MERCIE'S HOME #3

Official classification

Type A

Official code

87202(a)

Regulation authority

CCR

What the official deficiency says

(a) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, or the State Fire Marshal. Prior to accepting or retaining any of the following types of persons, the applicant or licensee shall notify the licensing agency and obtain an appropriate fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, or the State Fire Marshal: 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 that the kitchen door that leads to the laundry room has another door that leads to the patio. The laundry room door that leads to the patio was observed to have a latch at the top to secure the door closed. Administrator Adam Tauchen stated that staff advised that although the door is locked, it is able to be opened with a push, so the latch was put in place, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/11/2026 Plan of Correction Administrator immediately removed the latch to allow the door to be opened. Administrator Adam stated that he will get a quote to replace the door tomorrow and provide proof to CCLD by POC due date of 03/11/26. Once the door is replaced, administrator will provide proof.

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 and interview, the licensee did not comply with the section cited above in that LPA observed the exterior of the house paint peeling off, the gate on the west side of the residence is broken, patch up work is needed in the dining room and hallway entrance, bathroom ceiling is not completely painted, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/17/2026 Plan of Correction Administrataor stated that he will obtain quotes for the repairs needed and provide proof to CCLD. Once repairs are completed, administrator will provide proof.

Official classification

Type B

Official code

87506(b)(15)

Regulation authority

CCR

What the official deficiency says

(b) Each resident's record shall contain at least the following information: (15) The admission agreement and pre-admission appraisal, specified in Sections 87507, Admission Agreements and 87457, 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 in 4 out of 4 total count persons which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/26/2024 Plan of Correction Agreed to complete pre-appraisals and submit copies to the Department by POC due date of 4/26/2024.

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 record review, the licensee did not comply with the section cited above in 1 out of 4 persons which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/18/2024 Plan of Correction Agreed to contact Resident 2 physician and schedule an appointment. Licensee will contact the Department by POC due date 4/18/2024, with the scheduled appointment date

Official classification

Type B

Official code

87465(h)(6)

Regulation authority

CCR

What the official deficiency says

(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 was not met evident by: Based on LPA record review, 3 of 3 residents did not have a completed log between 8/2022 and 3/2023, which poses a potential health and safety risk to person's in care.

Official plan of correction

Administrator agreed to complete April 2023 Centrally Stored Logs with complete and accurate information for 3 residents. Administrator will submit logs to the Department by POC due date of 5/5/2023

Deadline recorded: May 5, 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, records review, the licensee did not comply with the section cited above. Staff on duty, S1, was found to be fingerprint cleared, but not associated to the facility and has been working since 5/12/21, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/29/2022 Plan of Correction Co-Administrator completed and submitted LIC9182 for S1. POC cleared during the inspection.

Official classification

Type B

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. First hall bathroom hot water tested at 100.4 degrees F and the second hall bathroom hot water tested at 102.5 degrees F, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/30/2022 Plan of Correction Co-Administrator will submit proof of hot water in first and second hall bathroom to be within range of 105-120 degrees F to CCL by POC due date.

Official classification

Type B

Official code

87555(b)(26)

Regulation authority

CCR

What the official deficiency says

(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 is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above. Supply of nonperishable foods of minimum of one week was not maintained in the facility, which poses a potential health or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/02/2022 Plan of Correction Co-Administrator will submit proof of receipt for purchase of nonperishable foods to CCL by POC due date.