VILLA BOARD AND CARE HOME

Official classification

Type A

Official code

87303(f)(2)

Regulation authority

CCR

What the official deficiency says

(f) All waste shall be located, stored, and disposed of in a manner that will not transmit communicable diseases or odors, pose a risk to health and safety, or provide a breeding place or food source for insects or rodents. (2) Syringes and needles are disposed of in accordance with the California Code of Regulations, Title 8, Section 5193 concerning bloodborne pathogens. 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 trash in a trash bad on the side of the house and having syringes located in an unlocked cabinet in the kitchen which poses an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 02/26/2026 Plan of Correction Administrator agreed to remove trash and put the sharps container in the locked cabinet and provide photos of the corrections to the department by the POC date.

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 a commode, 3 ladders, 3 gas cans,rake, 2 lawn mowers, broken table, wood planks, broken chairs, overgrown trees, wheelbarrow, dolly's, gulf club, 2 mattresses van, motor home and black small car all vehicles are not operable. 2 shovels, storage unit unlocked. which poses a potential health and risk to persons in care.

Official plan of correction

POC Due Date: 03/11/2026 Plan of Correction Administrator agreed to remove all items from the back and side yard, put a lock on the storage and have all the non operable vehicles moved by the POC date and submit photos to the department.

Official classification

Type B

Official code

87204(a)

Regulation authority

CCR

What the official deficiency says

(a) A licensee shall not operate a facility beyond the conditions and limitations specified on the license, including specification of the maximum number of persons who may receive services at any one time. An exception may be made in the case of catastrophic emergency when the licensing agency may make temporary exceptions to the approved capacity. 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 by having a staff member living at the facility sleeping in the living room which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 03/11/2026 Plan of Correction Administrator agreed to move staff members son to a room or out of the facility by the POC date.

Official classification

Type B

Official code

87308(c)

Regulation authority

CCR

What the official deficiency says

(c) General storage space shall be maintained for equipment and supplies as necessary to ensure that space used to meet other requirements of these regulations is not also used for 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 not maintaining space in the garage and having clutters which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 03/11/2026 Plan of Correction Administrator agreed to have all clutters removed from the garage to be able to use the space for general storage space. Administrator also agrees to submit a photo of all the clutter removed from the garage by the POC date.

Official classification

Type B

Official code

1569.618(c)(3)

Regulation authority

HSC

What the official deficiency says

(c)The facility shall employ, and the administrator shall schedule, a sufficient number of staff members to do all of the following: (3) Ensure that at least one staff member who has cardiopulmonary resuscitation (CPR) training and first aid training is on duty and on the premises at all times. This paragraph shall not be construed to require staff to provide CPR. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation during record review, the licensee did not comply with the section cited above by not being CPR or first aid certified and not having any staff that has a current CPR or first aid certificate which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 03/11/2026 Plan of Correction Administrator agreed to get CPR and first aid certified as well as have staff CPR and first aid trained by the POC date and submit copies of the certificate to the department.

Official classification

Type B

Official code

87412(c)(2)

Regulation authority

CCR

What the official deficiency says

(c) Licensees shall maintain in the personnel records verification of required staff training and orientation. (2) Documentation of staff training 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 by not having staff complete required staff trainings which poses a potential health and safety or risk to persons in care.

Official plan of correction

POC Due Date: 03/11/2026 Plan of Correction Administrator agreed to hire a CCLD approved vendor to conduct staff required trainings and submit copies of staff certificate of compleation.

Official classification

Type B

Official code

87307(d)(4)

Regulation authority

CCR

What the official deficiency says

(4) Stairways, inclines, ramps and open porches and areas of potential hazard to residents with poor balance or eyesight shall be made inaccessible to residents unless equipped with sturdy hand railings and unless well-lighted. 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 an open porch area with clutters which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 03/11/2026 Plan of Correction Administrator agreed to clear the open porch area and submit photos to the department by the POC date.

Official classification

Type B

Official code

87308(c)

Regulation authority

CCR

What the official deficiency says

(c) General storage space shall be maintained for equipment and supplies as necessary to ensure that space used to meet other requirements of these regulations is not also used for 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 clutters under the kitchen table, in the living room, entry way and back yard such as boxes of clothing, bedding, air fryer, rice cooker, wood planks, 3 ladders, bedrails, 2 ice chests, fruit picker, wheelchairs, 4 shovels, 2 lamps and an electric saw which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 02/24/2025 Plan of Correction Administrator agreed to remove all clutter under the kitchen table, in the living room, entry way and back yard such as boxes of clothing, bedding, air fryer, rice cooker, wood planks, 3 ladders, bedrails, 2 ice chests, fruit picker, wheelchairs, 4 shovels, 2 lamps and an electric saw and submit photos to the Department by the POC date.

