ROSE OF SHARON HEALTHCARE

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: 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 staff files available at facility for review which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/10/2025 Plan of Correction Administrator agreed to review regulation and submit self-certification that the facility will abide by the regulation going forward to CCLD by POC date.

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 observation, interview, and record review, the licensee did not comply with the section cited above in conducting a quarterly fire drill which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/10/2025 Plan of Correction Administrator agreed to conduct a fire drill and submit documentation to CCLD by POC date.

Official classification

Type B

Official code

87465(h)(5)

Regulation authority

CCR

What the official deficiency says

(h) The following requirements shall apply to medications which are centrally stored: (5) 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 evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above in having medication in it's original container which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/10/2025 Plan of Correction Administrator agreed to review regulation and submit a self certification that going forward the facility will abide by the regulation to CCLD by POC date.

Official classification

Type B

Official code

87506(a)

Regulation authority

CCR

What the official deficiency says

(a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff. 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 complete records for residents which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/10/2025 Plan of Correction Administrator agreed to review the regulation and submit a self-certificaton that the facility will abide by the regulation going forward to CCLD by POC date.

Official classification

Type A

Official code

87355(d)

Regulation authority

CCR

What the official deficiency says

(d) All individuals subject to criminal record review shall be fingerprinted and sign a Criminal Record Statement (LIC 508 [Rev. 1/03]) under penalty of perjury. This requirement was not met as evidence by: Based on record review and interview the Licensee did not comply with the section cited above in having S1 fingerprinted before being employed at the facility, which poses a potential health and safety risk to persons in care.

Official plan of correction

Licensee agreed to get S1 fingerprinted and submit copy of document to CCLD by POC date.

Deadline recorded: May 14, 2025. 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 was not met as evidence by: Based on observation and interview the Licensee did not comply with the section cited above in having S2 and S3 associated to the facility, which poses an potential health and safety risk to persons in care.

Official plan of correction

Licensee submtited LIC9182 and a copy of S2 and S3 identification to associate them to the facility during visit. Deficiency cleared during visit.

Deadline recorded: May 14, 2025. 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... the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances... and other similar items which could pose a danger to residents are in locked storage and are not left unattended... This requirement was not met as evidence by: Based on observation the Licensee did not comply with the section cited above by not having disinfectants, laundry detergents, paints accessible to residents, which poses an immediate health and safety risk to persons in care.

Official plan of correction

Licensee agreed to lock garage that contained laundry detergent, Clorox, paint and other items, and submit photo to CCLD by POC date.

Deadline recorded: May 14, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87202(a)(1)

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... Prior to accepting or retaining any of the following types of persons... (1) Non ambulatory persons. This requirement was not met as evidence by: Based on observation and record review the Licensee did not comply with the section cited above in having proper fire clearance for non ambulatory residents, which poses a potential health and safety risk to persons in care.

Official plan of correction

Licensee agreed to submit an LIC200 and updated copy of the facility sketch to CCLD by POC date.

Deadline recorded: May 14, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87307(a)(3)(c)

Regulation authority

CCR

What the official deficiency says

(a) ... The following provisions shall apply: (3) Equipment and supplies necessary for personal care and maintenance... shall be ...readily available to each resident. (C) Clean linen... towels, hand towels and wash cloths. The quantity shall be sufficient to permit changing at least once per week or more often... This requirement was not met as evidence by: Based on observation the Licensee did not comply with the section cited above in having a sufficient amount of bedding and towels available for residents, which poses a potential health and safety risk to persons in care.

Official plan of correction

License agreed to purchase bedding and linen and submit a photo to CCLD by POC date.

Deadline recorded: May 20, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

1569.605

Regulation authority

HSC

What the official deficiency says

... all residential care facilities for the elderly... shall maintain liability insurance covering injury to residents and guests in the amount of at least ($1,000,000) per occurrence and ($3,000,000) in the total annual aggregate, caused by the negligent acts or omissions to act of, or neglect by, the licensee or its employees. This requirement was not met as evidence by: Based on record review and interview the Licensee did not comply with the section above in having liability insurance for the facility which poses a potential health and safety risk to persons in care.

Official plan of correction

Licensee agreed to purchase liability insurance and submit a copy to CCLD by POC date.

Deadline recorded: May 20, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87405(a)

Regulation authority

CCR

What the official deficiency says

(a) All facilities shall have a qualified and currently certified administrator.... The administrator shall... on the premises a sufficient number of hours... When the administrator is not in the facility, there shall be coverage by a designated substitute who shall have qualifications.... This requirement was not met as evidence by: Based on observation and interview the Licensee did not comply with the section cited above in having an administrator

Official plan of correction

Licensee agreed to hire a qualified administrator and submit all documentation to CCLD by POC date.

Deadline recorded: May 20, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

1569.191(a)(1)

Regulation authority

HSC

What the official deficiency says

(a) Notwithstanding Section 1569.19, in the event of a sale of a licensed facility where the sale will result in a new license being issued, the sale and transfer of property and business shall be subject to both of the following: (1) The licensee shall provide written notice to the department and to each resident or his or her legal representative of the licensee's intent to sell the facility at least 30 days prior to the transfer of the property or business, or at the time that a bona fide offer is made, whichever period is longer. This requirement was not met as evidence by: Based on interview the Licensee did not comply with the section cited above in notifying CCLD and representatives of sale of business, which poses a potential health and safety risk to persons in care.

