DELTA SHORES ASSISTED LIVING

Official classification

Type B

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 failing to assist resident with medications which posed a potential health and safety risk to residents in care.

Official plan of correction

Deficiency corrected on 02/28/26. Director of Nursing (DN) conducted in-service retraining with all Med Techs on proper procedure in assisting residents with injections.

Deadline recorded: Mar 18, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87307(a)(F)

Regulation authority

CCR

What the official deficiency says

87307 Personal Accommodations ... (a) Living accommodations and grounds shall be ...function. The facility shall... provide comfortable ... residents, staff, and ... The following provisions shall apply: (F) Basic laundry service (washing, drying, and ...). Based on interviews and observation, licensee did not comply with the section cited above by not having timely basic laundry services, not replacing washers and dryers and hiring additional laundry staff.

Official plan of correction

Administrator agreed that the facility will purchase new washer and dryers and provide the department with a copy of purchase order and photos of the new machines once installed.

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

Official classification

Type A

Official code

87468.2(a)(4)

Regulation authority

CCR

What the official deficiency says

Residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: 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 R1 being left outside unattended during hot weather for extended amounts of time, resulting in R1 twice requiring hospitalization, which poses an immediate health & safety risk to residents in care.

Official plan of correction

Immediate civil penalty of $500 assessed during visit. Non compliance meeting (NCC) will be scheduled. By POC due date, Administrator agreed to complete and submit in-service staff training on proper care and supervision of residents in compliance with Title 22 Section 87468.2 (a)(4)

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

Official classification

Type B

Official code

87465(c)(1)

Regulation authority

CCR

What the official deficiency says

There is written direction from a physician, on a prescription blank, specifying the name of the resident, the name of the medication, all of the information in Section 87465(e), instructions regarding a time or circumstance (if any) when it should be discontinued, and an indication when the physician should be contacted for a medication reevaluation. This requirement was not met as evidenced by staff mismanaging resident’s medication which posed a potential health & safety risk to resident in care.

Official plan of correction

By POC due date, ADM agreed to complete and submit to CCL in-service staff retraining certifications on residents’ medication management in compliance with Title 22 Section 87465 (c) (1).

Deadline recorded: Dec 5, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468(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 did not attend to resident’s call for help which posed a potential health & safety risk to resident in care

Official plan of correction

By POC due date, ADM agreed to complete and submit to CCL in-service staff retraining certifications on residents’ personal rights in compliance with Title 22 Section 87468 (a) (4).

Deadline recorded: Dec 5, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.1(a)(3)

Regulation authority

CCR

What the official deficiency says

To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature, such as withholding residents’ money or interfering with daily living functions such as eating, sleeping, or elimination. This requirement was not met as evidenced by staff inappropriately pushing resident which posed a potential health & safety risk to resident in care

Official plan of correction

By POC due date, ED agrees to complete and submit to CCLD in-service staff retraining by a certified vendor on proper redirecting of resident in compliance with Section 87468.1(a)(3).

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

Official classification

Type B

Official code

87468.1(a)(1)

Regulation authority

CCR

What the official deficiency says

To be accorded dignity in their personal relationships with staff, residents, and other persons This requirement was not met as evidenced by staff inappropriately restraining a resident which posed a potential health & safety risk to resident in care.

Official plan of correction

By POC due date, ED agrees to complete and submit to CCLD in-service staff retraining by a certified vendor on personal rights of resident in compliance with Section 87468.1(a)(1).

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

Official classification

Type B

Official code

87303(a)(1)

Regulation authority

CCR

What the official deficiency says

Floor surfaces in bath, laundry and kitchen areas shall be maintained in a clean, sanitary, and odorless condition. This requirement was not met as evidenced by bad odor in bedrooms & bathrooms which posed a potential health & safety risk to residents in care.

Official plan of correction

By POC due date, ED agreed to have common areas, bedrooms, bathrooms, kitchen, living & dining rooms deep cleaned by a professional company and submit a copy of completed cleaning receipt to CCLD. In addition, ED agreed to complete and submit to CCLD in-service house staff retraining on proper cleaning procedures implemented daily at the facility for cleanliness maintenance.

Deadline recorded: Jun 30, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87470(a)(2)(A)

Regulation authority

CCR

What the official deficiency says

Surfaces such as floors, chairs, toilets, sinks, counters and tabletops shall be cleaned and disinfected on a regular basis to ensure they are safe and sanitary. These surfaces shall also be disinfected when these surfaces are contaminated and visibly soiled with blood or body fluids or other potentially infectious material. This requirement was not met as evidenced by dirty facility which posed a potential health & safety risk to residents in care.

Official plan of correction

By POC due date, ED agreed to complete and submit to CCLD in-service house staff retraining on proper sanitation practices on a regular basis to ensure facility is safe and sanitary.

Deadline recorded: Jun 30, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87203

Regulation authority

CCR

What the official deficiency says

This requirement is not met as evidenced by: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. Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/30/2025 Plan of Correction ADM contacted contracted fire extinguisher company who inspected and retagged all fire extinguishers in the facility during visit. Plan of correction completed 01/30/25.

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

This requirement is not met as evidenced by:The facility shall be clean, safe, sanitary and in good repair at all times Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/21/2025 Plan of Correction By POC due date, ADM agreed to complete and submit photos of repaired walls in compliance with Section 87303 regulations.

Official classification

Type B

Official code

87625(b)(3)

Regulation authority

CCR

What the official deficiency says

Managed Incontinence(b)(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: Based on LPA observation, the hallways on the first and second floors had a strong urine odor which posed a potential Health & Safety risk to residents in care.

Official plan of correction

ED will have all hallways deep cleaned and will train all staff on cleaning criteria, sanitary disposal, and ensure the facility does not have urine odor. ED will submit self certification of training with date, time, and attendees. ED will submit training material regarding the listed topics on Line 1 by POC date.

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

Official classification

Type B

Official code

87468.1(a)(1)

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: (1) To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement was not met as evidenced by staff handling resident in a rough manner which posed a potential health & safety risk to residents in care.

Official plan of correction

By POC due date, Administrator agreed to submit completed in-service retraining of all staff on residents’ personal rights in compliance with Title 22 Section 87468.1 regulations.

Deadline recorded: Aug 30, 2024. 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

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 provoking resident which posed a potential health & safety risk to residents in care.

Official plan of correction

By POC due date, Administrator agreed to submit completed in-service retraining of all staff on personal rights in compliance with Title 22 Section 87468.2 regulations.

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

Official classification

Type B

Official code

87468.2(a)(3)

Regulation authority

CCR

What the official deficiency says

To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature, such as withholding residents’ money or interfering with daily living functions such as eating, sleeping, or elimination. This requirement was not met as evidenced by staff did not allow resident to have his cigarettes which posed a potential health & safety risk to residents in care.

Official plan of correction

By POC due date, Administrator agreed to submit completed in-service retraining of all staff on personal rights in compliance with Title 22 Section 87468.1 regulations.

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

Official classification

Type B

Official code

87203

Regulation authority

CCR

What the official deficiency says

This requirement is not met as evidenced by: Deficient Practice Statement 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 Based on observation, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/15/2024 Plan of Correction By POC due date, Administrator agreed to submit to CCL a photo of stairwell fire/earthquake evacuation chair in compliance with Title 22 Section 87203