GOLDEN NEST ASSISTED LIVING

Official classification

Type A

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 degree C) and not more than 120 degree F (49 degree 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 the hot water in the shared residents' bathroom between 105 - 120 which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/07/2026 Plan of Correction Licensee agreed to adjust hot water temperature and send photo with water running to CCLD by POC date.

Official classification

Type B

Official code

87465(d)

Regulation authority

CCR

What the official deficiency says

(d) If the resident is unable to determine his/her own need for a prescription or nonprescription PRN medication, and is unable to communicate his/her symptoms clearly, facility staff designated by the licensee, shall be permitted to assist the resident with self-administration provided all of the following requirements are met: 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 administering the correct dosage of medications to R2, R3, and R4 which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/13/2026 Plan of Correction Licensee agreed to have an in-service training with all staff regarding administering medication and submit documentation to CCLD by POC date.

Official classification

Type A

Official code

87355(e)(1)

Regulation authority

CCR

What the official deficiency says

87355 Criminal Record Clearance (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department or This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, licensee did not comply with the section cited above by having uncleared staff (S1) work at the facility which poses an immediate health and safety risk to the persons in care.

Official plan of correction

POC Due Date: 01/09/2025 Plan of Correction S1 was asked to leave the facility. Facility has agreed to obtain fingerprint clearance for S1 prior to S1 returning to the facility. Facility will submit correspondence with CCLD regarding S1's clearance or S1's live scan form to CCLD by POC date. Civil penalty of $500 is being assessed.

Official classification

Type A

Official code

87465(h)(2)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care (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 medications in a kitchen cabinet with a broken lock which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/09/2025 Plan of Correction Administrator had Caregiver remove the medications and place in another cabinet with a functioning lock. Deficiency cleared during visit.

Official classification

Type A

Official code

87705(f)(1)

Regulation authority

CCR

What the official deficiency says

(f) The following shall be stored inaccessible to residents with dementia: (1) Knives, matches, firearms, tools and other items that could constitute a danger to the resident(s). 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 knives and a blue lighter inaccessible which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/09/2025 Plan of Correction Administrator had Caregiver immediately remove knives and lighter and place in a locked cabinet in kitchen making blue lighter and knives inaccessible. Deficiency cleared during visit.

Official classification

Type A

Official code

87303(2)

Regulation authority

CCR

What the official deficiency says

87303 Maintenance and Operation (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 degree C) and not more than 120 degree F (49 degree 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 between 105 - 120 degrees F. which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/09/2025 Plan of Correction Administrator will adjust water and submit photo of hot water temperature to CCLD by POC date.

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

87303 Maintenance and Operation (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 is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above in a broken window in the living room area and side gate in disrepair which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/15/2025 Plan of Correction Administrator agreed to send CCLD a photo email of the replaced window and gate by POC date.

Official classification

Type B

Official code

87412(f)

Regulation authority

CCR

What the official deficiency says

87412 Personnel Records 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: Based on observation, the licensee did not comply with the section cited above in having Personnel Records available to licensing agency to inspect, audit, and copy upon demand during normal business hours. which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

Administrator agreed to send a self certifying email to CCLD stating keys to all files will be available at the facility at all times by POC date

Deadline recorded: Nov 19, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87506(d)

Regulation authority

CCR

What the official deficiency says

87506 Resident Records (d) All resident 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: Based on observation, the licensee did not comply with the section cited above in having Residents Records available to licensing agency to inspect, audit, and copy upon demand during business hours which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

Administrator agreed to send a self certifying email to CCLD stating keys to all files will be available at the facility at all times by POC date

Deadline recorded: Nov 19, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87412(b)(3)(B)

Regulation authority

CCR

What the official deficiency says

(b) Personnel records shall be maintained for all volunteers and shall contain the following: (3) For volunteers that are required to be fingerprinted pursuant to Section 87355, Criminal Record Clearance: (B) Documentation of either a criminal record clearance or a criminal record exemption as required by Section 87355(e). 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 S1 associated to the facility which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/31/2024 Plan of Correction Administrator agreed to assoicated S1 to facility and submit association to CCLD by POC date.

