WALNUT CREEK SENIOR LIVING

Official classification

Type A

Official code

87204(a)

Regulation authority

CCR

What the official deficiency says

87204 Limitations - Capacity and Ambulatory Status (a) A licensee shall not operate a facility beyond the conditions and limitations specified on the license, including specification of the maximum number of persons who may receive services at any one time. . . This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above. 9 residents are residing at the facility, which poses an immediate health and safety risk to persons in care.

Official plan of correction

The Licensee has agreed to reduce the number of residents to 8 on or before the due date. An Immediate Civil Penalty of $1,000 was assessed.

Deadline recorded: Aug 6, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468(c)(2)(A)

Regulation authority

CCR

What the official deficiency says

87468 Personal Rights of Residents (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: Based on observation, the licensee did not comply with the section cited above by having a 12 " by 18 " complaint poster displayed, which poses a potential personal rights risk to persons in care.

Official plan of correction

On or before the due date, the Licensee has agreed to obtain and display the 20 x 26 inch Residential Care Facility for the Elderly (RCFE) Complaint Poster (PUB 475). It shall be posted in the main entryway of the facility. A Civil Penalty of $250 was assessed.

Deadline recorded: Jul 23, 2026. 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. . .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 record review, the licensee did not comply with the section cited above. The Administrator is not certified as an administrator, 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 notify LPA Sampair that they have completed and passed the Administrator certification test.

Deadline recorded: Mar 23, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87355(e)(2)

Regulation authority

CCR

What the official deficiency says

87355 Criminal Record Clearance (e) All individuals subject to a criminal record review . . . shall prior to working . . . in a licensed facility: (2) Obtain a California clearance or a criminal record exemption as required by the Department. This requirement is not met as evidenced by: Based on record review, the licensee did not comply with the section cited above. Staff S1 was not fingerprint cleared, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

The Licensee shall immediately remove S1 from the facility and not allow them to return until they are fingerprint cleared and associated with this facility.

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

Official classification

Type A

Official code

87204(a)

Regulation authority

CCR

What the official deficiency says

87204 Limitations - Capacity and Ambulatory Status (a) A licensee shall not operate a facility beyond the conditions and limitations specified on the license, including specification of the maximum number of persons who may receive services at any one time. . . This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above. 9 residents are residing at the facility, which poses an immediate health and safety risk to persons in care.

Official plan of correction

The Licensee shall reduce the number of residents to 8 as soon as possible.

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

Official classification

Type A

Official code

87202(a)

Regulation authority

CCR

What the official deficiency says

87202 Fire Clearance (a) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department, or district providing fire protection services, or the State Fire Marshal . . . This requirement is not met as evidenced by: Front door, an exit door, was locked from the interior, which which poses an immediate personal rights risk to persons in care.

Official plan of correction

Interior front door lock removed during inspection. $500 immediate fine issued.

Deadline recorded: Jan 31, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87468.2(a)(4)

Regulation authority

CCR

What the official deficiency says

87468.2 Additional Personal Rights . . . (a) In addition to the rights listed in Section 87468.1 . . . residents . . . 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. This requirement is not met as evidenced by: (1) locking the front door from the interior of the facility to restrict R1 from exiting the building and (2) R2 placed in a lounge chair with the leg rest propped up. Additionally, Staff S1 further increased height and blocked safe exit from chair by adding a chair at the end of the foot rest.

Official plan of correction

On or before due date, the Licensee shall speak with the Responsible Party to move R2 to an appropriate location as soon as possible. $500 immediate fine issued.

Deadline recorded: Jan 31, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

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) . . . residents in privately operated 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, medical treatment, personal care and assistance, visits, communications . . . and meetings of resident and family groups. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above. A monitor displaying videos of 9 resident rooms was located in the living room next to the television for anyone to see and without a wiaver of the personal rights of residents for the facility, which poses an immediate personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/30/2026 Plan of Correction On or before the due date, the Licensee shall remove the monitor and stop the use of all video recording in all residents' rooms or any other private areas within the facility.

