FAMILY COURTYARD

Official classification

Type B

Official code

87303(a)(b)(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. (b) A comfortable temperature for residents shall be maintained at all times. (1) The facility shall heat rooms that residents occupy to a minimum of 68 degree F, (20 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 ambient air temperature in hallways measuring 61 degrees Fahrenheit and LPA and LPM observed that the physical plant was cold; LPM also observed 2 residents stating that they were cold; which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/23/2025 Plan of Correction Licensee to monitor hallway air temperature, and keep it about 68 degrees Fahrenheit, take measurements and provide photos to LPA.

Official classification

Type B

Official code

87468.1(a)(2)

Regulation authority

CCR

What the official deficiency says

Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above in not having window covers on Room 35 which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/23/2025 Plan of Correction Licensee to install a window cover to provide privacy to resident in room 35 and provide photo proof to LPA by POC date.

Official classification

Type B

Official code

87303(d)

Regulation authority

CCR

What the official deficiency says

87303(d) Maintenance and Operation. (d) There shall be lamps or light appropriate for the use of each room and sufficient to ensure the comfort and safety of all persons in the facility. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above in not having adequate lighting throughout hallways. which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/30/2025 Plan of Correction License to install adequate lighting near bathrooms off hallways and ensure lights in hallways are kept on. Licensee provide photo proof to LPA by POC date. Licensee to have in-service training for staff and provide list of staff training to LPA.

Official classification

Type B

Official code

87303(e)(2)

Regulation authority

CCR

What the official deficiency says

(e) ... (2) ...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... Based on observation the licensee did not comply with the section cited above by having the hot water temperature measured at 94.3, 94.9, and 85.2 degree Fahrenheit, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

The Administrator agrees to self certify the regulation and send proof of the water temperature within range to CCLD by POC date.

Deadline recorded: Oct 3, 2025. A deadline is not proof that correction was completed.

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. Based on observation, the licensee did not comply with the section cited above by having the wooden fence in disrepair, debris all around the facility, resident bathroom soiled, flies around the facility, fire extinguisher case in disrepair, two wooden dressers in the hallway near Room #36, cart filled with wooden planks, overgrow tree in the courtyard, shower room # 2 drainage is not properly working, etc. which poses a potential safety risk to residents in care.

Official plan of correction

The Administrator agrees to fix the items in disrepair and clean the facility. Proof of correction will be sent to CCLD by POC date.

Deadline recorded: Oct 10, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87555(b)(25)

Regulation authority

CCR

What the official deficiency says

(25) Soaps, detergents, cleaning compounds or similar substances shall be stored in areas separate from food supplies. This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above by having the emergency food supply in the same storage room as the cleaning products which poses a potential health and safety risk to person in care.

Official plan of correction

The Administrator agrees to separate the food and cleaning products and send proof to CCLD by POC date.

Deadline recorded: Oct 3, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87415(a)(2)

Regulation authority

CCR

What the official deficiency says

87415 Night Supervision (a)...from l0:00 p.m. to 6:00 a.m. shall be familiar with the facility's planned emergency procedures, shall be trained in first aid as required...(2 )In facilities caring for sixteen (16) to one hundred (100) residents at least one employee shall be on duty on the premises, and awake. Another employee shall be on call, and capable of responding within ten minutes. - This requirement was not met as evidenced by: Based on records reviewed, Licensee did maintain the staff schedule to cover all shifts with contact information for on-call staff which poses/posed a potential health and safety risk to residents in care.

Official plan of correction

Licensee/ADM agreed to update that staff schedule and/or use LIC500 to cover all shifts and contact information for on-call staff; submit correction as proof to CCLD by POC date.

Deadline recorded: Sep 16, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87303(c)

Regulation authority

CCR

What the official deficiency says

87303 Maintenance and Operation. (c) All window screens shall be clean and maintained in good repair. LPAs observed multiple windows with missing or broken screens.

Official plan of correction

Administrator agrees to have screen repaiers and photos sent to LPA in twpo weeks.

Deadline recorded: Sep 12, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87303(d)

Regulation authority

CCR

What the official deficiency says

87303 Maintenance and Operation. (d) There shall be lamps or light appropriate for the use of each room and sufficient to ensure the comfort and safety of all persons in the facility. LPAs observed facility to not have adequate lighting throughout hallways.

Official plan of correction

Administrator agrees to come up with a solution for lights being left on in the hallways.

Deadline recorded: Sep 12, 2025. A deadline is not proof that correction was completed.

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...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. LPAs observed two bicycles in disrepairin the gazebo area, trash in the gazebo area, various construction tools such as a bucket, 2 by 4s, caulking tubes, a puddy knife, ect., multiple areas with debris/tras, three paint cans on the table outside of the dining area, most bathrooms missing toilet paper and hand soup and two out of service.

Official plan of correction

Administrator agrees to have trash, building materials and bicycles cleaned up. Administrator will take pictures and send to LPA by POC date.

