QCARE RESIDENTIAL FACILITY

Official classification

Type B

Official code

87355(e)(2)

Regulation authority

CCR

What the official deficiency says

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: Request a transfer of a criminal record clearance as specified in Section 87355(c) Based on observation, the licensee did not comply with the section cited above by having two staff who are not associated which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

The Administrator will submit a transfer request form with current I.D. to associate S1 and S2 to the facility by due date.

Deadline recorded: Aug 21, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87412(a)

Regulation authority

CCR

What the official deficiency says

(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: Based on observation, the licensee did not comply with the section cited above by not having staff records for S1 and S2

Official plan of correction

Licensee shall have S1 and S2, files completed and submit to licensing, copies of completed forms by POC date.

Deadline recorded: Aug 7, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87355(e)

Regulation authority

CCR

What the official deficiency says

(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: This requirement is not met as evidenced by: Based on interview and record review, the licensee did not comply with the section cited above. S1 is not fingerprint cleared to be in the facility which poses an immediate safety risk to persons in care.

Official plan of correction

Staff was removed from the premises during the visit and Licensee agrees to have the staff fingerprint cleared. Proof of correction will be sent to CCLD by POC date.

Deadline recorded: Jan 23, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(h)(2)

Regulation authority

CCR

What the official deficiency says

(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: Based on observation, the licensee did not comply with the section cited above by having unlocked Miralax and cold medicine in the kitchen cabinet which posed an immediate safety risk to persons in care.

Official plan of correction

Staff locked it during the visit. Deficiency cleared during the visit.

Deadline recorded: Jan 23, 2026. 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 in subsection (b), the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances, knives, matches, tools, sharp objects, and other similar items which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage. This requirement is not met as evidenced by: Based on observations, the licensee did not comply with the section cited above by having Lysol Wipes, Scrubbing Bubbles, laundry detergent, bleach, etc., all around the facility and backyard which poses an immediate safety risk to persons in care.

Official plan of correction

Staff will lock the items and send proof of correction by POC date.

Deadline recorded: Jan 23, 2026. 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 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: Based on observation, the licensee did not comply with the section cited above by having an uneven platform in the bathroom tiles, the mirror cabinet is loose, multiple trash bags and commode in the backyard that needs to be removed which poses a potential safety risk to persons in care.

Official plan of correction

Staff agrees to fix the bathroom tiles and mirror, schedule a bulk pick up, and send proof to CCLD by POC date.

Deadline recorded: Feb 5, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

1569.695(c)

Regulation authority

HSC

What the official deficiency says

(c) A facility shall conduct a drill at least quarterly for each shift. The type of emergency covered in a drill shall vary from quarter to quarter, taking into account different emergency scenarios. An actual evacuation of residents is not required during a drill. While a facility may provide an opportunity for residents to participate in a drill, it shall not require any resident participation. Documentation of the drills shall include the date, the type of emergency covered by the drill, and the names of staff participating in the drill. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, the licensee did not comply with the section cited above by not having done an emergency drill since 2022 which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/29/2025 Plan of Correction The facility agrees to review the regulation and conduct an emergency drill for the home. Proof of correction will be sent to CCLD by POC date.

Official classification

Type A

Official code

87309(a)

Regulation authority

CCR

What the official deficiency says

(a) 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: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above by having cleaning solutions left in the bathroom on the counter and with the personal care items which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/07/2024 Plan of Correction The facility agrees to remove the cleaning solutions from the bathroom and to review the regulation listed above. Proof of correction will be sent to CCD by POC date

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, the licensee did not comply with the section cited above by having old medical equipment, broken furniture and bags of trash stored in the side yard which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/19/2024 Plan of Correction The facility agrees to remove the old medical equipment, broken furniture and bags of trash. Proof of correction will be sent to CCLD by POC date.

Official classification

Type B

Official code

1569.618(a)

Regulation authority

HSC

What the official deficiency says

(a) The administrator designated by the licensee pursuant to paragraph (11) of subdivision (a) of Section 1569.15 shall be present at the facility during normal working hours. A facility manager designated by the licensee with notice to the department, shall be responsible for the operation of the facility when the administrator is temporarily absent from the facility. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, the licensee did not comply with the section cited above by not having the administrator or assistant administrator listed on the LIC 500 showing when they are at the facility which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/12/2024 Plan of Correction The facility agrees to submit an updated LIC 500 to CCLD showning the hours that all staff work. Proof of correction will be sent to CCLD by POC date.

Official classification

Type B

Official code

87463(c)

Regulation authority

CCR

What the official deficiency says

(c) The licensee shall arrange a meeting with the resident, the resident's representative, if any, appropriate facility staff, and a representative of the resident's home health agency, if any, when there is significant change in the resident's condition, or once every 12 months, whichever occurs first, as specified in Section 87467, Resident Participation in Decision Making. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, the licensee did not comply with the section cited above in 3 out of 3 Apprasial Needs and Services plans have not been updated since 2022 which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/12/2024 Plan of Correction The facility agrees to update the needs and services plans for all residents. Proof of correction will be sent to CCLD by POC date.

Official classification

Type B

Official code

87555(b)(8)

Regulation authority

CCR

What the official deficiency says

(b) The following food service requirements shall apply: (8) All food shall be of good quality. Commercial foods shall be approved by appropriate federal, state and local authorities. Food in damaged containers shall not be accepted, used or retained. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and interviews, the licensee did not comply with the section cited above in by storing eggs on the counter un-refridgerated which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/10/2023 Plan of Correction POC Cleared during visit.