BLUEMEADOW CARE

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

(a) Living accommodations and grounds shall be related to the facility's function. The facility shall be large enough to provide comfortable living accommodations and privacy for the residents, staff, and others who may reside in the facility. The following provisions shall apply: This requriment was not met as evidence by: Based on observation, the licensee did not comply with the section cited above in having staff sleeping in the garage which poses a potential personal rights risk to persons in care.

Official plan of correction

By POC facility agrees to remove all personal items from the garage including all beds, staff clothing, dressers, and other furniture and notify CCLD. LPA will return to do a POC visit upon notification.

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

Official classification

Type A

Official code

87465(h)(2)

Regulation authority

CCR

What the official deficiency says

(h) The following requirements shall apply to medications which are centrally stored:(2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. This requirement was not met as evidence by: Based on LPA's observation the licensee did not coply with the section cited above by med closet and kitchen drawer containing centerally stored medication unlocked which posed an immediate safety risk to residents in care.

Official plan of correction

Licensee agrees to create a medication procedure poster and post it on the outside of the medication closet and notify CCLD.

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

Official classification

Type B

Official code

87465(h)(5)

Regulation authority

CCR

What the official deficiency says

(h) The following requirements shall apply to medications which are centrally stored(5) Each resident's medication shall be stored in its originally received container. No medications shall be transferred between containers.: This requirment was not met evidence by: Based on LPA's observation and interview the licensee did not coply with the section cited above by having perscription medication transferred into a container which posed a potential safety and personnel rights risk to residents in care.

Official plan of correction

POC clear. Administrator retrained staff and provided an in service.

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

Official classification

Type B

Official code

87463(a)

Regulation authority

CCR

What the official deficiency says

(a) The pre-admission appraisal, as specified in Section 87457, Pre-Admission Appraisal, shall be updated, in writing as frequently as necessary or once every 12 months, whichever occurs first, to note significant changes in condition, as defined in Section 87101, Definitions, and to keep the appraisal accurate. For the purposes of this section, the updated pre-admission appraisal shall be referred to as the reappraisal. 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 4 out of 5resident records review not having an up to date appraisal of needs and services which poses a potential personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/01/2025 Plan of Correction By POC facility agrees to review residents files and up date them as neccessaey and notify CCLD.

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 in not having done any quaterly drills in 2025 which poses a potential safety risk to persons in care.

Official plan of correction

POC Due Date: 10/01/2025 Plan of Correction By POC facility agrees to conduct drills and notify CCLD.

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 is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above inhaving a knife accesable to residents which poses an immediate safety risk to persons in care.

Official plan of correction

POC Due Date: 09/04/2024 Plan of Correction Staff put knife away

Official classification

Type A

Official code

87355(e)(1)

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: (1) Obtain a California clearance … 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 having an unidentified uncleared individual working which poses an immediate health, safety and personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/04/2024 Plan of Correction Individual left during visit. Civil Penalty Assesed

Official classification

Type B

Official code

87303(c)

Regulation authority

CCR

What the official deficiency says

(c) All window screens shall be clean and maintained in good repair. 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 screens ripped which poses a potential personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/25/2024 Plan of Correction By POC Licensee agrees to repair or replace screens and notify CCLD.

Official classification

Type B

Official code

87412(a)

Regulation authority

CCR

What the official deficiency says

(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: 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 complete staff files which poses a potential personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/25/2024 Plan of Correction By POC Licensee agrees to review and update staff files and notify CCLD.

Official classification

Type B

Official code

1569.625(b)(2)

Regulation authority

HSC

What the official deficiency says

(2) In addition to paragraph (1), training requirements shall also include an additional 20 hours annually, eight hours of which shall be dementia care training, as required by subdivision (a) of Section 1569.626, and four hours of which shall be specific to postural supports, restricted health conditions, and hospice care, as required by subdivision (a) of Section 1569.696. This training shall be administered on the job, or in a classroom setting, or both, and may include online training. 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 staff up to date on trainings which poses a potential health, safety and personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/25/2024 Plan of Correction By POC Licensee agrees to provide trainings and record the competions and notify CCLD.

Official classification

Type B

Official code

87411(c)(1)

Regulation authority

CCR

What the official deficiency says

(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 all required staff first aid trained which poses a potential health, and safety risk to persons in care.

