WALNUT CREEK WILLOWS

Official classification

Type B

Official code

87468.2(a)(2)

Regulation authority

CCR

What the official deficiency says

To have their records and personal information remain confidential and to approve their release, except as authorized by law. This requirement was not met as evidenced by a staff member sharing personal information on a resident which poses a potential healt and safety risk to residents in care.

Official plan of correction

By POC due date, ADM agrees to complete and submit in-service staff retraining on residents' personal rights in compliance with Section 87468.2 regulations.

Deadline recorded: Sep 11, 2026. 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

87309 Storage Space and Access (a) Except as specified in subsection (b), the licensee shall ensure that disinfectants, cleaning solutions...and other similar items which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage. This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above by not having Clorox Bleach and Shurgard HP disinfectant chemicals inaccessible to residents in unlocked laundry room and Clorox Bleach under cabinet in memory care unit which poses an immediate health and safety risk to persons in care.

Official plan of correction

Administrator will conduct In-Service training with all staff and submit sign-in sheet to CCLD by POC due date. Repeat Civil Penalty $1000.00

Deadline recorded: Jul 20, 2026. 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

87463(a) Reappraisals (a) ...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... This requirement is not met as evidenced by: Based on observation, file review, interview, the licensee did not comply with the section cited above by not updating the Appraisal Needs and Services Plan (ANS) for R1 annually or significant changes in condition which poses a potential safety, personal rights risk to persons in care.

Official plan of correction

Administrator agreed to submit an updated signed by administrator and resident/resident's responsible party, ANS for R1 to CCLD by POC due date. Repeat Civil Penalty $250.00

Deadline recorded: Jul 9, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87309(a)(b)

Regulation authority

CCR

What the official deficiency says

87309(a) Storage Space and Access (a) Except...(b), the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances, ...and other similar items which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage. This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above in by not having spray bottle with toxic cleaning solution disinfectant, located in memory care unit, toxic cleaning solutions in bucket located on cleaning cart in hallways, inaccessible to residents and unattended by staff which poses an immediate health and safety risk to persons in care.

Official plan of correction

Administrator will conduct In-Service training with Staff/Housekeeping Staff on keeping disinfectants, cleaning solutions, poisonous substances inaccessible to residents and left unattended by staff. Submit participant sign-in sheet with topic summary to CCLD by POC due date. Immediate Civl Penalty Assessed $500.00

Deadline recorded: Jul 15, 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

87465 Incidental Medical and Dental Care (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. Based on observation, the licensee did not comply with the section cited above in by not having the medication room door locked, unopened and left unattended by staff which poses an immediate health and safety risk to persons in care.

Official plan of correction

Administrator will conduct In-Service training with Med Techs/Staff on keeping medications safe/locked and inaccessible to residents. Submit participant sign-in sheet with topic summary to CCLD by POC due date. Immediate Civl Penalty Assessed $500.00

Deadline recorded: Jul 15, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87555(b)(3)

Regulation authority

CCR

What the official deficiency says

87555 General Food Service Requirements (b) The following food service requirements shall apply: (3) Between-meal nourishment or snacks shall be made available for all residents unless limited by dietary restrictions prescribed by a physician. Based on observation, and interviews the licensee did not comply with the section cited above in by not ensuring that all residents receive snacks between their 3 daily meals which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Administrator agreed to conduct In-Service training with all staff on providing between-meal nourishment or snacks to all residents and send to CCLD by POC due date

Deadline recorded: Jul 15, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87555(b)(23)

Regulation authority

CCR

What the official deficiency says

87555 General Food Service Requirements (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. Based on observation, and interviews the licensee did not comply with the section cited above in by not ensuring that all readily perishable foods, i.e., fresh eggs are properly refrigerated which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Administrator agreed to conduct In-Service training with all kichen staff on storing perishable foods with a dietician consultant and send particiapnat sign in sheet to CCLD by POC due date

Deadline recorded: Jul 15, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87555(b)(27)

Regulation authority

CCR

What the official deficiency says

87555 General Food Service Requirements (b) The following food service requirements shall apply: (27) All kitchen areas shall be kept clean and free of litter, rodents, vermin and insects. Based on observation the licensee did not comply with the section cited above in by not ensuring all kitchen areas shall be kept clean which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Administrator agreed to conduct In-Service training with all kitchen staff on ensuring kitchen areas shall be kept clean and send to CCLD by POC due date.

Deadline recorded: Jul 15, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87555(b)(29)

Regulation authority

CCR

What the official deficiency says

87555 General Food Service Requirements (b) The following food service requirements shall apply: (29) All equipment, fixed or mobile, and dishes, shall be kept clean and maintained in good repair and free of breaks, open seams, cracks or chips. Based on observation the licensee did not comply with the section cited above in by not ensuring all kitchen areas shall be kept clean, including kitchen counter, appliances including but not limited to food mixers, blenders, food processors and stored away when not in use which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Administrator agreed to conduct In-Service training with all kitchen staff on ensuring kitchen areas shall be kept clean, including kitchen counters and all food appliances when not in use stored properly and send sign in sheet to CCLD by POC due date.

Deadline recorded: Jul 15, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87307(a)(3)(C)

Regulation authority

CCR

What the official deficiency says

87307 Personal Accommodations and Services (a) Living accommodation.. The following provisions shall apply: (3) Equipment and supplies necessary for personal care...the licensee shall assure provision of: (C) Clean linen, including blankets, bedspreads, top bed sheets, bottom bed sheets, pillow cases...shall be sufficient to permit changing at least once per week or more often when indicated to ensure that clean linen is in use by residents at all times. The linen shall be in good repair. Based on observation the licensee did not comply with the section cited above in by not ensuring that R1's bed linens were changed and clean which had blood stains on pillow case and sheets which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Administrator agreed to conduct In-Service training with all staff on ensuring that clean linen is in use by residents at all times and send sign in sheet to CCLD by POC due date.