Official classification

Type A

Official code

87355(e)(2)

Regulation authority

CCR

What the official deficiency says

87355 Criminal Record Clearance (e) All individuals subject to a criminal record review . . . shall prior to working . . . in a licensed facility: (2) Obtain a California clearance or a criminal record exemption as required by the Department. 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. Staff S4 was not fingerprint cleared, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/30/2026 Plan of Correction The Licensee shall immediately remove S4 from the facility and not allow them to return until they are fingerprint cleared and associated with this facility.

Official classification

Type B

Official code

87411(a)

Regulation authority

CCR

What the official deficiency says

(a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. In facilities licensed for sixteen or more, sufficient support staff shall be employed to ensure provision of personal assistance and care as required in Section 87608, Postural Supports. Additional staff shall be employed as necessary to perform office work, cooking, house cleaning, laundering, and maintenance of buildings, equipment and grounds. The licensing agency may require any facility to provide additional staff whenever it determines through documentation that the needs of the particular residents, the extent of services provided, or the physical arrangements of the facility require such additional staff for the provision of adequate services. 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. On 1/23/2026, staff members S1 and S2 complained of the facility being understaffed. On 1/29/26 staff member S3 complained of being understaffed, because she is being asked to do not only caregiving tasks but also administrative tasks, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/26/2026 Plan of Correction On or before the due date, the Licensee shall hire 1 additional staff member to work on administrative duties only.

Official classification

Type B

Official code

87413(a)(1)

Regulation authority

CCR

What the official deficiency says

(1) When regular staff members are absent, there shall be coverage by personnel with qualifications adequate to perform the assigned tasks. 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. On 1/23/2026, staff members S1 and S2 complained of being understaffed, because S3 was on vacation and the Licensee did not have enough staff to cover, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/26/2026 Plan of Correction On or before the due date, the Licensee shall hire 1 additional staff member to work on administrative duties only.

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 interviews and record review, the licensee did not comply with the section cited above. 0 of 5 staff had the training in 2025, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/12/2026 Plan of Correction On or before the due date, the Licensee shall have all staff complete their training.

Official classification

Type B

Official code

1569.69(a)(2)

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: (2) In facilities licensed to provide care for 15 or fewer persons, the employee shall complete 10 hours of initial training. This training shall consist of 6 hours of hands-on shadowing training, which shall be completed prior to assisting with the self-administration of medications, and 4 hours of other training or instruction, as described in subdivision (f), which shall be completed within the first two weeks of employment. 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 employees received medication training which poses a potential health risk to persons in care.

Official plan of correction

POC Due Date: 02/12/2026 Plan of Correction On or before due date, Licensee shall have all staff assists residents with medications complete the medication training.

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 interview and record review, the licensee did not comply with the section cited above, completing 1 of 4 drills during the past year, which posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/05/2026 Plan of Correction On or before due date, the Licensee shall conduct a quarterly drill and schedule the rest of the drill during the coming year.

Official classification

Type A

Official code

87204(a)

Regulation authority

CCR

What the official deficiency says

87204 Limitations - Capacity and Ambulatory Status (a) A licensee shall not operate a facility beyond the conditions and limitations specified on the license, including specification of the maximum number of persons who may receive services at any one time. . . This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above. On 1/23/2026, 9 residents were residing at the facility, which /posed a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 01/30/2026 Plan of Correction Licensee had 9 residents when LPA conducted the first visit on 1/23/2026. As of 1/29/2026, there are 8 residents. The Licensee shall not add another resident until their expansion of the facility has been licensed to operate with more than the 8 for which it is currently licensed to operate.

Official classification

Type B

Official code

1569.69(b)

Regulation authority

HSC

What the official deficiency says

1569.69 Employees assisting residents with self-administration of medication; training requirements (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 four 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. 0 of 6 employees received medication training which poses a potential health risk to persons in care.

