GINES RESIDENTIAL CARE HOME III

Official classification

Type A

Official code

87411(a)

Regulation authority

CCR

What the official deficiency says

(a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs...for the provision of adequate services. This requirement was not met as evidence by: Based on interview with the Licensee R1 was administered the incorrect medication because the Licensee failed to verify the medications received by the pharmacy thereby requiring R1 to be hospitilized which poses an immediate health and safety risk to residents in care.

Official plan of correction

By POC Licensee agrees to review regulation and medication managment procedures, develop and implement a medication logging process and notify CCLD.

Deadline recorded: Nov 7, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87307(d)(6)

Regulation authority

CCR

What the official deficiency says

(d) The following...shall apply to all facilities(6)All... passageways...shall be kept free of obstruction. This requirement was not met as evidence by: Based on observation the facility was not in compliance with the above regulation by having a table blocking the passage way into the kitchen which poses a potential safety risk to residents in care.

Official plan of correction

Facility removed table POC clear.

Deadline recorded: Aug 26, 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, 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 in having unlocked sharps which poses an immediate safety risk to persons in care.

Official plan of correction

POC Due Date: 03/07/2025 Plan of Correction Facility staff locked away all sharps POC clear.

Official classification

Type A

Official code

87412(a)(13)(B)

Regulation authority

CCR

What the official deficiency says

(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: (13) For employees that are required to be fingerprinted pursuant to Section 87355, Criminal Record Clearance: (B) Documentation of either a criminal record clearance or a criminal record exemption as required by Section 87355(e). 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 inhaving a staff working at the facility that has been excluded in guardian which poses an immediate safety and personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/07/2025 Plan of Correction Staff removed all belongings and left the facility POC clear. LPA also assesed an immediate $500 civil penalty.

Official classification

Type A

Official code

87465(h)(2)

Regulation authority

CCR

What the official deficiency says

(h) The following requirements shall apply to medications which are centrally stored: (2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored 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 in having the medication cabinent unlocked and accesable which poses an immediate safety risk to persons in care.

Official plan of correction

POC Due Date: 03/07/2025 Plan of Correction Staff locked and secured the cabinent POC clear.

Official classification

Type B

Official code

1569.695(a)

Regulation authority

HSC

What the official deficiency says

(a)In addition to any other requirement of this chapter, a residential care facility for the elderly shall have an emergency and disaster plan that shall include, but not be limited to, all of the following: 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 innot having an updated emergency disaster plan which poses a potential safety risk to persons in care.

Official plan of correction

POC Due Date: 03/14/2025 Plan of Correction By POC Licensee agrees to update and review emergency disaster plan and mail a copy to CCLD.

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 innot having any record or dates for drills conducted which poses a potential safety risk to persons in care.

Official plan of correction

POC Due Date: 03/14/2025 Plan of Correction By POC Licensee agrees to conduct emergency disaster drills and mail a copy of the logs to CCLD.

Official classification

Type B

Official code

87411(a)

Regulation authority

CCR

What the official deficiency says

(a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. In facilities licensed for sixteen or more, sufficient support staff shall be employed to ensure provision of personal assistance and care as required in Section 87608, Postural Supports. Additional staff shall be employed as necessary to perform office work, cooking, house cleaning, laundering, and maintenance of buildings, equipment and grounds. 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 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 not having enough staff scheduled for a 2 person assist 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 Durring visit Administrator called in more staff.

Official classification

Type B

Official code

87412(a)

Regulation authority

CCR

What the official deficiency says

(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 in not having a complete file for administrator which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/11/2023 Plan of Correction By POC date administrator agrees to submit a checklist for the required documents in admistrator file to CCLD

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 requirement is not met as evidenced by: Deficient Practice Statement Based on record review of five staff, the licensee did not comply with the section cited above in not having the required staff first aid certified which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/11/2023 Plan of Correction By POC date Administrator agrees to have all required staff first aid trained and certified and submit certificates to CCLD.

Official classification

Type B

Official code

87355(e)(2)

Regulation authority

CCR

What the official deficiency says

87355 Criminal Record Clearance (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(2) Request a transfer of a criminal record clearance as specified in Section 87355(c) 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 having S5 not associated to facility which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/11/2023 Plan of Correction By POC date administrator agrees to submit the nessesarry documents to associate S5 and self certify submission to CCLD

Official classification

Type B

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. LPA observed a 2x4 block placed against the side gate thus preventing the gate to open which poses a potential heatth, safetyy or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/01/2022 Plan of Correction LPA observed staff removed block. By POC date, Administrator will review regulation and submit self-certification letter stating Administrator have read and understood regulation.