BLUE PEARL HOME CARE II

Official classification

Type A

Official code

87309(a)

Regulation authority

CCR

What the official deficiency says

87309(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 when LPA and S1 observed at 11:22AM, S2’s medications unlocked in staff room. At 11:32AM, LPA and S1 observed laundry liquid fabric softener and S2’s medication bottle unlocked in the garage, accessible to residents in care this poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/18/2026 Plan of Correction Staff immediately locked staff medications and chemical bottle. POC cleared during visit.

Official classification

Type A

Official code

87465(c)(2)

Regulation authority

CCR

What the official deficiency says

87465(c)(2) Once ordered by the physician the medication is given according to the physician's directions. This requirement was not met as evidenced by: Deficient Practice Statement Based on interviews conducted, observation and records reviewed, R1’s medications Vitamin D3 was not administered on 02/17/26 in the morning. R1’s medication Mucus Relief was not administered on 02/16/26 in the evening and not administered on 02/17/26 in the morning. 2 out 11 of R1’s medications were not administered as prescribed by physician, which poses/posed an immediate health and safety risk for the person in care.

Official plan of correction

POC Due Date: 02/18/2026 Plan of Correction Licensee shall submit documents of steps the facility will take to ensure facility meets the regulation which will include medication audit, reviewing medication, and training to Fresno CCL office by POC due date 02/18/26. Licensee shall have all staff in-service training on medications regulations. Licensee will submit documentation of training topics including training date, training materials, training instructor name, and staff attendance rooster to the Fresno CCL office by 3/02/26.

Official classification

Type B

Official code

87608(a)(5)(B)

Regulation authority

CCR

What the official deficiency says

87608(a)(5)(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 and records reviewed, R2 is not hospice care and is using a hospital bed with full rail with doctor’s order, which poses/posed a potential health and safety and personal rights risk to the resident in care.

Official plan of correction

POC Due Date: 02/18/2026 Plan of Correction Staff removed full bed rails during inspection. POC cleared during visit.

Official classification

Type B

Official code

87612(a)(2)

Regulation authority

CCR

What the official deficiency says

87612 (a)(2) The licensee may provide care for residents who have any of the following restricted health conditions, (2) Catheter care as specified in Section 87623. This requirement is not met as evidenced by: Deficient Practice Statement Based on interview conducted, observation, and records reviewed, R1 has a restricted health conditions with no restricted health condition care plan on file or in placed, poses/posed a potential health and safety and personal rights risk to the resident in care.

Official plan of correction

POC Due Date: 03/06/2026 Plan of Correction The facility will obtain Restricted Health Condition care plan Foley Catheter for R1 that includes staff training if required staff care by POC due date. Care plan and staff trainings will be submitted to the Fresno CCL by POC due date 03/06/25.

Official classification

Type A

Official code

87309(a)

Regulation authority

CCR

What the official deficiency says

87309(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 when LPA, Licensee and S1 observed at 1:40PM, knives stored in kitchen drawer next to the stove unlock. Laundry detergent bottle and two cleaning chemical bottle was observed on top of the dryer in the laundry room unlock. A bottle of bleach was observed on the inside the garage on the side wall unlock. Tools were observed in kitchen drawer under kitchen counter by the medication shelf unlocked and accessible to residents in care this poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/04/2025 Plan of Correction Licensee immediately locked knife drawer. Staff immediately removed chemicals and tools to lock cabinet in laundry room. POC cleared during visit.

Official classification

Type A

Official code

87405(d)(2)

Regulation authority

CCR

What the official deficiency says

87405(d)(2) Administrator-Qualifications and Duties. The administrator shall have the knowledge of and ability to conform to applicable laws, rules and regulations. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, Fire Extinguisher has a last purchase date of 01/29/24, which poses an immediate health and safety risk to the residents.

Official plan of correction

POC Due Date: 03/04/2025 Plan of Correction All fire extinguishers shall be replaced or serviced with a current date. Proof of correction will be submitted to the CCL office by POC due date 03/04/25.

