WE CARE ELDERLY CARE #3

Official classification

Type A

Official code

87309(a)

Regulation authority

CCR

What the official deficiency says

(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. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above in the cabinet under kitchen sink and sharps drawer in kitchen that were unlocked, which posed an immediate safety risk to persons in care.

Official plan of correction

POC Due Date: 07/10/2026 Plan of Correction During the inspection, this was cleared when the Administrator put the sharps in the cabinet under the sink.

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 for 3 items, which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 07/10/2026 Plan of Correction The Licensee will have these repaired or replaced: hallway bathroom door mechanism, the chipped porcelain enamel on the middle of the double kitchen sink, and the missing left armrest for the chair in front room.

Official classification

Type B

Official code

87303(d)

Regulation authority

CCR

What the official deficiency says

(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 7 of the 8 rooms, which poses a potential safety risk to persons in care.

Official plan of correction

POC Due Date: 07/10/2026 Plan of Correction The Licensee will have adequate lighting added that uses the wall light switches to control the lights to light up the: garage, front room, and every resident room.

Official classification

Type B

Official code

87468(c)(2)(A)

Regulation authority

CCR

What the official deficiency says

(c) Licensees shall prominently post personal rights, nondiscrimination notice, and complaint information in areas accessible to residents, representatives, and the public. (2) Information on the appropriate reporting agency in case of a complaint or emergency, including procedures for filing confidential complaints, shall be posted as follows: (A) Licensees may use the Residential Care Facility for the Elderly (RCFE) Complaint Poster (PUB 475) or may develop their own poster as provided in this section. A poster developed by the licensee shall contain the same content as the PUB 475. The poster that is posted shall be 20” x 26” in size and be posted in the main entryway of the facility. PUB 475 may be accessed, downloaded, and printed from the www.ccld.ca.gov website. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/10/2026 Plan of Correction The Licensee purchased the PUB 475 during the visit. The Licensee will post it in accordance with the statute.

Official classification

Type B

Official code

87411(a)

Regulation authority

CCR

What the official deficiency says

(a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. In facilities licensed for sixteen or more, sufficient support staff shall be employed to ensure provision of personal assistance and care as required in Section 87608, Postural Supports. Additional staff shall be employed as necessary to perform office work, cooking, house cleaning, laundering, and maintenance of buildings, equipment and grounds. The licensing agency may require any facility to provide additional staff whenever it determines through documentation that the needs of the particular residents, the extent of services provided, or the physical arrangements of the facility require such additional staff for the provision of adequate services. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above for 5 of 5 residents, which poses a potential health, safety and personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/17/2026 Plan of Correction The Licensee will increase staff at the facility to 2 staff members 365 days a year during the day and 1 night staff.

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 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 for Staff S1, which posed a potential safety risk to persons in care.

Official plan of correction

POC Due Date: 07/10/2026 Plan of Correction The Licensee cleared the deficiency during the visit.

Official classification

Type B

Official code

87219(a)

Regulation authority

CCR

What the official deficiency says

(a) Residents shall be encouraged to maintain and develop their quality of life through participation in a variety of planned activities. The activities made available shall include: 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 5 out of 5 residents, which poses a potential health and personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/17/2026 Plan of Correction The Licensee will send proof to LPA Sampair of the residents engaging in at least 3 different planned activities on at least 3 different days.

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 by conducting the drill with every staff member working at this facility, which poses a potential safety risk to persons in care.

Official plan of correction

POC Due Date: 07/10/2026 Plan of Correction The Licensee will conduct drills including every staff member for the current quarter.

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 because the Emergency/Disaster Plan was not reviewed by the Licensee or the Administrator, which poses a potential safety risk to persons in care.

Official plan of correction

POC Due Date: 07/10/2026 Plan of Correction The Licensee will review and sign the Emergency/Disaster Plan and make any necessary changes.

