CASA AMORE CARE HOME INC

Official classification

Type B

Official code

87211(a)(1)

Regulation authority

CCR

What the official deficiency says

(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 specified in (A) through (D) below. This report shall include the resident's name, age, sex and date of admission; date and nature of event; attending physician's name, findings, and treatment, if any; and disposition of the case. 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 failing to submit an incident report regarding a resident's fall, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/06/2025 Plan of Correction On or before due date, administrator shall submit to CCLD the Unusual Incident Report (LIC624) for the incident on 09/17/2025 for R1.

Official classification

Type A

Official code

87555(b)(8)

Regulation authority

CCR

What the official deficiency says

87555 General Food Service Requirements. (b) The following food service requirements shall apply: (8) All food shall be of good quality. This requirement is not met as evidenced by: Based on observation, the licensee had 55 expired nonperishable foods and undated and uncovered perishable foods, which pose an immediate health and safety risk to persons in care.

Official plan of correction

Cleared during inspection.

Deadline recorded: Sep 20, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87412(a)(11)

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: (11) A health screening as specified in Section 87411, Personnel Requirements - General. 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 for ALL staff members, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/22/2024 Plan of Correction On or before due date, licensee shall obtain a LIC 503 Health Screen with TB test report for EVERY staff member.

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 as nunlocked garage door from kitchen giving residents access to Fabuloso, Downy Laundry detergent, and 409 cleaner which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/07/2024 Plan of Correction Install lock on garage door and provice proof to LPAs.

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 as hose was left on backyard sidewalk causing a trip hazard which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/07/2024 Plan of Correction corrected during visit.

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. The fire extinguisher was stored in a hallway closet and the staff person had to search to find it, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/29/2023 Plan of Correction In accordance with the 2013 California Fire Code 906.1, the Licensee shall obtain and store at least one 2A:10B:C rated fire extinguisher that has been mounted in a visible and accessible location with the top of the extinguisher no higher than 5 feet. The maximum travel distance to an extinguisher shall not be more than 75 feet. Fire extinguishers shall be serviced annually with a service tag attached.

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, because only 1 of the 4 required drills had been completed in the past year. This poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/29/2023 Plan of Correction The Licensee shall complete an emergency drill and complete documentation of its completion and send proof or attestation of its completition to LPA on or before due date.

Official classification

Type B

Official code

87465(a)(5)

Regulation authority

CCR

What the official deficiency says

87465 INCIDENTAL MEDICAL AND DENTAL CARE SERVICES: (a) ... provide for assistance in obtaining ... care by... (5) ... assist residents with self-administered medications as needed. This requirement is not met as evidenced by: Residents R1 and R2 stated, and their records supported their statements, that medications were not ordered and were not dispensed to them in a timely fashion.

Official plan of correction

Licensee corrected deficiency.

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

Official classification

Type B

Official code

87625(b)(3)

Regulation authority

CCR

What the official deficiency says

87625 MANAGED INCONTINENCE: (b) ... the licensee shall be responsible for ... (3) Ensuring that incontinent residents are kept clean and dry ... This requirement is not met as evidenced by: Residents R1 and R2 stated, and their records supported their statements, that their adult diapers were not kept dry and clean in a timely fashion.

Official plan of correction

Licensee corrected deficiency.

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

Official classification

Type A

Official code

87309(a)

Regulation authority

CCR

What the official deficiency says

(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 with an unlocked knife drawer in the kitchen and cleaners stored in unlocked cabinets in kitchen and garage, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/17/2022 Plan of Correction Licensee shall lock all of the drawers and cabinets storing potentially dangerous items or move the items to a safe storage location if the lock is broken on or before the due date.

Official classification

Type A

Official code

87555(b)(23)

Regulation authority

CCR

What the official deficiency says

(b) The following food service requirements shall apply: (23) All readily perishable foods or beverages capable of supporting rapid and progressive growth of micro-organisms which can cause food infections or food intoxications shall be stored in covered containers at appropriate temperatures. 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 all refrigerators and freezers where food was stored without a date on it identifying the date it was opened, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/17/2022 Plan of Correction Licensee shall date and securely close all foods stored in the refrigerators and the freezers.

Official classification

Type B

Official code

87307(d)(2)

Regulation authority

CCR

What the official deficiency says

(2) The premises shall be maintained in a state of good repair and shall provide a safe and healthful environment. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above, with non-working and unused locks where potentially dangerous items were stored, inadequate compliance with COVID-19 guidance, and the fire extinguisher not being mounted where visible which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/23/2022 Plan of Correction The licensee shall: (1) Repair or replace all non-working and unused locks where potentially dangerous items are stored. (2) Mount the fire extinguisher in a location where it is visible and accessible. (3) Post a minimum of 1 proper hand washing signs at every sink in the facility AND post a minimum of 10 additional COVID-19 related signs including those with social distancing and cough / sneeze etiquitte AND retrain staff concerning cloth towel use.

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 because though the fire extinguisher needs to be serviced or replaced every 12 months, it had not been serviced since March 2019, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/25/2021 Plan of Correction Licensee must send proof of the servicing or replacing of the fire extinguisher to the LPA by the due date.