AARON'S ADVANCE CARE HOME INC.

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 in 1 out of 1 fire extinguishers, which poses a potential safety risk to persons in care.

Official plan of correction

POC Due Date: 02/19/2026 Plan of Correction On or before the due date, the Licensee shall replace the old fire extinguisher with a new one and inform the LPA of the change.

Official classification

Type A

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. The maximum hot water temperature was 123.9 degrees Fahrenheit, which poses an immediate safety risk to persons in care.

Official plan of correction

POC Due Date: 02/13/2026 Plan of Correction On or before the due date, the Licensee shall reduce the maximum hot water temperature to the safe range and inform the LPA of the change.

Official classification

Type A

Official code

87303(e)(2)

Regulation authority

CCR

What the official deficiency says

(e) Water supplies and plumbing fixtures shall be maintained as follows: (2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degrees C) and not more than 120 degree F (49 degrees C). This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above. The maximum hot water temperature was measured at 127.9 degrees Fahrenheit, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/28/2025 Plan of Correction On or before the due date, the Licensee shall attest to LPA in an email that the error has been corrected.

Official classification

Type B

Official code

1569.153(d)

Regulation authority

HSC

What the official deficiency says

(d) A written resident personal property inventory is established upon admission and retained during the resident’s stay in the residential care facility for the elderly. Inventories shall be written in ink, witnessed by the facility and the resident or resident’s representative, and dated. A copy of the written inventory shall be provided to the resident or the person acting on the resident’s behalf. All additions to an inventory shall be made in ink, and shall be witnessed by the facility and the resident or resident’s representative, and dated. Subsequent items brought into or removed from the facility shall be added to or deleted from the personal property inventory by the facility at the written request of the resident, the resident’s family, a responsible party, or a person acting on behalf of a resident. The facility shall not be liable for items which have not been requested to be included in the inventory or for items which have been deleted from the inventory. A copy of a current inventory shall be made available upon request to the resident, responsible party, or other authorized representative. The resident, resident’s family, or a responsible party may list those items which are not subject to addition or deletion from the inventory, such as personal clothing or laundry, which are subject to frequent removal from 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 4 of 4 residents have missing, blank, unsigned, or undated forms which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/10/2025 Plan of Correction On or before the due date, the Licensee shall attest to LPA in an email to james.sampair@dss.ca.gov that the error has been corrected.

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 1 of 3 active employees had no health screening, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/10/2025 Plan of Correction On or before the due date, the Licensee shall attest to LPA in an email to james.sampair@dss.ca.gov that the error has been corrected.

Official classification

Type B

Official code

87411(d)

Regulation authority

CCR

What the official deficiency says

(d) All personnel shall be given on the job training or have related experience in the job assigned to them. This training and/or related experience shall provide knowledge of and skill in the following, as appropriate for the job assigned and as evidenced by safe and effective job performance: This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, the licensee did not comply with the section cited above, with no documentation of training for new or existing employees, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/10/2025 Plan of Correction On or before the due date, the Licensee shall: (1) attest to LPA in an email that ALL staff have carefully reviewed Title 22 regulations assigned relating to this citation and (2) the error has either been corrected or that as soon as the error has been corrected LPA Sampair will be contacted at james.sampair@dss.ca.gov.

Official classification

Type B

Official code

1569.625(b)(1)

Regulation authority

HSC

What the official deficiency says

(1) The department shall adopt regulations to require staff members of residential care facilities for the elderly who assist residents with personal activities of daily living to receive appropriate training. This training shall consist of 40 hours of training. A staff member shall complete 20 hours, including six hours specific to dementia care, as required by subdivision (a) of Section 1569.626 and four hours specific to postural supports, restricted health conditions, and hospice care, as required by subdivision (a) of Section 1569.696, before working independently with residents. The remaining 20 hours shall include six hours specific to dementia care and shall be completed within the first four weeks of employment. The training coursework may utilize various methods of instruction, including, but not limited to, lectures, instructional videos, and interactive online courses. The additional 16 hours shall be hands-on training. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, the licensee did not comply with the section cited above, 0 of 1 new staff member completed new hire training before providing care to residents, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/10/2025 Plan of Correction On or before the due date, the Licensee shall: (1) attest to LPA in an email that ALL staff have carefully reviewed Title 22 regulations assigned relating to this citation and (2) the error has either been corrected or that as soon as the error has been corrected LPA Sampair will be contacted at james.sampair@dss.ca.gov.

