FRIENDSHIP CARE HOME

Official classification

Type B

Official code

1569.652(c)

Regulation authority

HSC

What the official deficiency says

A refund of any fees paid in advance covering the time after the resident’s personal property has been removed from the facility shall be issued to the individual, individuals, or entity contractually responsible for the fees or, if the deceased resident paid the fees, to the resident’s estate, within 15 days after the personal property is removed… This requirement was not met as evidenced by facility not giving the refund to resident’s responsible party which posed a potential health & safety risk to resident in care.

Official plan of correction

Defiiciency corrected during visit. ADM issued refund check to POA on 10/22/25.

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

Official classification

Type B

Official code

87411(a)

Regulation authority

CCR

What the official deficiency says

Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs… This requirement was not met as evidenced by facility does not have enough afternoon and night staff to meet residents’ need which posed a potential health & safety risk to residents in care.

Official plan of correction

By POC due date, ADM agrees to hire additional staffing for PM and NOC shifts and submit to CCLD an updated Personnel record (LIC500) showing additional staff in compliance with Section 87411 (a) regulation

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

Official classification

Type B

Official code

87307(d)(1)

Regulation authority

CCR

What the official deficiency says

The following space and safety provisions shall apply to all facilities: Sufficient room shall be available to accommodate persons served in comfort and safety. This requirement was not met as evidenced by facility is not equipped to serve residents in the dining area which posed a potential health & safety risk to residents in care.

Official plan of correction

By POC due date, ADM agrees to purchase additional dining tables to accommodate residents’ dining needs and submit to CCLD an updated dining plan in compliance with Section 87307 (d)(1) regulation

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

Official classification

Type B

Official code

87405(a)

Regulation authority

CCR

What the official deficiency says

The Department may require that the administrator devote additional hours in the facility to fulfill his/her responsibilities when the need for such additional hours is substantiated by written documentation. This requirement was not met as evidenced by administrator is not at the facility a sufficient number of hours per week which posed a potential health & safety risk to residents in care.

Official plan of correction

By POC due date, ADM agrees to be at the facility a sufficient number of hours (minimum 20 hours per week) to permit adequate attention to the management and administration of the facility. ADM agrees to complete and submit to CCLD updated Personnel record (LIC 500) showing Administrator's sufficient number of work hours per week at the facility (minimum 20 hours per week) in compliance with Section 87405(a) regulation.

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

Official classification

Type B

Official code

87555(b)(6)

Regulation authority

CCR

What the official deficiency says

b) The following..shall apply:(6)In facilities for sixteen (16) persons or more, menus shall be written at least one week in advance... This requirement is not met as evidence by: Based on observation the facility did not comply with the section above by not creating and following a weekly menu which poses a potential personal rights violation for residents in care.

Official plan of correction

By POC facility agrees to create and impliment a weekly menu and document the dishes when served and also provide kitchen staff with training on nutrition and notify CCLD. **menus are to be written at least one week in advanced

Deadline recorded: Aug 1, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87465(d)

Regulation authority

CCR

What the official deficiency says

(d)If the resident is unable to determine...all of the following requirements are met: This requirement is not met as evidence by: Based on observation and record review the facility did not comply with the section above by having an inaccurate MAR which poses a potential health and safety violation for residents in care.

Official plan of correction

By POC Facility agrees to update and maintain the MAR as well as provide additional training to staff and notify CCLD.

Deadline recorded: Aug 1, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468(c)(2)(A)

Regulation authority

CCR

What the official deficiency says

(c)Licensees shall prominently post(2)Information...shall be posted as follows:(A) Licensees may use...PUB 475. The poster that is posted shall be 20 " x 26 " in size... This requirement is not met as evidence by: Based on observation the facility did not comply with the section above by PUB 475 poster being the incorrect dimensions and too small which poses a potential personal rights violation for residents in care.

Official plan of correction

By POC facility agrees to obtain the PUB 475 with the correct dimensions and notify CCLD.