Deadline recorded: Jul 15, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87202(a)(2)

Regulation authority

CCR

What the official deficiency says

87202 Fire Clearance (a) All facilities shall maintain a fire clearance approved...(2) Bedridden persons This requirement is not met as evidenced by: Based on observation, file review and interview the licensee did not comply with the section cited above by not having R1 in a bedridden room with approved fire clearance which is a immediate health, safety, persoanl rights risk to residents in care.

Official plan of correction

Administrator to move resident to a room with an approved bedridden fire clearance and send a photo showing the move to CCLD by POC due date. Immediate Civil Penalty Assesed $500.00 today.

Deadline recorded: Jun 3, 2026. 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

87463(a) Reappraisals (a) ...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... This requirement is not met as evidenced by: Based on observation, file review, interview, the licensee did not comply with the section cited above by not updating the Appraisal Needs and Services Plan (ANS) for R1 annually or significant changes in condition which poses a potential safety, personal rights risk to persons in care.

Official plan of correction

Administrator agreed to submit an updated ANS for R1 to CCLD by POC due date.

Deadline recorded: Jun 9, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87633(h)(5)

Regulation authority

CCR

What the official deficiency says

87633 Hospice Care of Terminally Ill Residents (h) For each terminally ill resident receiving hospice services in the facility, the licensee shall maintain the following in the resident’s record: (5) A statement signed by the resident's roommate...who will share a room with a person who is terminally ill... acknowledgment that the resident intends to receive hospice care in the facility for the remainder of the resident's life, and the roommate's voluntary agreement to grant access to the shared living space to hospice caregiver.... This requirement is not met as evidenced by:

Official plan of correction

Administrator agreed to send acknowledgemt from R2 or R2's authorized representative to CCLD by POC due date.

Deadline recorded: Jun 9, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87470(a)(2)(B)

Regulation authority

CCR

What the official deficiency says

(2) Environmental cleaning and disinfection activities shall be performed following the manufacturers'instructions for proper use of the cleaning and disinfecting products. These activities shall be completed, at a minimum, as follows: (B) Walls and window coverings in resident care areas shall be dusted or cleaned on a regular schedule to ensure they are safe and sanitary and when they are visibly contaminated or soiled. 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 by not having walls and windows coverings clean including blinds, curtains, windows screens with spider webs which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/23/2026 Plan of Correction Administrator agreed to send video and photos of walls and windows cleaned to CCLD by POC due 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 in by not having outside facility cleaned and clear of shovelswhich poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/23/2026 Plan of Correction Administrator agreed to send video and photos of area clean and cleared by POC due date.

Official classification

Type B

Official code

87303(e)(2)

Regulation authority

CCR

What the official deficiency says

(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 in by not having water temperature set 105-120 (Rm# 4 103.8) in residents' bathrooms which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/09/2026 Plan of Correction Administrator agreed to send a photo of water temperature set in resi

Official classification

Type B

Official code

87303(i)(1)(A)

Regulation authority

CCR

What the official deficiency says

(i) Facilities shall have signal systems which shall meet the following criteria: (1) All facilities licensed for 16 or more and all residential facilities having separate floors or buildings shall have a signal system which shall: (A) Operate from each resident's living unit. 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 in by not having signal units working in each resident's living unit including but not limited to the memory care unit (north wing) which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/23/2026 Plan of Correction Administrator agreed to send a proposed detail plan on next steps and send to CCLD for review by POC due date.

Official classification

Type B

Official code

1569.695(a)(1)

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: (1) Evacuation procedures, including identification of an assembly point or points that shall be included in the facility sketch. 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 by not completing an emergecy disaster plan (LIC 610-E 9 pages) which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/23/2026 Plan of Correction Administrator agrees to complete Emergency Disaster Plan and send document to CCLD by POC due date.

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 observation, interview, record review, the licensee did not comply with the section cited above in by not conducting quarterly drills each shift which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/23/2026 Plan of Correction Admiistrator agrees to conduct drills with staff during different shifts including NOC shift and send in participant sign-in sheet to CCLD by POC due date.

Official classification

Type B

Official code

87405(d)(2)

Regulation authority

CCR

What the official deficiency says

87405 Administrator - Qualifications and Duties (d) The administrator shall have the qualifications specified in Sections 87405(d)...(2) Knowledge...ability...the applicable laws, rules and regulations. This requirement is not met as evidenced by: Based on record reviews, the licensee did not comply with the section cited above in by completing the required 2hrs minumum courses with a approved CCLD vendor to cover policy procedures, laws and staff requirements in regards to staff trainings. The training certificates were for other topics and previous dates other than the proposed 12/10/25 class date. This poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Licensee will send training certificates that cover the topics on policies/regulations with staff, including but not limited to staff RCFE 20hrs trainings on how to train new staff and current staff. Civil Penalty $250.00 for repeat violation.

Deadline recorded: Feb 10, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87412(f)

Regulation authority

CCR

What the official deficiency says

87412 Personnel Records (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: Based on file review and interview, the licensee did not comply with the section cited above by not having staff records available including but not limited to staff schedules for Nov '25 thru Feb '26, LIC 500 (staff roster) and staff contact information which poses an health and safety risk to persons in care.

Official plan of correction

Administrator will submit copies of requested staff rosters, LIC 500 with staff contact information to CCLD by POC due date.

Deadline recorded: Feb 4, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87506(d)

Regulation authority

CCR

What the official deficiency says

87506 Resident Records (d) All resident records shall be available to the licensing agency to inspect, audit, and copy upon demand during normal business hours. This requirement is not met as evidenced by: Based on file review and interview, the licensee did not comply with the section cited above by not having resident records for R1-R8 available for Licensing review including but not limited to admission agreements, emergency contact info., physician's reports, appraisals/Appraisal Needs and Services, hospice care plans, home health care plans, care notes, MARS, doctor's orders which poses an health and safety risk to persons in care.

Official plan of correction

Administrator will submit copies for requested records for R1-R8 to CCLD by POC due date.

