REAL CARE LLC

Official classification

Type B

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 no met as evidenced by: LPA reviewed the acetaminophen medication for the afternoon and four out of the five pills in the bubble pack should have been dispensed. The MARs was signed to show medication was administered; however, the medication remained in the bubble pack. Staff did not have documentation to indicate or state a reason why the medication was not dispensed to R1. The MARs for R1 also indicated that on 04/06/2026, R1 refused medication reason being is that R1 was asleep. Staff interviews revealed R1 was asleep during the medication pass and staff did not want to wake up R1, so a refusal was indicated in the MARs log, which poses a potential health and safety risk to persons in care.

Official plan of correction

Licensee agrees to review section 87465 and train staff on the requirements of section 87465. Licensee will submit a copy of training topics and attendance to the Fresno CCL office by the POC due date.

Deadline recorded: Aug 19, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87411(c)

Regulation authority

CCR

What the official deficiency says

87411 Personnel Requirements – General (c) All RCFE staff who assist residents with personal activities of daily living shall receive initial and annual training as specified in Health and Safety Code sections 1569.625 and 1569.69 This requirement was not met as evidenced by: Staff interviews revealed that staff were not fully trained and the facility did not have record of the initial and annual trainings for staff, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

Facility will ensure that all staff are fully trained and provide documentation to CCLD by POC due date of 08/03/2026.

Deadline recorded: Aug 3, 2026. A deadline is not proof that correction was completed.

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 fenced patio in memory care has an exit; however, the exit was secured closed with a padlock. In addition,the facility utilizes delayed egress in memory care; however, the facility does not have fire cleareance for delayed egress, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/29/2026 Plan of Correction Administrator stated that the lock will be removed from the fenced patio gate in memory care and will submit documents for fire clearance request to include delayed egress by POC due date of 05/29/2026. *** Civil Penalty was assessed.

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 the kitchen area was observed to have dead water bugs, multiple resident rooms were observed to have stained carpet, dirty toilets, and a strong urine odor, which posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/12/2026 Plan of Correction Administrator stated that a schedule will be implemented to include the resident rooms restrooms and kitchen area are cleaned more often. Administrator will provide proof that the indentified areas were cleaned and provide the new schedule to CCLD by POC due date of 06/12/2026

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

87303(a) Maintenance and Operation (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 was not met as evidenced by: LPA, LPM, and S1 observed R2's mattress linens to be stained. S1 stated that she sees the stains and can smell it too. The bedroom linens were stained and the bedroom had a urine odor, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

Facility agrees to train staff to ensure client bedrooms are maintained clean and odorless. The schedule and training completed to be submitted to CCLD by POC due date of 05/22/2026.

Deadline recorded: May 22, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87202(a)

Regulation authority

CCR

What the official deficiency says

87202 Fire Clearance (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. This requirement was not met as evidenced by: Based on observation and interview, the gate on Real Rd was observed secured closed with a chain and a lock. Another exit gate from the walkway on Chester Lane was observed with a lock; however, the gate was unlocked, this gate leads to another gate that exits to parking lot, the area between both gates was observed being utilized to store lawn and gardening supplies and tools.

Official plan of correction

The administrator agreed to make corrections and submit photographs of correction by POC due date.

Deadline recorded: Apr 3, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87307(e)(2)(A)

Regulation authority

CCR

What the official deficiency says

87307 Personal Accommodations and Services (e) The licensee shall supervise residents as needed and as determined by the resident's appraisal pursuant to Section 87457, Pre-Admission Appraisal or Section 87463, Reappraisals, when residents are in proximity to or when there is use of the following items: (2) Fishponds, wading pools, hot tubs, swimming pools, or similar larger bodies of water. (A) The licensee shall ensure that the bodies of water specified above are inaccessible through fencing, covering, or other means when not in active use by residents. This requirement was not met as evidenced by: Based on observation and interview, the four gates to the pool were observed unlocked and one gate was observed with the key inside the lock, making the pool accessible to residents.

Official plan of correction

The administrator agreed to make corrections and submit photographs of correction by POC due date.