Official classification

Type B

Official code

87311

Regulation authority

CCR

What the official deficiency says

All facilities shall have telephone service on the premises. Facilities with a capacity of sixteen (16) or more persons shall be listed in the telephone directory under the name of the facility. 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 by not having a landline phone which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 02/06/2025 Plan of Correction Administrator agreed to get telephone service at the facility and submit the phone number to the Department by the POC date.

Official classification

Type B

Official code

1569.618(c)(3)

Regulation authority

HSC

What the official deficiency says

(c)The facility shall employ, and the administrator shall schedule, a sufficient number of staff members to do all of the following: (3) Ensure that at least one staff member who has cardiopulmonary resuscitation (CPR) training and first aid training is on duty and on the premises at all times. This paragraph shall not be construed to require staff to provide CPR. 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 Administrator and staff CPR certificates expired which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 02/07/2025 Plan of Correction Administrator agreed to update CPR training for all staff and submit a copy to the Department by the POC date

Official classification

Type B

Official code

87208(A)(7)

Regulation authority

CCR

What the official deficiency says

87208((A) Building(s) to be occupied, including a floor plan that describes the capacities of the buildings for the uses intended...7)Sketches, showing dimensions, of the following: This requirement is not met as evidenced by: Deficient Practice Statement Based on LPAs observation licensee did not comply with the section cited above by staff/family sleeping in the garage in a makeshift bedroom being used for accommodation. Which poses a potential health and safety risk to residents.

Official plan of correction

POC Due Date: 02/14/2025 Plan of Correction Administrator agreed not to allow staff/family to sleep in the garage. Facility will submit a written addendum to their operating plan describing how the garage will be utilized as intended to CCLD by POC date.

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 degrees C) and not more than 120 degree F (49 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 by having the hot water temperature at 128.5 which poses an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 01/18/2024 Plan of Correction Administrator agreed to lower hot water heather, do a video of water being checked and submit to CCLD by POC date.

Official classification

Type A

Official code

87309(a)

Regulation authority

CCR

What the official deficiency says

(a) Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients. 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 bar cleaner, stone cleaner, razor blade, mini saw, large saw, bernzomatic, propane, febreze air freshener, vitamins, syeringe, insulin, unlocked and assessable which poses an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 01/18/2024 Plan of Correction Administrator agreed to lock all items and make them in assessable to residents in care and submit photos to CCLD by POC date. Cleared during visit.

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

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 having a broken dish washer, spider webs on the walls in the living room, the living room window, and hanging from the ceiling, brown drippings coming down the wall in the living room, tables with dust, closet doors in bedroom #3 off track paperwork on dining table boxes on the floor in the passage way which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 01/31/2024 Plan of Correction Administrator agreed to repair/replace broken dish washer, and to clean spider webs on the walls in the living room, the living room window, and hanging from the ceiling, brown drippings coming down the wall in the living room, tables with dust, fix closet doors in bedroom #3 and remove paperwork on dining table and boxes on the floor in the passage way and provide CCLD with photos by POC date.

Official classification

Type B

Official code

87303(e)(6)

Regulation authority

CCR

What the official deficiency says

(e) Water supplies and plumbing fixtures shall be maintained as follows: (6) Toilet, handwashing and bathing facilities shall be maintained in operating condition. Additional equipment shall be provided in facilities accommodating physically handicapped and/or nonambulatory residents, based on the residents' needs. 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 knob in the 2nd bather shower, floor of the 2nd bathroom shower has stains, hair in the drain which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 01/31/2024 Plan of Correction Administrator agreed to fix broken knob in shower #2 and clean the stains and hair from the shower. and submit photos to CCLD by POC date.

Official classification

Type B

Official code

87303(f)(2)

Regulation authority

CCR

What the official deficiency says

(f) Solid waste shall be stored and disposed of as follows: (2) Syringes and needles are disposed of in accordance with the California Code of Regulations, Title 8, Section 5193 concerning bloodborne pathogens. 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 syringe needles in a container in the small room next to the dining area which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 01/31/2024 Plan of Correction Administrator agreed to get rid of syringes and read and understand regulation and submit self certification to CCLD by POC date.

Official classification

Type B

Official code

87307(d)(6)

Regulation authority

CCR

What the official deficiency says

(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 by having 2 large boxes in the door ways which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 01/31/2024 Plan of Correction Administrator agreed to move 2 large boxes out of the passageway and submit photos to CCLD by POC date.

