ELISABETH CARE HOME

Official classification

Type B

Official code

87303(e)(2)

Regulation authority

CCR

What the official deficiency says

(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 by hot water temperature in all shared bathrooms including kitchen sink was not regulating at minmum 105 degrees F. Water temperature measured at 100.9 which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/28/2026 Plan of Correction Administrator will raise the water temperature on water heat and re-check. Send a photo of water temperature and submit a photo to CCLD by POC due date. While at facility Administrator adjusted the water heater and water measured at 108.7 Deficiency cleared during visit. Repeat Violation. Assessed civil penalty $250.00 for today.

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, the licensee did not comply with the section cited above in by having a lock on side exit gate which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/28/2026 Plan of Correction Administrator removed the lock during visit. Deficiency cleared.

Official classification

Type B

Official code

1569.695(c)

Regulation authority

HSC

What the official deficiency says

§1569.695 Emergency Plans (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, record review, the licensee did not comply with the section cited above in by not conducting quarterly fire drills with staff for each staff including but not limited to all staff on different shifts which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/03/2026 Plan of Correction Administrator agrees to self-certify by reading and understanding the regulation moving forward and send self-certification to CCLD by POC due date. In addition, conduct fire drills with staff and have staff signatures as participating in the exercised drills.

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

87303 Maintenance and Operation (a) 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 a tv monitor, gardening shovel, rake, other items located outside in backyard which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/03/2026 Plan of Correction Administrator agrees to remove and clean the back yard, send a photo to CCLD by POC due date. While at the facility Administrator removed the shovel, rake, umbrella pole and tv monitor to the garage. Deficiency cleared. Repeat Violation. Assessed civil penalty $250.00 for today.

Official classification

Type B

Official code

87411(c)(1)

Regulation authority

CCR

What the official deficiency says

87411 Personnel Requirements – General (c) All RCFE staff who assist residents with personal activities of daily living shall receive initial and annual training as specified in Health and Safety Code sections 1569.625 and 1569.69 (1) Staff providing care shall receive appropriate training in first aid from persons qualified by such agencies as the American Red Cross. 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 S3 had expired First Aid expired which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/03/2026 Plan of Correction Administrator will send a copy of First Aid certificate for S3 to CCLD by POC due date.

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

(a) 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 having backyard cleaned up, flooring repaired in rear bedroom which poses a potential health and safety or risk to persons in care.

Official plan of correction

POC Due Date: 06/11/2025 Plan of Correction Administrator agreed to clean yard, remove items from back yards, and repair the broken wood in rear bedrooms by sending a photo to CCLD by POC due date.

Official classification

Type B

Official code

87303(a)(1)

Regulation authority

CCR

What the official deficiency says

(a) 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. (1) Floor surfaces in bath, laundry and kitchen areas shall be maintained in a clean, sanitary, and odorless condition. 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 the floor surfaces clean including but not limited to bathroom and shower floors in rear bedrooms which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 06/11/2025 Plan of Correction Administrator agreed to clean all flooring including rear bedrooms and bathrooms by sending a photo to CCLD by POC due date.

Official classification

Type B

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 by not having the water temp. measuring between 105-120 degree F. The water temperatures measured 126, 128.7 and 128 degree F in rear bathroom which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 06/11/2025 Plan of Correction Administrator will adjust water temp. and send a photo to CCLD by pOC due date.

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 interview and record review, the licensee did not comply with the section cited above in by not having on file including but not limited to application, First Aid/CPR, and employee documents for S4 which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/11/2025 Plan of Correction Administrator agreed to submit S4 documents to CCLD by POC due date.

Official classification

Type B

Official code

1569.625(b)(2)

Regulation authority

HSC

What the official deficiency says

(2) In addition to paragraph (1), training requirements shall also include an additional 20 hours annually, eight hours of which shall be dementia care training, as required by subdivision (a) of Section 1569.626, and four hours of which shall be specific to postural supports, restricted health conditions, and hospice care, as required by subdivision (a) of Section 1569.696. This training shall be administered on the job, or in a classroom setting, or both, and may include online training. 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 annual trainings for S1, S2 and S3 which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/11/2025 Plan of Correction Administrator agreed to complete staff trainings and submit training certificates to CCLD by POC due date.

