ANGEL'S LOVE RCFE

Official classification

Type B

Official code

87355(e)(3)

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: (3) Request a transfer of a criminal record clearance as specified in Section 87355(c) or This requirement was not met as evidence by: Based on record review the Licensee did not comply with the section cited above in having S2 associated to the facility which poses a potential health and safety risk to persons in care.

Official plan of correction

Administrator agreed to associate S2 to the facility and submit proof to CCLD by POC date.

Deadline recorded: Oct 8, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87307(e)(2)(A)

Regulation authority

CCR

What the official deficiency says

(e) The licensee shall supervise residents as needed and as determined by the resident's appraisal pursuant to Section 87457, Pre-Admission Appraisal or Section 87463, Reappraisals, when residents are in proximity to or when there is use of the following items: (2) Fishponds, wading pools, hot tubs, swimming pools, or similar larger bodies of water. (A) The licensee shall ensure that the bodies of water specified above are inaccessible through fencing, covering, or other means when not in active use by residents. 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 swimming pool accessible. The gate surrounding pool was apart from other part of gate which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/07/2025 Plan of Correction Administrator agreed to fix side of gate to make pool inaccessible to residents and submit photo to CCLD by POC date.

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: Deficient Practice Statement Based on observation, interview, and record review, the licensee did not comply with the section cited above in having S3 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: 03/28/2025 Plan of Correction Administrator agreed to have S3 associated to facility and submit verification to CCLD by POC date.

Official classification

Type A

Official code

87465(h)(2)

Regulation authority

CCR

What the official deficiency says

(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 having unlocked cabinets containing medication which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/28/2025 Plan of Correction Administrator repaired all cabinets with new locks and locked medicines. Deficiency cleared during visit.

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: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above in having detergents and cleaners in unlocked room and unlocked closet accessible to residents which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/28/2025 Plan of Correction Administrator agreed locked laundry room and closet that contained cleaners and disinfectants. Deficiency cleared during visit.

Official classification

Type B

Official code

87555(b)(26)

Regulation authority

CCR

What the official deficiency says

(b) The following food service requirements shall apply: (26) Supplies of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days shall be maintained on the premises. 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 a 7-day supply of non perishable and 2 day perishable foods for residents which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/30/2025 Plan of Correction Administrator agreed to purchase food and submit photo and receipt to CCLD by POC date.

Official classification

Type B

Official code

87632(d)

Regulation authority

CCR

What the official deficiency says

(d) If the Department grants a hospice care waiver it shall stipulate terms and conditions of the waiver as necessary to ensure the well-being of terminally ill residents and of all other facility residents, which shall include, but not be limited to, the following requirements: (2) The licensee shall notify the Department in writing within five working days of the initiation of hospice care services for any terminally ill resident in the facility or within five working days of admitting a resident already receiving hospice care services. The notice shall include the resident's name and date of admission to the facility and the name and address of the hospice. 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 submitted hospice notifications for R1 and R4 which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/03/2025 Plan of Correction Administrator agreed to review regulation 87632 and submit self-certification that the facility will abide by regulation going forward by POC date.

Official classification

Type B

Official code

87307(3)(B)

Regulation authority

CCR

What the official deficiency says

(3) Equipment and supplies necessary for personal care and maintenance of adequate hygiene practice shall be readily available to each resident. The resident may provide the following items; however, if the resident is unable or chooses not to provide them, the licensee shall assure provision of: (B) Bedroom furniture, which shall include, for each resident, a chair, night stand, a lamp, or lights sufficient for reading, and a chest of drawers. 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 not having night stand for 2 R5 and R^, and a chest of drawers for R1. which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/03/2025 Plan of Correction Administrator agreed to purchase a R5 and R6 a night stand, and R1 a chest of drawers, and submit a photo to CCLD by POC date.

Official classification

Type B

Official code

87506(b)

Regulation authority

CCR

What the official deficiency says

(b) Each resident's record shall contain at least the following information: 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 complete records for R3 and R4 which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/25/2024 Plan of Correction Administrator will complete records for R3, R4, and submit self-certification that records are complete to CCLD by POC date.

Official classification

Type B

Official code

87555(26)

Regulation authority

CCR

What the official deficiency says

87555 General Food Service Requirements (26) Supplies of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days shall be maintained on the premises. 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 have a supply of 7-day non-perishables and 2-day perishable for residents which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/22/2024 Plan of Correction Administrator agreed to purchase food and submit photo of food and receipts to CCLD by POC date.