Deadline recorded: Feb 4, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87632(d)(2)

Regulation authority

CCR

What the official deficiency says

87632 Hospice Care Waiver (d) If the Department grants a hospice care waiver..to ensure the well-being of terminally ill residents and of all other facility residents, which shall include, but not be limited to, the following requirements: (2) The licensee shall notify the Department in writing within five working days of the initiation of hospice care services for any terminally ill resident in the facility or within five working days of admitting a resident already receiving hospice care services. The notice shall include the resident's name and date of admission to the facility and the name and address of the hospice. Based on file review and interview, the licensee did not comply with the section cited above by not notifying Licensing of residents (R2-R10) with a notice of hospice services initiated within 5 working days which poses an health and safety risk to persons in care.

Official plan of correction

Administrator will read the regulation and self-certify understanding and send self-certification to CCLD by POC due date. In addition, send notices of all residents currently on hospice to CCLD by POC due date.

Deadline recorded: Feb 4, 2026. 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

87309 Storage Space and Access (a) Except as specified in subsection (b), the licensee shall ensure that disinfectants, cleaning solutions...and other similar items which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage. This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above by not having Clorox Bleach and Shurgard HP disinfectant chemicals inaccessible to residents in unlocked laundry room and Clorox Bleach under cabinet in memory care unit which poses an immediate health and safety risk to persons in care.

Official plan of correction

Administrator will conduct In-Service training with all staff and submit sign-in sheet to CCLD by POC due date. Immediate Civil Penalty assessed for $500.00

Deadline recorded: Feb 4, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87303(a)(1)

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. (1) Floor surfaces in bath, laundry and kitchen areas shall be maintained in a clean, sanitary, and odorless condition. This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above by not having shower floors clean, resident bedroom floors repaired with cracks, tile bulkling in assisted living and memory care units which poses an health and safety risk to persons in care.

Official plan of correction

Administrator will clean flooring and repair flooring in residents rooms and facility and send contractor receipts of repairs and photos to CCLD by POC due date.

Deadline recorded: Feb 10, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87618(b)(E)(I)

Regulation authority

CCR

What the official deficiency says

87618 Oxygen Administration - Gas and Liquid (b) In addition to Section 87611(b), the licensee shall be responsible for the following: (E) Oxygen tanks that are not portable shall be secured in a stand or to the wall. (I) Equipment shall be removed from the facility when no longer in use by the resident. This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above by not having oxygen tanks secured in a stand/wall and removed when resident was discharged or passed away which poses an health and safety risk to persons in care.

Official plan of correction

Administrator will read regulation, self-certify understanding by submitting self-certification and photos of oxygen tanks secured and/or removed if no longer in use by resident to CCLD by POC due date.

Deadline recorded: Feb 10, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87303(e)(2)

Regulation authority

CCR

What the official deficiency says

87303 Maintenance and Operation (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 degree C) and not more than 120 degree F (49 degree C). This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above by not having water temperatures maintained at 105-120 degrees F. in residents' shared bathrooms. Water temps measured at 94.3 and 97.5 degrees F. in assisted living memory care units which poses an health and safety risk to persons in care.

Official plan of correction

Administrator will set water temperatures for residents' bathrooms according to regulation and send photos of water temperatures in assisted living and memory care units bathrooms to CCLD by POC due date.

Deadline recorded: Feb 4, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

80087(a)

Regulation authority

CCR

What the official deficiency says

(a) The facility shall be...in good repair at all times... This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above by having disrepair flooring in residents rooms with tiles cracked, buckling and lifting which poses a potential health and safety risk to persons in care.

Official plan of correction

Licensee agreed to submit a detail plan of when they will have the flooring repaired in all residents rooms including but not limited to assised living and memory care units and submit photos of repaired floors to CCLD by POC date.

Deadline recorded: Feb 11, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87555(23)

Regulation authority

CCR

What the official deficiency says

87555 General Food Service Requirements (23) All readily perishable foods... shall be stored in covered containers at appropriate temperatures. This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above by having food in the freezer uncovered and not in a food container in memory care unit which poses a potential health and safety risk to persons in care.

Official plan of correction

Administrator will remove food a conduct In-Service training with all staff on food storage including but not limited to all perishable foods and send sign in sheet to CCLD by POC due date.

Deadline recorded: Feb 11, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87405(d)(2)

Regulation authority

CCR

What the official deficiency says

87405 Administrator - Qualifications and Duties (d) The administrator shall have the qualifications specified in Sections 87405(d)...(2) Knowledge...ability...the applicable laws, rules and regulations. This requirement is not met as evidenced by: Based on record reviews, interviews and observations, the licensee did not comply with the section cited above in by not having RCFE specific 20 hours staff annual trainings completed since annual inspection on 06/03/25. Which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Administrator will complete minimum 2hrs of Administrator Policies and Procedures including but not limited to RCFE laws, regulations and staff requirements with an approved CCLD vendor and submit to CCLD by POC due date.

Deadline recorded: Nov 22, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87405(a)

Regulation authority

CCR

What the official deficiency says

87405 Administrator - Qualifications and Duties a) All facilities shall have a qualified and currently certified administrator. ...shall be on the premises a sufficient number of hours to permit adequate attention to the management and administration of the facility...The Department may require that the administrator devote additional hours in the facility to fulfill his/her responsibilities when the need for such additional hours is substantiated by written documentation. This requirement is not met as evidenced by: Based on LPA's visits 08/15/25, 7/29/25, 6/10/25, 6/3/25, 4/10/25, 3/13/25 and 1/15/25 the Administrator was not available. There has been multiple deficencies citations and the designated substitute does not meet the qualifications adequate to be responsible and accountable for management and administration of the facility as specified in this section which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Administrator will submit a schedule (LIC 500) showing their work hours Monday-Friday at a minimum of 20 hours to CCLD by POC due date.