Official classification

Type B

Official code

87465(d)

Regulation authority

CCR

What the official deficiency says

(d) If the resident is unable to determine his/her own need for a prescription or nonprescription PRN medication, and is unable to communicate his/her symptoms clearly, facility staff designated by the licensee, shall be permitted to assist the resident with self-administration, provided all of the following requirements are met: 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 physician's report for R1 that indicates that R1 can administer their own prescription and non-prescription medications which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 06/11/2025 Plan of Correction Administrator to submit an updated Physician's Report for R1 to CCLD by POC due date.

Official classification

Type B

Official code

87465(e)

Regulation authority

CCR

What the official deficiency says

(e) For every prescription and nonprescription PRN medication for which the licensee provides assistance there shall be a signed, dated written order from a physician on a prescription blank, maintained in the resident's file, and a label on the medication. Both the physician's order and the label shall contain at least all of 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 by having R1's doctor's orders on file for prescription and non-prescription medications including but not limited to vitamins and herbal supplements which pose a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 06/11/2025 Plan of Correction Administrator agreed to submit a copy of doctor's orders for all prescription and non prescription medications for R1 to CCLD by POC due 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...Health and Safety Code Section 1569.17(b) shall prior to working, residing in a licensed facility: Based on observation and interview the licensee did not comply with the section cited above in by not having fingerprint clearance for 6 (six) family relatives that are residing at the facility submitted to CCLD which poses a potential health, safety or personal rights risk to persons in care. Immediate Civil Penalty Assessed of $3,000.00

Official plan of correction

Administrator will have all uncleared individuals removed from the house by POC due date.

Deadline recorded: Jul 18, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87412(d)

Regulation authority

CCR

What the official deficiency says

(d) The licensee shall maintain documentation that an administrator has met the certification requirements specified in Section 87406, Administrator Certification Requirements or the recertification requirements in Section 87407, Administrator Recertification 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 by not having Administrator Certificate submitted before it expired and renewal documentation available not limited to CE which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/05/2024 Plan of Correction Administrator will submit all renewal certification documentation to CCLD by POC due date.

Official classification

Type B

Official code

87458(b)(1)

Regulation authority

CCR

What the official deficiency says

(b) The medical assessment shall include, but not be limited to: (1) A physical examination of the resident indicating the physician's primary diagnosis and secondary diagnosis, if any and results of an examination for communicable tuberculosis, other contagious/infectious or contagious diseases or other medical conditions which would preclude care of the person by 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 not having a Physician's Report for R3 which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/05/2024 Plan of Correction Administrator agree to submit R3's Physician's Report to CCLD by POC due 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 and record review, the licensee did not comply with the section cited above in by not having doctor's orders for bed rails for R1 and R3 which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/05/2024 Plan of Correction Administrator agree to submit doctor's order for bed rails for R1 and R3 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 interview and record review, the licensee did not comply with the section cited above in by not having documentation in R1's file for oxygen use sent to local fire dept. which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 06/05/2024 Plan of Correction Administrator agree to submit a copy of letter sent to local fire dept for R1's oxygen use.

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 a No Smoking Oxygen in use signage which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 06/05/2024 Plan of Correction Administrator agree to submit a photo of signage on R1's door to CCLD by POC due date.

Official classification

Type B

Official code

87211(a)(1)

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. 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 notifying Licensing of R1's Hospitalizations and ER visits which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/05/2024 Plan of Correction Administrator agree to self-certify that they read the regulation and understand moving forward to comply with the regulations.

Official classification

Type B

Official code

87616(b)

Regulation authority

CCR

What the official deficiency says

87616 Exceptions for Health Conditions (b) Written requests shall include, but are not limited to, the following: 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 exception request for R1's Foley Catheter which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 06/05/2024 Plan of Correction Administrator agree to submit to CCLD an exception request for R1's Foley Catheter and provide all completed documentations by POC due date.

