WALNUT CREEK CARE HOME

Official classification

Type A

Official code

87309(a)

Regulation authority

CCR

What the official deficiency says

(a) Except as specified in subsection (b), the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances, knives, matches, tools, sharp objects, 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: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above. Sharps in kitchen drawer with broken lock, detergents and cleaning solutions, including Clorox liquid bleach with no lid, are stored in no cabinet and in unlocked cabinets in the backyard and in the garage, which poses an immediate safety risk to persons in care.

Official plan of correction

POC Due Date: 07/29/2026 Plan of Correction The deficiencies were corrected during the inspection.

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. Two 10-foot segments of the backyard fence had been removed. No temporary screen had been installed to stop residents with a dementia diagnosis from walking directly into a highly travelled street, Ygnacio Valley Boulevard, where the speed limit is 45 miles an hour, which poses a potential safety risk to persons in care.

Official plan of correction

POC Due Date: 08/03/2026 Plan of Correction Licensee has agreed to install temporary screens to block residents from walking through the openings in the fence.

Official classification

Type B

Official code

87303(c)

Regulation authority

CCR

What the official deficiency says

(c) All window screens shall be clean and maintained in good repair. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above. Two of the screen doors have holes in them and multiple window screens have spider webs and are full of dust, which poses a potential health risk to persons in care.

Official plan of correction

POC Due Date: 08/31/2026 Plan of Correction The Licensee has agreed to clean and repair the window screens.

Official classification

Type B

Official code

87303(e)(6)

Regulation authority

CCR

What the official deficiency says

(6) Toilet, handwashing and bathing facilities shall be maintained in operating condition. Additional equipment shall be provided in facilities accommodating physically handicapped and/or nonambulatory residents, based on the residents' needs. 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 handle to flush the shared toilet is broken, which poses/posed a potential health risk to persons in care.

Official plan of correction

POC Due Date: 08/03/2026 Plan of Correction The Licensee has agreed to repair the toilet handle.

Official classification

Type B

Official code

87307(d)(4)

Regulation authority

CCR

What the official deficiency says

(4) Stairways, inclines, ramps and open porches and areas of potential hazard to residents with poor balance or eyesight shall be made inaccessible to residents unless equipped with sturdy hand railings and unless well-lighted. 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 backyard, the end segment of the railing on a concrete incline and on a segment of the wooden deck, which poses a potential safety risk to persons in care.

Official plan of correction

POC Due Date: 08/31/2026 Plan of Correction The Licensee has agreed to repair the railing.

Official classification

Type B

Official code

87411(c)(1)

Regulation authority

CCR

What the official deficiency says

87411 Personnel Requirements - General (c) ... (1) Staff providing care shall receive appropriate training in first aid from persons qualified by such agencies as the American Red Cross. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, the licensee did not comply with the section cited above in 2 out of 5 staff records reviewed, which poses a potential safety risk to persons in care.

Official plan of correction

POC Due Date: 08/03/2026 Plan of Correction The Licensee has agreed to have the 2 staff complete their first aid training before providing direct assistance to residents with the activities of daily living again.

Official classification

Type B

Official code

87411(c)(6)

Regulation authority

CCR

What the official deficiency says

(6) The licensee shall maintain documentation pertaining to staff training in the personnel records, as specified in Section 87412(c)(2). For on-the-job training, documentation shall consist of a statement or notation, made by the trainer, of the content covered in the training. Each item of documentation shall include a notation that indicates which of the criteria of Section 87411(c)(3) is met by the trainer. This requirement is not met as evidenced by: Deficient Practice Statement Based on a review of the records, the licensee did not comply with the section cited above because of the inadequate or no records of required training for 3 of 5 staff member, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/05/2024 Plan of Correction Licensee shall send template for recording staff member training that will be used in the future to the LPA on or before due date.

Official classification

Type A

Official code

87555(b)(25)

Regulation authority

CCR

What the official deficiency says

(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: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above in the storage areas in the garage where food is stored in the same areas as soaps, detergents, and cleaning compounds, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/29/2024 Plan of Correction On or before the due date, the food and the cleaners will be moved to separate storage areas. The LPA will be informed of the change along with proof on or before the due date.

Official classification

Type B

Official code

87303(f)(1)

Regulation authority

CCR

What the official deficiency says

(f) Solid waste shall be stored and disposed of as follows: (1) Solid waste shall be stored, located and disposed of in a manner that will not permit the transmission of a communicable disease or of odors, create a nuisance, provide a breeding place or food source for insects or rodents. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above when caregiver disposed of unused cat litter with dog feces in a container from a deceased resident's cat by dumping the cat litter and dog feces on the ground in the backyard, which posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/02/2024 Plan of Correction Caregiver cleared by disposing of the cat litter and dog feces appropriately.

Official classification

Type B

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 the laundry room and garage where disinfectants and cleaning solutions are stored that have no functioning lock, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/02/2024 Plan of Correction On or before the due date, cabinets in the laundry room and garage where disinfectants are stored will have fully functioning locks installed. The LPA shall be informed of the repairs with proof of repairs on or before the due date.

Official classification

Type B

Official code

87555(b)(8)

Regulation authority

CCR

What the official deficiency says

(b) The following food service requirements shall apply: (8) All food shall be of good quality. Commercial foods shall be approved by appropriate federal, state and local authorities. Food in damaged containers shall not be accepted, used or retained. 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 a refrigerator in the garage where cartons of eggs, hot dog buns, bread, and other perishable foods beyond their use by dates were stored, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/02/2024 Plan of Correction On or before the due date, all expired food in the facility will be thrown out. The LPA shall be informed that all expired food has been properly disposed.