Official classification

Type B

Official code

87303(h)

Regulation authority

CCR

What the official deficiency says

(h) Emergency lighting shall be maintained. At a minimum this shall include flashlights, or other battery powered lighting, readily available in appropriate areas accessible to residents and staff. Open-flame lights shall not be used. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above, because they had only 1 flashlight, which poses a potential safety risk to persons in care.

Official plan of correction

POC Due Date: 07/10/2026 Plan of Correction The Licensee will supply an adequate number of flashlights and/or battery powered lights for a 72 hour loss of electricity.

Official classification

Type B

Official code

87461(a)(1)

Regulation authority

CCR

What the official deficiency says

(a) The licensee shall determine the amount of supervision necessary by assessing the mental status of the prospective resident to determine if the individual: (1) tends to wander; This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and interview, the licensee did not comply with the section cited above for 1 resident R1, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/17/2026 Plan of Correction The Licensee will increase staff at the facility to 2 staff members 365 days a year during the day and 1 night staff, so long as they have residents with Moderate to Severe Level of Dementia.

Official classification

Type B

Official code

87470(a)(4)

Regulation authority

CCR

What the official deficiency says

87470 Infection Control Requirements (a) A licensee shall ensure that infection control practices are maintained as follows: (4) All facility staff and volunteers shall use gloves as a protective barrier to prevent the spread of potential infection as specified below. This requirement is not met as evidenced by: Deficient Practice Statement Based on interview of Staff S1, the licensee did not comply with the section cited above. S1 stated that they were told " not to use so many gloves " . S1 paid for their own gloves to provide adequate protection, which poses a potential health risk to persons in care.

Official plan of correction

POC Due Date: 07/10/2026 Plan of Correction The Licensee will review Section 87470 Infection Control Requirements of Title 22 personally and with all staff members, highlighting the importance of using gloves for infection control while working at the facility.

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 for 1 out of 1 fire extinguishers, which poses a potential safety risk to persons in care.

Official plan of correction

POC Due Date: 07/10/2026 Plan of Correction The Licensee will purchase and mount 2A:10B:C rated fire extinguisher(s) to replace the existing one(s).

Official classification

Type B

Official code

87632(a)

Regulation authority

CCR

What the official deficiency says

87632 Hospice Care Waiver (a) In order accept or retain terminally ill residents and permit them to receive care from a hospice agency, the licensee shall have obtained a facility hospice care waiver from the Department. 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 no hospice waiver, which poses a potential health, safety, and personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/17/2026 Plan of Correction The Licensee will apply for a hospice waiver from the Department.

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) Obtain a California clearance.....as required ... -This requirement is not met as evidenced by: -Based on review of record, interview and upon checking of Guardian Portal, the licensee did not comply with the section in having S1 worked without being fingerprint cleared which posed an immediate risk to persons in care.

Official plan of correction

S1 left while LPA was at the facility. Administrator stated she'll not have S1 work. Self-certification to be submitted by 3/18/26.

Deadline recorded: Mar 18, 2026. A deadline is not proof that correction was completed.

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.... -This requirement is not met as evidenced by: -Based on interviews and record review, the licensee did not comply with the section above in not submitting incident report when R1 was sent out which posed a potential safety, health and/or personal rights risks to person in care.

Official plan of correction

Copy of incident report was provided to LPA on this day. In addition, administrator to ensure timely submission and submit self-certifcation by 3/31/26.

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

Official classification

Type B

Official code

87457(c)

Regulation authority

CCR

What the official deficiency says

87457 Pre-Admission Appraisal (c) Prior to admission a determination of the prospective resident's suitability for admission shall be completed and shall include an appraisal of their individual service needs in comparison with the admission criteria specified in Section 87455...... -Thi requirement is not met as evidenced by: -Based on interview, the licensee did not comply with the section above in not doing Pre-Admission Appraisal prior to R1's admission which posed a potential health, safety and/or personal rights risks to person in care.

Official plan of correction

R1 is no longer at the facility. Administrator to read the Regulation and self-certify that Pre-Admission Appraisal will be completed prior to resident's admission.

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