Official classification

Type B

Official code

1569.605

Regulation authority

HSC

What the official deficiency says

On and after July 1, 2015, all residential care facilities for the elderly...shall maintain liability insurance covering injury to residents and guests...($1,000,000) million dollars ($3,000,000) This requirement is not met as evidenced by: Based on interview and record review, the licensee did not comply with the section cited above in licensee failed to obtain facility's liability insurance which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Administrator will submit a copy of Liability Insurance to CCLD by POC Due Date.

Deadline recorded: Sep 25, 2023. A deadline is not proof that correction was completed.

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 by having water temp at 133.4F which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/28/2023 Plan of Correction Licensee/Administrator will adjust water temp and send photo to CCL by POC Due Date showing water temp

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 water temp 133.4 which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/28/2023 Plan of Correction Licensee/Administrator will adjust water temp and send photo to CCL by POC Due Date showing water temp 105-120F

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 scissors, viatmins, cleaning solutions inaccessible which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/28/2023 Plan of Correction Licensee/Administrator removed and locked scissors, vitamins, cleaning solutions during visit. Deficiency cleared during visit.

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 by not having knives inaccessible to residents which poses an immediate health, safety risk to persons in care.

Official plan of correction

POC Due Date: 06/28/2023 Plan of Correction Licensee/Administrator removed knives and locked in toolbox with a new pad lock during visit. 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 by having vitamins unlocked which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/28/2023 Plan of Correction Licensee/Administrator removed the vitamins and locked up during visit. 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 record review, the licensee did not comply with the section cited above in by not having TB and Health Screenings for all staff which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/11/2023 Plan of Correction Administrator to schedule TB tests and Health Screening for all staff and send copies to CCLD by POC Due Date

Official classification

Type B

Official code

87465(f)(1)

Regulation authority

CCR

What the official deficiency says

(f) Emergency care requirements shall include the following: (1) The name, address, and telephone number of each resident's physician and dentist shall be readily available to that resident, the licensee, and facility staff. 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 name, addresses, telephone numbers of resident's physicians and dentists on file which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/11/2023 Plan of Correction Administrator will update records and submit a copy to CCLD by POC Due Date

Official classification

Type B

Official code

87208(d)

Regulation authority

CCR

What the official deficiency says

(d) A licensee who accepts or retains bedridden persons shall include additional information in the plan of operation as specified in Section 87606(f). 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 Bedridden for R2 and R3 included in their plan which can pose a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/11/2023 Plan of Correction Administrator will update Plan of Operation for Bedridden. Administrator will send updated record for R3 in Shared Bedroom#2.

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 shower chair, microwave in outside back side yard accessible to residents in care which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 07/11/2023 Plan of Correction Administrator will remove items and send a picture to CCLD by POC Due Date

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 by having Non-skid mats in Shared Bathroom#2 which posesa pote ntial health and safety risk to persons in care.

Official plan of correction

POC Due Date: 07/11/2023 Plan of Correction Administrator will place non-skid mats in resident's bathroom and send a photo to CCLD by POC Due Date

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 record review, the licensee did not comply with the section cited above in by not having complete staff records maintained at the facility which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/11/2023 Plan of Correction Administrator will update all staff personnel records and send a copy of the names of all staff that records are complete along with a photo of all staff records to CCLD by POC Due 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 record review, the licensee did not comply with the section cited above in by not having each resident's records available, e.g., R3 which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/11/2023 Plan of Correction Administrator will update resident's records and send a copy and/or pictures of R3's records

Official classification

Type B

Official code

87506(b)(9)

Regulation authority

CCR

What the official deficiency says

(b) Each resident's record shall contain at least the following information: (9) Name, address and telephone number of physician and dentist to be called in an emergency. 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 resident's records with physician's telephone numbers which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/11/2023 Plan of Correction Administrator will update and send a copy to CCLD by POC Due Date

Official classification

Type B

Official code

87506(b)(11)

Regulation authority

CCR

What the official deficiency says

(b) Each resident's record shall contain at least the following information: (11) The documentation required by Section 87611(a) for residents with an allowable health condition. 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 health condition for R3 which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/11/2023 Plan of Correction Administrator will update and send a copy to CCLD by POC Due Date

Official classification

Type B

Official code

87506(b)(15)