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, 0 of 2 existing staff member completed their annual training, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/10/2025 Plan of Correction On or before the due date, the Licensee shall: (1) attest to LPA in an email that ALL staff have carefully reviewed Title 22 regulations assigned relating to this citation and (2) the error has either been corrected or that as soon as the error has been corrected LPA Sampair will be contacted at james.sampair@dss.ca.gov.

Official classification

Type B

Official code

1569.626(a)(1)

Regulation authority

HSC

What the official deficiency says

(a) All residential care facilities for the elderly shall meet the following training requirements, as described in Section 1569.625, for all direct care staff: (1) Twelve hours of dementia care training, six of which shall be completed before a staff member begins working independently with residents, and the remaining six hours of which shall be completed within the first four weeks of employment. All 12 hours shall be devoted to the care of persons with dementia. The facility may utilize various methods of instruction, including, but not limited to, preceptorship, mentoring, and other forms of observation and demonstration. The orientation time shall be exclusive of any administrative instruction. 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, 0 of 3 staff members with proof of dementia training, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/10/2025 Plan of Correction On or before the due date, the Licensee shall: (1) attest to LPA in an email that ALL staff have carefully reviewed Title 22 regulations assigned relating to this citation and (2) the error has either been corrected or that as soon as the error has been corrected LPA Sampair will be contacted at james.sampair@dss.ca.gov.

Official classification

Type B

Official code

1569.626(a)(2)

Regulation authority

HSC

What the official deficiency says

(a) All residential care facilities for the elderly shall meet the following training requirements, as described in Section 1569.625, for all direct care staff: (2) Eight hours of in-service training per year on the subject of serving residents with dementia. This training shall be developed in consultation with individuals or organizations with specific expertise in dementia care or by an outside source with expertise in dementia care. In formulating and providing this training, reference may be made to written materials and literature on dementia and the care and treatment of persons with dementia. This training requirement may be satisfied in one day or over a period of time. This training requirement may be provided at the facility or offsite and may include a combination of observation and practical application. 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, 0 of 3 staff members with proof of dementia training, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/10/2025 Plan of Correction On or before the due date, the Licensee shall: (1) attest to LPA in an email that ALL staff have carefully reviewed Title 22 regulations assigned relating to this citation and (2) the error has either been corrected or that as soon as the error has been corrected LPA Sampair will be contacted at james.sampair@dss.ca.gov.

Official classification

Type B

Official code

1569.696(a)(1)

Regulation authority

HSC

What the official deficiency says

(a) All residential care facilities for the elderly shall provide training to direct care staff on postural supports, restricted conditions or health services, and hospice care as a component of the training requirements specified in Section 1569.625. The training shall include all of the following: (1) Four hours of training on the care, supervision, and special needs of those residents, prior to providing direct care to residents. The facility may utilize various methods of instruction, including, but not limited to, preceptorship, mentoring, and other forms of observation and demonstration. The orientation time shall be exclusive of any administrative instruction. 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, 0 of 3 staff members with proof of dementia training, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/10/2025 Plan of Correction On or before the due date, the Licensee shall: (1) attest to LPA in an email that ALL staff have carefully reviewed Title 22 regulations assigned relating to this citation and (2) the error has either been corrected or that as soon as the error has been corrected LPA Sampair will be contacted at james.sampair@dss.ca.gov.

Official classification

Type B

Official code

1569.696(a)(2)

Regulation authority

HSC

What the official deficiency says

(a) All residential care facilities for the elderly shall provide training to direct care staff on postural supports, restricted conditions or health services, and hospice care as a component of the training requirements specified in Section 1569.625. The training shall include all of the following: (2) Four hours of training thereafter of in-service training per year on the subject of serving those residents. 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, 0 of 2 staff members with proof of training on postural supports, restricted conditions or health services, and hospice care, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/10/2025 Plan of Correction On or before the due date, the Licensee shall: (1) attest to LPA in an email that ALL staff have carefully reviewed Title 22 regulations assigned relating to this citation and (2) the error has either been corrected or that as soon as the error has been corrected LPA Sampair will be contacted at james.sampair@dss.ca.gov.