Deadline recorded: Jul 17, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87307(a)(1)

Regulation authority

CCR

What the official deficiency says

(a) Living...shall be large enough...The following provisions shall apply:(1) There shall be...dining rooms...shall be of sufficient...from interfering with other functions. This requirement is not met as evidence by: Based on observation the facility did not comply with the section above by placing residents in the walkways to eat because the dining area is insufficient which poses a potential personal rights violation for residents in care.

Official plan of correction

By POC Facility agrees to develop a plan for meal times where clients are not placed in walkways and notify CCLD

Deadline recorded: Jul 17, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87608(a)

Regulation authority

CCR

What the official deficiency says

(a) Based on the individual's preadmission appraisal...Postural supports may be used under the following conditions This Requirement is not met as evidence by: Based on observation and file review the facility did not comply with the section above by R1 and R2 utilizing postural supports that are not documented in their file and do not have spring releases which pose an immediate personal rights violation for residents in care.

Official plan of correction

By POC facility agrees to obtain new 602s and physcians orders for all residents utilizing postural supports.

Deadline recorded: Jul 8, 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.. sharp objects, and other similar items..are in locked storage ... This Requirement is not met as evidence by: Based on observation the facility did not comply with the section above by having unlocked and accessible scissors which pose an immediate personal rights violation safety risk for residents in care.

Official plan of correction

Facility locked away scissors POC Clear.

Deadline recorded: Jul 1, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

8755(b)(8)

Regulation authority

CCR

What the official deficiency says

(b) The following..shall apply:(8) All food shall be of good quality... This requirement is not met as evidence by: Based on observation the facility did not comply with the section above having expired food which poses a potential health and personal rights violation for residents in care.

Official plan of correction

By POC facility agrees to audit and dispose of all expired foods and notify CCLD

Deadline recorded: Jul 17, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

8755(b)(9)

Regulation authority

CCR

What the official deficiency says

(b) The following..shall apply:(9)Procedures.. of food shall be observed in food storage... This requirement is not met as evidence by: Based on observation the facility did not comply with the section above by not storing food properly which poses a potential health violation for residents in care.

Official plan of correction

By POC facility agrees to conduct an inservice with kitchen staff and purchase food storage containers and notify CCLD

Deadline recorded: Jul 17, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87555(b)(6)

Regulation authority

CCR

What the official deficiency says

(b) The following..shall apply:(6)In facilities for sixteen (16) persons or more, menus shall be written at least one week in advance... This requirement i not met as evidence by: Based on observation the facility did not comply with the section above by not creating and following a weekly menu which poses a potential personal rights violation for residents in care.

Official plan of correction

By POC facility agrees to create and impliment a weekly menu and document the dishes when served and also provide kitchen staff with training on nutrition and notify CCLD

Deadline recorded: Jul 17, 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

(a) The facility shall be clean...(1) Floor surfaces in ... kitchen areas... This requirement i not met as evidence by: Based on observation the facility did not comply with the section above by kitchen floors being dirty which poses a potential health risk for residents in care.

Official plan of correction

By POC facility agrees to clean the kitchen and kitchen floors and notify CCLD

Deadline recorded: Jul 17, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87465(d)

Regulation authority

CCR

What the official deficiency says

(d)If the resident is unable to determine...all of the following requirements are met: This requirement is not met as evidence by: Based on observation and record review the facility did not comply with the section above by having an inaccurate MAR which poses a potential health and safety violation for residents in care.

Official plan of correction

By POC Facility agrees to update and maintain the MAR as well as provide additional training to staff and notify CCLD.

Deadline recorded: Jul 17, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87506(b)

Regulation authority

CCR

What the official deficiency says

(b) Each resident’s record shall contain at least the following information: This requirement is not met as evidence by: Based on record review the facility did not comply with the section above by having incomplete resident records which poses a potential personal rights violation for residents in care.

Official plan of correction

By POC facility agrees to review all resident records and update them as necessary and notify CCLD

Deadline recorded: Jul 17, 2025. A deadline is not proof that correction was completed.

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... to meet resident needs... This requirement is not met as evidence by: Based on observation and conversation the facility did not comply with the section above by not having a sufficient number of staff to meet the residents needs which poses a potetional personal rights violation for residents in care.