Official classification

Type B

Official code

87307(d)(6)

Regulation authority

CCR

What the official deficiency says

87307 Personal Accommodations and Services (d) The following space and safety provisions shall apply to all facilities: (6) All outdoor and indoor passageways and stairways shall be kept free of obstruction. 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 passageways free of obstruction which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/29/2024 Plan of Correction Administrator agreed to remove all items and submit photo to CCLD by POC date.

Official classification

Type B

Official code

87412(a)(11)

Regulation authority

CCR

What the official deficiency says

87412 Personnel Records (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: (11) A health screening as specified in Section 87411, Personnel Requirements - General. 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 have S4 a health screening and TB test prior to working which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/25/2024 Plan of Correction Administrator agreed to have S4 obtain a health screening and TB test and submit a copy to CCLD by POC date.

Official classification

Type A

Official code

87608(a)(5)(B)

Regulation authority

CCR

What the official deficiency says

Postural Supports. Bed rails that extend the entire length of the bed are prohibited except for residents who are currently receiving hospice care... This requirement is not met as evidence by: Based on observation, licensee did not comply with the section cited above by having full bed rails for R2 who is not on hospice care which poses an immediate health and safety risk to the persons in care.

Official plan of correction

Staff have removed full bed rail during visit. Deficiency cleared.

Deadline recorded: Jan 13, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87355(d)

Regulation authority

CCR

What the official deficiency says

87355 Criminal Record Clearance (d) All individuals subject to criminal record review shall be fingerprinted and sign a Criminal Record Statement under penalty of perjury. This requirement was not met as evidence by: Based on record review the Licensee did not comply with the section cited above in having S3 and S4 fingerprinted and associated which poses an immediate health and safety risk to persons in care.

Official plan of correction

Administrator agreed to get S3 and S4 fingerprinted and submit document of completion to CCLD by POC date.

Deadline recorded: Dec 8, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87458(b)(4)

Regulation authority

CCR

What the official deficiency says

87458 Medical Assessment (b) The medical assessment shall include, but not be limited to: (4) Identification of physical limitations of the person... provided by the licensee, including any medically necessary diet limitations. This requirement was not met as evidence by: Based on observation the Licensee did not comply with the section cited above in having consent to puree food for R1 and R2 which poses a potential health and safety risk to persons in care.

Official plan of correction

Administrator agreed to obtain documentation to puree food for R1 and R2 and submit documentation to CCLD by POC date.

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

Official classification

Type B

Official code

87465(a)(5)(D)

Regulation authority

CCR

What the official deficiency says

87465 (a) A plan for incidental medical... care shall be developed by each facility. The plan shall encourage routine medical... (5) Facility staff... Assistance with self administered medications shall be limited to the following: (D) Assistance with self-administration does not include forcing a resident to take medication, hiding or camouflaging medications in other substances without the resident's knowledge and consent... This requirement was not met as evidence by: Based on observation the Licensee did not comply with the section cited above in not hiding medication in food which poses a potential health and safety risk to persons in care.

Official plan of correction

Administrator will obtain order to crush and camoflauge medication for both R1 and R2 and submit documentation to CCLD by POC date.

Deadline recorded: Dec 15, 2023. 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

87211 (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... within seven days of the occurrence of any of the events... This requirement was not met as evidence by: Based on LPA's interview and record review the Licensee did not comply with the seciton cited above in reporting and AWOL, which poses a potential health and safety risk to persons in care.

Official plan of correction

Co-Administrator agreed to submit incident report for AWOL to CCLD by POC date.

Deadline recorded: Jul 10, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.2(a)(1)

Regulation authority

CCR

What the official deficiency says

87468.2 (a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: This requirement was not met as evidence by: Based on LPA's observation the Licensee did not comply with the section cited above in resident having privacy in personal accommodations, which poses a potential health and safety risk to persons in care.

Official plan of correction

Staff immediately removed monitor from kitchen counter top. Deficiency cleared during visit.

Deadline recorded: Jul 10, 2023. 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) 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 having the Clorox, Comet, Clorox disinfectant, knives, scissors and other items inaccessible which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/04/2023 Plan of Correction Caregiver immediately locked cabinet that was located underneath the sink that contained items. Deficiency cleared during inspection. Deficiency cleared.