Official classification

Type B

Official code

1569.69(a)

Regulation authority

HSC

What the official deficiency says

(a) Each residential care facility for the elderly licensed under this chapter shall ensure that each employee of the facility who assists residents with the self-administration of medications meets all of the following training requirements: This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, the licensee did not comply with the section cited above, no medication training documentation for 1 new staff member assisting with the self-administration of medications, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/10/2025 Plan of Correction On or before the due date, the Licensee shall: (1) attest to LPA in an email that ALL staff have carefully reviewed Title 22 regulations assigned relating to this citation and (2) the error has either been corrected or that as soon as the error has been corrected LPA Sampair will be contacted at james.sampair@dss.ca.gov.

Official classification

Type B

Official code

1569.69(b)

Regulation authority

HSC

What the official deficiency says

(b) Each employee who received training and passed the examination required in paragraph (5) of subdivision (a), and who continues to assist with the self-administration of medicines, shall also complete eight hours of in-service training on medication-related issues in each succeeding 12-month period. 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, no documentation of annual medication training for 2 of 2 non-Administrator caregivers, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/10/2025 Plan of Correction On or before the due date, the Licensee shall: (1) attest to LPA in an email that ALL staff have carefully reviewed Title 22 regulations assigned relating to this citation and (2) the error has either been corrected or that as soon as the error has been corrected LPA Sampair will be contacted at james.sampair@dss.ca.gov.

Official classification

Type B

Official code

87465(h)(5)

Regulation authority

CCR

What the official deficiency says

(h) The following requirements shall apply to medications which are centrally stored: (5) Each resident's medication shall be stored in its originally received container. No medications shall be transferred between containers. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above,1 week of medications stored in dispenser, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/10/2025 Plan of Correction Cleared during inspection.

Official classification

Type B

Official code

87456(a)

Regulation authority

CCR

What the official deficiency says

(a) Prior to accepting a resident for care and in order to evaluate his/her suitability, the facility shall, as specified in this article 8: 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, 4 of 4 residents with missing, unsigned, undated, and/or incomplete documentation: pre-admission appraisal (LIC 603 Preplacement Appraisal Information or LIC 603A Resident Appraisal); LIC 625 Appraisal/Needs and Services Plan, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/10/2025 Plan of Correction On or before the due date, the Licensee shall: (1) attest to LPA in an email that ALL staff have carefully reviewed Title 22 regulations assigned relating to this citation and (2) the pre-admission appraisal (LIC 603 Preplacement Appraisal Information or LIC 603A Resident Appraisal); LIC 625 Appraisal/Needs and Services Plan has been completed for every resident.

Official classification

Type B

Official code

87463(a)

Regulation authority

CCR

What the official deficiency says

(a) The pre-admission appraisal, as specified in Section 87457, Pre-Admission Appraisal, shall be updated, in writing as frequently as necessary or once every 12 months, whichever occurs first, to note significant changes in condition, as defined in Section 87101, Definitions, and to keep the appraisal accurate. For the purposes of this section, the updated pre-admission appraisal shall be referred to as the reappraisal. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, the licensee did not comply with the section cited above, 0 of 4 residents have documented reappraisals within the past 12 months, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/10/2025 Plan of Correction On or before the due date, the Licensee shall: (1) attest to LPA in an email that ALL staff have carefully reviewed Title 22 regulations assigned relating to this citation and (2) a reappraisal (603A Resident Appraisal AND LIC 625 Appraisal/Needs and Services Plan) has been completed for every resident.

Official classification

Type B

Official code

87463(h)

Regulation authority

CCR

What the official deficiency says

(h) The licensee shall request that all residents receive an annual routine visit with a licensed medical professional once every twelve months, either in person or by video appointment. 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, 1 of 4 residents have a Physician's Report older than 12 months, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/10/2025 Plan of Correction On or before the due date, the Licensee shall attest to LPA in an email that either the resident has completed an annual routine visit with a licensed medical professional or that the resident's responsible party has made an appointment for the annual physical to be completed as soon as possible.