Regulation authority

CCR

What the official deficiency says

(b) Each resident's record shall contain at least the following information: (15) The admission agreement and pre-admission appraisal, specified in Sections 87507, Admission Agreements and 87457, Pre-admission Appraisal. 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 the appraisals completed for residents which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/11/2023 Plan of Correction Administrator will complete appraisals and pre-appraisals and send copies to CCLD by POC Due date

Official classification

Type B

Official code

87506(b)(17)(A)

Regulation authority

CCR

What the official deficiency says

(b) Each resident's record shall contain at least the following information: (17) Documents and information requried by the following: (A) Section 87457, Pre-Admission Appraisal; 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 Pre-Admission Appraisal which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/11/2023 Plan of Correction Administrator will complete and send a copy to CCLD by POC Due Date

Official classification

Type B

Official code

87506(b)(17)(B)

Regulation authority

CCR

What the official deficiency says

(b) Each resident's record shall contain at least the following information: (17) Documents and information requried by the following: (B) Section 87459, Functional Capabilities; 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 Functional Capabilities on file for residents in care which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/11/2023 Plan of Correction Administrator will complete and submit a copy to CCLD by POC Due Date

Official classification

Type B

Official code

87506(b)(17)(C)

Regulation authority

CCR

What the official deficiency says

(b) Each resident's record shall contain at least the following information: (17) Documents and information requried by the following: (C) Section 87461, Mental Condition; 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 Mental Conditions for residents in care which posesa potent ial health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/11/2023 Plan of Correction Administrator will complete and submit a copy to CCLD by POC Due Date

Official classification

Type B

Official code

87506(b)(17)(E)

Regulation authority

CCR

What the official deficiency says

(b) Each resident's record shall contain at least the following information: (17) Documents and information requried by the following: (E) Section 87463, Reappraisals; and 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 Reappraisals for residents in care which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/11/2023 Plan of Correction Administrator will complete reappraisals and send a copy to CCLD by POC Due Date

Official classification

Type B

Official code

87456(a)(2)

Regulation authority

CCR

What the official deficiency says

(a) Prior to accepting a resident for care and in order to evaluate his/her suitability, the facility shall, as specified in this article 8: (2) Perform a pre-admission appraisal. 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 pre-admission appraisal for residents in care which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/11/2023 Plan of Correction Administrator will send a copy of pre-admission appraisal to CCLD by POC Due Date and make sure that such appraisals are completed prior to admission for future residents

Official classification

Type B

Official code

87457(c)

Regulation authority

CCR

What the official deficiency says

(c) Prior to admission a determination of the prospective resident's suitability for admission shall be completed and shall include an appraisal of his/her individual service needs in comparison with the admission criteria specified in Section 87455, Acceptance and Retention Limitations. 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 on file an appraisal of individual service needs which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/11/2023 Plan of Correction Administrator will send a copy to CCLD by POC Due Date

Official classification

Type B

Official code

87457(c)(1)

Regulation authority

CCR

What the official deficiency says

(c) Prior to admission a determination of the prospective resident's suitability for admission shall be completed and shall include an appraisal of his/her individual service needs in comparison with the admission criteria specified in Section 87455, Acceptance and Retention Limitations. (1) The appraisal shall include, at a minimum, an evaluation of the prospective resident's functional capabilities, mental condition and an evaluation of social factors as specified in Sections 87459, Functional Capabilities and 87462, Social Factors. 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 Pre-Admission Appraisal for residents in care which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/11/2023 Plan of Correction Administrator will send a copy of pre-admission appraisal to CCLD by POC Due Date

Official classification

Type B

Official code

87458(a)

Regulation authority

CCR

What the official deficiency says

(a) Prior to a person's acceptance as a resident, the licensee shall obtain and keep on file, documentation of a medical assessment, signed by a physician, made within the last year. The licensee shall be permitted to use the form LIC 602 (Rev. 9/89), Physician's Report, to obtain the medical assessment. 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 signed Physicians Report for all residents in care which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/11/2023 Plan of Correction Administrator will send a copy to CCLD by POC Due Date

Official classification

Type B

Official code

87458(b)

Regulation authority

CCR

What the official deficiency says

(b) The medical assessment shall include, but not be limited to: 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 medical assessments for residents, R3 in care which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/11/2023 Plan of Correction Administrator will send a copy to CCLD by POC Due Date

