YOUR LOVED ONES MATTER LLC

Official classification

Type A

Official code

87303(e)(5)

Regulation authority

CCR

What the official deficiency says

(e) Water supplies and plumbing fixtures shall be maintained as follows: (5) Slip-resistant mats, strips, or flooring shall be used in all bathtub and shower floors. 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 resident restroom shower which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/30/2025 Plan of Correction Facility has purchased and installede non slip shower mat. Plan of correction to be cleared after today's visit is recorded.

Official classification

Type A

Official code

87412(c)

Regulation authority

CCR

What the official deficiency says

(c) Licensees shall maintain in the personnel records verification of required staff training and orientation. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and record reveiw, the licensee did not comply with the section cited above by not having documentation of training available for review. Training records and other documentation are stored electrtonicallly and seperately from the files and not readily available for review which poses an immediate health, safety or personal rights risk to persons in care as LPA could not ascertain who had recieved the proper and required traning.

Official plan of correction

POC Due Date: 06/10/2025 Plan of Correction Faciity will consilidate traninng and personnel records in a concise and readily availalbe format. This will enable staff to know exactly what training has been completed and what is due. Once records are consilidated and brought up to date, LPA will be notified and can schedule review.

Official classification

Type A

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 and record review, the licensee did not comply with the section cited above. Personnel records did not easily or accurately reflect the training hours provided . This poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/10/2025 Plan of Correction Facilty will ensure staff is up to date with training and provide hours that are missing. These records will be provided to LPA to ensure that training has been completed and is accurately documented.

Official classification

Type A

Official code

87456(a)(2)

Regulation authority

CCR

What the official deficiency says

(a) Prior to accepting a resident for care and in order to evaluate his/her suitability, the facility shall, as specified in this article 8: (2) Perform a pre-admission appraisal. 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 because only one of four resident files had that document. Failing to do an assesment ofr sutiabley in the facility can pose an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/10/2025 Plan of Correction Faciity will complete a pre assesment form on all current residents and any residents acquired in the future.

Official classification

Type A

Official code

87456(a)(3)

Regulation authority

CCR

What the official deficiency says

(a) Prior to accepting a resident for care and in order to evaluate his/her suitability, the facility shall, as specified in this article 8: (3) Obtain and evaluate a recent medical assessment. 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 which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/10/2025 Plan of Correction Facility will review resident files to ensure there is a medical assesment from their doctors current and readily availalble in their file. If an appointment is needed to obtain form, facility will notify LPA by June 10, 2025 of pending appointment date.

Official classification

Type A

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. Failing to determine resident suitability poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/10/2025 Plan of Correction Facility will ensure that documentation of resident suitibility for admission is completed and documented in each resident's file.

Official classification

Type A

Official code

87467(a)

Regulation authority

CCR

What the official deficiency says

(a) Prior to, or within two weeks of the resident's admission, the licensee shall arrange a meeting with the resident, the resident's representative, if any, appropriate facility staff, and a representative of the resident's home health agency, if any, and any other appropriate parties, to prepare a written record of the care the resident will receive in the facility, and the resident's preferences regarding the services provided at the facility. 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, as there was no care plan documented. This can pose an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/10/2025 Plan of Correction Facility will develop Care Plan for all residents currently in the home and will do so for all future residents as well.

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 due to a non utilized chicken coop that needs to be removed from back yard and damage to the wooden facing on the front of the house is rotted and warped in places and needs to be replaced. These issues pose a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/10/2025 Plan of Correction Facility will make repairs to the facing and remove the chicken coop by the due date of 6/10/2025. If more time is needed, a request for an extension will be made.

Official classification

Type A

Official code

87355(e)

Regulation authority

CCR

What the official deficiency says

Criminal Record Clearance: (e) All individuals subject to a criminal record review ... shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department. This requirement was not met as evidenced by Adult family member who turned 18 in October, 2024 was not cleared or associated to the facility at date of visit on February 7, 2025. This poses an immediate threat to the health, safety and/or personal rights of the residents in care.

Official plan of correction

LPA verified that the family member is now finger print cleared and associated to the facility, Your Loved Ones Matter. POC to be cleared at today's visit.

Deadline recorded: Feb 19, 2025. A deadline is not proof that correction was completed.

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 LPA observation of the shower in resident bedroom 3 which had dark colored mold on the shower floor and lower tiles and non skid mat. LPA observed chicken feces on patio chairs outside and in resident bedroom 3 the one glass of a dual pane sliding glass door is shattered which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/10/2024 Plan of Correction Licensee will clean shower and patio chairs and submit photo verification that it has been cleaned to this LPA by the POC due date. LIcensee will repair the glass or replace the sliding glass door in bedroom 3.

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 LPA observed there is no window screen in bedroom 2. Licensee explained this was damaged by a resident a few months ago and has not been replaced, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/10/2024 Plan of Correction Licensee will replace window screen and submit photo proof to this LPA by the POC due date.

Official classification

Type B

Official code

87412(a)(11)

Regulation authority

CCR

What the official deficiency says

(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: (11) A health screening as specified in Section 87411, Personnel Requirements - General. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review and interview with licensee, the licensee did not comply with the section cited above in that the Health Screening form was missing for 1 out of 2 staff files, which poses an immediate health, safety or personal rights risk to persons in care. which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/02/2024 Plan of Correction Staff person will be evaluated by a phycisian for the completion of the Health Screening form. Licensee will submit copy of the completed Health Screening form to this LPA by the POC due date.

Official classification

Type A

Official code

87412(a)(11)

Regulation authority

CCR

What the official deficiency says

(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: (11) A health screening as specified in Section 87411, Personnel Requirements - General. 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 in 1 out of 2 staff files which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/16/2023 Plan of Correction Licensee to have staff complete a Health Screening as soon as possible before returning to facility

Official classification

Type A

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 1 out of 1. Fire extinguisher was expired with a service date of 3/4/2022, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/03/2023 Plan of Correction Licensee to have either fire extinguisher serviced or buy new extinguisher and submit pictures as proof of POC.