QUALITY CARE ASSISTED LIVING

Official classification

Type B

Official code

87217(g)(1)

Regulation authority

CCR

What the official deficiency says

87217 Safeguards for Resident Cash, Personal Property, and Valuables (g) Each licensee shall maintain adequate safeguards and accurate records of cash resources and valuables entrusted to his care, including, but not limited to the following:(1) Records of residents' cash resources maintained as a drawing account shall include a ledger accounting (columns for income, disbursements and balance) for each resident, and supporting receipts filed in chronological order. Each accounting shall be kept current. The following requirement has not been met as evidenced by: Based on observation the facility staff was not keeping accurate record on a ledger documenting resident 1's purchases, which poses a potential, health, safety, or personalm rights risk to residents in care

Official plan of correction

Facility Administrator will provide receipts and updated purchase ledger to LPA by POC date of 02/14/2026.

Deadline recorded: Feb 14, 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

(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (2) Obtain a California clearance or a criminal record exemption as required by the Department or This requirement is not met as evidenced by: Licensee had S1 at the facility who was not fingerprint cleared according to LIS and Guardian which poses an immediate health safety and or personal rights risk to residents in care.

Official plan of correction

Licensee agrees to remove S1 from the facility and not return until fingerprint cleared. Licensee agrees to conduct an investigation and submit findings by POC due date 12/16/25. S1 was removed. Civil Penalty was issued.

Deadline recorded: Dec 16, 2025. 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 licensee and the administrator may be one and the same person. The administrator shall have sufficient freedom from other responsibilities and shall be on the premises a sufficient number of hours to permit adequate attention to the management and administration of the facility as specified in this section. When the administrator is not in the facility, there shall be coverage by a designated substitute who shall have qualifications adequate to be responsible and accountable for management and administration of the facility as specified in this section. 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 was not met as evidenced by Licensee did not have a current Administrator due to Administrator resigning 11/12/25 which poses a potential health safety and or personal rights risk to residents in care.

Deadline recorded: Jan 14, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87411(f)

Regulation authority

CCR

What the official deficiency says

(f) All personnel, including the licensee and administrator, shall be in good health, and physically and mentally capable of performing assigned tasks. Good physical health shall be verified by a health screening, including a chest x-ray or an intradermal test, performed by a physician not more than six (6) months prior to or seven (7) days after employment or licensure. A report shall be made of each screening, signed by the examining physician. The report shall indicate whether the person is physically qualified to perform the duties to be assigned, and whether he/she has any health condition that would create a hazard to him/herself, other staff members or residents. A signed statement shall be obtained from each volunteer affirming that he/she is in good health. Personnel with evidence of physical illness or emotional instability that poses a significant threat to the well-being of residents shall be relieved of their duties. This requirement was not met as evidenced by Licensee did not obtain a TB test for S1 and LPA observed S1 alter the health screening, writing in a date of 8/17/25 and marking the positive box which poses a potential health safety and or personal rights risk to residents in care.

Official plan of correction

Licensee agrees to submit a current health screening for S1 by POC due date 12/26/25

Deadline recorded: Dec 26, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87468.1(a)(8)

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: (8) To have their representatives regularly informed by the licensee of activities related to care or services, including ongoing evaluations, as appropriate to their needs. This requirement was not met as evidenced by: Licensee did not obtain a payee for R1's SSI money for rent and P & I money for R1 which poses an immediate health, safety and or personal rights risk to resident care.

Official plan of correction

Licensee agrees to obtain a payee for R1 and will submit proof of payee by POC due date 10/9/25

Deadline recorded: Oct 9, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(a)(4)

Regulation authority

CCR

What the official deficiency says

(4) The licensee shall assist residents with self-administered medications as needed. This requirement is not met as evidenced by: Deficient Practice Statement Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in administering two of R3's pills correctly. R3's medication 1 started on 5/1/25. Pill bottle originally contained 30 pills. R3 has 8 pills left and R3's medication 2 started on 5/1/25. Pill bottle originally contained 30 pills. R3 has 7 pills left, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/22/2025 Plan of Correction Licensee agrees to submit a plan to conduct medication training and will submit the scheduled training date by POC due date 5/22/25. After training is conducted Licensee will submit medication training showing staff signature, who provided the training and a training agenda.