Official classification

Type B

Official code

87458(b)(1)

Regulation authority

CCR

What the official deficiency says

(b) The medical assessment shall include, but not be limited to: (1) A physical examination of the resident indicating the physician's primary diagnosis and secondary diagnosis, if any and results of an examination for communicable tuberculosis, other contagious/infectious or contagious diseases or other medical conditions which would preclude care of the person by 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 not having full diagnosis information on residents in care which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/11/2023 Plan of Correction Administrator will update and send a copy to CCLD by POC Due Date

Official classification

Type B

Official code

87458(b)(5)

Regulation authority

CCR

What the official deficiency says

(b) The medical assessment shall include, but not be limited to: (5) The determination whether the person is ambulatory or nonambulatory as defined in Section 87101(a) or (n), or bedridden as defined in Section 87455(d). The assessment shall indicate whether nonambulatory status is based upon the resident's physical condition, mental condition or both. 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 medical assessments of all residents in care which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/11/2023 Plan of Correction Administrator will send copies to CCLD by POc Due Date

Official classification

Type B

Official code

87463(a)

Regulation authority

CCR

What the official deficiency says

(a) The pre-admission appraisal shall be updated, in writing as frequently as necessary to note significant changes and to keep the appraisal accurate. The reappraisals shall document changes in the resident's physical, medical, mental, and social condition. Significant changes shall include but not be limited to: 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 reappraisals for residents which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/11/2023 Plan of Correction Administrator will do re-appraisals and send copies to CCLD by POC Due Date

Official classification

Type B

Official code

87467(a)

Regulation authority

CCR

What the official deficiency says

(a) Prior to, or within two weeks of the resident's admission, 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, and any other appropriate parties, to prepare a written record of the care the resident will receive in the facility, and the resident's preferences regarding the services provided 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 not having meetings with residents and their reps which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/11/2023 Plan of Correction Administrator will do re-appraisals and send copies to CCLD by POC Due Date

Official classification

Type B

Official code

87467(a)(3)

Regulation authority

CCR

What the official deficiency says

(a) Prior to, or within two weeks of the resident's admission, 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, and any other appropriate parties, to prepare a written record of the care the resident will receive in the facility, and the resident's preferences regarding the services provided at the facility. (3) The licensee shall arrange a meeting with the resident and appropriate individuals identified in Section 87467(a)(1) to review and revise the written record as specified, when there is a significant change in the resident's condition, or once every 12 months, whichever occurs first. Significant changes shall include, but not be limited to occurrences specified in 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 having meeting scheduled with residents and their reps which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/11/2023 Plan of Correction Administrator will submit copies of updated meeting notes to CCLD by POC Due Date

Official classification

Type B

Official code

87507(e)(2)

Regulation authority

CCR

What the official deficiency says

(2) The licensee shall conspicuously post in a location accessible to public view in the facility a complete copy of the approved admission agreement, modifications and attachments, or notice of their availability 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 in by not having a copy of Admission Agreement which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/11/2023 Plan of Correction Administrator will complete and send a photo to CCLD by POC Due Date

Official classification

Type B

Official code

87508(b)

Regulation authority

CCR

What the official deficiency says

(a) The licensee shall ensure that a current register of all residents in the facility is maintained and contains the following updated information: 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 resident registry roster completed and on file which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/11/2023 Plan of Correction Administrator will complete and send a copy to CCLD by POC Due Date

Official classification

Type B

Official code

87508(a)(1)

Regulation authority

CCR

What the official deficiency says

(1) The resident's name and ambulatory status as specified in Section 87506(b)(1) and (b)(10). 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 R3's Medical Assessment on file which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/11/2023 Plan of Correction Administrator will complete a Medical Assessment and send to CCLD by POC Due Date

Official classification

Type B

Official code

87508(a)(2)

Regulation authority

CCR

What the official deficiency says

(2) Information on the resident's attending physician as specified in Section 87506(b)(7). 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 R3's Medical Assessment which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/11/2023 Plan of Correction Administrator will get Physician's Report for R3

Official classification

Type B

Official code

87508(a)(3)