Official classification

Type B

Official code

87458(b)(1)

Regulation authority

CCR

What the official deficiency says

(b) The medical assessment shall include, but not be limited to: (1) A physical examination of the resident indicating the physician's primary diagnosis and secondary diagnosis, if any and results of an examination for communicable tuberculosis, other contagious/infectious or contagious diseases or other medical conditions which would preclude care of the person by 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. 2 of the 3 residents had no Tuberculosis test, incorrect ambulatory assessments, and/or the wrong Physician's Report, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/02/2024 Plan of Correction On or before the due date, new appointments for those residents will be scheduled for a future date with their Primary Care Physicians to have TB tests and the proper Physician's Report completed. The LPA shall be informed of the future date and resident name on or before the due date.

Official classification

Type A

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 in 1 of the bathrooms and in the laundry room, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/13/2023 Plan of Correction Cleared during visit

Official classification

Type B

Official code

87203

Regulation authority

CCR

What the official deficiency says

87203 Fire Safety All facilities shall be maintained in conformity with the regulations adopted by the State Fire Marshal for the protection of life and property against fire and panic. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the fire extinguisher that was last serviced on 11/30/2021, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/03/2023 Plan of Correction Licensee shall send proof to LPA that the fire extinguisher has been services on or before the due date.

Official classification

Type B

Official code

87415(a)

Regulation authority

CCR

What the official deficiency says

(a) The following persons providing night supervision from 10:00 p.m. to 6:00 a.m. shall be familiar with the facility's planned emergency procedures, shall be trained in first aid as required in Section 87465, Incidental Medical and Dental Care Services, and shall be available as indicated below to assist in caring for residents in the event of an emergency: This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, the licensee did not comply with the section cited above in 2 out of 2 night staff because their first aid and CPR certification has expired, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/03/2023 Plan of Correction Licensee shall send proof to LPA on or before due date that all night staff have erned their first aid and CPR certificates.

Official classification

Type B

Official code

87465(a)(2)

Regulation authority

CCR

What the official deficiency says

(2) The licensee shall provide assistance in meeting necessary medical and dental needs. This includes transportation which may be limited to the nearest available medical or dental facility which will meet the resident's need. In providing transportation the licensee shall do so directly or make arrangements for this service. 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 1 out of 6 residents, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/10/2023 Plan of Correction Licensee shall send proof to LPA on or before due date that the resident R1 has completed her annual physical and that a new physician's report has been completed.

Official classification

Type B

Official code

87303(a)

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. This requirement was not met as evidenced by: Based on observation, there was no exhaust fan in the kitchen, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

On or before the due date, the Licensee shall have an exhaust fan installed in the kitchen above the stove. When completed, Licensee shall inform LPA.

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

Official classification

Type B

Official code

87470(a)(2)(A)

Regulation authority

CCR

What the official deficiency says

87470 Infection Control Requirements (a) A licensee shall ensure that ... (2) Environmental cleaning and disinfection activities shall be ... completed, at a minimum, as follows: (A) Surfaces ... shall be cleaned and disinfected on a regular basis ... [and] when these surfaces are contaminated or visibly soiled. This requirement was not met as evidenced by: Based on observation, inside and outside of kitchen cabinets had a visible and tactile accumulation of grease and grime, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

On or before the due date, the Licensee shall completely remove all grease and grime from all cabinets, handles, drawers, inside of cabinets, and all of the contents of those cabinets (including food and any spice containers). When completed, Licensee shall inform LPA.

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

Official classification

Type A

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. This requirement was not met as evidenced by: Based on LPA observation of rodent feces in kitchen drawer on 04/04/2023 that he had shared with Caregiver Norma Solon, which posed an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

Licensee had removed rodent feces and disinfected the kitchen drawer before LPA's arrival at the facility today, so citation cleared during inspection.

Deadline recorded: May 5, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87411(g)(2)

Regulation authority

CCR

What the official deficiency says

87411 Personnel Requirements - General (g) Prior to employment or initial presence in the facility, all employees and volunteers subject to a criminal record review shall: (2) Request a transfer of a criminal record clearance as specified in Section 87355(c). This requirement was not met as evidenced by: Staff person Fe Alolod was not associated with facility.

Official plan of correction

Until Fe Alolod has been associated with the facility, she shall not be allowed to work or volunteer in the facility. On or before the due date, Licensee shall associate Fe Alolod with the facility. Licensee shall inform LPA of successfully associating Fe with the facility.

Deadline recorded: Apr 11, 2023. 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

87468.1 PERSONAL RIGHTS OF RESIDENTS IN ALL FACILITIES (a) Residents ... have all of the following personal rights: (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This requirement was not met as evidenced by: Based on observation by LPA J Sampair on 04/04/2023 at 10:00 AM of ataff S1 not wearing a mask, Licensee failed to protect the personal rights of residents, which poses a potential health and safety risk to residents in care.

Official plan of correction

Cleared during inspection when all staff put on masks and Licensee acknowledged that he did not know of that requirement by the Department and the California Department of Public Health.

Deadline recorded: Apr 4, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87608(a)(3)

Regulation authority

CCR

What the official deficiency says

87608 Postural Supports (a) ... 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... This requirement was not met as evidenced by: Full railings on R1's bed without a physician's order.

Official plan of correction

Rails on R1's bed removed during visit.

Deadline recorded: Apr 5, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(h)(5)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care (h) The following ... shall apply ... (5) Each resident's medication shall be stored in its originally received container. No medications shall be transferred between containers. This requirement was not met as evidenced by: Based on LPA J Sampair's 10:45 AM observation and staff confirmation of 3 out of 3 resident's medications being stored outside of their original container, which poses an immediate Health, Safety or Personal Rights risk to residents in care.

Official plan of correction

During visit, resident medications were all removed from pill boxes and returned to original containers.

Deadline recorded: Apr 5, 2023. A deadline is not proof that correction was completed.