Official plan of correction

POC Due Date: 09/25/2024 Plan of Correction By POC Licensee agrees to provide trainings and record the competions and notify CCLD.

Official classification

Type B

Official code

87468(c)(1)

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. (1) The personal rights of residents specified in Sections 87468.1, Personal Rights of Residents in All Facilities and 87468.2, Additional Personal Rights of Residents in Privately Operated Facilities shall be posted as applicable to 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 the required information posted which poses a potential personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/25/2024 Plan of Correction By POC date Licensee agrees to post required information and notify CCLD.

Official classification

Type B

Official code

87307(a)

Regulation authority

CCR

What the official deficiency says

(a) Living accommodations and grounds shall be related to the facility's function. The facility shall be large enough to provide comfortable living accommodations and privacy for… staff… 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 S2 sleep in the living room at night which poses a potential personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/05/2024 Plan of Correction By POC Licensee agrees to no longer allow staff to sleep in common areas.

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 in not having the required sign posted which poses a potential personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/25/2024 Plan of Correction By POC date Licensee agrees to post the required signs and notify CCLD

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 fullest potential for independent living through participation in planned activities. The activities made available shall include: 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 scheduled activities which poses a potential personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/25/2024 Plan of Correction By POC date Licensee agrees to develop and implement an activities schedule and notify CCLD

Official classification

Type B

Official code

87555(a)

Regulation authority

CCR

What the official deficiency says

(a) The total daily diet shall be of the quality and in the quantity necessary to meet the needs of the residents an shall meet the Recommended Dietary Allowances of the Food and Nutrition Board of the National Research Council. All food shall be selected, stored, prepared and served in a safe and healthful manner. 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 enough food available which poses a potential personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/06/2024 Plan of Correction By POC date Licensee agrees to purchase adequate food and notify CCLD.

Official classification

Type B

Official code

87506(b)

Regulation authority

CCR

What the official deficiency says

(b) Each resident's record shall contain at least the following information: 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 residents records being incomplete which poses a potential personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/25/2024 Plan of Correction By POC date Licensee agrees to review all clients files and update and notify CCLD

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 in not having record of disaster drills which poses a potential safety risk to persons in care.

Official plan of correction

POC Due Date: 09/25/2024 Plan of Correction By POC date Licensee agrees to conduct and document drills and notify CCLD

Official classification

Type B

Official code

87705(c)(5)

Regulation authority

CCR

What the official deficiency says

(c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following: (5) Each resident with dementia shall have an annual medical assessment as specified in Section 87458, Medical Assessment, and a reappraisal done at least annually, both of which shall include a reassessment of the resident's dementia care needs. 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 clients not having an up to date medical which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/25/2024 Plan of Correction By POC date Licensee agrees to review all clients files and update and notify CCLD

Official classification

Type B

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 ...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 observation, the licensee did not comply with the section cited above in hot water temprature not measuring in range which poses a potential health and, personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/06/2024 Plan of Correction By POC Licensee agrees to adjust water and notify CCLD.

Official classification

Type B

Official code

87465(h)(5)

Regulation authority

CCR

What the official deficiency says

(h) The following requirements shall apply to medications which are centrally stored: (5) Each resident's medication shall be stored in its originally received container. No medications shall be transferred between containers. This requirement was not met as evidence by: Based on LPA's observation licensee did not coply with the section cited above by having medication transferred into a weekly pill organizer which poses a potential health and safety risk to residents in care.

Official plan of correction

Licensee/Administrator will submit a written statement of having read and understood the regulation and conducted in-service training with all staff, providing CCLD with a copy of all signatures of staff attended no later than the POC date.

Deadline recorded: Apr 11, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87202(a)

Regulation authority

CCR

What the official deficiency says

(a) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, or the State Fire Marshal. Prior to accepting or retaining any of the following types of persons, the applicant or licensee shall notify the licensing agency and obtain an appropriate fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, or the State Fire Marshal: 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. LPA observed garage is being utilized as a sleeping area for staff overnight which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/25/2023 Plan of Correction By POC date, Administator will either submit LIC 200 with floor sketch or submit a proof of photo that garage is no long being used as a sleeping area. An immediate $500 Civil Penalty is being assessed

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 maintaing hot water in shared resident's bathroom at 141 degrees F which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/25/2023 Plan of Correction By POC date, Administrator will lower the temperature between 105 degrees F - 120 degrees F and submit photo to CCLD.