Official plan of correction

By POC facility agrees to hire an additional caregiver for each shift and notify CCLD.

Deadline recorded: Jul 17, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87203

Regulation authority

CCR

What the official deficiency says

All facilities shall be maintained in...regulations adopted by the State Fire Marshal... This requirement was not met as evidence by Based on observation the facility did not comply with the section above by having multiple fire exits blocked which poses an immediete safety violation for residents in care.

Official plan of correction

By POC Administrator will notify CCLD that all fire exits have been cleared. $500 Civil Penalty assesed

Deadline recorded: Jun 16, 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...the licensee shall ensure that disinfectants... are in locked storage... Based on observation the facility did not comply with the section above by having room with disinfectent unlocked and kitchen unsecured which poses an immediete safety violation for residents in care.

Official plan of correction

By POC Administrator will notify CCLD that all dangerous items are secured.

Deadline recorded: Jun 16, 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

The facility shall ... in good repair at all times... This requirement is not met as evidenced by: Based on observation the facility did not comply with the section above by having multiple broken locks and door which poses a potential personal rights violation for residents in care.

Official plan of correction

By POC Administrator will notify CCLD that all repairs have been made

Deadline recorded: Jun 16, 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

(a) Residents in all residential care... shall have all of the following personal rights: (6) To leave or depart the facility at any time and to not be locked into any room, building.... This requirement is not met as evidenced by: Based on observation the , Licensee did not comply with the regulation cited above by locking front main entrance door with a key and having child locks on perimeter doors which poses an immediate personal rights violation to persons in care.

Official plan of correction

By POC Administrator will review the regulations and provide, remove all child locks, and provide an in service to all employees and notify CCLD

Deadline recorded: Jun 16, 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

This requirement is not met as evidenced by: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 and interviews, the licensee did not comply with the section cited above as evidenced by common hallway flooring needing repairs which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/06/2025 Plan of Correction By POC due date, ADM agrees to submit photos of completed floor repairs in compliance with Section 87303 regulations.

Official classification

Type B

Official code

87303(E)

Regulation authority

CCR

What the official deficiency says

This requirement is not met as evidenced by:All slip-resistant mats, strips, or flooring shall be in good repair and maintain slip-resistant properties Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above as evidenced by water leak causing floor to buckle & develop mold which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/06/2025 Plan of Correction By POC due date, ADM agrees to repair and submit photos of completed repair receipts, repaired floor and water leak pipes in compliance with Section 87303 (e)(5)

Official classification

Type B

Official code

87303

Regulation authority

CCR

What the official deficiency says

This requirement is not met as evidenced by: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, the licensee did not comply with the section cited above as evidenced by a large hole in the backyard asphalt driveway which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/06/2025 Plan of Correction By POC due date, ADM agrees to submit a photo of repaired asphalt backyard driveway in compliance with Section 87303 (a)(1)

Official classification

Type B

Official code

87468.2(a)(2)

Regulation authority

CCR

What the official deficiency says

This requirement is not met as evidenced by:To have their records and personal information remain confidential and to approve their release, except as authorized by law. Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above as evidenced by open and disorganized residents & staff office documents which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/06/2025 Plan of Correction By POC due date, ADM agrees to submit a photo of clean office with organized residents and staff binders in compliance with Section 87468.2 regulation.

Official classification

Type B

Official code

87217(j)(2)

Regulation authority

CCR

What the official deficiency says

The executor or the administrator of the estate shall be notified by the licensee, and the cash resources, personal property, and valuables surrendered to said party. This requirement was not met as evidenced by staff withholding resident’s personal belongings to authorized representative on 11/01/23.

Official plan of correction

By POC due date, administrator agreed to complete and submit in-service staff retraining certificates on how to properly safeguard & surrender residents’ personal belongings & valuables in compliance with Title 22 Section 87217(j)(2).