Deadline recorded: Sep 12, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

80088(e)(1)

Regulation authority

CCR

What the official deficiency says

(e) Faucets used by clients... shall deliver hot water.(1) Hot water temperature controls shall be maintained to automatically regulate temperature of hot water... a hot water temperature of not less than 105 degrees F and not more than 120 degrees F Based on observation, the licensee did not comply with the section cited above by having hot water temperature at 94.6 which poses an immediate health and safety risk to persons in care.

Official plan of correction

Administrator will have water tempurature corrected and send a photo to LPA with water tempurature with range

Deadline recorded: Aug 30, 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

87309 Storage Space and Access(a) ...ensure that disinfectants, cleaning solutions, poisonous substances, knives, matches, tools, sharp objects, and other similar items which could pose a danger...are not left unattended if outside the locked storage. Based on observations and interviews, S5 left cleaning solutions unattended which posed an immediate health and safety risk to residents in care.

Official plan of correction

Licensee/ADM in-serviced staff, and submitted proof of correction to CCLD by POC date.

Deadline recorded: Aug 21, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87555(b)(6)

Regulation authority

CCR

What the official deficiency says

87555 General Food Service Requirements (b) The following food service requirements ...for sixteen (16) persons or more, menus shall be written at least one week in advance and copies of the menus as served shall be dated and kept on file for at least 30 days.-This requirement was not met as evidenced by: Based on observations and interviews, weekly menuswere not posted and kept on file per the regulation which poses/posed a potential health and safety risk to residents in care.

Official plan of correction

Licensee/ADM agreed to provide in-service training to staff/cook to post weekly menus, alternative meals & retain copies for a minimum of 30 days. Submit a list of attendees’ signatures as proof to CCLD by POC date.

Deadline recorded: Aug 28, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87507(g)(4)

Regulation authority

CCR

What the official deficiency says

87507 Admission Agreements (g)... shall specify the following: (4) Modification conditions...at least 60 days prior written notice to the resident of any rate or rate structure change, or as soon as the licensee is notified of SSI/SSP rate changes.-This requirement was not met as evidenced by: Based on records reviewed and interviews, Licensee/ADM did not provide residences proper notice of rate increases per the regulations.

Official plan of correction

Licensee/ADM agreed to submit a template for rate increases to CCLD by POC date.

Deadline recorded: Sep 4, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87303

Regulation authority

HSC

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. Based on records reviewed, Licensee did maintain clean, safe and sanitary conditions which poses/posed a potential health and safety risk to residents in care.

Official plan of correction

Licensee/ADM agreed to in-service staff, and submit a plan with correction dates that will mitigate the spread of insects and vermin to CCLD by POC date.

Deadline recorded: Aug 21, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87211(a)(2)

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: (2) Occurrences, such as epidemic outbreaks,poisonings, catastrophes or major accidents which... threaten the welfare, safety or health of residents, personnel or visitors, shall be reported within 24 hours either by telephone or facsimile to the licensing agency and to the local health officer when appropriate. -This requirement is not met as evidenced by: ADM/Licensee did not report R1's 51/50 hold to CCLD within 24 hrs.

Official plan of correction

By POC due date, ADM agrees to complete and submit to CCLD in-service staff and Licensee training with signatures on reporting requirements and compliance.

Deadline recorded: Aug 13, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87506(b)

Regulation authority

CCR

What the official deficiency says

87506 Resident Records (b) Each resident’s record shall contain at least the following information: -This requirement is not met as evidenced by: -Based on recrords reviwed, the ADM/Licensee did not maintain R1's records which poses/posed a potential health and safety risk to persons in care.

Official plan of correction

By POC due date, ADM agrees to complete and submit to CCLD in-service staff and Licensee training with signatures on resident record requirements and compliance.

Deadline recorded: Aug 13, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87412(c)(1)(A)

Regulation authority

CCR

What the official deficiency says

87412 Personnel Records (c) Licensees shall maintain in the personnel records verification of records (1) training and orientation shall be documented: (A) For staff who assist with personal activities of daily living …at least ten hours of initial training within the first four weeks of employment, and at least four hours of training annually …areas as specified in Section 87411(c)(2). - This requirement was not met as evidenced by: Based on records reviewed, Licensee did maintain annual training records for S1 which posed a potential health and safety risk to residents in care.

Official plan of correction

Licensee agreed to provide in-service training to all staff and confirm that all staff’s training and records are updated. Submit a list of attendees’ signatures as proof to CCLD by POC date.

Deadline recorded: Dec 30, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(c)(2)

Regulation authority

CCR

What the official deficiency says

Incidental Medical and Dental Care. Once ordered by the physician the medication is given according to the physician's directions. This requirement is not met as evidence by: Based on investigation, licensee did not comply with the section cited above by not administering medications according to physician's order which poses an immediate health and safety risk to the persons in care.

Official plan of correction

Facility has agreed to conduct training for staff regarding medication administration and submit staff sign-in sheet to CCLD by POC date.

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

Official classification

Type A

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, interviews, and record review the licensee did not comply with the section cited above in 3 out of 3 gates having padlocks attached which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/09/2024 Plan of Correction Licensee to review the regulation, provide training to staff and submit proof to CCLD by POC. Locks removed from two gates during the visit to allow emergency exiting on both sides.

