TLC HOME CARE 1

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 door from the dining room into the laundry room was locked and the laundry room, leads to the staff office, which is a fire exit (Exit #3 on the sketch), which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/09/2026 Plan of Correction Licensee removed the locked door to allow access to exit #3. A RepeatCivil Penalty was assessed and issued. POC corrected during visit.

Official classification

Type A

Official code

87465(a)(4)

Regulation authority

CCR

What the official deficiency says

(4) The licensee shall assist residents with self-administered medications as needed. 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 the start date for R1's Losartan medication was on 12/18/25. Started with 30 pills, has eight pills left. Medication Hydrochlorothiazide has the same start date of 12/18/25 and started with 30 pills; however, has nine pills left. Both medications are administered in the morning according the MARs log. Hydrochlorothiazide medication was not administered, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/09/2026 Plan of Correction Licensee will schedule medication training for staff and provide an agenda to CCL by POC due date of 01/09/26

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, interview, and record review, the licensee did not comply with the section cited above in that Insulin medication was stored in a a lock box with no lock in a fridge in the garage. The garage is also kept unlocked, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/09/2026 Plan of Correction Licensee obtained a lock for the lock box to secure the insulin medication. A civil penalty was assessed and issued for repeat violation. POC corrected during this visit.

Official classification

Type B

Official code

87465(a)(6)

Regulation authority

CCR

What the official deficiency says

(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 is not met as evidenced by: Deficient Practice Statement Based on observation, interview, and record revidew, the licensee did not comply with the section cited above in that facility staff did not log on the centrally stored log, R1's medication of Doxazosinmesylate,which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/09/2026 Plan of Correction Licensee stated that a training will be conducted on logging centrally stored medication. Licensee will schedule training and provide proof once training is completed.

Official classification

Type B

Official code

87623(b)(B)

Regulation authority

CCR

What the official deficiency says

(b)In addtion to section 87611, Gerneral requirements for allowable health conditions, the licensee shall be responsible for the following:(B) There shall be written documentation by an appropriately skilled professional outlining the instruction of the procedures delegated and the names of the facility staff who have been instructed. 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 the facility staff do not have training by skilled professional for R2's restricted health condition, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/15/2026 Plan of Correction Licensee will obtain traning for all staf for R2's restricted health condition and provide proof to CCL by POC due date of 1/15/26.

Official classification

Type B

Official code

87464

Regulation authority

CCR

What the official deficiency says

(d) A facility need not accept a particular resident for care. However, if a facility chooses to accept a particular resident for care, the facility shall be responsible for meeting the resident's needs as identified in the pre-admission appraisal specified in Section 87457, Pre-admission Appraisal and providing the other basic services specified below, either directly or through outside resources. 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 the hospice care plan for R1 indicates to record blood pressure readings and provide guidance for elavated readings on when to seek medical attention;however, Facility staff are not recording blood pressure readings for R1 and were not trained on when the reading would require medical attention, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/15/2026 Plan of Correction Licensee agrees to submit a plan on how staff will meet R1's needs and obtain training from hospice, and submit copies of training for each staff by POC due date of 1/15/2026.

Official classification

Type A

Official code

87568.1(a)(13)

Regulation authority

CCR

What the official deficiency says

(a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (13) To have access to individual storage space for private use. 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 the licensee used a second bed to block R3's closet, to keeep R3 from accessing the closet space, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/09/2026 Plan of Correction Licensee removed the additional bed from R3's bedroom to allow R3 acess to their closet space.

Official classification

Type A

Official code

87203

Regulation authority

CCR

What the official deficiency says

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 that the fire extinguiser was last serviced on 09/17/2024,which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/09/2026 Plan of Correction Licensee stated that a fire extinguisher will be serviced tomorrow and will provide proof to CCL by POC due date of 1/09/2026.

Official classification

Type B

Official code

87633(a)(4)

Regulation authority

CCR

What the official deficiency says

87633 Hospice Care of Terminally Ill Residents (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 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 R3 and R4 do not have a hospice care plan on file, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/15/2026 Plan of Correction Licensee stated that a copy of the hospice care plans will be requested and placed residents file by POC due date of 1/15/26.

