KALYNNA 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 failing to provide adequate care and supervision to resident resulting in resident being hospitalized twice which posed an immediate health & safety risk to residents in care.

Official plan of correction

Immediate civil penalty of $500 assessed during visit.

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

Official classification

Type A

Official code

87355(d)(3)

Regulation authority

CCR

What the official deficiency says

(3) The licensee shall submit these fingerprints to the California Department of Justice, along with a second set of fingerprints for the purpose of searching the records of the Federal Bureau of Investigation, or comply with Section 87355(c), prior to the individual's employment, residence, or initial presence in the facility. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview and record reviews, the licensee did not comply with the section cited above by having uncleared & unassociated staff working at the facility which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/30/2024 Plan of Correction Uncleared/unassociated staff left the facility. Immediate civil penalty of $500 assessed during visit.

Official classification

Type B

Official code

87412(f)

Regulation authority

CCR

What the official deficiency says

(f) All personnel records shall be available to the licensing agency to inspect, audit, and copy upon demand during normal business hours. Records may be removed if necessary for copying. Removal of records shall be subject to the following requirements: This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview and record reviews 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: 09/20/2024 Plan of Correction By POC due date, ADM agrees to complete and submit to CCL proof of correction that all personnel records are available at the facility for inspection.

Official classification

Type B

Official code

87412(g)

Regulation authority

CCR

What the official deficiency says

(g) All personnel records shall be maintained at the facility. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interviews and record reviews, 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: 09/20/2024 Plan of Correction By POC due date, ADM agrees to completed and submit to CCL proof of correction in ensuring all personnel records are maintained at the facility.

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, interviews and record reviews, the licensee did not comply with the section cited above as eveidenced by a broken front gate which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/20/2024 Plan of Correction By POC due date, ADM agrees to repair broken front gate and submit proof of correction to CCL.

Official classification

Type B

Official code

87309(a)

Regulation authority

CCR

What the official deficiency says

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: observance of unlocked bleach sitting on top of resident's bathroom counter. Deficient Practice Statement Based on observation 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: 09/20/2024 Plan of Correction By POC due date, ADM agrees to submit proof of correction CCL of locked chemicals at the facility.

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 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 evidence by broken freezer/refrigerator. 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: 09/15/2023 Plan of Correction Administrator agreed to replace broken freezer/refrigerator and submit proof of correction receipt to CCL on or before POC due date.

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. This requirement was not met as evidenced by expired fire extinguisher. 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: 09/15/2023 Plan of Correction By POC due date, Administrator agreed to submit copy of purchase receipt for new fire extinguisher.