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 several window screens in the facility courtyard were screwed into the wall, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/02/2025 Plan of Correction Licensee agrees to fix screens that are screwed in by POC due date. LPA will return to clear POC.

Official classification

Type B

Official code

87465(a)(6)

Regulation authority

CCR

What the official deficiency says

(6) When requested by the prescribing physician or the Department, a record of dosages of medications which are centrally stored shall be maintained by the facility. This requirement is not met as evidenced by: Deficient Practice Statement Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in 2 of R3's medication were not properly documented. R3 had two different start dates of 5/1/25 and 5/16/25 for one medication and another medication did not indicate if it started AM or PM, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/02/2025 Plan of Correction Licensee agrees to conduct a training on documenting medications by POC due date 6/2/25.

Official classification

Type B

Official code

87458(a)

Regulation authority

CCR

What the official deficiency says

(a) Prior to a person's acceptance as a resident, the licensee shall obtain documentation of a medical assessment, signed by a licensed medical professional acting within the scope of their practice and made within the last year, to be kept in the resident's record. This requirement is not met as evidenced by: Deficient Practice Statement Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in R1 did not have a completed LIC 602 missing several required boxes, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/02/2025 Plan of Correction Licensee agrees to submit a completed LIC602 for R1 by POC due date 6/2/25.

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 [(observation) (interview) (record review)], the licensee did not comply with the section cited above in R3 did not have a current LIC 602 for change in condition or a diagnosis listed on LIC 602, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/02/2025 Plan of Correction Licensee agrees to submit an updated and complete LIC 602 by POC due date 6/2/25.

Official classification

Type B

Official code

87633(b)

Regulation authority

CCR

What the official deficiency says

(b) A current and complete hospice care plan shall be maintained in the facility for each hospice resident and include the following: This requirement is not met as evidenced by: Deficient Practice Statement Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in not having a hospice care plan for R3, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/02/2025 Plan of Correction Licensee agrees to submit a hospice care plan for R3 that meets this regulation by POC due date 6/2/25.

Official classification

Type A

Official code

87211(d)(5)

Regulation authority

CCR

What the official deficiency says

87211 Reporting Requirements (d) The licensee shall notify the Department, the State Long-Term Care Ombudsman, all residents, and, if applicable, their representatives, in writing within two business days of any of the following specified events, or knowledge thereof: (5) A utility company has sent a notice of intent to terminate electricity, gas, or water service on the property within not more than 15 days of the notice. This requirement was not met as evidenced by: Licensee did not report to Licensing Final Notice from PG & E that the electric was going to be shut off which poses an immediate health safety and or personal rights risk.

Official plan of correction

LIcensee agrees to submit copies of all utilities for the months listed on this report and licensee agrees to submit a written understanding of how this regulation will be met by POC due date 10/15/24.

Deadline recorded: Oct 16, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(a)(4)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following: (4) The licensee shall assist residents with self-administered medications as needed. This requirement was not met as evidenced by Licensee had two loggings of the same medication by different doctors which was not logged as to why it was not administered and PRN's were not properly documented for the month of June.2024 which poses an immediate health safety and or personal rights risk to residents in care

Official plan of correction

Plan of Correction Licensee agrees to develop a plan for logging PRN and prescription medication and submit by POC due date 09/11/24. Civil Penalty issued for repeat violation

Deadline recorded: Sep 11, 2024. 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 which poses an immediate health, safety or personal rights risk to persons in care. R3 & R5 water temperatures were above the allowed limit. R3 was 128.1 and R5 was 139.9

Official plan of correction

POC Due Date: 06/20/2024 Plan of Correction Licensee will correct water temperature to meet regulation listed above. Verification will be provided to LPA.

Official classification

Type A

Official code

87355(e)(3)

Regulation authority

CCR

What the official deficiency says

(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (3) Request a transfer of a criminal record clearance as specified in Section 87355(c) or This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview, record review, the licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care. Staff listed in the facility as the Administrator was not associated to the facility. Administrator was working in the facility for 2 months before being properly associated to the facility.

Official plan of correction

POC Due Date: 06/20/2024 Plan of Correction Staff will be associated to the facility. POC cleared during visit, staff associated during visit.

