DIVINE MERCY GUEST HOME II

Official classification

Type A

Official code

87309(a)

Regulation authority

CCR

What the official deficiency says

This requirement is not met as evidenced by: Deficient Practice Statement (a) Except as specified in subsection (b), the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances, knives, matches, tools, sharp objects, and other similar items which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage. This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above in that knives in the kitchen cabinet and disinfectants in the hallway restroom were observed unlocked,which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/23/2025 Plan of Correction Admininstrator immediately locked the restroom cabinet that contained the bleach and also locked the kitchen knives with a key lock.

Official classification

Type A

Official code

87465(h)(2)

Regulation authority

CCR

What the official deficiency says

This requirement is not met as evidenced by: Deficient Practice Statement (2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. This requirement is not met as evidenced by: Based on observation the licensee did not comply with the section cited above in that staff medication was observed unlocked in a kitchen cabinet and also in the office area. In addition, resident medication is stored in small fridge in the living room. The fridge was observed to be unlocked. This poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/29/2025 Plan of Correction Administrator placed staff medication in a locked cabinet. Administrator Ulysis locked the resident medication fridge. Administrators Susan and Ulyis stated that they will receive medical training for themselves and staff in the facility.

Official classification

Type B

Official code

87555(b)(8)

Regulation authority

CCR

What the official deficiency says

This requirement is not met as evidenced by: Deficient Practice Statement (8) All food shall be of good quality. Commercial foods shall be approved by appropriate federal, state and local authorities. Food in damaged containers shall not be accepted, used or retained. This requirement is not met as evidenced by: Based on observation, multiple food was observed to be expired and/or spoiled,which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/22/2025 Plan of Correction Administrator immediately disposed of the expired and/or spoiled food.

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 2 out of 2 areas were observed with unlocked chemicals which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/06/2024 Plan of Correction Staff locked chemicals during inspection.

Official classification

Type A

Official code

87465(h)(2)

Regulation authority

CCR

What the official deficiency says

(h) The following requirements shall apply to medications which are centrally stored: (2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and interview, the licensee did not comply with the section cited above in 1out of 1 residents medication was observed unlocked in the kitchen refrigerator which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/06/2024 Plan of Correction Staff removed medication and locked it. Licensee agrees to purchase a separate refrigerator for medication that will be locked.

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 out of 2 window screens were missing from resident bedroom and kitchen which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/19/2024 Plan of Correction Licensee agrees to purchase and replace missing window screens and submit proof of purchase by due date.

Official classification

Type B

Official code

87465(h)(1)

Regulation authority

CCR

What the official deficiency says

(h) The following requirements shall apply to medications which are centrally stored: (1) Medications shall be centrally stored under the following circumstances: 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 5 out of 5 medications were observed to be not logged in the Centrally Stored Medication and Destruction Record (CSMDR) which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/19/2024 Plan of Correction Licensee agrees to audit all medication and ensure all medication is logged into Centrally Stored Medication Log and complete in-service training and process of when medication should be logged.

Official classification

Type B

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 his/her 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 observation, interview and record review, the licensee did not comply with the section cited above in 5 out of 5 residents were missing Appraisal Needs and service plan which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/19/2024 Plan of Correction Licensee agrees to complete Appraisal needs and service plan for all residents and review regulations 87457 Pre-Admission Appraisal – General to be aware of documentation required at admission.

Official classification

Type A

Official code

87309(a)

Regulation authority

CCR

What the official deficiency says

87309 Storage Space (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: 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. LPA observed cleaning supplies/chemicals under the sick with a broken lock. and accessible to residents. LPA observed knives and others sharps as not locked and accessible to residents.

Official plan of correction

Chemicals will be removed from under the sink and placed somewhere locked and inaccessible to residents. POC completed today.

Deadline recorded: Feb 4, 2023. 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) 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. S1 was working in the facility and had worked two days, and was not associated to the facility, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/22/2022 Plan of Correction Licensee completed fingerprint transfer for S1 on Guardian website. POC cleared during inspection.

Official classification

Type A

Official code

87465(h)(2)

Regulation authority

CCR

What the official deficiency says

(h) The following requirements shall apply to medications which are centrally stored: (2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above. LPA found that the cabinet door, where centrally stored medication is kept, was unlocked and accessible, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/22/2022 Plan of Correction Licensee immediately locked the cabinet. POC cleared during the inspection.

Official classification

Type B

Official code

87224(d)

Regulation authority

CCR

What the official deficiency says

87224 Eviction Procedures (d) The licensee shall set forth in the notice to quit the reasons relied upon for the eviction with specific facts to permit determination of the date, place, witnesses, and circumstances concerning those reasons. This requirement is not met as evidenced by: LPA found that LIC did not issue proper eviction notice to R1. R1 was admitted to the hospital and upon hospital discharge, LIC admitted to refusing R1's return to the facility because R1 was positive for COVID-19 and did not want to infect the other residents. Facility submitted an approved mitigation plan to CCL on 2/25/21. This poses a potential personal rights risk to residents in care.

Official plan of correction

Licensee will submit proof of in-service training of mitigation plan LIC808 review for both Licensees to CCL by POC due date.

Deadline recorded: Feb 7, 2022. A deadline is not proof that correction was completed.