Deadline recorded: Aug 27, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87405(d)(2)

Regulation authority

CCR

What the official deficiency says

87405 Administrator - Qualifications and Duties (d) The administrator shall have the qualifications specified in Sections 87405(d)...(2) Knowledge...ability...the applicable laws, rules and regulations. This requirement is not met as evidenced by: Based on record reviews, interviews and observations, the licensee did not comply with the section cited above in by not having RCFE specific 20 hours staff annual trainings completed since annual inspection on 06/03/25. Which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Administrator will complete 2hrs of Administrator Policies and Procedures including but not limited to RCFE staff trainings with an approved CCLD vendor and submit to CCLD by POC due date.

Deadline recorded: Sep 3, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87224(a)

Regulation authority

CCR

What the official deficiency says

(a) The licensee may evict a resident for one or more of the reasons listed in Section 87224(a)(1) through (5). Thirty (30) days’ written notice to the resident is required except as otherwise specified in paragraph (5). This requirement was not met as evidence by: Based on interviews and record review the Licensee did not comply with the section cited above in giving proper notification for eviction, which poses a potential personal risk for persons in care.

Official plan of correction

Assistant Administrator agreed to Review regulation 87224 and submit a self-certification that the facility will abide by the regulation going forward to CCLD by POC date.

Deadline recorded: Aug 16, 2025. A deadline is not proof that correction was completed.

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: Based on record review, the licensee did not comply with the section cited above in by not having staff annual trianings for staff (S) S1-S10 including but not limited to direct care staff which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Administrator will submit a detailed plan to how and when the annual trainings will be completed by direct care staff. Submit training certiifcates to CCLD by POC due date. Trainings include: 8hrs Dementia, 4hrs postural support, 4hrs restricted health conditions and 4hrs hospice care. Civil Penalty $250.00 assessed for repeat violation.

Deadline recorded: Aug 14, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87355(e)(3)

Regulation authority

CCR

What the official deficiency says

(e) All individuals subject to a criminal record review... shall prior to working.. in a licensed facility: (3) Request a transfer of a criminal record clearance... This requirement was not met as evidence by: Based on record review the Licensee did not comply with the section cited above in having S11 associated to the facility, which poses an immediate health and safety risk to person in care.

Official plan of correction

Administrator agreed to send completed copy of fingerprints to CCLD to be associated by POC date.

Deadline recorded: Jul 30, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87355(e)(3)

Regulation authority

CCR

What the official deficiency says

(e) All individuals subject to a criminal record review... shall prior to working.. in a licensed facility: (3) Request a transfer of a criminal record clearance... This requirement was not met as evidence by: Based on record review the Licensee did not comply with the section cited above in having S2 associated to the facility, which poses an immediate health and safety risk to person in care.

Official plan of correction

Administrator agreed to send LIC9182 and S2 identification to CCLD to be associated by POC date.

Deadline recorded: Jun 11, 2025. A deadline is not proof that correction was completed.

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 by not having staff annual trianings for staff (S) S1-S10 which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/01/2025 Plan of Correction Administrator agreed to submit training certificates for staff to CCLD by POC due date.

Official classification

Type B

Official code

87555(b)(25)

Regulation authority

CCR

What the official deficiency says

87555 General Food Service Requirements (b) The following food service requirements shall apply: (25) Soaps, detergents, cleaning compounds or similar substances shall be stored in areas separate from food supplies. This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above in by not storing cases of Clorox Bleach and bottles of Fabuloso Multi-Purpose Cleaner in a area separate from food supplies which poses a potential health and safety risk to persons in care.

Official plan of correction

Administrator agreed to remove the cleaning disinfectant products and send a photo. In addition, read the regulation and self-certify understanding the regulation moving forward. POC documents will be sent to CCLD by POC due date. Repeat Violation Immediate Civil Penalty $250.00

Deadline recorded: Apr 17, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.2(a)

Regulation authority

CCR

What the official deficiency says

87468.2 Additional Personal Rights of Residents in Privately Operated Facilities (a)... residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: Based on observation and interview the licensee did not comply with the section cited above in by ensuring that camera with audio does not violate a residents' right to privacy and dignity as required by existing regulations. Including but not limited to all clients and residents maintain privacy and dignity rights that could be violated by negligent and/or abusive surveillance practices which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Administrator will read regulation and self-certify understanding this regulation moving forward. In addition, Administrator will have to ensure and attest that the camera does not obtain audio by sending a detailed letter to CCLD by POC due date. Repeat Violation Immediate Civil Penalty $250.00

Deadline recorded: Apr 17, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.2(a)(1)

Regulation authority

CCR

What the official deficiency says

87468.2 Additional Personal Rights of Residents in Privately Operated Facilities (a) In addition to the rights...87468.1, Personal Rights of Residents in All Facilities,...residential care facilities for the elderly shall have all of the following personal rights: (1) To have a reasonable level of personal privacy in accommodations... This requirement is not met as evidenced by: Based on observation and interview the licensee did not comply with the section cited above in by violating R1's personal rights to privacy including but not limited to picking up R1's phone and looking at messages when they are not present which poses a potential safety or personal rights risk to persons in care.

Official plan of correction

Administrator agrees to conduct In-service training with all staff on personal rights including but not limited to phones devices. Training-sign in sheet and synopsis of the training topic will be submitted to CCLD by POC due date. Repeat Violation Immediate Civil Penalty $250.00

Deadline recorded: Apr 17, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87307(c)

Regulation authority

CCR

What the official deficiency says

87307 Personal Accommodations and Services (c) Individual privacy shall be provided in all toilet, bath and shower areas. This requirement is not met as evidenced by: Based on interviews, licensee did not comply with the section cited above in by not ensuring R1’s privacy while showering which posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Administrator agreed to conduct In-Service Training with staff/caregivers and send copy of sign-in sheet to CCLD by POC due date. Repeat Violation Immediate Civil Penalty $250.00

Deadline recorded: Apr 17, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.1(a)(1)(b)(5)