Official classification

Type A

Official code

87465(a)(4)

Regulation authority

CCR

What the official deficiency says

(4) The licensee shall assist residents with self-administered medications as needed. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview, record review, the licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care. R1 had not received insulin medication from November 2023 to April 2024.

Official plan of correction

POC Due Date: 06/20/2024 Plan of Correction Licensee agrees to conduct a medication training for all medication technicians and submit a date training will be complete by POC due date 06/20/24.

Official classification

Type A

Official code

87465(a)(5)

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: This requirement is not met as evidenced by: Deficient Practice Statement Based on interview & record review, the licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care. Interviewees (staff and residents) stated glucose testing is conducted by staff. R2 & R3's physician reports state the residents cannot administer self injection or conduct own glucose testing.

Official plan of correction

POC Due Date: 06/20/2024 Plan of Correction Licensee agrees to update LIC 602's for R2 and R3 stating residents can administer their own injections and gluclose testing by POC due date 06/20/24

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

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 which poses/posed a potential health, safety or personal rights risk to persons in care. Broken window, screens torn, mold in ice maker, trash and misc. items along the side of the facility (pictures). Room 38's shower had mildew buildup (picture). Sliding door to courtyard does not open and close properly.

Official plan of correction

POC Due Date: 07/12/2024 Plan of Correction Licensee agrees to submit photos of items listed showing items are fixed and cleaned by POC due date 07/12/24.

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, interview, & record review, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care. After conducting interviews with staff it was stated Administrator assists with MedTech and Caregiver duties when there is not enough staff.

Official plan of correction

POC Due Date: 06/20/2024 Plan of Correction Licensee agrees to submit a copy of LIC500 staff schedule showing enough staff to complete all duties by POC due date 06/20/24

Official classification

Type B

Official code

1569.696(a)

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: This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview, & record review, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care. Licensee failed to document the number of hours completed for training.

Official plan of correction

POC Due Date: 07/12/2024 Plan of Correction Licensee agrees to conduct staff training to meet this regulation and submit to licensing by POC due date 07/19/24.

Official classification

Type B

Official code

1569.696(a)(1)

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: (1) Four hours of training on the care, supervision, and special needs of those residents, prior to providing direct care to residents. The facility may utilize various methods of instruction, including, but not limited to, preceptorship, mentoring, and other forms of observation and demonstration. The orientation time shall be exclusive of any administrative instruction. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview, & record review, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care. Licensee failed to document the number of hours completed for training.

Official plan of correction

POC Due Date: 07/19/2024 Plan of Correction Licensee agrees to conduct staff training to meet this regulation and submit to licensing by POC due date 07/19/24.

Official classification

Type B

Official code

1569.69(a)(1)

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: (1) In facilities licensed to provide care for 16 or more persons, the employee shall complete 24 hours of initial training. This training shall consist of 16 hours of hands-on shadowing training, which shall be completed prior to assisting with the self-administration of medications, and 8 hours of other training or instruction, as described in subdivision (f), which shall be completed within the first four weeks of employment. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview, record review, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care. Licensee failed to document training completed by staff.

Official plan of correction

POC Due Date: 07/12/2024 Plan of Correction Licensee agrees to conduct a staff training and submit training that meets this regulation by POC due date 07/12/24.

Official classification

Type B

Official code

87555(b)(17)

Regulation authority

CCR

What the official deficiency says

(b) The following food service requirements shall apply: (17) In facilities licensed for fifty (50) or more, and providing three (3) meals per day, a full-time employee qualified by formal training or experience shall be responsible for the operation of the food service. If this person is not a nutritionist, a dietitian, or a home economist, provision shall be made for regular consultation from a person so qualified. The consultation services shall be provided at appropriate times, during at least one meal. A written record of the frequency, nature and duration of the consultant's visits shall be secured from the consultant and kept on file in the facility. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview, record review, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care. Licensee failed to have consultation services provided in the facility for food services and document consultation services.

Official plan of correction

POC Due Date: 07/12/2024 Plan of Correction Licensee agrees to submit documentation that meets this regulation by POC due date 07/12/24.

