RELIEZ VALLEY CARE HOME

Official classification

Type A

Official code

87355(e)(2)

Regulation authority

CCR

What the official deficiency says

87355 Criminal Record Clearance (e) All individuals subject to a criminal record review . . . shall prior to working . . . in a licensed facility: (2) Obtain a California clearance or a criminal record exemption as required by the Department. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, licensee did not comply with the section cited above. Staff S1 was not fingerprint cleared, which poses an immediate safety risk to persons in care.

Official plan of correction

POC Due Date: 12/10/2025 Plan of Correction Cleared during visit. Licensee has agreed not to allow S1 to return to facility until fingerprint cleared.

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 degrees C) and not more than 120 degree F (49 degrees 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. The maximum hot water temperature was 128.8 degrees Fahrenheit, which posed an immediate safety risk to persons in care.

Official plan of correction

POC Due Date: 12/10/2025 Plan of Correction Citation cleared during visit. Staff reduced maximum hot water temperature to 115.5 degrees Fahrenheit.

Official classification

Type B

Official code

87411(f)

Regulation authority

CCR

What the official deficiency says

(f) All personnel, including the licensee and administrator, shall be in good health, and physically and mentally capable of performing assigned tasks. Good physical health shall be verified by a health screening, including a chest x-ray or an intradermal test, performed by a physician not more than six (6) months prior to or seven (7) days after employment or licensure. A report shall be made of each screening, signed by the examining physician. The report shall indicate whether the person is physically qualified to perform the duties to be assigned, and whether he/she has any health condition that would create a hazard to him/herself, other staff members or residents. A signed statement shall be obtained from each volunteer affirming that he/she is in good health.Personnel with evidence of physical illness or emotional instability that poses a significant threat to the well-being of residents shall be relieved of their duties. 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 1 of 3 staff working with residents, which posed a potential safety risk to persons in care.

Official plan of correction

POC Due Date: 12/16/2025 Plan of Correction Cleared during visit. Licensee has agreed not to allow S1 to return to facility until health screening completed.

Official classification

Type A

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 Based on observation, the licensee did not comply with the section cited above in by having the water temperature measuring at 129.2 F in shared bathroom which poses an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 12/06/2024 Plan of Correction Administrator agreed to lower the temp and/or submit a photo of water temperature at required levels or signage of HOT water to CCLD by POC due date. During visit, Administrator posted " Caution Hot Water " sign. Deficiency cleared.

Official classification

Type B

Official code

87411(f)

Regulation authority

CCR

What the official deficiency says

(f) All personnel, including the licensee and administrator, shall be in good health, and physically and mentally capable of performing assigned tasks. Good physical health shall be verified by a health screening, including a chest x-ray or an intradermal test, performed by a physician not more than six (6) months prior to or seven (7) days after employment or licensure. A report shall be made of each screening, signed by the examining physician. The report shall indicate whether the person is physically qualified to perform the duties to be assigned, and whether he/she has any health condition that would create a hazard to him/herself, other staff members or residents. A signed statement shall be obtained from each volunteer affirming that he/she is in good health.Personnel with evidence of physical illness or emotional instability that poses a significant threat to the well-being of residents shall be relieved of their duties. This requirement is not met as evidenced by: Deficient Practice Statement Based on interview and record review, the licensee did not comply with the section cited above in by not having a health screening and negative TB results for S2 and S4 signed by licensed physician which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 01/02/2025 Plan of Correction Administrator agreed to submit copy of health screening and TB results for S2 and S4 to CCLD by POC due 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 in by not having range stove removed in side outside backyard which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 01/02/2025 Plan of Correction Administrator agreed to remove range stove and send a photo of item removed to CCLD by POC due 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, interview, and record review the licensee did not comply with the section cited above in by having a doctor's order for 1/2 bed rail/hospital bed for R4 which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/02/2025 Plan of Correction Administrator agreed to submit a copy of doctor's order for 1/2 bed rail/hospital bed for R4 to CCLD by POC due date.

Official classification

Type B

Official code

87618(b)(3)(A)

Regulation authority

CCR

What the official deficiency says

(3) Ensuring that the use of oxygen equipment meets the following requirements: (A) A report shall be made in writing to the local fire jurisdiction that oxygen is in use at 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 in by having a report for R2's oxygen on file that was sent to local fire dept. which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 12/12/2024 Plan of Correction Administrator agreed to send a copy of letter sent to local fire jurisdiction for R2's oxygen in use to CCLD by POC due date.

Official classification

Type B

Official code

87618(b)(3)(B)

Regulation authority

CCR

What the official deficiency says

(3) Ensuring that the use of oxygen equipment meets the following requirements: (B) “No Smoking-Oxygen in Use” signs shall be posted in the appropriate areas. 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 by not having " No Smoking-Oxygen in Use " signage in appropriate areas which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 12/12/2024 Plan of Correction Administrator agreed to post signs and send a photo to CCLD by POC due date. While at facility during visit, Administrator posted signs on resident's bedroom door and outside front door. Deficiency cleared.

