STONEHEDGE GUEST HOME

Official classification

Type B

Official code

87355(e)(3)

Regulation authority

CCR

What the official deficiency says

e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (3) Request a transfer of a criminal record clearance as specified in Section 87355(c) or This requirement was not met as evidence by: Based on interview and record review the Licensee did not comply with the section cited above in having S3 associated to the facility which poses a potential health and safety risk to persons in care.

Official plan of correction

Administrator submitted a copy of S3's US Issued Picture ID and LIC 9182 form to CCLD. During visit, S3 was associated to facility. Deficiency cleared.

Deadline recorded: Oct 24, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87705(f)(2)

Regulation authority

CCR

What the official deficiency says

(f) The following shall be stored inaccessible to 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 not having prescription insulin medication inaccessible to residents which poses an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 12/30/2023 Plan of Correction Administrator agreed to read the regulation and self certify that they read and understand the regulation moving forward. During visit Administrator removed the insulin and locked the insulin in a toolbox in the refrigerator located in the garage.

Official classification

Type B

Official code

87411(c)(1)

Regulation authority

CCR

What the official deficiency says

(c) All RCFE staff who assist residents...shall receive initial and annual training. (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 S2 and S7 First Aid and CPR Training available which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/12/2024 Plan of Correction Administrator agreed to submit First Aid and CPR Training 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... Postural supports may be used under the following conditions. (3) A written order from a physician indicating the need for the postural support shall be maintained in the resident’s record. The licensing agency shall be authorized to require other additional documentation if needed to verify the order. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview, record review, the licensee did not comply with the section cited above in not having hospital 1/2 bed rail doctor's orders for R1, R2 and R3 who are not on hospice care which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/12/2024 Plan of Correction Administrator agreed to obtain doctor's orders for hospital half-bed rails for R1, R2 and R3 and submit to CCLD by POC due date.

Official classification

Type A

Official code

87705(I)(2)

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: (2) The licensee shall ensure that the fire clearance includes approval of locked exterior doors or locked perimeter fence gates. 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 being unable to open the backyard gates which poses an immediate health & safety risk for persons in care.

Official plan of correction

POC Due Date: 12/09/2022 Plan of Correction Administrator agreed to remove the lock on the gate and to submit a picture to CCLD by POC due date. Administrator will complete an In-Service training with Staff and will send a copy with each Staff's signature. Facility is being assess $500 civil penalty for todays 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 having bleach, Pine-Sol, ammonia, window cleaner, Lysol Spray, Pledge Spray, hammer, screw driver, scissors, Tide Laundry Detergent PODS which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/09/2022 Plan of Correction Administrator agreed to store cleaners in locked cabinet and submit photo to CCLD by POC date.

Official classification

Type B

Official code

87208(A)

Regulation authority

CCR

What the official deficiency says

87208 Plan of Operation (A) Building(s) to be occupied, including a floor plan that describes the capacities of the buildings for the uses intended and a designation of the rooms to be used for nonambulatory residents and for bedridden residents, other than for a temporary illness or recovery from surgery as specified in Sections 87606(d) and (e) 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 allowing Staff to dwell in a small storage room attached to the home without permits which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/29/2022 Plan of Correction Administrator agreed to have Staff vacate the storage area and submit a LIC 200 along with an updated facility sketch to request for a new fire clearance to CCLD no later then the POC date.

Official classification

Type B

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 having these items accessible plank wood, table, blinds, potting soil, concrete, door screens, wood, WD-40, saw, hammer, monkey wrench, dolly, paint can, caulking which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/05/2023 Plan of Correction Administrator agreed to remove plank wood, table, blinds, potting soil, concrete, door screens, wood, WD-40, saw, hammer, monkey wrench, dolly, paint can and caulking by submitting a photo to CCLD by POC due date.