maintain liability insurance per the Health and Safety Code.

Official plan of correction

The licensee agrees to follow the recommendations that are indicated in the report.

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

Official classification

Type A

Official code

87705(f)(2)

Regulation authority

CCR

What the official deficiency says

87705(f)(2)-Care of Persons with Dementia-The following shall be stored inaccessible to residents with dementia:cleaning supplies and disinfectants. This requirement is not met as evidenced by: Based upon interview and review of documents the Licensee failed to- Keep cleaning supplies from 1 of 1 residents in care. This poses an immediate Health, Safety and/or Personal Rights risk to residents in care.

Official plan of correction

Licensee completed POC prior to visit. Licensee bought new cart that has the ability to lock.

Deadline recorded: Mar 9, 2022. A deadline is not proof that correction was completed.