Regulation authority

CCR

What the official deficiency says

87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (1) To be accorded dignity in their personal relationships with staff, residents, and other persons. (b) All residents in all residential care facilities for the elderly shall be protected from all of the actions specified in this subsection. (5) Willfully and repeatedly fail to use a resident’s preferred name or pronouns after being informed of the resident’s preferred name or pronouns in a clear manner. This requirement is not met as evidenced by: Based on observation and interview, the licensee did not comply with the section cited above in by not according dignity and respect with bathing, showering, toileting, and addressing residents by their preferred names and pronouns which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Administrator agreed to conduct In-Service Training with staff/caregivers and send copy of sign-in sheet to CCLD by POC due date. Repeat Violation Immediate Civil Penalty $250.00

Deadline recorded: Apr 17, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87224(a)

Regulation authority

CCR

What the official deficiency says

87224 Eviction Procedures (a) The licensee may evict a resident for one or more of the reasons listed in Section 87224(a)(1) through (5). Thirty (30) days written notice to the resident is required except as otherwise specified in paragraph (5) This requirement is not met as evidenced by: Based on interviews and record review the licensee did not comply with the section cited above in by serving R1 with an appropriate eviction notice after deciding not to accept R1 back to the facility once R1 was discharged from the hospital ER which posed a potential health and safety risk and personal rights to persons in care.

Official plan of correction

The licensee will read regulation 87224 and submit self-certification that it has been read, understood and they will abide going forward to CCLD by POC due date. Repeat Violation Immediate Civil Penalty $250.00

Deadline recorded: Apr 17, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.2(a)(5)

Regulation authority

CCR

What the official deficiency says

87468.2 Additional Personal Rights of Residents in Privately Operated Facilities (a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (5) To be served food of quality and quantity necessary to meet their nutritional needs. This requirement is not met as evidence by: Based on observation, licensee did not comply with the section cited above by not serving hot food that should be hot, nutritious and of quality and quantity which poses an health, safety and personal rights risk for persons in care.

Official plan of correction

Administrator agreed to have ALL staff cooks to take a food course on food, sanitation and preparation of meals and will submit certificates to CCLD by POC due date.

Deadline recorded: Apr 30, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87411(d)(3)

Regulation authority

CCR

What the official deficiency says

87411 Personnel Requirements – General (d) All personnel shall be given on the job training...This training...shall provide knowledge of and skill in the following, as appropriate for the job assigned... (3) Skill and knowledge required...including the ability to communicate with residents. This requirement is not met as evidence by: Based on interview, the licensee did not comply with the section cited above by ensuring staff has the ability to communicate with residents when providing care which poses an health, safety and personal rights risk for persons in care.

Official plan of correction

Administrator agreed to create a plan on how to address this issue with communications with language barriers with staff providing care to residents and submit to CCLD by POC due date.

Deadline recorded: May 8, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.2(a)(4)

Regulation authority

CCR

What the official deficiency says

87468.2 Additional Personal Rights of Residents in Privately Operated Facilities (a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (4) To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs. Based on observation, interview and record review, the licensee did not comply with the section cited above by not, including but not limited to, responding to residents' call buttons in a timely manner and addressing the residents' care needs after turing off the call light which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Administrator agreed to create a chart for each caregiver and their rounds. Rounds will have 2hr checks for incontinence and everything else by signing off. Administrator will submit the chart to CCLD by POC due date. Repeat Violation Civil Penalty Assessed $250.00

Deadline recorded: Apr 30, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

1569.261(b)

Regulation authority

HSC

What the official deficiency says

§1569.261 Legislative intent; fundamental rights for residents of residential care facilities (b) In establishing this bill of rights, the Legislature intends that persons residing in residential care facilities for the elderly be treated with dignity, kindness, and respect, and that their civil liberties be fully honored. Based on interviews the licensee did not comply with the section cited above in by treating residents with dignity, kindness and respect including but not limited to how staff communicates while giving care to residents in care which poses a potential health and safety risk and personal rights to persons in care.

Official plan of correction

Administrator agreed to read the regulation and self-certify. In addition, will conduct a In-Service training with all staff on all shifts with treating residents with dignity, kindness and respect in communication and giving care. Submit self-certification and in-service training sign-in sheet and a copy of what was covered during training to CCLD by POC due date.

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

Official classification

Type B

Official code

87468.2(a)(4)

Regulation authority

CCR

What the official deficiency says

87468.2 Additional Personal Rights of Residents in Privately Operated Facilities (a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (4) To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs. Based on interviews the licensee did not comply with the section cited above in by responding to call light buttons timely, changing diapers including but not limited to making sure residents' are completely cleaned after soiled diaper changes during NOC shift and between shift changes which poses a potential health, safety risk and personal rights to persons in care.

Official plan of correction

Administrator agreed to submit a detailed plan on how they will ensure that diaper changes and hygiene care needs are completed with staff during all shifts and submit to CCLD for review by POC due date.

Deadline recorded: Apr 10, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.2(a)

Regulation authority

CCR

What the official deficiency says

87468.2 Additional Personal Rights of Residents in Privately Operated Facilities (a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (4) To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs. Based on observation, interview and record review, the licensee did not comply with the section cited above by not, including but not limited to, responding to residents' call buttons in a timely manner and addressing the residents' care needs after turing off the call light which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Administrator agreed to provide a written plan to address the long response time for call button. Administrator will submit the written plan to CCLD for review by POC date.

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

Official classification

Type B

Official code

87555(b)(25)

Regulation authority

CCR

What the official deficiency says

87555 General Food Service Requirements (b) The following food service requirements shall apply: (25) Soaps, detergents, cleaning compounds or similar substances shall be stored in areas separate from food supplies. This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above in by not storing cases of Clorox Bleach and bottles of Fabuloso Multi-Purpose Cleaner in a area separate from food supplies which poses a potential health and safety risk to persons in care.

Official plan of correction

Administrator agreed to remove the cleaning disinfectant products and send a photo. In addition, read the regulation and self-certify understanding the regulation moving forward. POC documents will be sent to CCLD by POC due date.