Official classification

Type A

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 and record review the licensee did not comply with the section cited above by having a matress, wooden boards, metal items, and white PVC tubing in the backyard which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/11/2024 Plan of Correction Licensee to provide photos to CCLD that the items have been removed by POC date.

Official classification

Type B

Official code

87303

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, interviews and record review, the licensee did not comply with the section cited above by not providing hot water at a least 105 F., keeping facility free of mildew, and keeping residents' room in sanitary condition which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/23/2024 Plan of Correction Licensee to inspect facility for repairs, and inspect residents' room for housekeeping needs to include but not limited to cleaning and disinfecting furniture and floor surfaces. Submit photos of room #35, window repairs, and self-certify that other maintenance and operational needs have been met.

Official classification

Type A

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 having key padlocks on the exit gate and drive gate on right side of building locked which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/02/2023 Plan of Correction Administrator agreed to remove locks and submit photo 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 (b) The following food service requirements shall apply: (26) Supplies of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days shall be maintained on the premises. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above in having 7-day perishable and 2-day non perishable foods for residents which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/08/2023 Plan of Correction Administrator agreed to purchase food and submit photo and receipts 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, the licensee did not comply with the section cited above in having a complete 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: 12/08/2023 Plan of Correction Administrator agreed to purchase a first aid kit and additional first aid supplies and submit photo to CCLD by POC date.

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 have facility's window, ceiling and heater in repair which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/08/2023 Plan of Correction Administrator agreed to submit invoices showing that repairs will be provided or have been completed 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 free of obstruction which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/08/2023 Plan of Correction Administrator agreed to have all items removed and submit photo to CCLD by POC date.

Official classification

Type B

Official code

87465(h)(6)

Regulation authority

CCR

What the official deficiency says

Incidental Medical and Dental Care. The licensee shall be responsible for assuring that a record of centrally stored prescription medications for each resident is maintained... This requirement is not met as evidence by: Based on record review, licensee did not comply with the section cited above by not having centrally stored records for a few residents which poses a potential health and safety risk to the persons in care.

Official plan of correction

Administrator has agreed to maintain centrally stored records for all residents and submit a sample copies to CCLD by POC date.

Deadline recorded: Sep 29, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87303(a)(1)

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. (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 observations and interviews, the licensee did not comply with the section cited above. LPA's observed mold/mildew in shower room #1 and #2, and the shared sink area at rooms #14, #15, and room #17 had cobwebs around the sink which poses potential risks to persons in care.

Official plan of correction

POC Due Date: 09/15/2022 Plan of Correction Administrator will review regulations, conduct in-service training with staff and submit a copy of training agenda with staff signatures and photos of bathrooms and sink areas.

Official classification

Type B

Official code

87303(e)(4)

Regulation authority

CCR

What the official deficiency says

87303 Maintenance and Operation (e) Water supplies and plumbing fixtures shall be maintained as follows: (4) Grab bars shall be maintained for each toilet; bathtub and shower used by residents. This requirement is not met as evidenced by: Deficient Practice Statement Based on observations and interviews, the licensee did not comply with the section cited above. LPAs observed a broken grab bar in the bath room of room #32 which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 09/27/2022 Plan of Correction Administrator will review regulations, conduct in-service training with staff and submit a copy of training agenda with staff signatures and photos of grab bar in room #32.

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 observations and interviews, the licensee did not comply with the section cited above. LPA's observed closet door and blinds of bedroom #32 and vanity cabinet door and blinds of bedroom #23 in disrepair which poses a potential health and safety risks to persons in care.

Official plan of correction

POC Due Date: 09/27/2022 Plan of Correction Administrator will review regulations, conduct in-service training with staff and submit a copy of training agenda with staff signatures and photos of closet, cabinet and blinds.

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 degree C) and not more than 120 degree F (49 degree C). This requirement is not met as evidenced by: Deficient Practice Statement Based on observations and interviews, the licensee did not comply with the section cited above. LPA's observed hot water tempertaure in shower room #2 at 68.6 degree F and 93.4 degree F in the shared common bathroom.

Official plan of correction

POC Due Date: 09/16/2022 Plan of Correction Administrator will review regulations, conduct in-service training with staff and submit a copy of training agenda with staff signatures. Administartor will submit proof of the correction by a certified plumber.

Official classification

Type B

Official code

87463(a)

Regulation authority

CCR

What the official deficiency says

87463 Reappraisals (a)The pre-admission appraisal shall be updated, in writing to note significant changes and to keep the appraisal accurate. The reappraisals shall document changes physical, medical, mental, and social condition. -This requirement is not met as evidenced by: -Based on interviews and record reviews, the Administrator did not comply with the section above by not updating R1's Weight Records, LIC601, LIC603, LIC613C and Consent for Emergency Care which poses a potential health and safety risk to persons in care.

Official plan of correction

Administrator to review all residents records and files, ensure reappraisals are updated and submit a self certification of completion by POC due date. R1's dietary orders will be provided to staff on or before 06/21/2022; completed while at facility on 06/20/2022.

Deadline recorded: Jul 6, 2022. A deadline is not proof that correction was completed.