ANNAI HOUSE

Official classification

Type B

Official code

87706(a)(1)

Regulation authority

CCR

What the official deficiency says

(a) In addition to the requirements in Section 87705, Care of Persons with Dementia, licensees who advertise, promote, or otherwise hold themselves out as providing special care, programming, and/or environments for residents with dementia or related disorders shall meet the following requirements: (1) In addition to the requirements specified in Sections 87208, Plan of Operation, the licensee shall include in the plan of operation a brief narrative description addressing the following additional 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 that LPA did not observe a Dementia care plan which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/28/2026 Plan of Correction Facility to provide the current Plan of Operation which shall include the Dementia Care Plan.

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 in 2 resident rooms, no screens were observed which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/28/2026 Plan of Correction Facility to provide screens on all windows of the facility.

Official classification

Type B

Official code

87555(b)(7)

Regulation authority

CCR

What the official deficiency says

(7) Modified diets prescribed by a resident's physician as a medical necessity shall be provided. 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 Resident 1 file, no prescription for diabetic diet was observed. Kitchen staff did not have a copy of the diabetic diet which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/28/2026 Plan of Correction Facility shall obtain a diet written and/or prescribed by a doctor, for any diabetic client living at the facility.

Official classification

Type B

Official code

87506(b)(11)

Regulation authority

CCR

What the official deficiency says

(b) Each resident's record shall contain at least the following information: (11) The documentation required by Section 87611(a) for residents with an allowable health condition. 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 resident 5 has a colostomy bag and has no doctors care plan for this allowable, restricted condition which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/28/2026 Plan of Correction Facility must obtain proper documentation from the residents doctor required by Section 87611(a) for residents with an allowable health condition.

Official classification

Type B

Official code

87208(a)

Regulation authority

CCR

What the official deficiency says

87208(a) The licensee shall have and maintain a current, written definitive plan of operation for the faciltiy. The licensee shall operate the facility in accordance with the terms specified in the plan of operation and may be cited for not doing so pursuant to Health and Safety Code section 1569.49. The plan and related materials shall be submitted to the licensing agency with the license application. Any significant changes in the plan of operation which would affect the services to residents shall be submitted to the licensing agency for approval. The plan and related materials shall contain the following: This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and record review, the licensee did not comply with the section cited above in that no Plan of Operation was found at the facility. The Plan of Operation found at the Licensing Office was reviewed and it was found that it did not include mental health, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/28/2026 Plan of Correction Facility to submit a plan to Licensing which includes mental health or the facility shall remove the clients that fall under this description.

Official classification

Type A

Official code

87464(f)(1)

Regulation authority

CCR

What the official deficiency says

Basic Services(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 was not met as evidenced by Resident had a prior history of elopment and a LIC602A stating that the resident is unable to leave the facility unsupervised. Staff allowed resident to go outside of the doctors office alone, to the bathroom, from which she eloped and was not found for 3 days, when residents mother called facility from the hospital where resident was admitted, which poses an immediate risk to the health, safety, or personal rights risk to the residents in care.

Official plan of correction

Facility shall review policy and procudures for taking residents off site. Facility to ensure that there is enough staff available to provide care and supervision of all residents. A written statement shall be submitted to licensing by 07/09/26 stating the policy regarding supervision of residents.

Deadline recorded: Jul 8, 2026. A deadline is not proof that correction was completed.

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 in 5 staff files out of 5 the training reuquirements were not met per regulation which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/27/2026 Plan of Correction Facility to provide a training plan with an authorized vendor to meet regulations.

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 in 1 staff out of 5 did not have CPR First Aid which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/13/2026 Plan of Correction Facility shall ensure that staff received training before returning to work. Proof shall be sent to CCL office.