ROSE WATERS HOME

Official classification

Type A

Official code

87202(a)(2)

Regulation authority

CCR

What the official deficiency says

(a) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, or the State Fire Marshal. Prior to accepting or retaining any of the following types of persons, the applicant or licensee shall notify the licensing agency and obtain an appropriate fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, or the State Fire Marshal: (2) Bedridden persons 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 R3 in a bedroom that is not cleared for bedridden which poses an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 08/14/2025 Plan of Correction Administrator agrees to submit an LIC200 and a new facility sketch to request a fire clearance to change bedrooom #5 to bedridden to CCLD by POC date.

Official classification

Type B

Official code

87608(a)(5)(A)

Regulation authority

CCR

What the official deficiency says

(A) A bed rail that extends from the head half the length of the bed and used only for assistance with mobility shall be allowed. 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 that R3 has half rails on their bed but no appropriate order in place in their records, which poses a potential health and safety or risk to persons in care.

Official plan of correction

POC Due Date: 08/20/2025 Plan of Correction Administrator agrees to submit paperwork to R3's primary care physician and obtain a signed order for a bed rail. A copy of this order will be emailed to CCLD by the POC date.

Official classification

Type B

Official code

87465(h)(5)

Regulation authority

CCR

What the official deficiency says

87465(h)(5) Incidental Medical and Dental Care. Each resident's medication shall be stored in its originally received container. No medications shall be transferred between containers. This requirement is not met as evidence by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above. LPA observed medications pre-poured in a locked cabnet in the kitchen which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/28/2024 Plan of Correction Administration shall train staffon providetraining in the correct way to store and passmedication and proof of training to LPA by POC date.

Official classification

Type A

Official code

87412(a)(13)

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: (13) For employees that are required to be fingerprinted pursuant to Section 87355, Criminal Record Clearance: 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 volunteers that are not finger print cleared working at the facility which poses an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 09/02/2022 Plan of Correction Admistrator will associate volunteers to facility and send proof to CCLD by POC date

Official classification

Type A

Official code

87309(1)(a)

Regulation authority

CCR

What the official deficiency says

(1) 87309 Storage Space (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. Storage areas for poisons... shall be locked. 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 ant/roach/spider spray accessible to residents which poses an immediate health and safety risk do to persons in care

Official plan of correction

POC Due Date: 09/02/2022 Plan of Correction Administrator moved bug spray to a locked cabinet. Deficiency cleared during visit.

Official classification

Type B

Official code

87507(f)

Regulation authority

CCR

What the official deficiency says

ADMISSION AGREEMENTS (f) The licensee shall comply with all applicable terms and conditions set forth in the admission agreement, including all modifications and attachments. This requirement is not met as evidenced by: Based on record review, Licensee did not comply with the regulation cited above. LPAs observed a total $2626 for R2's fees and property damage were deducted from R1's refund which poses a potential personal rights to persons in care.

Official plan of correction

Administrator will issue a refund to resident and submit a copy of payment to CCL by POC date.

Deadline recorded: Jul 6, 2022. A deadline is not proof that correction was completed.