Background checksType A
- Official classification
- Type A
- Official code
- 87355(d)(3)
- Regulation authority
- CCR
What the official deficiency says
(3) The licensee shall submit these fingerprints to the California Department of Justice, along with a second set of fingerprints for the purpose of searching the records of the Federal Bureau of Investigation, or comply with Section 87355(c), prior to the individual's employment, residence, or initial presence in the facility. 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 one out of one applicant which poses an immediate health, safety or personal rights risk to persons in care. Applicant Wilson Arcinue has spent the night in one of the resident rooms, LPA found his personal items in the closet of the home. Applicant is not fingerprint cleared.
Official plan of correction
POC Due Date: 10/07/2025 Plan of Correction Applicant must vacate the premises and not return until he has been fingerprint cleared.
Medical and dental careType A
- Official classification
- Type A
- Official code
- 87465(a)(5)(D)
- Regulation authority
- CCR
What the official deficiency says
(5) Facility staff, except those authorized by law, shall not administer injections, but staff designated by the licensee may assist persons with self-administration as needed. Assistance with self-administered medications shall be limited to the following: (D) Assistance with self-administration does not include forcing a resident to take medications, hiding or camouflaging medications in other substances without the resident's knowledge and consent, or otherwise infringing upon a resident's right to refuse to take a medication. 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 two out of two residents which poses an immediate health, safety or personal rights risk to persons in care. Two residents were observed to have been fed crushed medications in applesauce and no orders were found for doing so.
Official plan of correction
POC Due Date: 10/07/2025 Plan of Correction Facility staff must be retrained on medication management and administration. Proof of retraining must be provided to Licensing by 10/13/2025.
Medication handling and storageType A
- Official classification
- Type A
- 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 in 5 out of 5 residents which poses an immediate health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 10/07/2025 Plan of Correction Medication training is to be completed by staff and proof to be sent by 10/15/2025
Licensing and administrationType B
- Official classification
- Type B
- Official code
- 1569.618(b)
- Regulation authority
- HSC
What the official deficiency says
(b) At least one administrator, facility manager, or designated substitute who is at least 21 years of age and has qualifications adequate to be responsible and accountable for the management and administration of the facility pursuant to Title 22 of the California Code of Regulations shall be on the premises 24 hours per day. The designated substitute may be a direct care staff member who shall not be required to meet the educational, certification, or training requirements of an administrator. The designated substitute shall meet qualifications that include, but are not limited to, all of the following: 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 that there was no Administrator available to assist at facility which poses/posed a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 10/14/2025 Plan of Correction Facility to appoint an Administrator that can be available to assist at the facility on a daily basis. New Administrator to be submitted to Licensing by 10/14/25.
Facility condition and maintenanceType B
- 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 in the fence in the backyard needs repair which poses/posed a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 10/14/2025 Plan of Correction Facility to provide proof of repair to Licensee by 10/14/2025.
Facility condition and maintenanceType B
- Official classification
- Type B
- Official code
- 87303(a)(1)
- 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. (1) Floor surfaces in bath, laundry and kitchen areas shall be maintained in a clean, sanitary, and odorless condition. 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 one bathroom was not kept clean from mold of tile grout which poses/posed a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 10/14/2025 Plan of Correction Facility to clean the tile and the grout in the back bathroom for staff.
Facility condition and maintenanceType B
- Official classification
- Type B
- Official code
- 87303(f)
- Regulation authority
- CCR
What the official deficiency says
(f) All waste shall be located, stored, and disposed of in a manner that will not transmit communicable diseases or odors, pose a risk to health and safety, or 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 in that used medical gloves were seen laying out in the backyard which poses/posed a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 10/14/2025 Plan of Correction Facility needs to ensure that yard is kept free from trash and staff will be trained on facility maintenance.