IZENE'S HAVEN ASSISTED LIVING

Official classification

Type A

Official code

87202(a)

Regulation authority

CCR

What the official deficiency says

87202 (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, the licensee did not comply with the section cited above when LPA and L1 observed facility exit 2 in master bedroom blocked with a plastic rod preventing sliding exit door to open, which an immediate health and safety risk which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/14/2026 Plan of Correction Licensee immediately removed the plastic rod. 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 and L1 observed an alcohol bottle unlock in next to R1’s bed unlock and accessible to the residents in care this poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/14/2026 Plan of Correction Licensee immediately locked chemical. POC cleared during visit.

Official classification

Type A

Official code

1569.618(c)(3)

Regulation authority

HSC

What the official deficiency says

HSC 1569.618 (c)(3) Ensure that at least one staff member who has cardiopulmonary resuscitation (CPR) training and first aid training is on duty and on the premises at all times. This paragraph shall not be construed to require staff to provide CPR. This requirement is not met as evidenced by: Deficient Practice Statement Based on records reviewed and interviews, 2 out of 4 staff do not have current First Aid and CPR certification, this poses an immediately health and safety risk for the residents in care.

Official plan of correction

POC Due Date: 05/14/2026 Plan of Correction Licensee shall ensure that all staff have current first aid certification and CPR certification. Proof of S2 and S3’s First Aid and CPR certification is to be submitted to the Fresno CCL by 05/14/26.

Official classification

Type B

Official code

87609(b)(4)

Regulation authority

CCR

What the official deficiency says

87609 (b)(4) The licensee and home health agency agree in writing on the responsibilities of the home health agency, and those of the licensee in caring for the resident’s medical condition(s). This requirement is not met as evidenced by: Deficient Practice Statement Based on record review and interview conducted, the licensee did not comply with the section cited above when LPA review R3 file, whose currently receiving home health with no home health care plan on file, which poses a potential health or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/19/2026 Plan of Correction Licensee will obtain R3’s home health record and submit it to Fresno CCL by POC due date 05/19/26.

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 receiving hospice care, R5 whose on home health, and R5 were observed with full rail bed with no 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: 05/15/2026 Plan of Correction Licensee shall obtain doctor orders for R2 who’s currently receiving hospice care that specific the need for full bed rails by POC due date. If full bed rail is not indicated by physician that is needed, full bed rail is to be removed by POC due date. R3 and R5 full rail beds is to removed by POC due date 05/15/26.

Official classification

Type B

Official code

87608(a)(3)

Regulation authority

CCR

What the official deficiency says

87608 (a)(3) A written order from a physician indicating the need for the postural support shall be maintained in the resident’s record. The licensing agency shall be authorized to require other additional documentation if needed to verify the order. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and records reviewed, half rail beds were observed for R1 and R4 with no 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: 05/19/2026 Plan of Correction Licensee will obtain doctor orders for R1 and R4 indicating the need for half bed rail if physician indicates the need for half bed rail or half rails will be removed by POC due date 05/19/26.

Official classification

Type B

Official code

87633(b)

Regulation authority

CCR

What the official deficiency says

87633(b) A current and complete hospice care plan shall be maintained in the facility for each hospice resident… 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 when LPA review R2’s file, whose currently receiving hospice care with no hospice care plan on file, which poses a potential health or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/22/2026 Plan of Correction Licensee will obtain R1’s hospice care plan and submit it to Fresno CCL by POC due date 05/22/26.

Official classification

Type B

Official code

87609(b)(4)

Regulation authority

CCR

What the official deficiency says

87609 (b)(4) The licensee and home health agency agree in writing on the responsibilities of the home health agency, and those of the licensee in caring for the resident’s medical condition(s). This requirement is not met as evidenced by: Deficient Practice Statement Based on record review and interview conducted, the licensee did not comply with the section cited above when LPA review R3’s file, whose currently receiving home health with no home health records and care plan on file, which poses a potential health or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/22/2026 Plan of Correction Licensee will obtain R3’s home health record and submit it to Fresno CCL by POC due date 05/22/26.

