AMBASSADOR CARE HOME

Official classification

Type A

Official code

87468.2(a)(4)

Regulation authority

CCR

What the official deficiency says

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 staff working under the influence of alcohol which posed an immediate health and safety risk to residents in care

Official plan of correction

Deficiency was corrected on 07/21/26 by ADM terminating S2’s employment after discharge from the hospital the same day. Immediate civil penalty of $500 assessed during visit.

Deadline recorded: Aug 3, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87303(1)

Regulation authority

CCR

What the official deficiency says

(1) Floor surfaces in bath, laundry and kitchen areas shall be maintained in a clean, sanitary, and odorless condition. Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above as evidenced by smell of urine in dining areas which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/05/2025 Plan of Correction By POC due date, ADM agrees to complete and submit to CCLD proof of correction in compliance with Section 87303 (1) regulation.

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. Deficient Practice Statement Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in [count] out of [total count] [(objects) (persons)] [identifiers] which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/05/2025 Plan of Correction By POC due date, ADM agrees to complete and submit to CCLD proof of correction in compliance with Section 87303(a) regulation.

Official classification

Type B

Official code

87625(b)(3)

Regulation authority

CCR

What the official deficiency says

In addition to Section 87611, General Requirements for Allowable Health Conditions, 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 requirement was not met as evidenced by staff did not assist resident timely with incontinence care needs which posed a potential health & safety risk to residents in care.

Official plan of correction

By POC due date, ADM agrees to complete and submit to CCLD in-service staff retraining by a certified vendor on observation of resident in compliance with Section 87625(b)(3)

Deadline recorded: Aug 15, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87466

Regulation authority

CCR

What the official deficiency says

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 staff failed to observe resident’s change in condition which posed a potential health & safety risk to resident in care.

Official plan of correction

By POC due date, ADM agrees to complete and submit to CCLD in-service staff retraining by a certified vendor on observation of resident in compliance with Section 87466.

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

Official classification

Type B

Official code

87463(e)

Regulation authority

CCR

What the official deficiency says

The licensee shall immediately, or as soon as reasonably possible, bring any significant change in condition, as defined in Section 87101, Definitions, to the attention of the appropriate licensed medical professional and if applicable, other specialized care provider… This requirement was not met as evidenced by staff failed to meet resident’s medical needs in a timely manner which posed a potential health & safety risk to resident in care.

Official plan of correction

By POC due date, ADM agrees to complete and submit to CCLD in-service staff retraining by a certified vendor on proper resident reappraisal in compliance with Section 87463(e)

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

Official classification

Type A

Official code

87355(d)

Regulation authority

CCR

What the official deficiency says

87355 Criminal Record Clearance (d) All individuals subject to criminal record review shall be fingerprinted and sign a Criminal Record Statement under penalty of perjury. This requirement was not met as evidence by: Based on interview and record review the Licensee did not comply with the section cited above in having S2 fingerprinted and associated to the facility which poses an immediate health and safety risk to persons in care.

Official plan of correction

Administrator agreed to have S2 fingerprinted and submit application to CCLD by POC date.

Deadline recorded: Apr 16, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87411(d)(3)

Regulation authority

CCR

What the official deficiency says

(d) All personnel shall be given on the job training or have related experience in the job... This training and/or related experience shall provide knowledge of and skill... (3) Skill and knowledge required to provide resident care and supervision, including... to communicate with residents. This requirement was not met as evidence by: Based on observation and interview the Licensee did not comply with the section cited above in have a staff available on premises to communicate with residents and other, which poses an immediate health and safety risk to persons in care.

Official plan of correction

Administrator agreed to submit a written plan on how the facility will operate when short staff and how S2 will not be left alone with residents after fingerprinted and associated.

Deadline recorded: Apr 16, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87625(b)(2)

Regulation authority

CCR

What the official deficiency says

(b)...the licensee shall be responsible for the following: (2) Ensuring that incontinent residents are checked during those periods of time when they are known to be incontinent, including during the night. This requirement was not met as evidence by: Based on interviews the Licensee did not comply with the section cited above in ensuring incontinent residents are changed checked and changed timely, which poses a potential health and safety risk to persons in care.

Official plan of correction

Administrator agreed submit a written on plan on scheduling for incontinent residents and create a schedule and submit both to CCLD by POC date.

Deadline recorded: Apr 22, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.2(a)(4)

Regulation authority

CCR

What the official deficiency says

(a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (4) 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 evidence by: Based on interviews the Licensee did not comply with the section cited above in responding to resident in a timely manner, which poses a potential health and safety risk to persons in care.

Official plan of correction

LPA observed upon arrival on 4/15/2025, that each resident had a call bell to notify staff that they need assistance. Deficiency cleared.

Deadline recorded: Apr 22, 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) 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 in having cleaners and disinfectants inaccessible to residents which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/13/2024 Plan of Correction Caregiver immediately removed items from master bathroom, and locked cabinet in laundry room and cabinet underneath kitchen sink. Deficiency was cleared during visit.

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 observation and record review, the licensee did not comply with the section cited above in requesting an exception for a prohibited health condition which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/13/2024 Plan of Correction Administrator agreed to request an exception for R2 prohibited health condition from CCLD by POC date.

