ANGEL WINGS CARE HOME III

Official classification

Type B

Official code

87468.2(a)(1)

Regulation authority

CCR

What the official deficiency says

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: (1) To have a reasonable level of personal privacy in accommodations, medical treatment, personal care and assistance, visits, communications, telephone conversations, use of the Internet, and meetings of resident and family groups. This requirement was not met as evidenced by staff failing to respect resident’s private telephone conversation 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 in-service staff training by an accredited CCL vendor on residents’ personal rights in compliance with Title 22 Section 87468.2 (a)(1)

Deadline recorded: Apr 13, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87411(g)

Regulation authority

CCR

What the official deficiency says

Prior to employment or initial presence in the facility, all employees and volunteers subject to a criminal record review shall: (1) Obtain a California clearance or a criminal record exemption as required by law or Department regulations... This requirement was not met as evidenced by presence of uncleared, unassociated and untrained staff working at the facility which posed an immediate health & safety risk to residents in care.

Official plan of correction

Immediate civil penalty of $1,000 assessed for one staff (S3) without criminal record clearance and association to the facility. LPA advised ADM that S3 cannot stay and must leave the facility asap.

Deadline recorded: Mar 17, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87303(f)

Regulation authority

CCR

What the official deficiency says

This requirement is not met as evidenced by: All waste shall be located, stored, and disposed of in a manner that will not transmit communicable diseases or odors, pose a risk to health and safety, or provide a breeding place or food source for insects or rodents. Deficient Practice Statement Based on observation, record reviews and interviews, 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: 01/23/2026 Plan of Correction Deficiency corrected during visit. ADM removed open trash bin in the master bathroom and replaced it with trash bin with lid.

Official classification

Type B

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 staff allowed resident to be soiled which posed a potential health & safety risk to residents in care.

Official plan of correction

ADM agreed to have additional trained staff provide proper care and supervision to residents in care effective 06/04/25. By POC due date, ADM also agreed to complete and submit in-service staff retraining on proper care and supervision of residents by an accredited vendor in compliance with Title 22 Section 87468.

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

Official classification

Type B

Official code

87411(d)(3)

Regulation authority

CCR

What the official deficiency says

Skill and knowledge required to provide necessary resident care and supervision, including the ability to communicate with residents. This requirement was not met as evidenced by staff did not meet the needs of a resident while in care which posed a potential health & safety risk to residents in care.

Official plan of correction

By POC due date, ADM agreed to complete and submit to CCLD in-service staff retraining on proper care and supervision by an accredited vendor in compliance with Title 22 Section 87411

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

Official classification

Type B

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 Hot water temperature was measured at 127.3 deg F during visit 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: 01/24/2025 Plan of Correction By POC due date, Administrator agreed to submit proof of correction to CCL in compliance with Title 22 Section 87303 (e)(3).