MEMORY CARE OF CONTRA COSTA

Official classification

Type A

Official code

87468.2(a)(4)

Regulation authority

CCR

What the official deficiency says

87468.2 (a)(4) Additional Personal Rights of Residents in Privately Operated Facilities (a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (4) To care, supervision, and... are delivered by staff...to meet their needs. Based on record review and interview the licensee did not comply with section above by not ensuring care and supervision when R1 eloped during the night and later found by a neighbor who called the facility to ask if R1 was a resident which poses an immediate Health & Safety risk to residents in care.

Official plan of correction

The Administrator agreed to conduct an in-service training for all staff on managing resident wandering and elopement. The Administrator will submit a copy of the training lesson outline/synopsis and the staff sign-in sheet to CCLD by the Plan of Correction (POC) due date. Civil Penalty $500.00 assessed today.

Deadline recorded: Jul 31, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87355(e)(2)

Regulation authority

CCR

What the official deficiency says

(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility:(2) Obtain a California clearance or a criminal record exemption as required by the Department or Based on interview and record review the Licensee did not comply with the section cited above in by having uncleared staff at the facility which poses an immediate health and safety risk to the persons in care.

Official plan of correction

S1 left the facility during inspection. Facility will follow up with Guardian regarding S1's fingerprint clearance and send email communication with Guardian to CCLD by POC date. Civil Penalty Assessed $500.00

Deadline recorded: Jul 10, 2026. A deadline is not proof that correction was completed.

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. Based on interview and record review the Licensee did not comply with the section cited above in by not having access to residents' and staff records which poses an potential health, and personal rights risk to persons in care.

Official plan of correction

Administrator will submit requested to documents to CCLD by POC due date.

Deadline recorded: Jul 10, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87309(a)

Regulation authority

CCR

What the official deficiency says

87309 Storage Space and Accesss (a) Except as specified in subsection (b), the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances, knives, matches, tools, sharp objects, and other similar items which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage. Based on observation the Licensee did not comply with the section cited above in by not having ensuring cleaning solutions are unacessible to residents which poses an potential health, and personal rights risk to persons in care.

Official plan of correction

Administrator will read the regulation, self certify and conduct a In-Service training with staff. Send sign-in sheet to CCLD by POC due date.

Deadline recorded: Jul 16, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87463(h)(1)

Regulation authority

CCR

What the official deficiency says

87463 Reappraisals (h) The licensee shall request that all residents receive an annual routine visit with a licensed medical professional once every twelve months, either in person or by video appointment. (1) Documentation of the annual routine visit, such as a visit summary, shall be added to the resident's record. This requirement was not met as evidenced by: Based on record review, the licensee did not comply with the section cited above in by not having an updated annual medical assessment for R1-R4 which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Administrator agreed to submit updated LIC 602-A for R1-R4 to CCLD by POC due date.

Deadline recorded: Nov 17, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.2(a)(8)

Regulation authority

CCR

What the official deficiency says

87468.2 Additional Personal Rights of Residents in Privately Operated Facilities (a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (8) To be free from neglect, financial exploitation, involuntary seclusion, punishment, humiliation, intimidation, and verbal, mental, physical, or sexual abuse. This requirement is not met as evidenced by: Based on interviews, the licensee did not comply with the section cited above when S1 placed their hand over R1’s mouth while R1 was agitated. This conduct violates the resident’s personal rights and poses an immediate health and safety risk to residents in care.

Official plan of correction

Licensee shall ensure all staff receive training regarding residents’ personal rights, including techniques for de-escalation and appropriate interventions for residents exhibiting behavioral challenges. Proof of training shall be submitted to the Department by POC due date.