Official classification

Type B

Official code

87212(a)

Regulation authority

CCR

What the official deficiency says

87212 (a) Emergency Disaster Plan This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview and record review, the licensee did not comply with the section cited above in by not having an updated Emergency Disaster Plan (LIC 610E) available which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/02/2025 Plan of Correction Administrator agreed to submit a copy of updated Emergency Disaster Plan and submit to CCLD for review by POC due 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 in by having Clorox Bleach inaccessible which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/01/2023 Plan of Correction Administrator removed and locked Clorox Bleach during visit. Deficiency cleared.

Official classification

Type B

Official code

87705(c)(6)

Regulation authority

CCR

What the official deficiency says

(c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following: (6) Appraisals are conducted on an ongoing basis pursuant to Section 87463, Reappraisals. 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 by not having Appraisal Needs and Services completed annually for R1, R3 and R5 which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/14/2023 Plan of Correction Administrator will read the regulation, complete Appraisal Needs and Services for R1, R3 and R5 and submit the updated copies to CCLD by POC Due Date.

Official classification

Type B

Official code

87411(f)

Regulation authority

CCR

What the official deficiency says

80065(g)(1) Personnel Requirements:(g)All personnel, ...be in good health, and shall be physically, mentally,...(1) a health screening, including a test for tuberculosis... This requirement was not met as evidence by: 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 by not having a Health Screening and TB test for S4 which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/14/2023 Plan of Correction Administrator agreed to obtain S4's health screening and TB test results. Administrator will submit a copy of health screening with TB test result to CCLD by POC date.

Official classification

Type B

Official code

87608(a)(3)

Regulation authority

CCR

What the official deficiency says

(a) Based on the individual's preadmission appraisal, and subsequent changes to that appraisal, the facility shall provide assistance and care for the resident in those activities of daily living which the resident is unable to do for himself/herself. Postural supports may be used under the following conditions: (3) A written order from a physician indicating the need for the postural support shall be maintained in the resident's record. The licensing agency shall be authorized to require other additional documentation if needed to verify the order. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview and record review, the licensee did not comply with the section cited above in by not having a doctor's order for full rail hospital bed for R5 which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/14/2023 Plan of Correction Administrator will read the regulation and get a doctor's order for full rail hospital bed for R5 and submit a copy of doctor's order to CCLD by POC Due Date.

Official classification

Type A

Official code

87468.1(a)(6)

Regulation authority

CCR

What the official deficiency says

Personal Rights of Residents in All Facilities. Residents... shall have all of the following personal rights: To leave or depart the facility at any time and to not be locked... This requirement is not met as evidenced by: Based on observation, Licensee did not comply with the section cited above by having a door chain latch at front door which poses an immediate health and safety risk to the persons in care.

Official plan of correction

Administrator removed door chain latch at front door. Deficiency cleared.

Deadline recorded: Feb 15, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87355(e)(2)

Regulation authority

CCR

What the official deficiency says

(e) All individuals subject to a criminal record review... ...l prior to working, residing or volunteering...(2)... transfer of a... Section 87355(c) This requirement is not met as evidenced by: Based on interview, the licensee did not comply with the section cited above which poses an immediate health and safety rights risk to persons in care. Unassociated staff working.

Official plan of correction

Administrator instructed S2 to leave the premises immediately. Administrator will associate S2 before she returns to work.

Deadline recorded: Jan 18, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87705(f)(2)

Regulation authority

CCR

What the official deficiency says

. (f) The following shall be stored inaccessible to... (2) Over-the-counter medication...vitamins...as certain plants, gardening supplies, cleaning supplies and disinfectants. Based on LPAs observations there was vitamins sitting on the counter located in the created room in the garage.

Official plan of correction

Administrator will lock the vitamins and keep it inaccessible to residents in care.

Deadline recorded: Jan 18, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87705(f)(1)

Regulation authority

CCR

What the official deficiency says

Care of Persons with Dementia (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: Based on observation, the licensee did not comply with the section cited above by having scissors on the kitchen counter and keys hanging from the medicine cabinet accessible to residents in care which poses an immediate health and safety risk to persons in care.

Official plan of correction

Administrator locked the scissors with the sharps and locked the medicine cabinet and removing the keys. Deficiency cleared during visit.

Deadline recorded: Dec 1, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87355(e)(2)

Regulation authority

CCR

What the official deficiency says

All individuals subject to a criminal record review.... 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. -This requirement is not met as evidenced by: Licensee failed to ensure all staff had a criminal record clearance. LPA observed S1 & S2 did not have a criminal record clearance, which poses a immediate safety risk to residents in care.

Official plan of correction

Administrator completed LIC9182 document and faxed to CCLD office. Deficiency was cleared during visit

Deadline recorded: Dec 1, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87305(a)

Regulation authority

CCR

What the official deficiency says

Prior to construction or alterations, all facilities shall obtain a building permit. This requirement was not met as evidenced by: LPA observed that a bedroom was constructed in the garage which is a potential threat to the health and safety of clients in care.

Official plan of correction

By POC date, facility will submit to CCL a copy of the County permit, along with an updated facility sketch, and a formal letter explaining the alteration,.

Deadline recorded: Feb 28, 2023. A deadline is not proof that correction was completed.