Official plan of correction

POC Due Date: 02/12/2026 Plan of Correction On or before due date, Licensee shall have all staff assists residents with medications complete the medication training.

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 2 out of 2 fire extinguishers, which poses a potential safety risk to persons in care.

Official plan of correction

POC Due Date: 01/30/2026 Plan of Correction On or before the due date, the Licensee shall attest to LPA Sampair that all of the fire extinguishers at the facility have either been serviced or replaced.

Official classification

Type A

Official code

87608(a)(5)(B)

Regulation authority

CCR

What the official deficiency says

(B) Bed rails that extend the entire length of the bed are prohibited except for residents who are currently receiving hospice care and have a hospice care plan that specifies the need for full bed rails. 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 5 out of 9 residents' beds, which posed an immediate safety risk to persons in care.

Official plan of correction

POC Due Date: 01/24/2026 Plan of Correction Cleared during visit.

Official classification

Type B

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 124.7 degrees Fahrenheit, which poses a potential safety risk to persons in care.

Official plan of correction

POC Due Date: 01/30/2026 Plan of Correction On or before the due date, the Licensee shall reduce the maximum hot water temperature to 105 to 120 degrees. Staff will send photo proof of hot water being between 105 and 120 degrees by 1/26/26.

Official classification

Type B

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. knives, cleaning products, and other dangerous items such as Lysol were not stored in locked drawers or cabinets in the kitchen area, which poses a potential safety risk to persons in care.

Official plan of correction

POC Due Date: 01/30/2026 Plan of Correction On or before the due date, the Licensee shall store all knives, cleaning products, and other dangerous items such as Lysol in locked cabinets. Licensee will attest to this via phone or email to LPA Sampair.

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 by having no complaint poster displayed, which poses a potential personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/30/2026 Plan of Correction On or before the due date, the Licensee shall obtain and display the 20 x 26 inch Residential Care Facility for the Elderly (RCFE) Complaint Poster (PUB 475). It shall be posted in the main entryway of the facility.

Official classification

Type B

Official code

87555(b)(23)

Regulation authority

CCR

What the official deficiency says

(b) The following food service requirements shall apply: (23) All readily perishable foods or beverages capable of supporting rapid and progressive growth of micro-organisms which can cause food infections or food intoxications shall be stored in covered containers at appropriate temperatures. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above in all of the freezers and refrigerators because of the open and undated food containers, which poses a potential health risk to persons in care.

Official plan of correction

POC Due Date: 01/30/2026 Plan of Correction On or before the due date, the Licensee shall cover and date all food stored and retratin staff on the importance of covering and dating food.

Official classification

Type B

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 the kitchen where medications were left in an unlocked drawer and there is no lock on the refrigerator storing medications, which poses a potential health risk to persons in care.

Official plan of correction

POC Due Date: 01/30/2026 Plan of Correction On or the due date, all of the medications will be stored in the locked centrally stored medication area and the refrigerator storing medications will be locked.

Official classification

Type B

Official code

87506(a)

Regulation authority

CCR

What the official deficiency says

(a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff. 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 9 of 9 resident files that are incomplete, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/30/2026 Plan of Correction On or before the due date, the licensee must have gotten signed Resident Rights forms, completed Information forms, completed valuables forms, and Emergency Medical forms for all of the residents.

Official classification

Type B

Official code

87457(c)

Regulation authority

CCR

What the official deficiency says

(c) Prior to admission a determination of the prospective resident's suitability for admission shall be completed and shall include an appraisal of their individual service needs in comparison with the admission criteria specified in Section 87455, Acceptance and Retention Limitations. 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 9 out of 9 residents, which poses a potential health risk to persons in care.

Official plan of correction

POC Due Date: 01/30/2026 Plan of Correction On or before the due date, the Licensee shall review Section 87457 of Title 22 and inform LPA Sampair of it's completion by phone, text, or email.

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 in 9 out of 9 residents, which poses a potential health risk to persons in care.