Official classification

Type B

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, interview, & record review, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care. LPA observed medication not being stored in original containers, and being placed in envelopes to be passed out in the evenings.

Official plan of correction

POC Due Date: 07/12/2024 Plan of Correction Licensee agrees to submit a plan on how this regulation will be met by POC due date 07/12/24

Official classification

Type B

Official code

87465(c)(1)

Regulation authority

CCR

What the official deficiency says

(c) If the resident's physician has stated in writing that the resident is unable to determine his/her own need for nonprescription PRN medication, but can communicate his/her symptoms clearly, facility staff designated by the licensee shall be permitted to assist the resident with self-administration, provided all of the following requirements are met: (1) There is written direction from a physician, on a prescription blank, specifying the name of the resident, the name of the medication, all of the information specified in Section 87465(e), instructions regarding a time or circumstance (if any) when it should be discontinued, and an indication of when the physician should be contacted for a medication reevaluation. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview, & record review, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care. Facility did not to have proper doctor's orders for resident's PRNs

Official plan of correction

POC Due Date: 07/12/2024 Plan of Correction Licensee agrees to submit in writing the understanding of this regulation and how it will be met by POC due date 07/12/24

Official classification

Type B

Official code

87465(e)

Regulation authority

CCR

What the official deficiency says

(e) For every prescription and nonprescription PRN medication for which the licensee provides assistance there shall be a signed, dated written order from a physician on a prescription blank, maintained in the resident's file, and a label on the medication. Both the physician's order and the label shall contain at least all of the following information. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview, & record review, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care. LPA observed resident files which did not have doctor's orders for PRN medication.

Official plan of correction

POC Due Date: 07/19/2024 Plan of Correction Licensee agrees to update files and create a procedure to meet this regulation. Licensee will submit plan by POC due date 07/19/24.

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 observation, interview, & record review, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care. Licensee did not to have required documentation for R1, R2, R3, R4, & R5

Official plan of correction

POC Due Date: 06/20/2024 Plan of Correction Licensee agrees to update resident records and submit in writing how this regulation will be met by POC due date 07/19/24.

Official classification

Type B

Official code

87506(b)(13)

Regulation authority

CCR

What the official deficiency says

(b) Each resident's record shall contain at least the following information: (13) Continuing record of any illness, injury, or medical or dental care, when it impacts the resident's ability to function or the services he needs. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview, & record review, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care. Licensee did not keep record of R1's medical needs when R1 refuses treatment.

Official plan of correction

POC Due Date: 07/12/2024 Plan of Correction Licensee agrees to submit in writing the understanding of this regulation and how it will be met by POC due date 07/19/24.

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, interview, & record review, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care. Licensee failed to maintain R3's physician report which did not have diagnosis listed.

Official plan of correction

POC Due Date: 07/12/2024 Plan of Correction Licensee agrees to update R3's physician report to show R3's diagnosis by POC due date 07/12/24.

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 Licensee had cleaning supplies in unlocked closets and outdoors on the outside yard of the facility accessible to residents, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/20/2024 Plan of Correction Licensee agrees to put a procedure in place to ensure cleaning supplies are locked. Licensee will conduct an inservice and submit by POC due date 6/20/24.

Official classification

Type A

Official code

87608(a)(5)(B)

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. (5) Under no circumstances shall postural supports include tying, depriving, or limiting the use of a resident's hands or feet. (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) (interview) (record review)], the licensee did not comply with the section cited above in Licensee did not have a physician note for R6 to have full bed rails which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/20/2024 Plan of Correction Licensee agrees to Hospice care plan that addresses doctor order for full bed rails by POC due date 06/20/24.

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 observation, interview, & record review, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care. Licensee did not have documentation to verify training was completed.

Official plan of correction

POC Due Date: 07/19/2024 Plan of Correction Licensee agrees to conduct staff traing to meet this regulation by POC due date 07/19/24. Civil Penalty issued.

Official classification

Type B

Official code

87412(a)

Regulation authority

CCR

What the official deficiency says

87412 Personnel Records (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 was not met as evidenced by Licensee did not have a complete personnel file for S1 which poses a potential health safety and or personal rights risk to residents in care.