Official classification

Type B

Official code

87463(i)

Regulation authority

CCR

What the official deficiency says

(i) When there is significant change in condition, as defined in Section 87101, Definitions, or once every 12 months, whichever occurs first, the licensee shall arrange an in-person or virtual meeting or conference call to share the reappraisal with the resident, the resident's representative, if applicable, and appropriate facility staff, as specified in Section 87467, Resident Participation in Decision Making. 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, 0 of 4 residents have documented reappraisal meetings with the residents' representative within the past 12 months, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/10/2025 Plan of Correction On or before the due date, the Licensee shall attest to LPA in an email that either they have completed and documented the in-person or virtual meeting with 4 of the 4 residents' representatives or they have a meeting scheduled with them to be completed as soon as possible.

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, no disaster/emergency and fire drills are being conducted, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/10/2025 Plan of Correction On or before the due date, the Licensee shall attest to LPA in an email that a quarterly disaster/emergency and fire drills has been conducted AND all have been scheduled for the rest of 2025.

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: Deficient Practice Statement Based on record review, the licensee did not comply with the section cited above, no record of LIC 610E being reviewed within the past 12 months, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/10/2025 Plan of Correction On or before the due date, the Licensee shall attest to LPA in an email that the LIC 610E being reviewed and that the final page has been signed that it has been reviewed by Licensee.

Official classification

Type A

Official code

87465(h)(2)

Regulation authority

CCR

What the official deficiency says

(h) The following requirements shall apply to medications which are centrally stored: (2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above in 2 of 2 medicine cabinets which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/21/2024 Plan of Correction On or before due date, Licenee shall inform LPA that a system has been put into place so that keys are managed and so that the cabinets will be locked at all times other than the brief time medications are being prepared for dispensing to residents.

Official classification

Type B

Official code

87412(a)

Regulation authority

CCR

What the official deficiency says

(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above, because all of the personnel records were missing, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/27/2024 Plan of Correction Licensee shall replace all of the missing personnel records on or before the due date.

Official classification

Type B

Official code

87465(a)(8)(A)

Regulation authority

CCR

What the official deficiency says

(8) If a facility has no medical unit on the grounds, a complete first aid kit shall be maintained and be readily available in a specific location in the facility. The kit shall be a general type approved by the American Red Cross, or shall contain at least the following: (A) A current edition of a first aid manual approved by the American Red Cross, the American Medical Association or a state or federal health agency. 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 the first aid kit had no approved first aid manual, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/27/2024 Plan of Correction Licensee shall get an approved first aid manual to add to the first aid kit on or before the due date.

Official classification

Type A

Official code

87465(h)(2)

Regulation authority

CCR

What the official deficiency says

(h) The following requirements shall apply to medications which are centrally stored: (2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above in 2 of 2 medicine cabinets which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/17/2023 Plan of Correction On or before due date, Liceness shall inform LPA that cabinets are locked at all times other than the brief time medications are being prepared for dispensing to residents.

Official classification

Type A

Official code

87705(f)(1)

Regulation authority

CCR

What the official deficiency says

(f) The following shall be stored inaccessible to residents with dementia: (1) Knives, matches, firearms, tools and other items that could constitute a danger to the resident(s). This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above in the kitchen where a pair of scissors was stored in an unlocked drawer, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/17/2023 Plan of Correction On or before due date, Liceness shall inform LPA that drawers and cabinets storing sharp tools, detergents, and poisons are locked at all times other than the brief time those items are being removed for use.

Official classification

Type A

Official code

87705(f)(2)

Regulation authority

CCR

What the official deficiency says

(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 in the kitchen and outside cabinet where detergents and poisons are stored, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/17/2023 Plan of Correction On or before due date, Liceness shall inform LPA that drawers and cabinets storing sharp tools, detergents, and poisons are locked at all times other than the brief time those items are being removed for use.

Official classification

Type B

Official code

87705(h)

Regulation authority

CCR

What the official deficiency says

(h) Outdoor facility space used for resident recreation and leisure shall be completely enclosed by a fence with self-closing latches and gates, or walls, to protect the safety of residents. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above in 2 out of 2 not working self-closing gates, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/23/2023 Plan of Correction On or before due date, Licensee shall repair or replace the self-closing mechanism to the gates and inform the LPA of their repair.