Official plan of correction

POC Due Date: 01/30/2026 Plan of Correction On or before the due date, the Licensee shall complete an Appraisal Needs and Service form 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 in 7 of 9 residents, which poses a potential health risk to persons in care.

Official plan of correction

POC Due Date: 01/30/2026 Plan of Correction On or before the due date, the Licensee shall make a request of every resident's responsible party that they schedule an annual routine visit for every resident who has not had one.

Official classification

Type B

Official code

87508(a)

Regulation authority

CCR

What the official deficiency says

(a) The licensee shall ensure that a current register of all residents in the facility is maintained and contains the following updated 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 by not having a current register of residents, which poses a potential safety risk to persons in care.

Official plan of correction

POC Due Date: 01/30/2026 Plan of Correction Cleared during visit.

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. 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 9 residents, which poses a potential safety risk to persons in care.

Official plan of correction

POC Due Date: 01/30/2026 Plan of Correction On or before due date, the Licensee will either get a physician's orders or remove the half bed rails for residents with half bed rails.

Official classification

Type B

Official code

87204(a)

Regulation authority

CCR

What the official deficiency says

87204 Limitations - Capacity and Ambulatory Status (a) A licensee shall not operate a facility beyond the conditions and limitations specified on the license, including specification of the maximum number of persons who may receive services at any one time. This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above. They are licensed for 8 residents and 9 residents are living at the facility, which poses a potential safety risk to persons in care.

Official plan of correction

On or before the due date, the Licensee will submit a written plan to LPA Sampair concerning the way in which staff will safely care for residents in case of an emergency or disaster until the licensed capacity of their facility has been increased to 12 residents.

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

Official classification

Type B

Official code

87411(c)(1)

Regulation authority

CCR

What the official deficiency says

(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. 2 of 6 staff members have no record of completing first aid training within the past 2 years, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/28/2025 Plan of Correction On or before the due date the Licensee will submit proof to LPA that the 2 of 6 staff members have completed their first aid training and proof of training has been added to their records.

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 6 staff had a record of 8 hours of dementia training 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: 02/28/2025 Plan of Correction On or before the due date the Licensee will submit proof to LPA that the 6 of 6 staff members have completed 8 hours of dementia training and proof of training has been added to their records.

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 6 staff had a record of 4 hours of training on postural supports, restricted conditions or health services, and hospice care 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: 02/28/2025 Plan of Correction On or before the due date the Licensee will submit proof to LPA that the 6 of 6 staff members have completed 4 hours of training on postural supports, restricted conditions or health services, and hospice care and proof of training has been added to their records.

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. 0 of 6 staff had a record of 8 hours of training on medications 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: 02/28/2025 Plan of Correction On or before the due date the Licensee will submit proof to LPA that the 6 of 6 staff members have completed 8 hours of medication training and proof of training has been added to their records.

Official classification

Type B

Official code

87506(a)

Regulation authority

CCR

What the official deficiency says

(a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff. 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 0 of 5 resident files had complete records, including only the Admission Agreement and a Medical Assessment, and 1 contained only the Admission Agreement, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/30/2025 Plan of Correction On or before the due date, the Licensee shall complete the missing forms for each resident and shall send proof to the LPA.

Official classification

Type B

Official code

87457(c)

Regulation authority

CCR

What the official deficiency says

(c) Prior to admission a determination of the prospective resident's suitability for admission shall be completed and shall include an appraisal of their individual service needs in comparison with the admission criteria specified in Section 87455, Acceptance and Retention Limitations. 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 0 of 5 resident files included a pre-placement appraisal, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/30/2025 Plan of Correction On or before the due date, the Licensee shall complete the pre-placement appraisals for each resident and shall send proof to the LPA.

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 in 0 of the 5 resident files contain a reappraisal completed 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: 01/30/2025 Plan of Correction On or before the due date, the Licensee shall complete the LIC 625 Appraisal & Needs and Services Plan form for each resident and shall send proof to the LPA.