Deadline recorded: Mar 13, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87555(b)(9)(15)

Regulation authority

CCR

What the official deficiency says

87555 General Food Service Requirements (b) The following food service requirements shall apply: (9) Procedures which protect the safety, acceptability and nutritive values of food... (15) All persons engaged in food preparation and service...food services sanitation practices which protect the food from contamination. This requirement is not met as evidence by: Based on observation, interview and record review, the licensee did not comply with the section cited above by not including but not limited to having staff practicing safe food sanitation when preparing and serving food. In addition, serving food that is of good quality, taste and is not cold to residents which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Administrator agreed to conduct an In-Service Training with staff on personal hygiene and food services sanitation practices which protect the food from contamination. All kitchen staff/cooks shall submit food handler certifications to CCLD by POC due date. Also Administrator agreed to schedule an appointment for a nutritionist, a dietitian, or a home economist to do consultations during meal time at the facility and will send the consultant's report to CCLD through March 2026.

Deadline recorded: Apr 3, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87555(b)(17)

Regulation authority

CCR

What the official deficiency says

87555 General Food Service Requirements (b) The following food service requirements shall apply: (17) In facilities licensed for fifty (50) or more, and providing three (3) meals per day, a full-time employee qualified by formal training or experience shall be responsible for the operation of the food service... This requirement is not met as evidenced by: Based on observation and interview, the licensee did not comply with the section cited above in by not having a full-time qualified employee by formal training responsible for food services which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Administrator agreed to hire an full-time employee with formal training and send copy of certifications to CCLD by POC due date.

Deadline recorded: Mar 12, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.2(a)

Regulation authority

CCR

What the official deficiency says

87468.2 Additional Personal Rights of Residents in Privately Operated Facilities (a)... residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: Based on observation and interview the licensee did not comply with the section cited above in by ensuring that camera with audio does not violate a residents' right to privacy and dignity as required by existing regulations. Including but not limited to all clients and residents maintain privacy and dignity rights that could be violated by negligent and/or abusive surveillance practices which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Administrator will read regulation and self-certify understanding this regulation moving forward. In addition, Administrator will have to ensure and attest that the camera does not obtain audio by sending a detailed letter to CCLD by POC due date.

Deadline recorded: Mar 31, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.2(a)(1)

Regulation authority

CCR

What the official deficiency says

87468.2 Additional Personal Rights of Residents in Privately Operated Facilities (a) In addition to the rights...87468.1, Personal Rights of Residents in All Facilities,...residential care facilities for the elderly shall have all of the following personal rights: (1) To have a reasonable level of personal privacy in accommodations... This requirement is not met as evidenced by: Based on observation and interview the licensee did not comply with the section cited above in by violating R1's personal rights to privacy including but not limited to picking up R1's phone and looking at messages when they are not present which poses a potential safety or personal rights risk to persons in care.

Official plan of correction

Administrator agrees to conduct In-service training with all staff on personal rights including but not limited to phones devices. Training-sign in sheet and synopsis of the training topic will be submitted to CCLD by POC due date.

Deadline recorded: Mar 21, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87224(a)(2)(f)

Regulation authority

CCR

What the official deficiency says

87224(a)(2)(f) Eviction Procedures: A licensee of a licensed residential care facility for the elderly shall...(2) Provide each resident...with a written notice.... The notice shall include all of the following: (F) The contact information for the local long-term care ombudsman, including address and telephone number. Based on record review the licensee did not comply with the section cited above. The eviction notice did not include contact information which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Licensee shall provide an eviction notice that meets regulation to CCL by 1/15/2025.

Deadline recorded: Jan 15, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87307(c)

Regulation authority

CCR

What the official deficiency says

87307 Personal Accommodations and Services (c) Individual privacy shall be provided in all toilet, bath and shower areas. This requirement is not met as evidenced by: Based on interviews, licensee did not comply with the section cited above in by not ensuring R1’s privacy while showering which posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Administrator agreed to conduct In-Service Training with staff/caregivers and send copy of sign-in sheet to CCLD by POC due date.

Deadline recorded: Dec 30, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87307(a)(3)(C)

Regulation authority

CCR

What the official deficiency says

87307 Personal Accommodations and Services (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: (3) Equipment and supplies necessary for personal care...(C) Clean linen...The quantity shall be sufficient... This requirement is not met as evidenced by: Based on observation and interview, the licensee did not comply with the section cited above in by not having clean bath towels, hand towels and wash cloths with sufficient quantity for residents in care at all times which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Administrator agreed to purchase towels and send copy of receipts to CCLD by POC due date.

Deadline recorded: Jan 10, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87555(b)(17)

Regulation authority

CCR

What the official deficiency says

87555 General Food Service Requirements (b) The following food service requirements shall apply: (17) In facilities licensed for fifty (50) or more, and providing three (3) meals per day, a full-time employee qualified by formal training or experience shall be responsible for the operation of the food service... This requirement is not met as evidenced by: Based on observation and interview, the licensee did not comply with the section cited above in by not having a full-time qualified employee by formal training responsible for food services which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Administrator agreed to hire an full-time employee with formal training and send copy of certifications to CCLD by POC due date.

Deadline recorded: Dec 30, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.1(a)(1)(b)(5)

Regulation authority

CCR

What the official deficiency says

87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (1) To be accorded dignity in their personal relationships with staff, residents, and other persons. (b) All residents in all residential care facilities for the elderly shall be protected from all of the actions specified in this subsection. (5) Willfully and repeatedly fail to use a resident’s preferred name or pronouns after being informed of the resident’s preferred name or pronouns in a clear manner. This requirement is not met as evidenced by: Based on observation and interview, the licensee did not comply with the section cited above in by not according dignity and respect with bathing, showering, toileting, and addressing residents by their preferred names and pronouns which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Administrator agreed to conduct In-Service Training with staff/caregivers and send copy of sign-in sheet to CCLD by POC due date.

Deadline recorded: Dec 30, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87224(a)

Regulation authority

CCR

What the official deficiency says

87224 Eviction Procedures (a) The licensee may evict a resident for one or more of the reasons listed in Section 87224(a)(1) through (5). Thirty (30) days written notice to the resident is required except as otherwise specified in paragraph (5) This requirement is not met as evidenced by: Based on interviews and record review the licensee did not comply with the section cited above in by serving R1 with an appropriate eviction notice after deciding not to accept R1 back to the facility once R1 was discharged from the hospital ER which posed a potential health and safety risk and personal rights to persons in care.