Official classification

Type A

Official code

87606(c)

Regulation authority

CCR

What the official deficiency says

(c) To accept or retain a bedridden person, other than for a temporary illness or recovery from surgery, a facility shall obtain and maintain an appropriate fire clearance as specified in Section 87202(a). 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 R4 in bedroom that is not cleared for bedridden which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/31/2024 Plan of Correction Administrator will either change R4 to room that is fire cleared for bedridden, or submit an LIC200 and new facility sketch to request a fire clearance to change bedroom #4 to bedridden.

Official classification

Type A

Official code

87705(f)(1)

Regulation authority

CCR

What the official deficiency says

(f) The following shall be stored inaccessible to residents with dementia: (1) Knives, matches, firearms, tools and other items that could constitute a danger to the resident(s). 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 knives and medication inaccessible which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/31/2024 Plan of Correction Caregiver immediately locked cabinet and drawer in kitchen making medication and knives inaccessible. Deficiency cleared during visit.

Official classification

Type B

Official code

1569.618(c)(3)

Regulation authority

HSC

What the official deficiency says

(c)The facility shall employ, and the administrator shall schedule, a sufficient number of staff members to do all of the following: (3) Ensure that at least one staff member who has cardiopulmonary resuscitation (CPR) training and first aid training is on duty and on the premises at all times. This paragraph shall not be construed to require staff to provide CPR. 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 four (4) staff first aid certified which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/06/2024 Plan of Correction Administrator agreed to have all staff first aid certified and submit a copy of certification to CCLD by POC date.

Official classification

Type B

Official code

87608(a)(5)(B)

Regulation authority

CCR

What the official deficiency says

(B) Bed rails that extend the entire length of the bed are prohibited except for residents who are currently receiving hospice care and have a hospice care plan that specifies the need for full bed rails. 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 doctor orders for R5 and R2 full bedrails which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/06/2024 Plan of Correction Licensee removed full bedrails from R2 and R5 beds. Deficiency cleared during visit.

Official classification

Type A

Official code

87303(2)

Regulation authority

CCR

What the official deficiency says

87303 Maintenance and Operation (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 degree C) and not more than 120 degree F (49 degree 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 between 105 - 120 degrees F. which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/31/2024 Plan of Correction Administrator will adjust water and submit photo of hot water temperature to CCLD by POC date.

Official classification

Type A

Official code

1569.269(a)(10)

Regulation authority

HSC

What the official deficiency says

HSC Enumerated rights; severability. To be free from neglect,..., intimidation, and verbal, mental, physical, or sexual abuse. This This requirement is not met as evidenced by: Based on interviews & records reviews, Licensee did not comply with the regulation above, facility staff failed to assist R1, based on staff interview R1 fell more than once which resulted to hip fracture, which posed an immediate health & safety risk to resident in care.

Official plan of correction

By POC date, Administrator will conduct training with all staff of Sec. 1569.269 Enumerated Rights and submit proof of training and sign in sheet to CCL. A Non-Compliance Conference (NCC) will be scheduled at a later time. A $500.00 immediate civil penalty is assessed on this day. Civil penalty determination related to serious bodily injury is pending.

Deadline recorded: Aug 25, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(g)

Regulation authority

CCR

What the official deficiency says

Incidental Medical and Dental Care The licensee shall immediately telephone 9-1-1 if an injury or other circumstance has resulted in an imminent threat to a resident’s health including... This This requirement is not met as evidenced by: Based on record review and interviews, Licensee did not comply with the regulation above, it was confirmed by multiple staff that staff did not immediately contact 911 when R1 was found on the floor on 4/30/2022, staff sent R1 at the hospital not until 5/2/2022, which poses an immediate health and safety risk to residents in care.

Official plan of correction

By POC date, Administrator agrees to review regulation and conduct training with staff and submit a self-certification letter to CCL.

Deadline recorded: Aug 25, 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

REPORTING REQUIREMENTS (a) Each licensee shall furnish to the licensing agency such reports as the Department may require... (1) A written report shall be submitted to the licensing agency and to the person responsible for the resident.... This This requirement is not met as evidenced by: Based on interview and records review Licensee did not comply with the regulation above, staff failed to report to responsible party regarding R1’s fall incidents, including two fall incidents prior to 4/30/2022, which posed a potential health & safety risk to resident in care.

Official plan of correction

Administrator agrees to review regulation and obtain training with a vendor covering topic. By POC date, Administrator will submit a registration confirmation and self-certification letter on understanding of regulation to CCLD.

Deadline recorded: Aug 26, 2022. A deadline is not proof that correction was completed.