Official classification

Type A

Official code

87465(c)(2)

Regulation authority

CCR

What the official deficiency says

87465(c)(2) Once ordered by the physician the medication is given according to the physician's directions. This requirement was not met as evidenced by: Deficient Practice Statement Based on interviews conducted, observation and records reviewed, R1’s medication Duloxetine 60 mg, Amlodipine Besylate 10mg, and Gabapentin 300mg were not administered as prescribed by physician. R2’s medication Fluoxetine Hcl 20mg, Levothyroxine 50mcg, Melatonin 5mg, Mirtazapine 15 mg, Hydroxyzine Hcl 25mg, Atorvastatin 10mg, Escitalopram 10mg, Fluticasone HFA 110mcg, Furosemide 20 mg, and Spironolactone 25mg were not administered as prescribed by physician for which poses an immediate health and safety risk for the person in care.

Official plan of correction

POC Due Date: 03/04/2025 Plan of Correction Licensee shall submit documents of steps the facility will take to ensure facility meets the regulation which will include medication audit, reviewing medication, and training to Fresno CCL office by POC due date 03/04/25. Licensee will have all staff in-service trainings on medications regulations. Licensee will submit documentation of training topics including training date, training materials, training instructor name, and staff attendance rooster to the Fresno CCL office by 3/17/25.

Official classification

Type A

Official code

87465(d)(3)

Regulation authority

CCR

What the official deficiency says

87465(d)(3) The date and time …medication was taken, the dosage taken, and the resident’s response shall be documented and maintained in the resident’s facility record. This requirement was not met as evidenced by: Deficient Practice Statement Based on interviews conducted, observation, records reviewed, R1’s medication Hydrocodone/ Apap 10/325 mg was not record in the R1’s MAR. R1’s medication Risperidone 25mg, Clopidogrel 75mg were administered on 03/01/25 and 03/02/25, staff did not record on MAR. R2’s medication Atorvastatin 10mg, Melatonin 5mg, and Mirtazapine 15mg were administered on 03/01/25 and 03/02/25, staff did not record on MAR. R2’s medication Fluoxetine Hcl 20mg, Levothyroxine 50mcg, Losartan Potassium 50mg, and Triamcinolone 0.1% cream were administered on 03/02/25, staff did not record on MAR for which poses an immediate health and safety risk for the person in care.

Official plan of correction

POC Due Date: 03/04/2025 Plan of Correction Licensee will ensure to record all medications on resident’s MARs and record when medications are administered. A written statement of steps facility will take to ensure to record each time medications is administered and R1’s medication Hydrocodone/Apap 10/325 mg recorded on R1’s MARs will be submitted to the Fresno CCL by POC due date 03/04/25.

Official classification

Type A

Official code

87608(a)(5)(B)

Regulation authority

CCR

What the official deficiency says

87608(a)(5)(B) Based on the individual's preadmission appraisal, and subsequent changes to that appraisal, the facility shall provide assistance and care for the resident in those activities of daily living which the resident is unable to do for himself/herself. Postural supports may be used under the following conditions. (5) Under no circumstances shall postural supports include tying, depriving, or limiting the use of a resident's hands or feet. (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 interview conducted and observation, R1 has a full rail bed with no exception granted by the department and no physician order, which poses an immediate health and safety risk to the residents

Official plan of correction

POC Due Date: 03/04/2025 Plan of Correction Licensee agrees submit exception request for full rail bed for R1. Licensee removed full rail from R1's bed. Full rail shall not be used until an exception request is granted by Fresno CCL. POC cleared during visit.

Official classification

Type A

Official code

87465(h)(6)

Regulation authority

CCR

What the official deficiency says

87465 (h)(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… This requirement was not met as evidenced by: Deficient Practice Statement Based on records review and interview conducted, R1’s medication Losartan 50mg bottle filled on 08/28/24 was observed in the resident’s medication basket not recorded in the Centrally Stored Medication Record (Lic 622) which poses/posed a potential health and safety risk for the person in care.

