DIVINE MERCY GUEST HOME I

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, interior window frames had spider webs and dust. The fan in R2 and R3's bedroom had dust accumulated and the dust was building up on the fan blades. The light fixture in the dinning room also had dust accumulated, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/17/2025 Plan of Correction POC corrected at time of visit. DCS cleaned window frames and ceiling fixtures.

Official classification

Type B

Official code

87633(b)

Regulation authority

CCR

What the official deficiency says

87633 Hospice Care of Terminally Ill Residents (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, and record review, the licensee did not comply with the section cited above in that Administrator Susan stated that R1 is on hospice. Per R1's physician report dated 3/11/25, resident is receiving hospice care for terminal illness. However, Administrator Susan stated that they do not have a hospice care plan for R1, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/17/2025 Plan of Correction Licensee stated that she will obtain a hospice care plan and will email the plan to LPA by POC due date of 10/17/25.

Official classification

Type B

Official code

87468.1(a)(1)

Regulation authority

CCR

What the official deficiency says

(a) Residents in residential care facilities for the elderly shall have personal rights which include, but are not limited to, those listed in Sections 87468.1, Personal Rights of Residents in All Facilities, and 87468.2, Additional Personal Rights of Residents in Privately Operated Facilities, as applicable to the facility. (1) " Privately operated facility " means a residential care facility for the elderly that is licensed to an individual, firm, partnership, association, or corporation. Based on interview, the licensee did not comply with the section cited that staff yells at resident which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Licensee agrees to provide Personal Rights training and will submit completion documents to CCLD by POC due date.

Deadline recorded: Jun 5, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87609(b)(4)

Regulation authority

CCR

What the official deficiency says

(b) Incidental medical care may be provided to residents through a licensed home health agency provided the following conditions are met: (4) The licensee and home health agency agree in writing on the responsibilities of the home health agency, and those of the licensee in caring for the resident's medical condition(s). 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 6 residents did not have a care plan from Palliative Care Agency which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/05/2024 Plan of Correction Licensee to obtain a care plan from Palliative care for R2 and submit copies to CCLD by due date.

Official classification

Type A

Official code

87465(h)(6)

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: (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: 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 6 residents did not have a centrally stored medication log older than current year and medication that was not logged which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/05/2024 Plan of Correction Licensee agrees to schedule in-service training by due date and submit records of training when completed. Licensee agrees to audit all residents’ records to ensure all medication is logged.

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, interview, the licensee did not comply with the section cited above in 3 out of 3 window screens were torn, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/11/2024 Plan of Correction Licensee agrees to repair or replace window screens and submit pictures once completed.