Official plan of correction

Plan of Correction Plan of Correction Licensee agrees to submit a copy of S1's entire file including all Licensing requirements by POC due date 4/26/24.

Deadline recorded: Apr 26, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87219(f)

Regulation authority

CCR

What the official deficiency says

87219 Planned Activities (f) In facilities licensed for fifty (50) persons or more, one staff member shall have full-time responsibility to organize, conduct and evaluate planned activities, and shall be given such staff assistance as necessary in order for all residents to participate in accordance with their interests and abilities. The program of activities shall be written, planned in advance, kept up-to-date, and made available to all residents. The responsible employee shall have had at least one year of experience in conducting group activities and be knowledgeable in evaluating resident needs, supervising other employees, and in training volunteers. This requirement was not met as evidenced by Licensee does not have a full time staff for activities or planned activities for residents in care which poses an immediate health safety and/or personal rights risk to residents in care.

Official plan of correction

Plan of Correction Licensee agrees to hire a full time activities staff designated to create activities for residents and submit the staff hired information and a copy of a planned activities calendar by POC due date 5/17/24.

Deadline recorded: May 17, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

1522(C)

Regulation authority

HSC

What the official deficiency says

1522 Fingerprints and criminal records; exemptions; criminal record clearances (C) Any person who provides client assistance in dressing, grooming, bathing, or personal hygiene. Any nurse assistant or home health aide meeting the requirements of Section 1338.5 or 1736.6, respectively, who is not employed, retained, or contracted by the licensee, and who has been certified or recertified on or after July 1, 1998, shall be deemed to meet the criminal record clearance requirements of this section. A certified nurse assistant and certified home health aide who will be providing client assistance and who falls under this exemption shall provide one copy of their current certification, prior to providing care, to the community care facility. The facility shall maintain the copy of the certification on file as long as care is being provided by the certified nurse assistant or certified home health aide at the facility or in a certified family home or resource family home of a foster family agency. This paragraph does not restrict the right of the department to exclude a certified nurse assistant or certified home health aide from a licensed community care facility or certified family home or resource family home of a foster family agency pursuant to Section 1558.

Official plan of correction

Plan of Correction POC Licensee agrees to associate S1 to the facility by POC due date 04/23/24. Licensee will submit proof of association. Civil Penalty issued

Deadline recorded: Apr 23, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87555(b)(28)

Regulation authority

CCR

What the official deficiency says

87555 General Food Service Requirements (b) The following food service requirements shall apply(28) All food shall be protected against contamination. Contaminated food shall be discarded immediately upon discovery. This requirement was not met as evidenced by Licensee did not properly store uncooked hamburger meat which was left out and felt warm to touch. Facility staff placed meat back in the freezer which poses an immediate health safety and or personal rights risk to residents in care.

Official plan of correction

Plan of Correction POC Licensee agrees to properly store food and conduct a staff training on food storage and submit a copy of agenda and trained staff by POC due date 4/26/24 .

Deadline recorded: Apr 26, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87555(b)(26)

Regulation authority

CCR

What the official deficiency says

87555 General Food Service Requirements(b) The following food service requirements shall apply: (26) Supplies of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days shall be maintained on the premises. This requirement was not met as evidenced by Licensee did not have nonperishable foods for a minimum of one week and perishable foods for a minimum of two days shall be maintained on the premises, which poses a potential health safety and or personal rights risk to residents in care.

Official plan of correction

Plan of Correction POC Licensee agree to submit a plan on how this regulation will be met in the future and have sufficient food at the facility to meet the requirements of this regulation by POC due 0412/24. LPA will return to clear POC during a visit.

Deadline recorded: Apr 9, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87555(b)(17)

Regulation authority

CCR

What the official deficiency says

87555 General Food Service Requirements (b) The following food service requirements shall apply: (17) In facilities licensed for fifty (50) or more, and providing three (3) meals per day, a full-time employee qualified by formal training or experience shall be responsible for the operation of the food service. If this person is not a nutritionist, a dietitian, or a home economist, provision shall be made for regular consultation from a person so qualified. The consultation services shall be provided at appropriate times, during at least one meal. A written record of the frequency, nature and duration of the consultant's visits shall be secured from the consultant and kept on file in the facility. This requirement was not met as evidenced by Licensee could not provide copies of trained staff that will meet this regulation which poses a potential health safety and or personal rights risk to residents in care.