Official classification

Type B

Official code

1569.618(c)(3)

Regulation authority

HSC

What the official deficiency says

(c)The facility shall employ, and the administrator shall schedule, a sufficient number of staff members to do all of the following: (3) Ensure that at least one staff member who has cardiopulmonary resuscitation (CPR) training and first aid training is on duty and on the premises at all times. This paragraph shall not be construed to require staff to provide CPR. 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 by not renewing Administrator and staff CPR or First Aid certification which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 01/31/2024 Plan of Correction Administrator agreed to get CPR/First Aid renewed and send a copy of updated CPR/First Aid to CCLD via email by POC date.

Official classification

Type B

Official code

87412(d)

Regulation authority

CCR

What the official deficiency says

(d) The licensee shall maintain documentation that an administrator has met the certification requirements specified in Section 87406, Administrator Certification Requirements or the recertification requirements in Section 87407, Administrator Recertification Requirements. 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 by not having the Administrator continuing education or recertification documents which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 01/31/2024 Plan of Correction Administrator agreed to provide CCLD a copy of Administrator recertification document via email by POC date.

Official classification

Type B

Official code

1569.696(a)

Regulation authority

HSC

What the official deficiency says

(a) All residential care facilities for the elderly shall provide training to direct care staff on postural supports, restricted conditions or health services, and hospice care as a component of the training requirements specified in Section 1569.625. The training shall include all of the following: This requirement is not met as evidenced by: Deficient Practice Statement Based on interview and record review, the licensee did not comply with the section cited above by not providing staff training which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 01/31/2024 Plan of Correction Administrator agreed to read understand regulation, provide staff with training's and send a copy of self certification and training documents to CCLD by POC date.

Official classification

Type B

Official code

1569.267(d)

Regulation authority

HSC

What the official deficiency says

(d) The licensee shall provide initial and ongoing training for all members of its staff to ensure that residents’ rights are fully respected and implemented. This requirement is not met as evidenced by: Deficient Practice Statement Based on interview and record review, the licensee did not comply with the section cited above by not providing staff with ongoing training which poses a potential health and safety or risk to persons in care.

Official plan of correction

POC Due Date: 01/31/2024 Plan of Correction Administrator agreed to read understand regulation, provide staff with training's and send a copy of self certification and training documents to CCLD by POC date.

Official classification

Type B

Official code

87555(b)(27)

Regulation authority

CCR

What the official deficiency says

(b) The following food service requirements shall apply: (27) All kitchen areas shall be kept clean and free of litter, rodents, vermin and insects. 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 spider webs with a spider in the kitchen sink area which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 01/31/2024 Plan of Correction Administrator agreed to clean and remove spider and spider web from the kitchen sink area and send photo to CCLD via email by POC date.

Official classification

Type B

Official code

1569.695(a)

Regulation authority

HSC

What the official deficiency says

(a)In addition to any other requirement of this chapter, a residential care facility for the elderly shall have an emergency and disaster plan that shall include, but not be limited to, all of the following: 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 not having a copy of the facilities emergency and disaster plan posted or on file which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 01/31/2024 Plan of Correction Administrator agreed to provide CCLD a copy of the facilities emergency and disaster plan via email by the POC date.

Official classification

Type B

Official code

85076(d)(1)

Regulation authority

CCR

What the official deficiency says

(1) Supplies of staple nonperishable foods for a minimum of one week and fresh perishable foods for a minimum of two days shall be maintained on the premises. This requirement is not met as evidenced by: 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 non-perishable which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 01/24/2024 Plan of Correction Administrator agreed to purchase food (meat)and submit receipts and photos of food to CCLD by POC date.

Official classification

Type B

Official code

87203

Regulation authority

CCR

What the official deficiency says

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 This requirement was not met as evidenced by expired fire extinguisher which poses a potential health & safety risk to residents in care.

Official plan of correction

POC Due Date: 01/24/2024 Plan of Correction Administrator agreed to provide CCLD with a copy of purchase receipt for new fire extinguisher or service tag from fire extinguisher. Administrator also agreed to have fire extinguisher inspected annually for fire safety compliance.

Official classification

Type B

Official code

87208(A)(7)

Regulation authority

CCR

What the official deficiency says

87208((A) Building(s) to be occupied, including a floor plan that describes the capacities of the buildings for the uses intended...7)Sketches, showing dimensions, of the following: This requirement was not met as evidence by: Deficient Practice Statement Based on LPAs observation licensee did not comply with the section cited above by staff/family sleeping in the garage in a makeshift bedroom being used for accommodation. Which poses a potential health and safety risk to residents.

