Hazardous items and storageType A
- 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 having unlocked screw driver located in a drawer in the family/recreation room. knives in a drawer in the kitchen with only a child safety lock which poses an immediate health and safety risk to persons in care.
Official plan of correction
POC Due Date: 07/31/2025 Plan of Correction Caregiver put screwdriver in locked drawer and Administrator agreed to change the lock by the POC date and submit photo to the department.
Hazardous items and storageType A
- Official classification
- Type A
- Official code
- 87309(c)
- Regulation authority
- CCR
What the official deficiency says
(c) Except as specified in subsection (d), the licensee shall implement reasonable interventions in order to ensure that nutritional supplements, vitamins, alcohol, cigarettes and other potentially toxic substances, such as certain plants, gardening supplies, and auto supplies, are stored so as not to pose a hazard to residents. 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 vitamins in an unlocked drawer located in the family/recreation room which poses an immediate health and safety risk to persons in care.
Official plan of correction
POC Due Date: 07/31/2025 Plan of Correction Caregiver locked vitamins during visit. DEFICIENCY CLEARED DURING VISIT.
Staffing, personnel, and trainingType B
- Official classification
- Type B
- Official code
- 87412(f)
- Regulation authority
- CCR
What the official deficiency says
(f) All personnel records shall be available to the licensing agency to inspect, audit, and copy upon demand during normal business hours. Records may be removed if necessary for copying. Removal of records shall be subject to the following requirements: This requirement is not met as evidenced by: Deficient Practice Statement Based on observation record review, the licensee did not comply with the section cited above not having resident records at the facility which poses/posed a potential health and safety risk to persons in care.
Official plan of correction
POC Due Date: 08/08/2025 Plan of Correction Licensee agreed to complete personnel files and submit self-certification that personnel files are complete and will be available for review to CCLD by POC date.
Background checksType B
- Official classification
- Type B
- Official code
- 87355(d)(3)
- Regulation authority
- CCR
What the official deficiency says
(3) The licensee shall submit these fingerprints to the California Department of Justice, along with a second set of fingerprints for the purpose of searching the records of the Federal Bureau of Investigation, or comply with Section 87355(c), prior to the individual's employment, residence, or initial presence in the facility. 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 not having S3 fingerprinted and associated which poses an immediate health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 09/01/2025 Plan of Correction Licensee agreed to have S3 fingerprinted and submit copy of fingerprint document to the department by POC date.
Not classified in the sourceType B
- Official classification
- Type B
- Official code
- 85087(a)(3)
- Regulation authority
- CCR
What the official deficiency says
Buildings and Grounds. " No room used as a common area shall be used as a bedroom for any person. " 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 creating a staff room in the family/recreation area which poses/posed a potential health and safety risk to persons in care. **Caregiver informed LPA the facility converted the family/recreation room into a staff room.**
Official plan of correction
POC Due Date: 08/06/2025 Plan of Correction Administrator agreed to turn the created caregivers room back into family/recreation room and submit photos to the facility by the POC date.
Facility condition and maintenanceType B
- 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 by having plank on the fence broken, sowing machine, metal screen, broke down metal cabinet, bucket of nails, tool box with tools such as saw, jumper cables, electoral outlet. Hedge trimmers, screws, ladder, heavy duty stapler, 2 sinks, wood planks located on the side yard and 2 unlocked storage sheds. which poses/posed a potential health and safety risk to persons in care.
Official plan of correction
POC Due Date: 08/13/2025 Plan of Correction Administrator agreed to fix the plank on the fence broken, remove sowing machine, metal screen, broke down metal cabinet, bucket of nails, tool box with tools such as saw, jumper cables, electoral outlet. Hedge trimmers, screws, ladder, heavy duty stapler, 2 sinks, wood planks located on the back and side yard and will purchace locks for the 2 unlocked storage sheds located in the backyard and submit photos to the Department by the POC date.
Hazardous items and storageType A
- 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 by having a broken lock on the door which has bleach, bleach wipes, laundry soap and other chemicals accessible which poses an immediate health and safety risk to persons in care.
Official plan of correction
POC Due Date: 07/31/2025 Plan of Correction Administrator agreed to replace the lock and submit a photo to the Department by the POC date.