Deadline recorded: Nov 30, 2023. 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

This requirement is not met as evidenced by: Deficient Practice Statement Facility staff did not comply with Section 87303 (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 was not met as evidenced by broken gate, kitchen vents and damaged shower walls and flooring which posed a potential health & safety risk to residents in care.

Official plan of correction

POC Due Date: 07/28/2023 Plan of Correction Administrator agreed to fix the following on or before POC due date of 7/28/23: Broken automatic gate Broken kitchen vents Damaged Shower# 2 walls & flooring Lifting floor boards at Shower#2 entrance and hallway

Official classification

Type B

Official code

87555(a)

Regulation authority

CCR

What the official deficiency says

This requirement is not met as evidenced by: Deficient Practice Statement Facility staff did not comply with Section 87555 (a): The total daily diet shall be of the quality and in the quantity necessary to meet the needs of the residents and shall meet the Recommended Dietary Allowances of the Food and Nutrition Board of the National Research Council. All food shall be selected, stored, prepared and served in a safe and healthful manner. This requirement was not met as evidenced by insufficient 2 day perishable food supply which posed a potential health and safety risk to residents in care.

Official plan of correction

POC Due Date: 07/28/2023 Plan of Correction Administrator agreed to purchase 2 day perishable food supply on 06/30/23 and submit food receipts to LPA on 07/01/23. Administrator also agreed to maintain adequate food supply for all residents in the quantity and quality required to meet residents needs.

Official classification

Type B

Official code

87217(b)

Regulation authority

CCR

What the official deficiency says

Every facility shall take appropriate measures to safeguard residents' cash resources, personal property and valuables which have been entrusted to the licensee or facility staff… This requirement was not met as evidenced by R1's misplaced personal belongings at the facility which posed a potential health & safety risk to residents in care

Official plan of correction

By POC due date, Administrator agreed to complete and submit to CCL in-service staff retraining certifications on safeguarding residents' cash resources and personal belongings in compliance with Title 22 Section 87217. Administrator stated POA and Ombudsman were both notified regarding R1's remaining personal belongings that need to be picked up at the facility.

Deadline recorded: Jul 14, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87506(c)(01)

Regulation authority

CCR

What the official deficiency says

All information and records obtained from or regarding residents shall be confidential. (1) ... The licensee and all employees shall reveal or make available confidential information only upon the resident's written consent or that of his designated representative. This requirement was not met as evidenced by facility not providing authorized representative a copy of resident's records which posed a potential health & safety risk to resident in care.

Official plan of correction

By POC due date, ADM agrees to send authorized representative coplies of R1's records and submit to CCL proof of submission.

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

Official classification

Type B

Official code

87507(g)(5)(A)

Regulation authority

CCR

What the official deficiency says

Facility policy concerning refunds, including the conditions under which a refund for advanced monthly fees will be returned in the event of a resident’s death, pursuant to Health and Safety Code section 1569.652 This requirement was not met as evidenced by late refund of R1's paid September 2022 when R1 passed away on 09/26/22 which was in violation of Title 22 Section 87507 refund regulation.

Official plan of correction

Administrator corrected deficiency during visit. Final refund check of $45 sent to R1's POA dated 11/04/22. Licensee and administrator understood Title 22 Section 87507 and will comply with Admission agreement regulations including refund policies.

Deadline recorded: Nov 4, 2022. 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

87307(d)(6) PERSONAL ACCOMODATIONS AND SERVICES (d)The following space and safety provisions shall apply to all facilities: (6) All outdoor and indoor passageways and stairways shall be kept free of obstruction. This requirement is not met as evidenced by: Based on observation, Licensee did not comply with the regulation cited above by storing items blocking the exit doors which poses a potential health and safety risk to persons in care.

Official plan of correction

By POC date, Administrator will remove items and submit a photo to CCLD.

Deadline recorded: Oct 10, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87211(a)(1)

Regulation authority

CCR

What the official deficiency says

87211(a)(1) REPORTING REQUIREMENTS (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... This requirement is not met as evidenced by: Based on record review, Licensee did not comply with the regulation cited above by not submitted an incident report for R1 which poses a potential heatlh and safety risk to residents in care.

