AGNES HOUSE

Official classification

Type B

Official code

87412(a)

Regulation authority

CCR

What the official deficiency says

(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, the licensee did not comply with the section cited above in 4 out of the 5 employee files reviewed that were missing documentation, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/04/2023 Plan of Correction Licensee shall ensure that every employee file contains required documents as per Title 22 Section 87412 Personnel Records and inform LPA on or before due date.

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 of 2 gates, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/03/2023 Plan of Correction Licensee shall add self-closing mechanism and fully functioning latch to both of the gates and send electronic pictures of them to LPA on or before due date.

Official classification

Type B

Official code

1569.175(b)

Regulation authority

HSC

What the official deficiency says

(b) In order to assure the opportunity for complaints to be made directly to the owner, licensee, or person designated by the owner or licensee, and to provide the opportunity for the owner, licensee, or person designated by the owner or licensee to meet residents and learn of problems in the neighborhood, any facility with a nonresident owner shall establish a fixed time on a weekly basis when the owner, licensee, or person designated by the owner or licensee will be present. 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 which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/10/2023 Plan of Correction Licensee shall appoint persons of appropriate skill and training by the due date to serve as Administrator of this and all of the facilities under which he is licensed to provide adequate time (minimum 20 hours per week to work solely as an admiinitrator) to fulfill the regulation above.

Official classification

Type B

Official code

87468.1(a)(2)

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: (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This requirement is not met as evidenced by: Based on interviews, the licencee did not comply with the section cited above, which poses a potential Health, Safety or Personal Rights risk to residents in care.

Official plan of correction

Administrator shall: (1) obtain all supplies necessary for adhering to the current COVID-19 protocols AND (2) training all staff members in all aspects of those COVID-19 protocols in accordance with PIN 23-02-ASC.

Deadline recorded: Feb 17, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87211(a)(2)

Regulation authority

CCR

What the official deficiency says

87211 REPORTING REQUIREMENTS (a) Each licensee shall furnish reports as the Department may require ... (2) Occurrences, such as epidemic outbreaks which threaten ... health of residents ... within 24 hours This requirement is not met as evidenced by: Based on interviews, the licencee did not comply with the section cited above, which poses a potential Health, Safety or Personal Rights risk to residents in care.

Official plan of correction

Administrator shall complete and send copy of LIC624 to the Oakland Regional Office by fax or email.

Deadline recorded: Feb 17, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87303(e)(2)

Regulation authority

CCR

What the official deficiency says

(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, with the hot water temperature measured at 133 degrees Farenheit which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/28/2022 Plan of Correction Licensee corrected deficiency during visit by reducing maximum hot water temperature at 118 degrees Farenheit.

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 because the facility does not have at least 30 gallons of water in case of an emergency on hand which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/04/2022 Plan of Correction Licensee corrected deficiency during visit by obtaining and storing 30 gallons of water for emergencies on the premises.

Official classification

Type B

Official code

80088(a)(1)

Regulation authority

CCR

What the official deficiency says

80088 FIXTURES, FURNITURE, EQUIPMENT AND SUPPLIES (a) A comfortable temperature for clients shall be maintained at all times. (1) The licensee shall maintain the temperature in rooms that clients occupy between a minimum of 68 degrees F (20 degrees C) and a maximum of 85 degrees F (30 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 the rooms where the temperature was measured to be as low as 66.1 degrees Farenheit which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/28/2022 Plan of Correction Licensee corrected the deficiencyduring the visit and the temperature was measured by the LPA at 68.2 degrees Farenheit at 10:15AM.