Official classification

Type A

Official code

87303(e)(3)

Regulation authority

CCR

What the official deficiency says

(e) Water supplies and plumbing fixtures shall be maintained as follows: (3) Taps delivering water at 125 degree F (52 degrees C) or above shall be prominently identified by warning signs. 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. Based observation, hot water is maintained at 141 degrees F and no warning sign was posted which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/24/2023 Plan of Correction Deficiency cleared during visit. Administrator posted a warning sign in resident's shared bathroom.

Official classification

Type B

Official code

87411(f)

Regulation authority

CCR

What the official deficiency says

(f) All personnel, including the licensee and administrator, shall be in good health, and physically and mentally capable of performing assigned tasks. Good physical health shall be verified by a health screening, including a chest x-ray or an intradermal test, performed by a physician not more than six (6) months prior to or seven (7) days after employment or licensure. A report shall be made of each screening, signed by the examining physician. The report shall indicate whether the person is physically qualified to perform the duties to be assigned, and whether he/she has any health condition that would create a hazard to him/herself, other staff members or residents. A signed statement shall be obtained from each volunteer affirming that he/she is in good health. Personnel with evidence of physical illness or emotional instability that poses a significant threat to the well-being of residents shall be relieved of their duties. 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 not obtaining a health screening and TB test for S1 and S2 which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/31/2023 Plan of Correction By POC date, Administrator will obtain health screening and TB test for S1 and S2 and submit a copy to CCLD.

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 record review, the licensee did not comply with the section cited above by not having a staff for each shift with CPR training which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/31/2023 Plan of Correction By POC date, Administrator agrees to obtain a CPR training for all staff and submit a copy of CPR certificate to CCLD

Official classification

Type B

Official code

87415(a)

Regulation authority

CCR

What the official deficiency says

(a) The following persons providing night supervision from 10:00 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 in Section 87465, Incidental Medical and Dental Care Services, and shall be available as indicated below to assist in caring for residents in the event of an emergency: 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 first aid and amergency procedure training with night shfit staff which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 03/31/2023 Plan of Correction By POC date, Administrator will review regulation and provide in-service training with staff who provides night supervision and submit a copy of training with staff signature to CCLD

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 record review, the licensee did not comply with the section cited above by not maintaing records for S1 and S2 which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/31/2023 Plan of Correction By POC date, Administrator will review regulation and submit self-certification letter that records for S1 and S2 are maintained at facility to CCLD

Official classification

Type B

Official code

87412(a)

Regulation authority

CCR

What the official deficiency says

(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: 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 not having complete records S1 and S2 which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/31/2023 Plan of Correction By POC date, Administrator will review regulations and submit self certification letter that all staff records are complete with the required documents including but not limited to: LIC 501, LIC 308 with TB test results, LIC 508, Employee Rights, and First Aid/CPR Certificate.

Official classification

Type B

Official code

87411(d)

Regulation authority

CCR

What the official deficiency says

(d) All personnel shall be given on the job training or have related experience in the job assigned to them. This training and/or related experience shall provide knowledge of and skill in the following, as appropriate for the job assigned and as evidenced by safe and effective job performance: 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 not having the required training for S2 which pose a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/07/2023 Plan of Correction By POC date, Administrator will review regulation and obtain training for S2 and maintain training certificate on file and submit a copy to CCLD

Official classification

Type B

Official code

87412(c)

Regulation authority

CCR

What the official deficiency says

(c) Licensees shall maintain in the personnel records verification of required staff training and orientation. 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 not obtaining training required for S2 which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/07/2023 Plan of Correction By POC date, Administrator will review regulation and obtain training for S2 and maintain training certificate on file and submit a copy to CCLD

Official classification

Type B

Official code

1569.625(b)(1)

