DEVOTED HEARTS SENIOR CARE HOME LLC

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, observation, and records review, R2’s morning medications were not administered on 10/24/25 and R1’s medication Cinacalcet 30mg and Benazepril 40 mg as directed by physician, which poses an immediate health and safety risks to persons in care.

Official plan of correction

POC Due Date: 10/25/2025 Plan of Correction Licensee will review regulations and submit written statement detailing steps on how facility will meet regulations by POC due date 10/25/25. All staff will have in-service re-training on administering medications and medication documentation. Licensee will submit documentation of training which will include trainer’s information and staff attendance roster to the Fresno CCL office by POC due date 10/30/25.

Official classification

Type A

Official code

87465(h)(2)

Regulation authority

CCR

What the official deficiency says

87465(h)(2) Centrally stored medicines shall be kept in a safe and locked place... not accessible to persons other than employees... 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 R4’s medication pill planner filled with medication tablet unlock on the kitchen counter next to the stove, which poses an immediate health, safety or personal rights risk to person in care.

Official plan of correction

POC Due Date: 10/25/2025 Plan of Correction Staff immediately locked medications. POC cleared during visit.

Official classification

Type B

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 and includes: This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and record review, licensee did not comply with the section cited above when R3’s medication Citalopram HBR 20 mg was administered daily and not recorded in R3’s Centrally Stored Medication List (Lic 622), which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/25/2025 Plan of Correction Licensee recorded all R3’s medication into Lic 622 during visit. POC cleared during visit.

Official classification

Type B

Official code

87465(c)(3)

Regulation authority

CCR

What the official deficiency says

87465 (c)(3) A record of each dose is maintained in the resident's record. The record shall include the date and time the PRN medication was taken, the dosage taken, and the resident's response. This requirement is not met as evidenced by: Deficient Practice Statement Based on interviews and records reviewed, R1’s medication Multi-50 plus for Her vitamin was not record in the resident’s MAR. 4 out of 5 residents medications were administered on 10/24/25 in the morning and not recorded, which poses a potential health and safety risk for the person in care.

Official plan of correction

POC Due Date: 10/28/2025 Plan of Correction Licensee record all R1’s medications into the R1’s MARs during visit. Licensee will review regulations and submit written statement detailing steps on how facility will meet regulations by POC due date 10/28/25.

Official classification

Type A

Official code

87555(b)(8)

Regulation authority

CCR

What the official deficiency says

87555(b)(8) All food shall be of good quality. Commercial foods shall be approved by appropriate federal, state, and local authorities. Good in damaged containers shall not be accepted, used, or retained. This requirement is not met as evidenced by: Based on observation, expired nonperishable food was observed, poses/posed an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

Licensee immediately disposed expired food. POC cleared during visit.

Deadline recorded: Sep 10, 2025. A deadline is not proof that correction was completed.

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: Based on interviews, observation, and records review, R1 and R2’s morning medications were not administered on 09/09/25 as directed by physician, which poses an immediate health and safety risks to persons in care.

Official plan of correction

All staff will have in-service training which will also include administering medications and medication documentation. Licensee will submit documentation of training topics and staff attendance roster to the Fresno CCL office by POC due date 09/10/25.

Deadline recorded: Sep 10, 2025. A deadline is not proof that correction was completed.

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: Based on observation and records reviewed, R1 is receiving hospice care using hospital bed with full rail with doctor’s order for half rail, which poses/posed a potential health and safety and personal rights risk to the resident in care.

Official plan of correction

Full bed rails are prohibited. Licensee shall obtain doctor orders for R1 who’s currently receiving hospice care that specific the need for full bed rails and submitted to the Fresno CCL 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

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 records review and observation, staff did not administer 3 out of 4 medications for R1 as directed by physician and staff administered expired medication to R2, which poses an immediate health and safety risk for the person in care.

Official plan of correction

POC Due Date: 12/20/2024 Plan of Correction Licensee agree to write statement of steps facility will take to ensure regulations is met. Statement will be submitted to Fresno CCL by POC due date 12/20/24. Licensee shall have all staff retrained on medication training which include administering medications and review medications. Licensee will submit documentation of training topics with staff attendance rooster to the Fresno CCL office by 01/02/25.

Official classification

Type A

Official code

87465(h)(2)

Regulation authority

CCR

What the official deficiency says

87465(h)(2) Centrally stored medicines shall be kept in a safe and locked place... not accessible to persons other than employees... 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 medications unlock in room 1, room 2, and in the garage mini refrigerator, which poses an immediate health, safety or personal rights risk to person in care.

Official plan of correction

POC Due Date: 12/20/2024 Plan of Correction Licensee immediately removed the medications in room 1 and 2 and locked it in kitchen shelf. Licensee immediately lock garage mini refrigerator. POC cleared during visit.

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 observed cleaning supplies unlock under kitchen counter, staff closet, and in garage unlock 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: 12/20/2024 Plan of Correction L1 immediately removed chemicals off the premises. 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 and includes: This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and record review, licensee did not comply with the section cited above when R2’s Aller-zyrs Cetrizine 10 mg was not logged in centrally stored list which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/20/2024 Plan of Correction Licensee shall ensure that all resident’s medications that are centrally stored are record in the facility. Licensee to submit copies of Centrally Stored Medication Record (Lic 622) for R1 to CCL by POC due date 12/20/24.

Official classification

Type B

Official code

87465(i)

Regulation authority

CCR

What the official deficiency says

87465(i) Prescription medications which are not taken with the resident upon termination of services, not returned to the issuing pharmacy, nor retained in the facility as ordered by the resident’s physician and documented in the resident’s record nor disposed of according to the hospice’s established procedures or which are otherwise to be disposed of shall be destroyed in the facility by the facility administrator and one other adult who is not a resident. Both shall sign a record, to be retained for at least three years… This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, destructed medications for residents for former residents and current residents were observed stored under kitchen counter no processed to be disposed and destroyed, which poses a potential health, safety or personal rights risk to person in care

Official plan of correction

POC Due Date: 12/27/2024 Plan of Correction Licensee shall ensure that all medications being disposed shall be documented and destroyed according to procedures. Proof of disposed medications documented and destroy per procedure shall be submitted the department by POC due date 12/27/24.

Official classification

Type B

Official code

1796.45

Regulation authority

HSC

What the official deficiency says

HSC 1796.45 Affiliated home care aides hired on or after January 1, 2016, shall submit to an examination 90 days prior to employment, or within seven days after employment, to determine that the individual is free of active tuberculosis disease. This requirement is not met as evidenced by: Deficient Practice Statement Based on records review, S1 and S2 did not have a TB result on file which poses a potential risk to the health and safety of the residents.

Official plan of correction

POC Due Date: 01/08/2025 Plan of Correction Licensee shall ensure all staff have a TB result on file prior or within 7 days after employment. S1 and S2 TB result shall be submitted to the Fresno CCL office by POC due date 01/08/25.