Official plan of correction

Plan of Correction POC Licensee agrees to submit copies of a qualified person responsible for food service that will meet this regulation by POC due date 4/46/24.

Deadline recorded: Apr 26, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87555(a)

Regulation authority

CCR

What the official deficiency says

87555 General Food Service Requirements (a) The total daily diet shall be of the quality and in the quantity necessary to meet the needs of the residents and shall meet the Recommended Dietary Allowances of the Food and Nutrition Board of the National Research Council. All food shall be selected, stored, prepared and served in a safe and healthful manner. This requirement was not met as evidenced by: Licensee did not have a sufficient amout of meat planned to cook for dinner. Facility had 5 to 7 pounds of meat out for dinner for 43 residents which poses an immediate health safety and or personal rights risk to residents in care.

Official plan of correction

Plan of Correction Licensee agrees to provide a written statement of quality and quanity of food that will meet the needs of the residents. by POC due date 04/9/24. Facility staff took out an additional 6.82 pounds of hamburger meat during visit to serve for dinner and stated facility would add canned green beans to the meal.

Deadline recorded: Apr 12, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87555(b)(7)

Regulation authority

CCR

What the official deficiency says

87555 General Food Service Requirements (b) The following food service requirements shall apply:(7) Modified diets prescribed by a resident's physician as a medical necessity shall be provided. Licensee did not provide a modfied diet menu for residents R1 thru R6 that require doctor order modified diets which poses a potential health safety and or personal rights risk to residents in care.

Official plan of correction

Plan of Correction POC Licensee agrees to create and submit a menu from a licensed professional or qualified person to meet the needs of residents requiring a special diet by POC due date 4/9/24.

Deadline recorded: Apr 9, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

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) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, 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, telephone conversations, use of the Internet, and meetings of resident and family groups.This was not met as evidenced by Licensee sends calls to staff's personal cell phones for residents which does not allow privacy which poses a potential health safety and or personal rights risk to residents in care.

Official plan of correction

Plan of Correction POC Licensee agrees to submit in writing how this regulation will be met without using staff's personal cellphones for residents by POC due date 3/15/24

Deadline recorded: Mar 15, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87465(6)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care(6) The licensee shall be responsible for assuring that a record of centrally stored prescription medications for each resident is maintained for at least one year and includes: Licensee did not comply with this section by not having a centrally stored log for some of R1's medications which poses a potential health safety and or personal rights risk to residents in care.

Official plan of correction

POC Plan of Correction Licensee agrees to do a written statement on how this regulation will be met in the future. Licensee agrees to submit updated Centrally stored log to licensing by POC due date 1/19/24 Civil Penalty issued

Deadline recorded: Jan 19, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(a)(4)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following: (4) The licensee shall assist residents with self-administered medications as needed. This requirement was not met as evicdenced by: Licensee did not ensure R1's medication was administered from 1/1/24 to 1/4/24 which poses an immediate health safety and or personal rights risk to residents in care.

Official plan of correction

Plan of Correction POC Licensee agrees to conduct training by the pharmacist to ensure this regulation is met and agrees to submit agenda, with pharmacist information and staff roster by POC due date 1/19/24.

Deadline recorded: Jan 10, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87555(b)(17)

Regulation authority

CCR

What the official deficiency says

87555 General Food Service Requirements (b) The following food service requirements shall apply: (17) In facilities licensed for fifty (50) or more, and providing three (3) meals per day, a full-time employee qualified by formal training or experience shall be responsible for the operation of the food service. If this person is not a nutritionist, a dietitian, or a home economist, provision shall be made for regular consultation from a person so qualified. The consultation services shall be provided at appropriate times, during at least one meal. A written record of the frequency, nature and duration of the consultant's visits shall be secured from the consultant and kept on file in the facility. This regulation was not met as evidenced by Licensee does not had trained kitchen staff or a consultation with a qualified person which poses a potential health safety and or personal rights risk to clients in care.

Official plan of correction

Plan Of Correction POC Licensee agrees to provide staff training and provide proof of how this regulation was met by POC due date of 11/3/23.