Official plan of correction

The licensee will read regulation 87224 and submit self-certification that it has been read, understood and they will abide going forward to CCLD by POC due date.

Deadline recorded: Dec 20, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

1569.686(a)(3)

Regulation authority

HSC

What the official deficiency says

§1569.686 Licensee notificacified events..(a) A licensee shall notify the department, the State Long-Term Care Ombudsman, all residents, and, if applicable, their legal representatives, in writing, within two business days, and shall notify all applicants for potential residence, and, if applicable, their legal representatives, prior to admission, of any of the following events, or knowledge of the event: (3) The licensee files for bankruptcy. This requirement is not met as evidenced by: Based on interview with the licensee did not comply with the section cited above in by not notifying the Department, Ombudsman and Residents of filed bankruptcy which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Licensee will submit copies of letters sent to Residents, Ombudsman, and a copy of the bankruptcy filing, LIC 500 to CCLD by POC date. Civil Penalty of $2,000 is being assessed.

Deadline recorded: Sep 20, 2024. A deadline is not proof that correction was completed.

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: Based on record review, the licensee did not comply with the section cited above in by not having health screening and negative TB results which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Administrator will submit health screening for S3, S5, S7-S12 and a Negative TB for S2, S4, S5, S7-S12.

Deadline recorded: Sep 6, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

80087(a)

Regulation authority

CCR

What the official deficiency says

80087 Buildings and Grounds (a) The facility shall be...in good repair at all times... This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above by having disrepair flooring in residents rooms and hallways which poses a potential health and safety risk to persons in care.

Official plan of correction

Licensee agreed to submit a detail plan of when they will have the flooring completely repaired and submit photos of repaired floors to CCLD by POC date.

Deadline recorded: Sep 6, 2024. A deadline is not proof that correction was completed.

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 in by not having health screening and negative TB results which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/03/2024 Plan of Correction Administrator will submit health screening for S3, S5, S7-S12 and a Negative TB for S2, S4, S5, S7-S12.

Official classification

Type B

Official code

87618(b)(3)(A)

Regulation authority

CCR

What the official deficiency says

(3) Ensuring that the use of oxygen equipment meets the following requirements: (A) A report shall be made in writing to the local fire jurisdiction that oxygen is in use at the facility. 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 by not reporting to the local fire dept oxygen in use for R1 and R2 which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 06/19/2024 Plan of Correction Administrator agree to send a letter to local fire dept and submit a copy of letter to CCLD by POC due date.

Official classification

Type B

Official code

1569.695(d)

Regulation authority

HSC

What the official deficiency says

(d) A facility shall review the plan annually and make updates as necessary, including changes in floor plans and the population served. The licensee or administrator shall sign and date documentation to indicate that the plan has been reviewed and updated as necessary. This requirement is not met as evidenced by: 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 by not having a Emergency Disaster Plan which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 06/19/2024 Plan of Correction Administrator will submit a copy of Emergency Disaster Plan to CCLD by POC due date.

Official classification

Type B

Official code

1569.17

Regulation authority

CCR

What the official deficiency says

Fingerprints and criminal records of individuals in contact with clients...record exemption from the State Department of Social Services before his or her initial presence in a residential care facility for the elderly.

Official plan of correction

Administrator will read the Regulation and send self certification of understanding to Community Care Licensing (CCL) by POC date. In addition, licensee will not allow any individual to work, reside, or volunteer prior to being finger print cleared and associated. Administrator will also forward a copy of S1 clearance and association to CCLD by POC date.

Deadline recorded: May 15, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87608(a)(3)

Regulation authority

CCR

What the official deficiency says

(a) Based on the individual's preadmission appraisal, and subsequent changes to that appraisal, the facility shall provide assistance and care for the resident in those activities of daily living which the resident is unable to do for himself/herself. Postural supports may be used under the following conditions. (3) A written order from a physician indicating the need for the postural support shall be maintained in the resident’s record. The licensing agency shall be authorized to require other additional documentation if needed to verify the order. Based on interview, the licensee did not comply with the section cited above in by not having a written order from a physician for a bed rail for R1 which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Administrator removed bed rail. Deficiency cleared during visit.

Deadline recorded: May 2, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87405(a)

Regulation authority

CCR

What the official deficiency says

(a) All facilities shall have a qualified and currently certified administrator... This requirement is not met as evidence by: Based on observation and interview, the licensee did not comply with the section cited above in by not having an Administrator available which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Licensee to submit documents of new administrator.

Deadline recorded: Apr 18, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87407(k)(1)

Regulation authority

CCR

What the official deficiency says

(k) Whenever a certified administrator assumes or relinquishes responsibility for administering a residential care facility for the elderly, he or she shall provide written notice, within thirty (30) days, to: (1) The local licensing office responsible for receiving information regarding personnel changes at the licensed facility with whom the certificate holder is or was associated, and Based on observation and interview, the licensee did not comply with the section cited above in by not providing written notice to CCLD the personnel changes which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Licensee to self-certify that they read and understand the regulation. Submit written notice of personnel changes from the last Administrator.

Deadline recorded: Apr 18, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87705(f)(2)

Regulation authority

CCR

What the official deficiency says

87705 Care of Persons with Dementia (f) The following shall be stored inaccessible to residents with dementia: (2) Over-the-counter medication, nutritional supplements or vitamins, alcohol, cigarettes, and toxic substances such as certain plants, gardening supplies, cleaning supplies and disinfectants. This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above by not having cleaning disinfecting solutions (Fabuloso) inacessible to residnts which poses a potential health and safety risk to persons in care. During visit Administrator locked the disinfective cleaning spray.

Official plan of correction

Administrator will place locks on cabinets in memory care and submit photo. Administrator will conduct an in-training with staff and submit particpant roster to CCLD.