Official classification

Type A

Official code

87309(b)

Regulation authority

CCR

What the official deficiency says

(b) Medicines shall be stored as specified in Section 87465(c) and separately from other items specified in (a) above. 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 medication inaccessible to residents which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/04/2023 Plan of Correction Caregiver immediately locked cabinets that contained medication. Deficiency cleared during inspection.

Official classification

Type B

Official code

87303(e)(5)

Regulation authority

CCR

What the official deficiency says

(e) Water supplies and plumbing fixtures shall be maintained as follows: (5) Non-skid mats or strips shall be used in all bathtubs and showers. 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 a non-skid mat in shared residents' bathroom which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/10/2023 Plan of Correction Administrator agreed to purchase and place a non-skid mat in the shared residents' bathroom and submit a photo to CCLD by POC date.

Official classification

Type B

Official code

87608(a)(3)

Regulation authority

CCR

What the official deficiency says

87608 Postural Supports (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... 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's orders for hospital bed for R1, R2, and R3 which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/10/2023 Plan of Correction Administrator agreed to obtain a doctor's order for R1, R2, and R3 and submit a photo copy to CCLD by POC date.

Official classification

Type B

Official code

87468.2(a)(1)

Regulation authority

CCR

What the official deficiency says

87468.2 Additional Personal Rights of Residents in Privately Operated Facilities (a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (1) To have a reasonable level of personal privacy in accommodations,... 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 a monitor watching R5 in the bedroom and locking the refrigerator and freezer which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/10/2023 Plan of Correction Administrator removed locks from refrigerator and freezer, and took out monitor from bedroom and kitchen counter. Deficiency cleared during inspection.

Official classification

Type B

Official code

87506(a)

Regulation authority

CCR

What the official deficiency says

87506 Resident Records (a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident... readily available to facility staff and to licensing agency staff. This requirement was not met as evidence by: Based on record review and observation the Licensee did not comply with the section cited above in having a complete file for R1, which poses a potential health and safety risk to persons in case.

Official plan of correction

Administrator agreed to submit a self-certification that regulation 87506 has been reviewed and administrator will abide by the regulation. Self-certification will be submitted by the POC date.

Deadline recorded: Nov 9, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87705(c)(4)

Regulation authority

CCR

What the official deficiency says

87705 (c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following: (4) There is an adequate number of direct care staff to support each resident’s... safety and health care needs as identified in his/her current appraisal. This requirement was not met as evidence by: Based on LPAs interviews and record review the Licensee did not comply with the section cited above in supporting R1's needs, which poses a potential health and safety risk to residents in care.

Official plan of correction

Administrator agreed to submit a written plan of correction stating what plan will be implemented to prevent an AWOL from occurring again. Plan will be submitted to CCLD by POC date.

Deadline recorded: Nov 9, 2022. 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) 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 the utility room unlocked with chemicals out which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/07/2022 Plan of Correction POC corrected during visit

Official classification

Type A

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, the licensee did not comply with the section cited above by having expired cans of food which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/14/2022 Plan of Correction Go through pantry and clean out any expired foods. Submit proof by POC date

Official classification

Type A

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 is not met as evidenced by: Deficient Practice Statement Based on observation and interview, the licensee did not comply with the section cited above by having constrution done on the bathroom without informing CCLD which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/14/2022 Plan of Correction Submit a plan/letter to CCLD explaining how you will care for the residents during constrution by POC date

Official classification

Type A

Official code

87307(d)(6)

Regulation authority

CCR

What the official deficiency says

(6) All outdoor and indoor passageways and stairways shall be kept free of obstruction. 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 a gate in disrepair which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/14/2022 Plan of Correction Fix the gate and submit a picture as a POC by POC date

Official classification

Type B

Official code

87208(a)

Regulation authority

CCR

What the official deficiency says

(a) Each facility shall have and maintain a current, written definitive plan of operation. The plan and related materials shall be on file in the facility and shall be submitted to the licensing agency with the license application. Any significant changes in the plan of operation which would affect the services to residents shall be submitted to the licensing agency for approval. The plan and related materials shall contain the following: 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 changing a resident room into a staff room which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/14/2022 Plan of Correction Submit a new LIC 999 that correctly identifys the new use for each room by POC date.