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

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 patio screen in den in repair, exit door to back yard in repair, refrigerator and freezer sanitary which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/19/2024 Plan of Correction Administrator agreed to repair door, screen, clean refrigerator ,freezer, and submit photos to CCLD by POC date.

Official classification

Type B

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 hot water in shared bathroom's faucet which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/19/2024 Plan of Correction Administrator agreed to have hot water coming from shared bathroom's faucet and submit photo showing temperature while water is running to CCLD by POC date.

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 in keeping passageway on left side of facility outside free of obstruction which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/19/2024 Plan of Correction Administrator agreed to have all items removed and submit a photo to CCLD by POC date.

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 observation and record review, the licensee did not comply with the section cited above in having all staff files complete which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/19/2024 Plan of Correction Administrator agreed to complete all staff files and submit self-certification that they were completed to CCLD by POC date.

Official classification

Type B

Official code

87555(b)(27)

Regulation authority

CCR

What the official deficiency says

(b) The following food service requirements shall apply: (27) All kitchen areas shall be kept clean and free of litter, rodents, vermin and insects. 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 kitchen area clean of insects which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/19/2024 Plan of Correction Administrator agreed to submit invoice from exterminator stating what services the facility have 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 observation and record review, the licensee did not comply with the section cited above in conducting quarterly fire drills which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/19/2024 Plan of Correction Administrator agreed to conduct a fire drill and submit document to CCLD by POC date.

Official classification

Type B

Official code

87609(b)(4)

Regulation authority

CCR

What the official deficiency says

(b) Incidental medical care may be provided to residents through a licensed home health agency provided the following conditions are met: (4) The licensee and home health agency agree in writing on the responsibilities of the home health agency, and those of the licensee in caring for the resident's medical condition(s). 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 home health care plan for R2 which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/19/2024 Plan of Correction Administrator agreed to obtain care plan and submit copy to CCLD by POC date.

Official classification

Type B

Official code

87628(a)

Regulation authority

CCR

What the official deficiency says

(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: Deficient Practice Statement Based on observation, interview, and record review, the licensee did not comply with the section cited above in retaining residents that are able to perform his/her own glucose testing which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/19/2024 Plan of Correction Administrator agreed to implement a plan for R1 and R2 to conduct own glucose testing or have a skilled professional conduct testing and submit to CCLD by POC date.

Official classification

Type B

Official code

87633(b)

Regulation authority

CCR

What the official deficiency says

(b) A current and complete hospice care plan shall be maintained in the facility for each hospice resident and include the following: 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 hospice care plan maintained at the facility for R4 which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/19/2024 Plan of Correction Administrator agreed to obtain a hospice care plan for R4 and submit a copy to CCLD by POC date.

Official classification

Type A

Official code

87705(l)(6)

Regulation authority

CCR

What the official deficiency says

(l) The following initial and continuing requirements shall be met for the licensee to lock exterior doors or perimeter fence gates: (6) Locked exterior doors or perimeter fences with locked gates shall not substitute for trained staff in sufficient numbers to meet the care and supervision needs of all residents. 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 a bolt lock on door leading to back yard which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/13/2024 Plan of Correction Administrator agreed to remove lock and submit photo to CCLD by POC date

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 medication inaccessible to residents which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/13/2024 Plan of Correction Caregiver removed ointment and locked medicine cabinet located in kitchen immediately. Deficiency was cleared during visit.

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 in having a 7-day supply of non-perishables and 2-day perishable foods which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/22/2024 Plan of Correction Administrator agreed to purchase food and submit photos of food and receipts to CCLD by POC date.

Official classification

Type B

Official code

87606(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 observation and record review, the licensee did not comply with the section cited above in having all resident records complete which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/19/2024 Plan of Correction Administrator agreed to complete all resident records and submit a self-certification to CCLD that records are complete to by POC date.

Official classification

Type B

Official code

87465(e)

Regulation authority

CCR

What the official deficiency says

(e) For every prescription and nonprescription PRN medication for which the licensee provides assistance there shall be a signed, dated written order from a physician, on a prescription blank, maintained in the residents file, and a label on the medication. Both the physician's order and the label shall contain at least all of the following information. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview, and record review, the licensee did not comply with the section cited above in having and accurate record for all medication maintained in each residents file which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/19/2024 Plan of Correction Administrator will complete a record for each residents' medication, maintain it in the file and submit a self-certification that it has been completed to CCLD by POC date.

Official classification

Type B

Official code

Not listed

Regulation authority

Not listed

What the official deficiency says

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 was not met as evidenced by expired fire extinguisher which posed a potential health & safety risk to residents in care.

Deadline recorded: Oct 26, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

Not listed

Regulation authority

Not listed

What the official deficiency says

Every facility licensed or certified pursuant to this chapter shall have one or more carbon monoxide detectors in the facility that meet the standards established in Chapter 8 (commencing with Section 13260) of Part 2 of Division 12. The department shall account for the presence of these detectors during inspections This requirement was not met as evidenced by missing carbon monoxide which posed a potential health & safety risk to residents in care,

Deadline recorded: Oct 26, 2023. A deadline is not proof that correction was completed.