Deadline recorded: Nov 17, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87211(a)(1)(A)

Regulation authority

CCR

What the official deficiency says

CCR 87211(a)(1)(A) – Reporting Requirements Each licensee shall ensure that required information, including contact information for the Licensing Agency, Ombudsman, and other public resources, is posted in areas accessible to residents, representatives, and the public. This requirement is not met as evidenced by: During the visit, the licensee did not comply with the section cited above when LPA observed that the ombudsman contact poster was missing from the facility’s common area This poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Licensee shall immediately replace the missing ombudsman contact poster in an area accessible to residents and visitors. Licensee shall submit photographic proof of posting to the Department by POC due date. LPA observed Ombudsman poster was posted in the hall entrance. Deficiency cleared during visit.

Deadline recorded: Nov 17, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87355(e)(2)

Regulation authority

CCR

What the official deficiency says

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 an drecord review, the licensee did not comply with the section cited above in by not having S1 associated through Guardian which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/30/2025 Plan of Correction Administrator associated Staff during visit. Deficiency cleared during visit.

Official classification

Type B

Official code

87463(h)

Regulation authority

CCR

What the official deficiency says

87463 Reappraisals (h) The licensee shall request that all residents receive an annual routine visit with a licensed medical professional once every twelve months, either in person or by video appointment. 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 an updated annual medical assessment for R1-R4 which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/12/2025 Plan of Correction Administrator agreed to submit updated LIC 602-A for R1-R4 to CCLD by POC due date.

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 record review, the licensee did not comply with the section cited above in by not having updated First Aid/CPR certifiications for S2 and S3 which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/26/2025 Plan of Correction Administrator agreed to submit First Aid/CPR certificates for S1 and S2 to CCLD by POC due date.

Official classification

Type B

Official code

87555(b)(15)

Regulation authority

CCR

What the official deficiency says

87555 General Food Service Requirements b) The following food service requirements shall apply: (15) All persons engaged in food preparation and service shall observe personal hygiene and food services sanitation practices which protect the food from contamination. 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 current Food Handler Certifications for S4 and S5 which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/12/2025 Plan of Correction Administrator agreed to submit updated food handler certificates for S3 and S4 to CCLD by POC due date.

Official classification

Type B

Official code

87211(a)

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: This requirement is not met as evidenced by: Based on record review and interview with Staff, the licensee did not comply with the section cited above in by not submitting incident reports including but not limited to hospitalizations to Licensing for residents in care which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Administrator agreed to submit a detailed plan on how they will use proper procedures to inform and notify CCLD and will submit plan to CCLD by POC due date.

Deadline recorded: Dec 5, 2024. A deadline is not proof that correction was completed.

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 record review, the licensee did not comply with the section cited above in not having current First Aid/CPR for S1 which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/19/2024 Plan of Correction Administrator agrees to submit First Aid/CPR Certificate for S1 to CCLD by POC due date.

Official classification

Type B

Official code

87411(f)

Regulation authority

CCR

What the official deficiency says

87411 Personnel Requirements – General (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 not having a health screening and TB for S3 and S5 which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/19/2024 Plan of Correction Administrator agrees to get a health screening and Negative TB Test results for S3 and S5 and submit to CCLD by POC due date.

Official classification

Type B

Official code

87705(c)(5)

Regulation authority

CCR

What the official deficiency says

87705 Care of Persons with Dementia (c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following: (5) Each resident with dementia shall have an annual medical assessment as specified in Section 87458, Medical Assessment, and a reappraisal done at least annually, both of which shall include a reassessment of the resident’s dementia care needs 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 updated medical assessment for R2 which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/19/2024 Plan of Correction Administrator agrees to get an updated Physician's Report for R2 and submit to CCLD by POC due date.

Official classification

Type B

Official code

87355(e)(2)

Regulation authority

CCR

What the official deficiency says

Criminal Record Clearance (e) All individuals subject to a criminal record review ..... 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). -This requirement is not met as evidenced by: -Based on observation, interview and review of record, the licensee did not comply with the above Regulation by not S1 and S3 associated which poses potential safety risk to persons in care.

Official plan of correction

Administrator has agreed to associate S1 and S2 to the facility and submit documentation to CCLD by POC date

Deadline recorded: Jun 22, 2022. A deadline is not proof that correction was completed.