Official plan of correction

POC Due Date: 01/31/2024 Plan of Correction Administrator agreed not to allow staff/family to sleep in the garage. Facility will submit a written addendum to their operating plan describing how the garage will be utilized as intended to CCLD by POC date.

Official classification

Type A

Official code

87606(f)(1)

Regulation authority

CCR

What the official deficiency says

87606(f)(1) (f) To accept or retain a bedridden person, a facility shall ensure the following: (1) The facility's Plan of Operation includes a statement of how the facility intends to meet the overall health, safety and care needs of bedridden persons. This requirement was not met as evidence by: Based on LPAs observation licensee did not comply with the section cited above by accepting a bedridden resident with restricted health condition without fire clearance in room #1. Which poses an immediate health and safety risk to clients.

Official plan of correction

Administrator agreed to apply for a fire clearance and update the facilities Plan of Operation and provide a copy to CCLD by the POC date.

Deadline recorded: Mar 23, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87621(b)(1)(B)

Regulation authority

CCR

What the official deficiency says

87621(b) In addition to Section 87611 the licensees shall be responsible... (1) Ensuring that ostomy care is provided by an appropriately...(B)There shall be written documentation by an appropriately skilled professional outlining...instruction...facility staff who have been instructed. This requirement was not met as evidence by: Based on LPAs observation licensee did not comply with the section cited above by accepting a bedridden resident with restricted health condition without fire clearance in room #1. Which poses an immediate health and safety risk to clients.

Official plan of correction

Administrator agreed to apply for a fire clearance and update the facilities Plan of Operation and provide a copy to CCLD by the POC date.

Deadline recorded: Mar 23, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87506(b)(17)(A)(B)

Regulation authority

CCR

What the official deficiency says

87506(b) Each resident’s record shall contain at least the following ...(17)Documents and information required...(A)Section 87457, Pre-Admission Appraisal;(B)Section 87459, Functional Capabilities;(C) Section 87461, Mental Condition; (D)Section 87462, Social Factors This requirement was not met as evidence by: Based on LPAs observation licensee did not comply with the section cited above by missing required documentation in residents files, Pre-placement Appraisal Needs and Services Plan, Identification and Emergency Information, Consent for Medical Treatment and Residents Rights. Which poses a potential health and safety risk to residents.

Official plan of correction

Administrator agreed to provide a copy of the Mitigation Plan to CCLD by POC date.

Deadline recorded: Mar 29, 2022. 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, 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 was not met as evidence by: Based on LPAs observation licensee did not comply with the section cited above by not providing a grab bar in the bathtub. having a hole in the ceiling from an upstairs bathroom leak in the shared bathroom. Using a screwdriver to operate the shower faucet in bedroom #1. Which poses a potential health and safety risk to residents.

Official plan of correction

Administrator agreed not to allow staff to sleep in the garage. Facility will submit a written addendum to their operating plan describing how the garage will be utilized as intended to CCLD by POC date.

Deadline recorded: Mar 29, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87208(A)(7)

Regulation authority

CCR

What the official deficiency says

87208((A) Building(s) to be occupied, including a floor plan that describes the capacities of the buildings for the uses intended...7)Sketches, showing dimensions, of the following: This requirement was not met as evidence by: Based on LPAs observation licensee did not comply with the section cited above by staff sleeping in the garage in a makeshift bedroom being used for accommodation. Which poses a potential health and safety risk to residents.

Official plan of correction

Administrator agreed not to allow staff to sleep in the garage. Facility will submit a written addendum to their operating plan describing how the garage will be utilized as intended to CCLD by POC date.

Deadline recorded: Mar 29, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87303(e)(2)

Regulation authority

CCR

What the official deficiency says

87303 (e) Water...shall be maintained as follows:(2) Faucets used by residents for personal care...Hot water temperature controls shall be maintained... temperature of not less than 105 degree F (41 degree C) and not more than 120 degree...This requirement was not met as evidence by: Based on LPAs observation licensee did not comply with the section cited above by maintaining water temperature between 105 degree F and 120 degree F which poses an immediate health and safety risk to residents.

Official plan of correction

Administrator agreed to adjust temperature to measure between 105 - 120 degrees F. and submit a photo copy of temperature to CCLD by POC date. Deficiency cleared during visit.

Deadline recorded: Mar 11, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87705(f)(1)

Regulation authority

CCR

What the official deficiency says

(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 was not met as evidence by: Based on LPAs observation licensee did not comply with the section cited above by not maintaining a safe environment with unlocked rakes, shovel, paint, tree trimmer, 3 ladders, lawn mower and unlocked shed located in the back yard. which poses an immediate health and safety risk to residents.