Official plan of correction

Licensee agreed to submit letter given to resident or residents representative to CCLD by POC date.

Deadline recorded: May 20, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87465(h)(5)

Regulation authority

CCR

What the official deficiency says

(h) The following requirements shall apply to medications which are centrally stored: (5) Each resident's medication shall be stored in its originally received container. No medications shall be transferred between containers. This requirement was not met as evidence by: Based on observation the Licensee did not comply with the section cited in maintaining medication in it's original container, which poses a potential health and safety risk to persons in care.

Official plan of correction

Licensee agreed to review regulation 87465 and submit self-certification that the facility will abide by regulation going forward to CCLD by POC date.

Deadline recorded: May 20, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87465(h)(6)

Regulation authority

CCR

What the official deficiency says

(h) The following requirements shall apply to medications which are centrally stored: (6) The licensee shall be responsible for assuring that a record of centrally stored prescription medications for each resident is maintained for at least one year and includes: This requirement was not met as evidence by: Based on observation and record review the Licensee did not comply with the section cited above in having records of medication for all 3 residents, which poses a potential health and safety risk to persons in care.

Official plan of correction

Licensee agreed to obtain records for medication for all 3 residents and submit records to CCLD by POC date.

Deadline recorded: May 20, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87623(b)

Regulation authority

CCR

What the official deficiency says

(b) In addition to Section 87611, General Requirements for Allowable Health Conditions, the licensee shall be responsible for the following: This requirement was not met as evidence by: Based on observation the Licensee did not comply with the section cited above in having documentation for R1's catheter/home health which poses a potential health and safety risk to persons in care.

Official plan of correction

Licensee agreed to obtain care plan from home health for R1 and submit plan to CCLD by POC date.

Deadline recorded: May 20, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87202(a)(1)

Regulation authority

CCR

What the official deficiency says

87202 (a) All facilities shall maintain a fire clearance approved by the city, county... fire protection services... Prior to accepting... persons, the applicant or licensee shall notify the licensing agency and obtain an appropriate fire clearance...(1) Nonambulatory persons. This requirement was not met as evidence by: Based on observation and record review the Licensee did not comply with the section cited above in have an approved fire clearance for non-ambulatory residents, which poses a potential health and safety risk for persons in care.

Official plan of correction

House manager agreed to sumbit a LIC200 and updated facility sketch to CCLD by POC date. *An immediate $500 civil penalty fire fire clearance*

Deadline recorded: Oct 2, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87555

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 was not met as evidence by: Based on observation the Licensee did not comply with the section cited above in having 7 day supply of non-perishable and 2-day perishable foods for residents, which poses a potential health and safety risk to persons in care.

Official plan of correction

House Manager agreed to purchase food and submit photos of food and receipts to CCLD by POC date.

Deadline recorded: Oct 4, 2024. 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

(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 sharps locked and inaccessible which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/21/2024 Plan of Correction Caregiver put scissors in drawer and locked kitchen drawer immediately. Deficiency cleared during visit.

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 residents with dementia: (2) Over-the-counter medication, nutritional supplements or vitamins, alcohol, cigarettes, and toxic substances such as certain plants, gardening supplies, cleaning supplies and disinfectants. 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 melatonin sitting next to R1's bed which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/21/2024 Plan of Correction Administrator agreed to lock away melatonin and submit a photo to CCLD by POC date.

Official classification

Type B

Official code

87411(a)

Regulation authority

CCR

What the official deficiency says

(a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. In facilities licensed for sixteen or more, sufficient support staff shall be employed to ensure provision of personal assistance and care as required in Section 87608, Postural Supports. Additional staff shall be employed as necessary to perform office work, cooking, house cleaning, laundering, and maintenance of buildings, equipment and grounds. The licensing agency may require any facility to provide additional staff whenever it determines through documentation that the needs of the particular residents, the extent of services provided, or the physical arrangements of the facility require such additional staff for the provision of adequate services. 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 in not having a NOC shift employed which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/27/2024 Plan of Correction Administrator agreed to hire or plan for another staff to cover NOC shift and submit and updated LIC500 to CCLD by POC date.

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: Deficient Practice Statement Based on observation, interview, and record review, the licensee did not comply with the section cited above in having resident records available for review during visit which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/27/2024 Plan of Correction Administrator agreed to submit self certification to have resident records available for review in facility to CCLD 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: Deficient Practice Statement Based on observation, interview, and record review, the licensee did not comply with the section cited above in having staff records available for review during visit which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/27/2024 Plan of Correction Administrator agreed to submit self certification to have staff records available for review in facility to CCLD by POC date.