Official plan of correction

POC Due Date: 03/04/2025 Plan of Correction Licensee will ensure to record all resident’s centrally stored medication in the Lic 622. R1’s medication Losartan 50mg bottled filled on 08/28/24 will be recorded in R1’s Lic 622 and submitted to Fresno CCL POC due date 03/04/25.

Official classification

Type A

Official code

87309(a)

Regulation authority

CCR

What the official deficiency says

87309(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 when LPA and A1 observed cleaning chemicals and gardening tools in the garage stored unlocked accessible to residents in care this poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/15/2024 Plan of Correction Staff immediately removed chemicals to lock shelf and gardening tools off the premises. POC cleared during visit.

Official classification

Type A

Official code

87465(a)(5)

Regulation authority

CCR

What the official deficiency says

Incidental Medical and Dental Care The licensee shall assist residents with self-administered medications as needed. This requirement was not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above when LPA and Licensee reviewed all the residents’ medications and observed multiple medications were not accounted for which poses an immediate health and safety risks to persons in care.

Official plan of correction

POC Due Date: 03/15/2024 Plan of Correction Licensee shall submit a written statement on how Licensee will ensure staff are administering medications as prescribed by POC due date 03/15/24. Licensee shall have all staff retrained in an in-service training on administering medication. Training materials and rooster of staff attendance will be submitted to department by 03/27/23.

Official classification

Type B

Official code

87465(h)(6)

Regulation authority

CCR

What the official deficiency says

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… This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above when resident’s medication and MARs was reviewed and observed medications were not logged into residents’ Centrally store medication log, which poses a potential health, safety or personal rights risk to person in care.

Official plan of correction

POC Due Date: 03/27/2024 Plan of Correction In-service training for all staff shall be completed on documentation of medications. Training materials and rooster of staff attendances shall be submitted to the department by POC due date 03/27/24.

Official classification

Type A

Official code

87309(a)

Regulation authority

CCR

What the official deficiency says

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 when LPA and Licensee observed knives stored in drawer unlocked, two laundry detergent stored in unlocked cabinet in laundry room, and multiple paint cans next to a bottle of bug spray in garage unlocked. The knives and chemicals were unlocked and accessible to residents in care this poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/07/2023 Plan of Correction Licensee immediately locked the shelf where knives were stored and removed chemcials into locked shelf. POC cleared during visit.

Official classification

Type B

Official code

87156(a)

Regulation authority

CCR

What the official deficiency says

An applicant or licensee shall be charged fees as specified in Health and Safety Code section 1569.185…(a)An application fee adjusted by facility and capacity shall be charged by the department for the issuance of a license to operate a residential care facility for the elderly. After initial licensure, a fee shall be charged by the department annually on each anniversary of the effective date of the license. This requirement is not met as evidenced by: Deficient Practice Statement The facility annual fee is overdue with a past due amount of $1,237.00. This is poses potential health and safety risk to residents in care.

Official plan of correction

POC Due Date: 02/20/2023 Plan of Correction Licensee shall provide documents of annual fees have been renewed to CCL by due date 2/20/23.

Official classification

Type A

Official code

87616(a)(2)

Regulation authority

CCR

What the official deficiency says

87616 Exceptions for Health Conditions (b) Written requests shall include, but are not limited to, the following: (2) The licensee's plan for ensuring that the resident's health related needs can be met by the facility. This requirement was not met as evidenced by LPA's records review and interviews. Facility did not request an exception for a prohibited condition for R1 while R1 was receiving Home Health Care services at the time of admission.

Official plan of correction

Licensee obtained and provided LPA with a Hospice Care Plan for R1 at the time of visit today, therefore, no exception is needed at this time. LPA printed a copy of the cited regulation to Licensee (L1) during the visit. LPA and L1 reviewed and discussed regulation requirements. LPA obtained a dated signature from licensee verifying the regulation is understood. **POC Cleared**

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