Official plan of correction

Administrator agreed to turn the garage doorknob around to lock from the outside. To move tools into the locked garage. To purchase a new lock for the shed and submit photo copies to CCLD by POC date.

Deadline recorded: Mar 5, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87621(b)(1)(B)

Regulation authority

CCR

What the official deficiency says

87621(b) In addition to Section 87611 the licensees shall be responsible... (1) Ensuring that ostomy care is provided by an appropriately...(B)There shall be written documentation by an appropriately skilled professional outlining...instruction...facility staff who have been instructed. This requirement was not met as evidence by: Based on LPAs observation licensee did not comply with the section cited above by accepting a resident with a restricted health condition. Which poses an immediate health and safety risk to clients.

Official plan of correction

Administrator agreed to obtain training for staff from an appropriately skill professional and apply for a waver from CCLD, and provide copies to CCLD by the POC date.

Deadline recorded: Mar 11, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87606(f)(1)

Regulation authority

CCR

What the official deficiency says

87606(f)(1) (f) To accept or retain a bedridden person, a facility shall ensure the following: (1) The facility's Plan of Operation includes a statement of how the facility intends to meet the overall health, safety and care needs of bedridden persons. This requirement was not met as evidence by: Based on LPAs observation licensee did not comply with the section cited above by accepting a bedridden resident with restricted health condition without fire clearance in room #1. Which poses an immediate health and safety risk to clients.

Official plan of correction

Administrator agreed to apply for a fire clearance and update the facilities Plan of Operation and provide a copy to CCLD by the POC date.

Deadline recorded: Mar 11, 2022. 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 (a) Each licensee shall furnish to the licensing agency such reports as the Department may require, ... (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,,, This requirement was not met as evidence by: Based on LPAs observation licensee did not comply with the section cited above by not having a Mitigation Plan LIC 808. Which poses a potential health and safety risk to residents.

Official plan of correction

Administrator agreed to provide a copy of the Mitigation Plan to CCLD by POC date.

Deadline recorded: Mar 11, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87506(b)(17)(A)(B)

Regulation authority

CCR

What the official deficiency says

87506(b) Each resident’s record shall contain at least the following ...(17)Documents and information required...(A)Section 87457, Pre-Admission Appraisal;(B)Section 87459, Functional Capabilities;(C) Section 87461, Mental Condition; (D)Section 87462, Social Factors This requirement was not met as evidence by: Based on LPAs observation licensee did not comply with the section cited above by missing required documentation in residents files, Pre-placement Appraisal Needs and Services Plan, Identification and Emergency Information, Consent for Medical Treatment and Residents Rights. Which poses a potential health and safety risk to residents.

Official plan of correction

Administrator agreed to complete the resident file and send a copy to CCLD by POC date.

Deadline recorded: Mar 11, 2022. 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, 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 was not met as evidence by: Based on LPAs observation licensee did not comply with the section cited above by not providing a grab bar in the bathtub. having a hole in the ceiling from an upstairs bathroom leak in the shared bathroom. Using a screwdriver to operate the shower faucet in bedroom #1. Which poses a potential health and safety risk to residents.

Official plan of correction

Administrator agreed to install a grab bar in the bathtub, to get the hole in the ceiling fixed and provide pictures and a copy of the invoice to CCLD by the POC date.

Deadline recorded: Mar 11, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87208(A)(7)

Regulation authority

CCR

What the official deficiency says

87208((A) Building(s) to be occupied, including a floor plan that describes the capacities of the buildings for the uses intended...7)Sketches, showing dimensions, of the following: This requirement was not met as evidence by: Based on LPAs observation licensee did not comply with the section cited above by staff sleeping in the garage in a makeshift bedroom being used for accommodation. Which poses a potential health and safety risk to residents.

Official plan of correction

Administrator agreed not to allow staff to sleep in the garage. Facility will submit a written addendum to their operating plan describing how the garage will be utilized as intended to CCLD by POC date.

Deadline recorded: Mar 11, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

156.72

Regulation authority

CCR

What the official deficiency says

87212 Emergency Disaster Plan (a) Each facility shall have a disaster and mass casualty plan of action. The plan shall be in writing and shall be readily available. This requirement was not met as evidence by: Based on LPAs observation licensee did not comply with the section cited above by not having an Emergency Disaster Plan. Which poses a potential health and safety risk to residents. which poses a potential health and safety risk to residents.

Official plan of correction

Administrator agreed to provide a copy of the facilities Emergency Disaster Plan to CCLD by POC date.

Deadline recorded: Mar 11, 2022. A deadline is not proof that correction was completed.