Official classification

Type B

Official code

87705(l)(8)

Regulation authority

CCR

What the official deficiency says

87705 Care of Persons with Dementia (l) The following initial and continuing requirements shall be met for the licensee to lock exterior doors or perimeter fence gates: (8) Fire and earthquake drills shall be conducted at least once every three months on each shift and shall include, at a minimum, all direct care staff. 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 conducting a fire drill every three months which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/27/2024 Plan of Correction Administrator agreed to conduct a fire drill and submit signed document to CCLD by POC date.

Official classification

Type B

Official code

87465(8)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care (8) If a facility has no medical unit on the grounds, a complete first aid kit shall be maintained and be readily available in a specific location in the facility. The kit shall be a general type approved by the American Red Cross, or shall contain at least the following: 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 in having a first aid kit which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/27/2024 Plan of Correction Administrator agreed to purchase a first aid kit and submit a photo to CCLD by POC date.

Official classification

Type B

Official code

87203

Regulation authority

CCR

What the official deficiency says

87203 Fire Safety All facilities shall be maintained in conformity with the regulations adopted by the State Fire Marshal for the protection of life and property against fire and panic 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 not having the fire extinguishers serviced which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/27/2024 Plan of Correction Administrator agreed to have fire extinguishers serviced or purchase and submit picture of tag or receipt to CCLD by POC date.

Official classification

Type B

Official code

87465(h)(6)

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: (6) The licensee shall be responsible for assuring that a record of centrally stored prescription medications for each resident is maintained for at least one year and includes: 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 not having medications prescribed listed on MAR for all residents which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/27/2024 Plan of Correction Administrator agreed to update the MAR for all residents

Official classification

Type B

Official code

87211(a)(1)(B)

Regulation authority

CCR

What the official deficiency says

87211 Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: (1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below. This report shall include the resident's name, age, sex and date of admission; date and nature of event; attending physician's name, findings, and treatment, if any; and disposition of the case. (B) Any serious injury as determined by the attending physician and occurring while the resident is under facility supervision. 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 submitting an incident report to CCLD for R1 which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/27/2024 Plan of Correction Administrator agreed to submit an incident report for R1 to CCLD by POC date.

Official classification

Type B

Official code

87405(a)

Regulation authority

CCR

What the official deficiency says

87405 Administrator - Qualifications and Duties (a) All facilities shall have a qualified and currently certified administrator. The licensee and the administrator may be one and the same person. The administrator shall have sufficient freedom from other responsibilities and shall be on the premises a sufficient number of hours to permit adequate attention to the management and administration of the facility as specified in this section. When the administrator is not in the facility, there shall be coverage by a designated substitute who shall have qualifications adequate to be responsible and accountable for management and administration of the facility as specified in this section. The Department may require that the administrator devote additional hours in the facility to fulfill his/her responsibilities when the need for such additional hours is substantiated by written documentation. 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 a certified administrator employed at facility which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/27/2024 Plan of Correction Administrator agreed to hire an administrator or submit proof that administrator recertification is in process 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 having 7-day perishable and 2-day non perishable foods available for residents which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/23/2024 Plan of Correction Administrator agreed to purchase food and submit photos and pictures 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 passageway clear in back yard on right side of house which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/27/2024 Plan of Correction Administrator agreed to have all items removed from back yard and submit a photo to CCLD by POC date.

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 in having the hot water between 105 - 120 which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/23/2023 Plan of Correction Licensee agreed to have hot water temperature adjusted and submit photo with hot water temperature 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 in having toxins inaccessible to residents which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/23/2023 Plan of Correction Caregiver immediately locked toxins in locked cabinet in garage. Deficiency cleared during visit.

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: 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 personnel records completed and administrator record available which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/29/2023 Plan of Correction Licensee agreed to complete staff records, administrator records, and submit a self-certification that all have been completed 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 having both resident files completed which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/29/2023 Plan of Correction licensee agreed to complete both residents files and submit self-certification to CCLD by POC date.

Official classification

Type B

Official code

87465(a)(6)

Regulation authority

CCR

What the official deficiency says

(6) When requested by the prescribing physician or the Department, a record of dosages of medications which are centrally stored shall be maintained by the 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 prescriptions listed on the MAR which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/29/2023 Plan of Correction licensee agreed to update the MAR and submit self-certification to CCLD by POC date.

Official classification

Type B

Official code

87555(b)(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 the facility having 7-days non-perishable and 2-day perishable foods which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/29/2023 Plan of Correction Licensee agreed to purchase food and submit pictures and copies of receipts to CCLD by POC date.

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 pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (2) Request a transfer of a criminal record clearance as specified in Section 87355(c) or 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 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: 09/23/2023 Plan of Correction Licensee submitted LIC9182 and identification for S3 to LPA during visit. Deficiency cleared during visit.

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 (LIC 508 [Rev. 1/03]) under penalty of perjury. 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 have S2 fingerprinted and associated which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/23/2023 Plan of Correction licensee agreed to remove S3 and have S3 fingerprinted and associated before returning to work. Licensee will submit copy of paid live scan to CCLD by POC date.

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 6 bottles were on R2 night stand which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/23/2023 Plan of Correction Licensee removed bottles and locked them with other medicines. Deficiency cleared during visit.