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 in 1 out of 1 fire extinguishers, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/23/2023 Plan of Correction On or before due date, Licensee will purchase new fire extinguisher.

Official classification

Type B

Official code

87616(a)

Regulation authority

CCR

What the official deficiency says

87616 EXCEPTIONS FOR HEALTH CONDITIONS (a) As specified in Section 87209, Program Flexibility, the licensee may submit a written exception request if he/she agrees that the resident has a prohibited . . . health condition but believes that the intent of the law can be met through alternative means. This requirement is not met as evidenced by: Based on interview and record review, the licensee submitted a written request for an exception without having it granted by the Department, which poses a potential health risk to residents in care.

Official plan of correction

By the due date, the licensee shall submit to the LPA a written exemption request that includes, but is not limited to: (1) Documentation of the resident's current health condition including updated medical reports, other documentation of the current health, prognosis, and expected duration of condition. (2) The licensee's plan for ensuring that the resident's health related needs can be met by the facility. (3) Plan for minimizing the impact on other residents.

Deadline recorded: Aug 24, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.1(a)(2)

Regulation authority

CCR

What the official deficiency says

(a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. 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 this facility does not have a mitigation plan to mitigate the spread of COVID-19 nor a 30 day supply of PPE. This practice has a health and safety impact that includes, but is not limited to buildings and grounds, personnel requirements, responsibility for providing care and supervision, and personal rights.

Official plan of correction

POC Due Date: 05/06/2022 Plan of Correction Completed COVID-19 mitigation plan and an a 30-day supply of PPE (e.g., facemasks, respirators, gowns, gloves, and eye protection such as face shield or goggles). Proof sent to LPA by POC.

Official classification

Type B

Official code

87466

Regulation authority

CCR

What the official deficiency says

The licensee shall ensure that residents are regularly observed for changes in physical, mental, emotional and social functioning and that appropriate assistance is provided when such observation reveals unmet needs. When changes such as unusual weight gains or losses or deterioration of mental ability or a physical health condition are observed, the licensee shall ensure that such changes are documented and brought to the attention of the resident's physician and the resident's responsible person, if any. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, the licensee did not comply with the section cited above in 3 out of 3 resident files which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/29/2022 Plan of Correction Licensee shall create process and records for the residents in care.

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 which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/12/2022 Plan of Correction The Licensee shall complete a deep clean of the kitchen by the POC due date and send proof to the LPA.

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 which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/19/2022 Plan of Correction The Licensee shall clear the junk on the back and side yards and send proof of clearance to LPA by POC due date.

Official classification

Type B

Official code

87309(a)(1)

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. (1) Storage areas for poisons, and firearms and other dangerous weapons shall be locked. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/05/2022 Plan of Correction Licensee shall lock all of the outside sheds with working locks and provide proof to LPA of the security of those locks by the 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 have proof of CPR training for staff as required which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/05/2022 Plan of Correction Licensee shall provide proof of training of CPR certification to the LPA by the POC due date.

Official classification

Type B

Official code

87465(d)(3)

Regulation authority

CCR

What the official deficiency says

(d) If the resident is unable to determine his/her own need for a prescription or nonprescription PRN medication, and is unable to communicate his/her symptoms clearly, facility staff designated by the licensee, shall be permitted to assist the resident with self-administration, provided all of the following requirements are met: (3) The date and time the PRN medication was taken, the dosage taken, and the resident's response shall be documented and maintained in the resident's facility record. 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 the medication log had not been completed since July of 2021, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/29/2022 Plan of Correction Licensee shall update all of the medication logs that were to have been completed and show proof to the LPA before the POC due date.

Official classification

Type B

Official code

1569.695(a)(2)

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: (2) Plans for the facility to be self-reliant for a period of not less than 72 hours immediately following any emergency or disaster, including, but not limited to, a short-term or long-term power failure. If the facility plans to shelter in place and one or more utilities, including water, sewer, gas, or electricity, is not available, the facility shall have a plan and supplies available to provide alternative resources during an outage. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/12/2022 Plan of Correction Licensee shall purchase and safely store a minimum of 30 gallons of water and an adequate supply of non-perishable food along with a written plan to provide emergency power to be self-reliant for the required period of time. Proof of completion shall be provided to the LPA before the POC due date.