Deadline recorded: Apr 3, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87309(a)

Regulation authority

CCR

What the official deficiency says

87309 Storage Space and Access (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 was not met as evidenced by: Based on observation and interview, exit gate from the walkway on Chester Lane was observed with a lock; however, the gate was unlocked, this gate leads to another gate that exits to parking lot, the area between both gates was observed being utilized to store plastic gasoline cans, lawn and gardening supplies and tools.

Official plan of correction

The administrator agreed to make corrections and submit photographs of correction by POC due date.

Deadline recorded: Apr 3, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87355(b)

Regulation authority

CCR

What the official deficiency says

87355 Criminal Record Clearance (b) Prior to the Department issuing a license, the applicant, administrator and any adults other than a client, residing in the facility shall have a criminal record clearance or exemption. This requirement was not met as evidenced by LPAs observation of two individuals not on the facility schedule as employees, had personal belongings in rooms 166 and 269 and staff reported that they reside there. A Civil Penalty in the ammount of $500 per individual for Criminal Record Clearance is here by assessed. If not corrected, the violation will have a direct and immediate risk to the health, safety, or personal righs of persons in care.

Official plan of correction

Administrator is immediately removing I1 & I2 from the property. I1 & I2 will not reside at the facility until a Livescan is completed and fingerprints are cleared.

Deadline recorded: Sep 26, 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

87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times... This requirement was not met as evidenced by LPA observed room 174 to be floaded and with an industrial fan to air out the room. LPAs also observed multiple resident rooms and hallways throughout the facility with dirty and/or stained carpet, toilets, and showers. In addition the kitchen tiles have dirt built up in the groute.

Official plan of correction

Administrator has completed a cleaning schedule and task binder to ensure facility remains clean. POC cleared during this visit.

Deadline recorded: Oct 2, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87211(a)(1)(D)

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... (D)Any incident which threatens the welfare, safety or health of any resident... This requirement was not met as evidenced by LPAs interview with R1, who stated went to the hospital on two occassions. A review of facility files, shows no incident was submitted for R1's hospital visit.

Official plan of correction

In addition, administrator stated they will provide training with staff on reporting requirements by POC due date of 10/02/2025.

Deadline recorded: Oct 2, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87355(a)

Regulation authority

CCR

What the official deficiency says

87355 Criminal Record Clearance (a) The Department shall conduct a criminal record review of all individuals specified in Health and Safety Code section 1569.17 and shall have the authority to approve or deny a facility license, or employment, residence, or presence in the facility, based upon the results of such review. This requirement was not met as evidenced by LPAs observed S1 to not be on the personnel roster and not finger print cleared. A Civil Penalty in the amount of $500 for Criminal Record Clearance is here by assessed. If not corrected, the violation will have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Official plan of correction

Administrator stated that she will contact S1 and advise that until a Criminal Background Clearance is completed and finger prints are completed, S1 is not to return to the facility.

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

Official classification

Type A

Official code

87618(b)(3)(E)

Regulation authority

CCR

What the official deficiency says

87618 Oxygen Administration - Gas and Liquid (b) In addition to Section 87611(b), the licensee shall be responsible for the following:(3) Ensuring that the use of oxygen equipment meets the following requirements: (E) Oxygen tanks that are not portable shall be secured in a stand or to the wall. This requirement was not met as evidenced by LPAs observation of 5 unsecured Oxygen tanks in Resident R2s room. If not corrected, the violation will have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Official plan of correction

Administrator stated that oxygen tanks not in use will be removed from the R2's room and the one's in use will be secured. Administrator stated that she will send photos to CCLD and email LPA J. Duarte of the secured oxygen tanks by 09/26/2025.

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

Official classification

Type A

Official code

87303(i)(1)(A)

Regulation authority

CCR

What the official deficiency says

87303 Maintenance and Operation (i) Facilities shall have signal systems which shall meet the following criteria:(1) All facilities licensed for 16 or more and all residential facilities having separate floors or buildings shall have a signal system which shall: (A) Operate from each resident's living unit. This requirement was not met as evidenced by LPAs observation of Resident R1 and R2 did not have a signal system. If not corrected, the violation will have a direct and immediate risk to the health, safety, or personal righs of persons in care.

Official plan of correction

Administrator assigned a call pendant to R1 and R2 and stated that all resident will be assigned a pendant by POC due date of 09/26/25.