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 count fire department, or district providing the fire protection services, or the State Fire Marshal. ***This was not met as evidenced by 3 of the 4 designated exits from resident rooms were locked requiring key to exit.

Official plan of correction

Licensee to change locks to open from interior of bedrooms. Licensee to submit plan of correction to department by due date. IMMEDIATE CIVIL PENALTY ASSESSED

Deadline recorded: Oct 16, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87355(e)(3)

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(3) Request a transfer of a criminal record clearance as specified in Section 87355(c) or : **This was not met as evidenced by Staff 1 (S1) is fingerprint cleared and not associated to facility. S1 has worked daily since 10/10/25 for a total of 5 days.

Official plan of correction

Licensee to submit LIC 9182 to department and associate S1 to facility and submit plan of correction to department by due date. IMMEDIATE CIVIL PENALTY ASSESSED

Deadline recorded: Oct 16, 2025. 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

(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 was not met as evidenced by LPAs observed a clear bin with S2's medication in the kitchen unsecured. Medication for R1 in the refrigerator unsecured and cabinet under kitchen sink with cleaning supplies unlocked. All accessible to residents.

Official plan of correction

S2 secured medication in locked staff room and R1's family removed medication to keep at home during visit. Staff also locked cabinet under sink. DEFICIENCY CLEARED AT TIME OF VISIT. ,

Deadline recorded: Oct 16, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87705(d)

Regulation authority

CCR

What the official deficiency says

(d) The licensee shall ensure that the facility has an auditory device or other staff alert feature to monitor exits on exterior doors and perimeter fence gates accessible to those residents who may be at risk for elopement, as defined in Section 87101, Definitions. ***This was not met as evidenced by: LPA's observed that the front door auditory alarm was in place but not in the " on " position upon arrival. Four of four exit doors from resident bedrooms did not have auditory alarms, and the sliding door to back yard had an auditory alarm that was not " on " during inspection.

Official plan of correction

Licensee/Administrator to add auditory alarms to all exit doors and keep them on. All auditory alarms must remain " on " at all times. Plan of correction to be submitted to Fresno Regional office by due date.

Deadline recorded: Oct 16, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(h)(2)

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: (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. Licensee did not ensure resident medications were stored as required. Medication box was observed on a kitchen table and Insulin was found to be refrigerated when orders state at room temp after opening. This poses a potential health and safety risk to residents in care.

Official plan of correction

AD has agreed to submit a written statement which will include the staff training plan related to medication storage. A in-service sign in sheet and copy of training materials will be sumbmitted after completion of training. Statement will be submitted via email to CCL by POC date.

Deadline recorded: Apr 10, 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..... 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: Licensee did not ensure: Patio area was unsafe and cluttered, side yard storage which stores tools was unlocked, multiple piles of trash and construction materials in the yard, shower mat was not clean, sharps storage was unsafe for staff. This poses a potential health & safety risk to residents in care.

Official plan of correction

AD has agreed to schedule a video call with LPA to show that the items listed have been adressed, cleaned or replaced as required. The video call will be scheduled and completed prior to POC date.

Deadline recorded: Apr 16, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(a)(5)

Regulation authority

CCR

What the official deficiency says

(5) Facility staff, except those authorized by law, shall not administer injections, but staff designated by the licensee may assist persons with self-administration as needed. Assistance with self-administered medications shall be limited to the following: 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, which poses an immediate health, safety or personal rights risk to persons in care. LPA observed S1 administer an Insulin Injection for R3.

Official plan of correction

POC Due Date: 01/29/2025 Plan of Correction Licensee has agreed to immediately assign a facility LVN to assist R3 with Insulin injections until updated physician orders and Physicians report to obtained. A writen statement will be faxed to CCL which explains the plan to meet the needs of R3 relating to Insulina dn Diabetes management. The statement will be faxed by poc date

Official classification

Type A

Official code

87758(a)

Regulation authority

CCR

What the official deficiency says

87758 Serious Deficiencies – Examples (a) Regulations including but not limited to the following may result in serious deficiencies when a failure to comply presents an immediate or substantial threat to the physical health, mental health, or safety of the residents: (2) Section 87202 relating to fire clearance. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and intervie, the licensee did not comply with the section cited above, which poses an immediate health, safety or personal rights risk to persons in care. Licensee has altered the facility building by adding exit doors to each resident room without proper fire clearance or pcity permits. Two of the newly added doors are completely blocked by resident beds and a third is obstructed by forniture and resident bed. The fire marshall or licensing were not informed.