Official plan of correction

By POC date, Administrator will review regulation and submit a self-certification letter (LIC 9098) to CCLD

Deadline recorded: Oct 14, 2022. 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

87568.1(a)(6) 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: (6) To leave or depart the facility at any time and to not be locked into any room, building.... This requirement is not met as evidenced by: Based on observation and interviews, Licensee did not comply with the regulation cited above by locking front main etrance door with a key which poses an immediate personal rights to persons in care.

Official plan of correction

By POC date, Administrator will review regulations, cease locking the exterior doors, and submit a self-certification letter to CCLD. In addition, Administrator will conduct staff training and submit a copy of training agenda with staff signatures.

Deadline recorded: Oct 7, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87405(d)(2)

Regulation authority

CCR

What the official deficiency says

87405(d)(2) ADMINISTRATOR - QUALIFICATIONS AND DUTIES (d) The administrator shall have the qualifications specified in Sections 87405(d)(1) through (7)...(2) Knowledge of and ability to conform to the applicable laws, rules and regulations. This requirement is not met as evidenced by: Based on observation, Licensee did not comply with the regulation cited above by visitor was not screened and requested to sign in which poses a potential health and safety risk to persons in care.

Official plan of correction

By POC date, Administrator will review PIN 22-28-ASC and conduct in-service training with staff, and submit a copy of training agenda with staff signatures to CCLD.

Deadline recorded: Oct 7, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87507(g)(5)(A)

Regulation authority

CCR

What the official deficiency says

87507(g)(5)(A) ADMISSION AGREEMENT (5) Refund conditions.(A) Facility policy concerning refunds, including the conditions under which a refund for advanced monthly fees will be returned in the event of a resident’s death, pursuant to Health and Safety Code section 1569.652. This requirement is not met as evidenced by: Based on record review and interview, the Licensee did not comply with the regulation cited above by stating there is a non-refundable policy which poses a potential personal rights to persons in care.

Official plan of correction

By POC date, Administrator will amend admission agreement in accordance to regulation and submit a copy to CCL.

Deadline recorded: Oct 14, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87211(a)(2)

Regulation authority

CCR

What the official deficiency says

Occurrences, such as epidemic outbreaks, poisonings, catastrophes or major accidents which threaten the welfare, safety or health of residents, personnel or visitors, shall be reported within 24 hours either by telephone or facsimile to the licensing agency and to the local health officer when appropriate This requirement was not met as evidenced by absence of LIC 624 on incident which posed a potential health & safety risk to residents in care

Official plan of correction

By POC due date, administrator agrees to submit to CCLD self certification that staff has read and will comply with Title 22 Section 87211 reporting requirements.

Deadline recorded: Jun 24, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87555(a)

Regulation authority

CCR

What the official deficiency says

General food service requirements The total daily diet shall be of the quality and in the quantity necessary to meet the needs of the residents and shall meet the Recommended Dietary Allowances of the Food and Nutrition Board of the National Research Council. All food shall be selected, stored, prepared and served in a safe and healthful manner. This requirement was not met as evidenced by insufficient perishable and non perishable food in the kitchen pantry which posed an immediate health & safety risk to residents in care

Official plan of correction

By POC due date, administrator agreed to submit to CCLD copies of purchase receipts for perishable & non-perishable foods sufficient to meet residents' needs.

Deadline recorded: Jun 17, 2022. 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 This requirement was not met as evidenced by insufficient staff to meet residents' needs which posed an immediate health & safety risk to residents in care

Official plan of correction

By POC due date, administrator agreed to hire additional staff sufficient to meet residents' needs.

Deadline recorded: Jun 17, 2022. 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 & 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 deteriorating floorings, warm temperature and broken window blinds which posed a potential health & safety risk to residents in care

Official plan of correction

By POC due date, administrator agreed to submit to CCLD proof of corrections for repairs to deteriorating floorings, broken window blinds and warm temperature to ensure the health & safety of residents are not compromised.

Deadline recorded: Jul 15, 2022. A deadline is not proof that correction was completed.