Regulation authority

HSC

What the official deficiency says

(1) The department shall adopt regulations to require staff members of residential care facilities for the elderly who assist residents with personal activities of daily living to receive appropriate training. This training shall consist of 40 hours of training. A staff member shall complete 20 hours, including six hours specific to dementia care, as required by subdivision (a) of Section 1569.626 and four hours specific to postural supports, restricted health conditions, and hospice care, as required by subdivision (a) of Section 1569.696, before working independently with residents. The remaining 20 hours shall include six hours specific to dementia care and shall be completed within the first four weeks of employment. The training coursework may utilize various methods of instruction, including, but not limited to, lectures, instructional videos, and interactive online courses. The additional 16 hours shall be hands-on training. 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 not having the required training for S2 prior to employment which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/07/2023 Plan of Correction By POC date, Administrator will review regulation and obtain training for S2 and maintain training certificate on file and submit a copy to CCLD

Official classification

Type B

Official code

1569.625(b)(2)

Regulation authority

HSC

What the official deficiency says

(2) In addition to paragraph (1), training requirements shall also include an additional 20 hours annually, eight hours of which shall be dementia care training, as required by subdivision (a) of Section 1569.626, and four hours of which shall be specific to postural supports, restricted health conditions, and hospice care, as required by subdivision (a) of Section 1569.696. This training shall be administered on the job, or in a classroom setting, or both, and may include online training. 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 not completing the required training for S3 which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/07/2023 Plan of Correction By POC date, Administrator will review regulation and obtain training for S3 and maintain training certificate on file and submit a copy to CCLD

Official classification

Type B

Official code

1569.625(c)

Regulation authority

HSC

What the official deficiency says

(c) The training 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, Licensee did not comply with the section cited above by not obtaining the training for S2 which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/14/2023 Plan of Correction By POC date, Administrator will review regulation and obtain training for S2 and maintain training certificate on file and submit a copy to CCLD

Official classification

Type B

Official code

87411(c)(1)

Regulation authority

CCR

What the official deficiency says

(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 by not having current first aid training for S1, S2 and S3 which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/31/2023 Plan of Correction By POC date, Administrator will obtain first aid training for all staff assisting with ADLs and submit a copy of certificate to CCLD

Official classification

Type B

Official code

1569.626(a)

Regulation authority

HSC

What the official deficiency says

(a) All residential care facilities for the elderly shall meet the following training requirements, as described in Section 1569.625, for all direct care staff: 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 completing training requirements for S2 which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/07/2023 Plan of Correction By POC date, Administrator will review regulation and obtain training for S2 and maintain training certificate on file and submit a copy to CCLD

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 record review, the licensee did not comply with the section cited above by not having required training for S2 once employed which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/07/2023 Plan of Correction By POC date, Administrator will review regulation and obtain training for S2 and maintain training certificate on file and submit a copy to CCLD

Official classification

Type B

Official code

87506(a)

Regulation authority

CCR

What the official deficiency says

(a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff. 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 not maintaing R5's record at facility which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/27/2023 Plan of Correction By POC date, Administrator will review regulation and submit a self-certification letter to CCLD

Official classification

Type B

Official code

87468(c)(1)

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. (1) The personal rights of residents specified in Sections 87468.1, Personal Rights of Residents in All Facilities and 87468.2, Additional Personal Rights of Residents in Privately Operated Facilities shall be posted as applicable to 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 by not posting personal rights and nondiscrimination notice which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/31/2023 Plan of Correction By POC date, Administrator will post the required postings and submit a photo to CCLD

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 by not having an Emergency Disaster Plan on file which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/31/2023 Plan of Correction Administrator will submit a copy of LIC 610E to CCLD

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 not having a record of emergency drill which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/27/2023 Plan of Correction By POC date, Adminsitrator will review regulation and conduct an emergency drill and submit a copy of drill to CCLD

Official classification

Type A

Official code

87705(f)(2)

Regulation authority

CCR

What the official deficiency says

87705(f)(2) CARE OF PERSONS WITH DEMENTIA (f)The following shall be stored inaccessible to residents with dementia:(2)...and toxic substances such as certain plants, gardening supplies, cleaning supplies and disinfectants. This requirement is not met as evidenced by: Based on observation, Licensee did not comply with regulation cited above. LPAs observed unlocked cleaning supplies in unlocked laundry room which poses an immediate health and safety risk to persons in care.

Official plan of correction

By POC date, Licensee will review regulation and conduct in-service training with all staff and submit a copy of training with staff signatures to CCL.