Deadline recorded: Mar 30, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87608(1)(A)

Regulation authority

CCR

What the official deficiency says

87608 Postural Supports (1) Postural supports shall be limited to appliances or devices...used to achieve proper body position and balance, to improve a resident's mobility...restrict movement including, but not limited to, preventing a resident from falling out of bed, a chair, etc. (A) Physician-prescribed orthopedic devices such as braces or casts, used for support of a weakened body part or correction of body parts, are considered postural supports. This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above by having a doctor's order for postural support fo R1 which poses a potential health and safety risk and persoanl rights to persons in care.

Official plan of correction

Administrator agree to get Physician's Report updated for R1. Get a Dr's order for postural support or hospital bed for R1 and submit to CCLD by POC due date.

Deadline recorded: Apr 5, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

80087(a)

Regulation authority

CCR

What the official deficiency says

80087 Buildings and Grounds (a) The facility shall be...in good repair at all times... This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above by having disrepair flooring in residents rooms and hallways which poses a potential health and safety risk to persons in care.

Official plan of correction

Administrator agree to repair flooring in all areas where cracks, tape, nails and molding is lifting. Send an invoice of floor repairs and photos to CCLD by POC due date.

Deadline recorded: Apr 26, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87211(b)

Regulation authority

CCR

What the official deficiency says

87211 Reporting Requirements (b) Any suspected physical abuse that results in serious bodily injury of an elder...shall be reported to the local ombudsman... This requirement is not met as evidenced by: Based on record review and interview, the Administrator did not comply with the section above for not reporting to the local ombudsman and submitting SOC341 which posed a potential health and safety risk to persons in care.

Official plan of correction

Administrator will go over reporting requirements and submit a self certification of understanding of reporting requirements. Administrator shall submit self-certification to CCLD by POC due date.

Deadline recorded: Apr 5, 2024. 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 in by having toxic chemicals inaccessible to residents in care which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/22/2023 Plan of Correction Licensee locked all chemicals. Deficiency cleared during visit

Official classification

Type B

Official code

1569.618(b)(3)

Regulation authority

HSC

What the official deficiency says

(b) At least one administrator, facility manager, or designated substitute who is at least 21 years of age and has qualifications adequate to be responsible and accountable for the management and administration of the facility pursuant to Title 22 of the California Code of Regulations shall be on the premises 24 hours per day. The designated substitute maybe a direct care staff member who shall not be required to meet the educational, certification, or training requirements of an administrator. The designated substitute shall meet qualifications that include, but are not limited to, all of the following: (3) Training to effectively interact with emergency personnel in the event of an emergency call, including an ability to provide a resident’s medical records to emergency responders. 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 by not having an administrator on the premises which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/21/2023 Plan of Correction Licensee has 30 days to hire a new administrator. Licensee will email CCL LIC 9082, LIC 500, LIC 501 and Administrator Certificate by POC Due 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 in by having bikes, ladders, mirrors, mattresses etc..inaccessible to residents in care which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/05/2023 Plan of Correction Licensee to have all items: ladders, bikes, wheelchairs, brooms, rakes, toilets removed and submit photos to CCL by POC Due 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 record review, the licensee did not comply with the section cited above in by not having staff scheduled with CPR Training which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/05/2023 Plan of Correction Licensee will have First Aid/CPR Training for all staff. Will submit certificates and/or In-Training to CCL by POC Due Date.

Official classification

Type B

Official code

1569.618(a)

Regulation authority

HSC

What the official deficiency says

(a) The administrator designated by the licensee pursuant to paragraph (11) of subdivision (a) of Section 1569.15 shall be present at the facility during normal working hours. A facility manager designated by the licensee with notice to the department, shall be responsible for the operation of the facility when the administrator is temporarily absent from 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 by not having a facility manager available when Administrator is absent which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/28/2023 Plan of Correction Licensee will submit updated Designation of Facility Responsibility to CCL by POC Due Date.

Official classification

Type B

Official code

1569.618(b)

Regulation authority

HSC

What the official deficiency says

(b) At least one administrator, facility manager, or designated substitute who is at least 21 years of age and has qualifications adequate to be responsible and accountable for the management and administration of the facility pursuant to Title 22 of the California Code of Regulations shall be on the premises 24 hours per day. The designated substitute may be a direct care staff member who shall not be required to meet the educational, certification, or training requirements of an administrator. The designated substitute shall meet qualifications that include, but are not limited to, all of the following: 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 by not having responsible substitute at the facility which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/28/2023 Plan of Correction Licensee will submit updated Designation of Facility Responsibility to CCL by POC Due Date.

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 by having Complaint Poster accessible to which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/28/2023 Plan of Correction Licensee will get a 20x26 poster made at FEDEx and will submit photos to CCL by POC Due Date.

Official classification

Type B

Official code

87618(b)(3)(A)

Regulation authority

CCR

What the official deficiency says

(3) Ensuring that the use of oxygen equipment meets the following requirements: (A) A report shall be made in writing to the local fire jurisdiction that oxygen is in use at the facility. 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 by having record of letter sent to fire department which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/28/2023 Plan of Correction Licensee will send a letter to fire department and will send a copy to CCL by POC Due Date.

Official classification

Type B

Official code

87705(c)(6)

Regulation authority

CCR

What the official deficiency says

(c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following: (6) Appraisals are conducted on an ongoing basis pursuant to Section 87463, Reappraisals. 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 by not having current Appraisal Needs and Services Plans for residents in care which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/05/2023 Plan of Correction Licensee will review and update Appraisals for residents and send copies of residents that are updated to CCL by POC Due Date.

Official classification

Type A

Official code

87705(f)(2)

Regulation authority

CCR

What the official deficiency says

87705 Care of Persons with Dementia (f) The following shall be stored inaccessible to residents with dementia: (2) Over-the-counter medication, nutritional supplements or vitamins, alcohol, cigarettes, and toxic substances such as certain plants, gardening supplies, cleaning supplies and disinfectants. 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 cleaning solution accessible to residents which poses an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 05/13/2022 Plan of Correction Administrator locked cleaning solution during visit. Deficiency cleared during visit.