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

Official classification

Type B

Official code

87465(6)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care (6) When requested by the prescribing physician or the Department, a record of dosages of medications which are centrally stored shall be maintained by the facility. This requirement was not met as evidenced by Licensee did not have a centrally stored log for some of C1's and C2's medications which poses a health safety and personal rights risk to clients in care.

Official plan of correction

Plan of Correction POC Licensee agrees to submit a written plan on how this regulation will be met and a copy of C1 and C2's centrally stored log listing all medications by POC due date 11/03/23

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

Official classification

Type B

Official code

87555(b)(7)

Regulation authority

CCR

What the official deficiency says

87555 General Food Service Requirements (b) The following food service requirements shall apply: (7) Modified diets prescribed by a resident's physician as a medical necessity shall be provided. This requirement was not met as evidenced by: Licensee did not provide a special diet for C2 who requires a special diet on LIC602. Based on observation and interview, C2 had cereal for breakfast and raviolis, peaches and potato chips for lunch which poses a potential health safety and or personal rights risk to clients in care.

Official plan of correction

Plan of Correction POC Licensee agrees to provide a menu of a special diet to meet the needs of C2 by POC due date 11/3/23.

Deadline recorded: Oct 20, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87616(a)

Regulation authority

CCR

What the official deficiency says

87616 Exceptions for Health Conditions (a) As specified in Section 87209, Program Flexibility, the licensee may submit a written exception request if he/she agrees that the resident has a prohibited and/or restrictive health condition but believes that the intent of the law can be met through alternative means. This requirement was not met as evidenced by Licensee did not submit an exception for R2's restricted health care plan which poses and immediate health safety and/or personal rights risk to residents in care.

Official plan of correction

Plan of Correction POC Licensee agrees to submit a request to retain residents with restricted health conditions and plans of care by POC due date.

Deadline recorded: Sep 28, 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 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 was not met as evidenced by Licensee did not store all residents medications in original container. LPA observed all resident medcations in individual small manilla envelopes with residents names which poses an immediate health and safety and or personal rights risk to residents in care.

Official plan of correction

Plan of Correction: Licensee agrees to submit a written understanding of this regulation by POC due date 09/28/23

Deadline recorded: Sep 28, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87625(b)(3)

Regulation authority

CCR

What the official deficiency says

87625 Managed Incontinence (b) In addition to Section 87611, General Requirements for Allowable Health Conditions, the licensee shall be responsible for the following:(3) Ensuring that incontinent residents are kept clean and dry and that the facility remains free of odors from incontinence. This requirement was not met as evidenced by Licensee did not ensure R1 was clean and dry by R1 being observed outside soiled with flies on R1 which poses a potential health safety and or personal rights risk to residents in care.

Official plan of correction

Plan of Correction POC Licensee agrees to have resident records accessible at all times to facility staff to ensure residents care needs are met. Licensee agrees to submit a written understanding of this regulation and how it will be met in the future by POC due date of 10/13/23.

Deadline recorded: Oct 13, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(a)(4)

Regulation authority

CCR

What the official deficiency says

(4) The licensee shall assist residents with self-administered medications as needed. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation interview and record review, the licensee did not comply with the section cited above by not logging R1's medication on MARS or having a start date to show when medication was being administered which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/16/2023 Plan of Correction Plan of Correction POC Licensee agrees to conduct a medication training to medication technician staff by POC due date 08/18/23. Licensee agrees to submit an an agenda with staff signatures of training.

Official classification

Type A

Official code

87465(d)

Regulation authority

CCR

What the official deficiency says

(d) If the resident is unable to determine his/her own need for a prescription or nonprescription PRN medication, and is unable to communicate his/her symptoms clearly, facility staff designated by the licensee, shall be permitted to assist the resident with self-administration, provided all of the following requirements are met: This requirement is not met as evidenced by: Deficient Practice Statement Based on observation interview and record review, the licensee did not comply with the section cited above by having missing PRN narcotics that were not logged as being given to R2, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/16/2023 Plan of Correction Plan of Correction POC Licensee agrees to conduct a medication training for PRNs for all medication technician staff by POC due 08/18/23. Licensee agrees to submit an an agenda with staff signatures of training.