Deadline recorded: Jan 19, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87411(a)(1)(D)

Regulation authority

CCR

What the official deficiency says

87411(a)(1)(D) REPORT 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…(D) Any incident which threatens the welfare, safety or health of any resident, such as psychological abuse of a resident by staff or other residents, or unexplained absence of any residents. This requirement is not met as evidenced by: Based on record review, Licensee did not comply with the regulation cited above. Facility did not submit incident reports for when R1 fell off the wheelchair and sustained a cut on the chin in April 2020. In addition on May 28, 2020 where R1 was observed with bleeding eyes which poses a potential health and safety risk to persons in care.

Official plan of correction

By POC date, Administrator will review Sec 87211 Reporting Requirements and submit self-certification of understanding to CCL

Deadline recorded: Jan 19, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87705(c)(5)

Regulation authority

CCR

What the official deficiency says

87705(c)(5) CARE OF PERSONS WITH DEMENTIA (c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following:(5) Each resident with dementia shall have an .... and a reappraisal done at least annually... This requirement is not met as evidenced by: Based on record review, Licensee did not comply with the regulation cited above. LPAs observed R4 does not have an updated appraisal on file which poses a potential health and safety risk to persons in care.

Official plan of correction

By POC date, Administrator agrees to update R4's appraisal and submit a copy to CCL.

Deadline recorded: Jan 24, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

1569.269(a)(10)

Regulation authority

HSC

What the official deficiency says

1569.269(a)(10) ENUMERATED RIGHTS; SEVERABILITY (a) Residents of residential care facilities for the elderly shall have all of the following rights: (10)To be free from neglect... This requirement is not met as evidenced by: Based on the Department’s interviews and record review, Licensee did not comply with the regulation cited above. In April 2020, Home Health nurse instructed staff to off-load pressure to R1’s right heel at all times and to reposition every 2 hours. Nurse observed R1’s wound pressed against the bed twice. On 6/9/2020, R1 was admitted to hospital and pressure injury was diagnosed at Stage 4. Bone was exposed and test results revealed R1 had Osteomyelitis due to bacterial infection which infected R1’s bloodstream.

Official plan of correction

By POC date, Administrator will conduct training with staff on the Health and Safety Code 1569.269 Enumerated Rights; severability and submit proof of training with staff signatures to CCL by 1/13/2023 A Non-Compliance Conference (NCC) will be scheduled. A $500 Civil Penalty is being assessed. Civil penalty determination related to serious bodily injury is pending.

Deadline recorded: Jan 13, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87466

Regulation authority

CCR

What the official deficiency says

87466 OBSERVATION OF THE RESIDENT The licensee shall ensure that residents are regularly observed for changes in physical......changes are documented and brought to the attention of the resident's physician and the resident's responsible person, if any. This requirement is not met as evidenced by: Based on the Department’s interviews and record review, Licensee did not comply with the regulation cited above. Facility staff were instructed by Home Health nurse to supervise R1 at all times. On 5/28/2020, R1 fell off the wheelchair which resulted to R1 sustaining a cut on the chin. On 6/9/2020, staff informed Home Health nurse that R1’s eyes have been bleeding for two days. R1’s primary doctor was not notified.

Official plan of correction

By POC date, Administrator and staff will review Sec 87466 Observation of Resident and submit proof to CCL by 1/13/2023

Deadline recorded: Jan 13, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87468.1(a)(6)

Regulation authority

CCR

What the official deficiency says

87568.1 Personal Rights of Residents in All Facilities (a) Residents...shall have all of the following personal rights: (6) To leave or depart the facility at any time and to not be locked into any room, building, or on facility premises by day or night. Thiis requirment was not met as evidence by: Based on observation, Licensee did not comply with the regulation cited above. LPA observed a latch installed in the front main entrance door and R1's exit door which poses an immediate health and safety risk to residents in care.

Official plan of correction

Administrator agrees to review the regulation and remove the lock. Administrator is to submit a self-certification and photos to CCL by POC date.

Deadline recorded: Feb 26, 2022. A deadline is not proof that correction was completed.

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, licensee did not comply with the section cited above. LPAs observed no Emergency Disaster Plan is maintained at facility which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 10/15/2021 Plan of Correction Administrator agrees to maintain an Emergency Disaster Plan (LIC 610E) and submit a copy to CCL by POC date.