Regulation authority

CCR

What the official deficiency says

(3) Information on the resident's responsible person as specified in Section 87506(b)(6). 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 R3's information on file which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/11/2023 Plan of Correction Administrator will get R3's information and send copy to CCLD by POC Due Date

Official classification

Type B

Official code

87508(c)(1)

Regulation authority

CCR

What the official deficiency says

(1) The register shall be treated as confidential information pursuant to Section 87506(c). 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 registry information of all residents which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/11/2023 Plan of Correction Administrator will get ALL Resident's information and send copy to CCLD by POC Due Date

Official classification

Type B

Official code

1569.695(a)(1)

Regulation authority

HSC

What the official deficiency says

(a) In addition to any other requirement of this chapter, a residential care facility for the elderly shall have an emergency and disaster plan that shall include, but not be limited to, all of the following: (1) Evacuation procedures, including identification of an assembly point or points that shall be included in the facility sketch. 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 by not having such plans available which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/11/2023 Plan of Correction Administrator will complete plan and send a copy to CCLD by POC Due 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 record review, the licensee did not comply with the section cited above in by not having fire drills completed which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/11/2023 Plan of Correction Administrator will conduct a fire drill with staff and have all staff sign-off that they participated and send a copy of fire drill to CCLD by POC Due Date

Official classification

Type B

Official code

1569.695(d)

Regulation authority

HSC

What the official deficiency says

(d) A facility shall review the plan annually and make updates as necessary, including changes in floor plans and the population served. The licensee or administrator shall sign and date documentation to indicate that the plan has been reviewed and updated as necessary. 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 reviewing plans annually. R2 has been at facility over a year and no review in file which posesa pote ntial health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/11/2023 Plan of Correction Administrator will update R2's file and send a copy to CCLD by Due Date

Official classification

Type B

Official code

1569.695(e)(1)

Regulation authority

HSC

What the official deficiency says

(e) A facility shall have all of the following information readily available to facility staff during an emergency: (1) A resident roster with the date of birth for each resident. 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 noy having resident roster's completed which posesa potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/11/2023 Plan of Correction Administrator will complete resident's roster and send a copy to CCLD by POC Due Date

Official classification

Type B

Official code

1569.695(e)(2)

Regulation authority

HSC

What the official deficiency says

(e) A facility shall have all of the following information readily available to facility staff during an emergency: (2) An appraisal of resident needs and services plan for each resident. 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 Plans for residents which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/11/2023 Plan of Correction Administrator will complete Appraisal Needs and Sevices for R1, R2 and R3 and send copies to CCLD by POC Due Date

Official classification

Type B

Official code

87632(d)(2)

Regulation authority

CCR

What the official deficiency says

(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 record review, the licensee did not comply with the section cited above in by notifying CCL of R2's hospice care which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/11/2023 Plan of Correction Administrator will submit Initiation of Hospice Services for R2 to CCLD by POC Due Date

Official classification

Type B

Official code

87633(b)

Regulation authority

CCR

What the official deficiency says

(b) A current and complete hospice care plan shall be maintained in the facility for each hospice resident and include the following: 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 hospice care plan for R2 in their file which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/11/2023 Plan of Correction Administrator will send a copy of hospice care plan to CCLD by POC Due Date

Official classification

Type B

Official code

87633(b)(1)

Regulation authority

CCR

What the official deficiency says

(b) A current and complete hospice care plan shall be maintained in the facility for each hospice resident and include the following: (1) The name, office address, business telephone number, and 24-hour emergency telephone number of the hospice agency and the resident's physician. 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 complete hospice care plan for R2 which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/11/2023 Plan of Correction Administrator will submit a copy to CCLD by POC Due Date

Official classification

Type B

Official code

87633(b)(4)

Regulation authority

CCR

What the official deficiency says

(b) A current and complete hospice care plan shall be maintained in the facility for each hospice resident and include the following: (4) A description of the licensee's area of responsibility for implementing the plan including, but not limited to, facility staff duties; record keeping; and communication with the hospice agency, resident's physician, and the resident's responsible person(s), if any. This description shall include the type and frequency of the tasks to be performed by 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 not having a hospice care plan for R2's file which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/11/2023 Plan of Correction Administrator will send a copy to CCLD by POC Due Date