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

Official classification

Type A

Official code

87618(b)(3)(F)

Regulation authority

CCR

What the official deficiency says

87618 Oxygen Administration - Gas and Liquid (b) In addition to Section 87611(b), the licensee shall be responsible for the following:(3) Ensuring that the use of oxygen equipment meets the following requirements:(F)Plastic tubing from the nasal canula or mask to the oxygen source shall be long enough to allow the resident movement within his/her room but does not constitute a hazard to the resident or others. R1 was observed in a wheelchair. The wheelchair wheels were observed to be rolling over the canula tube while moving around the room. The canula tube was observed to measure approximately 20 ft in length causing possible obstruction to oxygen flow.

Official plan of correction

Administrator stated that she will contact hospice to order a portable oxygen machine for R1. Administrator will email request to LPA J. Duarte by POC due date of 09/26/25.

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

Official classification

Type A

Official code

87465(h)(4)

Regulation authority

CCR

What the official deficiency says

87465(h)- The following requirements shall apply to medications which are centrally stored:(4) -All centrally stored medications shall be labeled and maintained in compliance with state and federal laws. No persons other than the dispensing pharmacist shall alter a prescription label. This requirement was not met as evidenced by: Licensee did not ensure prescription labels remained unaltered. LPAs observed the time for R1 to take a prescribed medication at noon was altered to indicate to take at 2 PM, which poses an immediate health, safety, and/or personal rights risk to resident in care.

Official plan of correction

Licensee agrees to submit an agenda and date training will be conducted by the pharmacy to LPA by POC due date (09/12/25).

Deadline recorded: Sep 12, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87202(a)

Regulation authority

CCR

What the official deficiency says

87202(a) - (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 was not met as evidenced by: Licensee did not ensure approved fire cleareance was maintained by attaching latch locks on the outside of the main builiding, on top of the door, locking residents in facility which poses an immediate health, safety, and/or personal rights risk to resident in care.

Official plan of correction

Licensee agrees to immediately remove outisde latch locks. POC was cleared during the visit. A Civil Penalty was issued.

Deadline recorded: Sep 11, 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

(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 did not ensure R1's medication were issued as prescribed. LPAs observed the Centrally stored medication log for R1 has a start date of 09/01/2025; however, medication bubble pack has a label indicating Date Opened is 09/05/25. Medication bubble pack shows eight pills out of 28 were administered for the evening and the bubble pack for the morning shows seven out of 28 were administered for the morning,which poses an immediate health, safety, and/or personal rights risk to resident in care.

Official plan of correction

Licensee agrees to submit an agenda and training date for admininstering medication to LPA by POC due date of 09/12/25.

Deadline recorded: Sep 12, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87465(a)(6)

Regulation authority

CCR

What the official deficiency says

(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: (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 ensure R1 and R2 had a centrally stored log for August of 2025, which poses a potential health, safety, and/or personal rights risk to residents in care.

Official plan of correction

Licensee agrees to conduct a training on centrally stored logs by POC due date of 09/25/2025.

Deadline recorded: Sep 25, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87633(a)(4)

Regulation authority

CCR

What the official deficiency says

(a)The licensee shall be permitted to accept or retain residents who have been diagnosed as terminally ill by his or her physician and surgeon and who may or may not have restrictive and/or prohibited health conditions, to reside in the facility and receive hospice services from a hospice agency in the facility when all of the following conditions are met:(4) A written hospice care plan which specifies the care, services, and necessary medical intervention related to the terminal illness as necessary to supplement the care and supervision provided by the facility is developed for each terminally ill resident or prospective resident by that resident’s hospice agency and agreed to by the licensee and the resident, or prospective resident, or the resident’s or prospective resident’s Health Care Surrogate Decision Maker, if any, prior to the initiation of hospice services in the facility for that resident, and all hospice care plans are fully implemented by the licensee and by the hospice(s). This requirement was not met as evidenced by: Licensee did not ensure R2 had a Hospice Care Plan, which poses a potential health, safety, and/or personal rights risk to residents in care.

Official plan of correction

Licensee agrees to submit a Hospice Care Plan for a resident that meets regulations to LPA by POC due date of 09/25/25.

Deadline recorded: Sep 25, 2025. A deadline is not proof that correction was completed.