Official classification

Type B

Official code

1569.696(a)

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: 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 staff training, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/15/2023 Plan of Correction Plan of Correction POC Licensee agrees to conduct staff training to meet this regulation by POC due date 09/15/23. Licensee agrees to submit proof of correction.

Official classification

Type B

Official code

87465(a)(6)

Regulation authority

CCR

What the official deficiency says

(6) When requested by the prescribing physician or the Department, a record of dosages of medications which are centrally stored shall be maintained by the facility. This requirement is not met as evidenced by: Deficient Practice Statement Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above by not having a centrally stored log for 3 out of 5 residents reviewed, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/15/2023 Plan of Correction Plan of Correction POC Licensee agrees to submit copies of centrally stored logs of 5 residents showing an understanding of the regulation by POC due date 09/15/23.

Official classification

Type B

Official code

87465(c)(3)

Regulation authority

CCR

What the official deficiency says

(c) If the resident's physician has stated in writing that the resident is unable to determine his/her own need for nonprescription PRN medication, but can communicate his/her symptoms clearly, facility staff designated by the licensee shall be permitted to assist the resident with self-administration, provided all of the following requirements are met: (3) A record of each dose is maintained in the resident's record. The record shall include the date and time the PRN medication was taken, the dosage taken, and the resident's response. This requirement is not met as evidenced by: Deficient Practice Statement Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above by not having a complete record for R2's PRN log, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/16/2023 Plan of Correction Plan of Correction POC Licensee agrees to administer staff training in logging PRN medications to medication technician staff by POC due date. Licensee agrees to submit copy of 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 [(observation) (interview) (record review)], the licensee did not comply with the section cited above in [count] out of [total count] [(objects) (persons)] [identifiers] which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/25/2023 Plan of Correction Plan of Correction POC Licensee agrees to submit proof of fire drill by POC due date 08/25/23.

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 degree C) and not more than 120 degree F (49 degree 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 4 out of 4 rooms, where water measured at over 130 F in each room, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/16/2023 Plan of Correction Plan of Correction POC LIcenssee agrees to bring the water termperature to 105 F to 120 F by POC due date.

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: 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 by not having staff training to meet this requirement, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/15/2023 Plan of Correction Plan of Correction POC Licensee agrees to conduct staff training to meet this requirement by POC due date 09/15/23.

Official classification

Type B

Official code

87211(a)(1)

Regulation authority

CCR

What the official deficiency says

87211 Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: (1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below. This report shall include the resident's name, age, sex and date of admission; date and nature of event; attending physician's name, findings, and treatment, if any; and disposition of the case. This requirement was not met as evidenced by: Licensee did not report communicable disease or hospitalizations for R1, which poses a potential health, safety, and/or personal rights risk to residents in care.

Official plan of correction

Plan of Correction POC Licensee agrees to submit a written statement on how this regulation will be met in the future by POC due date 7/14/23.

Deadline recorded: Jul 14, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

1569.49(c)(1)

Regulation authority

HSC

What the official deficiency says

1569.49 Civil penalties; regulations setting forth appeal procedures for deficiencies (c) The department shall assess an immediate civil penalty of five hundred dollars ($500) per violation and one hundred dollars ($100) for each day the violation continues after citation for any of the following serious violations: (1) Any violation that the department determines resulted in the injury or illness of a resident. This was not met as evidenced by: Licensee did not seek timely medical attention for R1, resulting in a hospitalization with additional medical issues due to neglect, which poses an immediate health, safety, and/or personal rights risk to residents in care.

Official plan of correction

Plan of Correction POC Licensee agrees to submit a written statement on how the facility will meet this regulation in the future. Immediate $500 Civil Penalty was issued

Deadline recorded: Jul 6, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(a)(4)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following:(4) The licensee shall assist residents with self-administered medications as needed. This was not met as evidenced by: Licensee was not following physician orders when administering R1's medication, which poses an immediate health, safety, and/or personal rights risk to residents in care.

Official plan of correction

Plan of Correction POC Licenee agrees to conduct a staff training on applying medication and following physicians orders by POC due date 07/14/23

Deadline recorded: Jul 6, 2023. A deadline is not proof that correction was completed.