Official classification

Type B

Official code

87633(b)(4)(A)

Regulation authority

CCR

What the official deficiency says

(b) A current and complete hospice care plan shall be maintained in the facility for each hospice resident and include the following: (4) A description of the licensee's area of responsibility for implementing the plan including, but not limited to, facility staff duties; record keeping; and communication with the hospice agency, resident's physician, and the resident's responsible person(s), if any. This description shall include the type and frequency of the tasks to be performed by the facility. (A) The plan shall specify all procedures to be implemented by the licensee regarding the storage and handling of medications or other substances, and the maintenance and use of medical supplies, equipment, or appliances. 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 complete hospice care plan for R2 which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/11/2023 Plan of Correction Administrator will submit hospice care plan to CCLD by POC Due Date

Official classification

Type B

Official code

87633(h)(1)

Regulation authority

CCR

What the official deficiency says

(h) For each terminally ill resident receiving hospice services in the facility, the licensee shall maintain the following in the resident's record: (1) A written request for acceptance or admittance to or retention in the facility while receiving hospice services, along with any advance directive and/or request regarding resuscitative measures form executed by the resident or (in certain instances) the resident's Health Care Surrogate Decision Maker. 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 in the resident's files an advanced directive which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/11/2023 Plan of Correction Administrator will update and send a copy to CCLD by POC Due Date

Official classification

Type B

Official code

87633(h)(5)

Regulation authority

CCR

What the official deficiency says

(h) For each terminally ill resident receiving hospice services in the facility, the licensee shall maintain the following in the resident's record: (5) A statement signed by the resident's roommate, if any, or any resident who will share a room with a person who is terminally ill to be accepted or retained as a resident, indicating his or her acknowledgment that the resident intends to receive hospice care in the facility for the remainder of the resident's life, and the roommate's voluntary agreement to grant access to the shared living space to hospice caregivers, and the resident's support network of family members, friends, clergy, and others. 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 R2's acknowledgement to receive hospi ce care and R3's agreement to shared living space which posesa potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/11/2023 Plan of Correction Administrator will update the records and file documents. Administrator will send a signed copy to CCLD by POC Due Date

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 R2's appraisals/reappraisals completed which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/11/2023 Plan of Correction Administrator will update resident's appraisals and send a copy to CCLD by POC Due Date

Official classification

Type B

Official code

87307(d)(6)

Regulation authority

CCR

What the official deficiency says

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 by having a Masters pad lock on entry gate and a piece of tree trunk wood placed on the outside side entry gate which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/11/2023 Plan of Correction Administrator will fix/repair the side entry gate to where there will be a latch to keep the side entry gate closed. Administrator will send a photo to CCLD by POC Due Date

Official classification

Type A

Official code

87705(f)(1)(2)

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). (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 by having laundry room unlocked with cleaning supplies listed above and garden tools bed rail and 2 ladders accessible to residents which poses an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 05/13/2022 Plan of Correction Administrator locked the laundry room door with the cleaning products and put garden tools, ladder, and bed rail in the locked garage. Deficiency cleared during visit.

Official classification

Type A

Official code

87705(f)(1)

Regulation authority

CCR

What the official deficiency says

87705 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: Deficient Practice Statement Based on observation the licensee did not comply with the section cited above by storing knives in an unlocked drawer which poses an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 05/13/2022 Plan of Correction Administrator agreed to purchase a lock for the kitchen draw/cabinet and keep the knives locked. Administrator will email photo copies to CCLD no later then the POC date,

Official classification

Type B

Official code

87211(a)(1)

Regulation authority

CCR

What the official deficiency says

Reporting Requirements. A written report shall be submitted to the licensing agency...within seven days of the occurrence of any of the events specified... This requirement was not met as evidence by: Based on investigation, licensee did not comply with the section cited above by not submitting incident report regarding bed bugs at the facility which poses a potential health and safety risk to the residents in care.

Official plan of correction

Licensee has agreed to review reporting requirements and submit self-certification to CCLD by POC date.

Deadline recorded: May 2, 2022. A deadline is not proof that correction was completed.