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 in 3 of the 5 resident files do not contain documentation of a routine medical visit within 12 months, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/30/2025 Plan of Correction On or before the due date, the Licensee shall document informing the responsible party and/or scheduling a routine medical visit and obtaining an updated LIC 602 for each of those 3 residents and shall send proof to the LPA.

Official classification

Type B

Official code

87508(a)

Regulation authority

CCR

What the official deficiency says

(a) The licensee shall ensure that a current register of all residents in the facility is maintained and contains the following updated 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 Register of Residents not up-to-date, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/30/2025 Plan of Correction On or before the due date, the Licensee shall send proof to LPA of the update to the Register of Residents.

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 the kitchen, cabinets containing mineral spirits and paint were unlocked. In the garage, washing detergents and paint were left out in the open, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/30/2024 Plan of Correction Licensee shall place all of these items in an area not available to residents and plan with contractor installation of locking cabinet for the garage.

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 there were knives and an ice chipper in unlocked drawers, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/30/2024 Plan of Correction Licensee shall place all of these items in an area not available to residents and plan with contractor the repair of the locks for all of the drawers in the kitchen.

Official classification

Type B

Official code

87705(c)(5)

Regulation authority

CCR

What the official deficiency says

(c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following: (5) Each resident with dementia shall have an annual medical assessment as specified in Section 87458, Medical Assessment, and a reappraisal done at least annually, both of which shall include a reassessment of the resident's dementia care 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, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/05/2024 Plan of Correction The Licensee shall schedule annual physicals for all of the residents diagnosed with dementia to be complated on or before 03/31/2024.

Official classification

Type B

Official code

87468.1(a)(2)

Regulation authority

CCR

What the official deficiency says

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 03/27/2023 at 10:00 AM of no ataff 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 17, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.1(a)(6)

Regulation authority

CCR

What the official deficiency says

PERSONAL RIGHTS OF RESIDENTS IN ALL FACILITIES (a) Residents ... have all of the following personal rights: (6) To leave or depart the facility at any time and to not be locked into any ... facility premises by day or night. This requirement was not met as evidenced by: Based on observation by LPA J Sampair on 03/27/2023 at 10:10 AM of a key-operated deadbolt on the front door of the facility, Licensee failed to protect the personal rights of residents, which poses a potential health and safety risk to resident in care.

Official plan of correction

On or before the due date, Licensee shall replace the key-operated deadbolt facing inside of the front door AND the inside of the door between the kitchen and the garage with one that opens without a key facing inside of the facility. On or before the due date, Licensee will send picture proof of the change to LPA J Sampair that the 2 locks have been replaced with ones that do not need a key to open from inside of the facility.

Deadline recorded: Apr 3, 2023. A deadline is not proof that correction was completed.

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 the kitchen cabinets containing poisonous cleaning and repair supplies that had been left unlocked. The contents of those cabinets included cooking fuel, mineral spirits, Raid, and cleaning supplies, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/04/2022 Plan of Correction Staff corrected the problem during the visit. Additionally, licensee said that he plans to replace existing locks with magnetic locks to decrease the likelihood of staff leaving them unlocked in the future, as they have already done for the sharps.

Official classification

Type B

Official code

87464(f)(1)

Regulation authority

CCR

What the official deficiency says

(f) Basic services shall at a minimum include: (1) Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(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 on the front door where no signs were posted at the facility entrance with updates to visitor policy to notify of policies and procedures necessary to protect residents from infection during pandemic, in accordance with personal rights requirements. This practice has a health and safety impact that includes, but is not limited to buildings and grounds, personnel requirements and personal rights, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/10/2022 Plan of Correction Licensee will send picture proof of Covid-19 signs at the front door to LPA on or before POC due date.

Official classification

Type B

Official code

87303(i)(1)(B)

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: (B) Transmit a visual and/or auditory signal to a central staffed location or produce an auditory signal at the living unit loud enough to summon staff. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above at the back of the facility where the auditory signal device was broken, which posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/10/2022 Plan of Correction Staff repaired device during the visit.