Official plan of correction

POC Due Date: 01/29/2025 Plan of Correction Licensee has agreed to rearrange the 3 resident rooms to comply with fire clearance access to exits. The fire Marshall will be contacted and notified of the facility alterations and CCL will be notified in writing of the plan moving forward to obtain proper clearance.

Official classification

Type B

Official code

87411(f)

Regulation authority

CCR

What the official deficiency says

(f) All personnel, including the licensee and administrator, shall be in good health, and physically and mentally capable of performing assigned tasks. Good physical health shall be verified by a health screening, including a chest x-ray or an intradermal test, performed by a physician not more than six (6) months prior to or seven (7) days after employment or licensure. A report shall be made of each screening, signed by the examining physician. The report shall indicate whether the person is physically qualified to perform the duties to be assigned, and whether he/she has any health condition that would create a hazard to him/herself, other staff members or residents. A signed statement shall be obtained from each volunteer affirming that he/she is in good health. Personnel with evidence of physical illness or emotional instability that poses a significant threat to the well-being of residents shall be relieved of their duties. This requirement is not met as evidenced by: Deficient Practice Statement Based on observations, interview, records review, the licensee did not comply with the section cited above in two out of two staff not having current health assessments, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/14/2022 Plan of Correction Licensee will submit proof of health screenings for S1 and S2 to CCL by POC due date.

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 observations and interview, the licensee did not comply with the section cited above. LPA observed the complete grass area in backyard to be covered in dog feces and observed there were 3 dogs present on the facility premises, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/14/2022 Plan of Correction Licensee will submit proof of receipt of service to clean dog feces from backyard from landscaper to CCL by POC due date.

Official classification

Type B

Official code

1569.625(b)(1)

Regulation authority

HSC

What the official deficiency says

(1) The department shall adopt regulations to require staff members of residential care facilities for the elderly who assist residents with personal activities of daily living to receive appropriate training. This training shall consist of 40 hours of training. A staff member shall complete 20 hours, including six hours specific to dementia care, as required by subdivision (a) of Section 1569.626 and four hours specific to postural supports, restricted health conditions, and hospice care, as required by subdivision (a) of Section 1569.696, before working independently with residents. The remaining 20 hours shall include six hours specific to dementia care and shall be completed within the first four weeks of employment. The training coursework may utilize various methods of instruction, including, but not limited to, lectures, instructional videos, and interactive online courses. The additional 16 hours shall be hands-on training. This requirement is not met as evidenced by: Deficient Practice Statement Based on interview and records review, the licensee did not comply with the section cited above in two out of two staff. S1 and S2 started working on 1/1/22 and have only received 10.5 training hours, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/14/2022 Plan of Correction Licensee will submit proof of a total of 40 hours of initial training for S1 and S2 to CCL by POC due date.

Official classification

Type B

Official code

87608(a)(5)(B)

Regulation authority

CCR

What the official deficiency says

(B) Bed rails that extend the entire length of the bed are prohibited except for residents who are currently receiving hospice care and have a hospice care plan that specifies the need for full bed rails. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview, and records review, the licensee did not comply with the section cited above. R1 has full length bed rails, but R1 is not on hospice and facility does not have an approved exception on file for R1, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/14/2022 Plan of Correction Licensee will submit an exception request for approval of full length bed rails for R1 by POC due date.

Official classification

Type A

Official code

87303(e)(2)

Regulation authority

CCR

What the official deficiency says

87303 Maintenance and Operation (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 degree C) and not more than 120 degree F (49 degree C). This requirement is not met as evidenced by: Deficient Practice Statement Based on observations, the licensee did not comply with the section cited above. LPA measured the hall bathroom hot water at 130.1 degrees F, which poses an immediate safety risk to persons in care.

Official plan of correction

POC Due Date: 02/01/2022 Plan of Correction Licensee will submit proof of hall bathroom hot water to measure within regulation to CCL by POC due date.