Official classification

Type B

Official code

87405(a)

Regulation authority

CCR

What the official deficiency says

87405(a) Administrator - Qualifications and Duties - All facilities shall have a qualified and currently certified administrator. This requirement is not met as evidenced by: Based on record review, Administrator/ Licensee does not have a valid and current Administrator certificate and has not have one since 2023. Administrator/Licensee appointed S1 who do not have current Administrator certificate, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Licensee state will assign an Administrator who has a current Administrator certificate. Once certified Administrator has been assigned, Licensee shall send request with required documents for Administrator change to the department shall be submitted to the Fresno CCL by the POC due date 08/04/25.

Deadline recorded: Aug 4, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87224(f)

Regulation authority

CCR

What the official deficiency says

87224 (f) A written report of any eviction shall be sent to the licensing agency within five (5) days. This requirement was not met as evidenced by: Based on record review and interview, the department was not notified of R1's 30 days eviction notice that was given to the resident on 05/12/25, this poses a potential health and safety risk to residents in care.

Official plan of correction

Licensee shall review Title 22 Regulation section 87224 regarding eviction procedures and submit in writing a plan to comply with this regulation. Plan to be submitted by POC date 05/21/25. R1’s eviction notice shall be submitted to the department.

Deadline recorded: May 21, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87211(a)(1)

Regulation authority

CCR

What the official deficiency says

87211(a) (1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below. This report shall include the resident's name, age, sex and date of admission; date and nature of event; attending physician's name, findings, and treatment, if any; and disposition of the case. This requirement was not met as evidenced by: Based on record review and interview, Licensee did not submit a written report to the department within 7 days of incident when R1 had went to the hospital on 01/06/25, 01/24/25, and 04/08/25, this poses a potential health and safety risk to residents in care.

Official plan of correction

Licensee agrees to submit a plan detailing steps the facility will take to ensure the requirements of Reporting requirements are met by the POC due date 05/26/25.

Deadline recorded: May 26, 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 observation and records reviewed, R1’s medications Lisinopril 20 mg and Clonidine Hcl 0.1 were not administered as directed by physician, which poses/posed an immediate health and safety risk for the person in care

Official plan of correction

POC Due Date: 05/21/2025 Plan of Correction Licensee shall submit documents of steps the facility will take to ensure facility meets the regulation to Fresno CCL office by POC due date 05/21/25.

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 S1 observed chemicals unlock 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: 05/21/2025 Plan of Correction Staff immediately locked chemicals. POC cleared during visit.

Official classification

Type B

Official code

1569.185(e)

Regulation authority

HSC

What the official deficiency says

HSC 1569.185(e) Fees for license or applications; use of revenues; collected; denial or forfeiture. The failure of an applicant for licensure or a licensee to pay all applicable and accrued fees and civil penalties shall constitute grounds for denial or forfeiture of a license. This requirement was not met by: Deficient Practice Statement Based on records reviewed and interview conducted, the Facility has overdue Annual and Late Fees, this is poses/posed potential health and safety risk to residents in care.

Official plan of correction

POC Due Date: 05/26/2025 Plan of Correction Licensee shall provide documents of annual fees have been renewed to CCL by due date 05/26/25.

Official classification

Type A

Official code

87405(d)(2)

Regulation authority

CCR

What the official deficiency says

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 purchase date of 06/06/23, which poses an immediate health and safety risk to the residents.

Official plan of correction

POC Due Date: 06/19/2024 Plan of Correction Fire extinguisher shall be replaced or serviced with a current date. Proof of correction will be submitted to the CCL office by POC due date 06/18/24.

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 reviewed and observation, all residents' MARS were reviewed, and all medications were audit, medications were not administered as directed by physician to 4 out of 5 resident, which poses an immediate health and safety risk for the person in care.

Official plan of correction

POC Due Date: 06/19/2024 Plan of Correction Licensee shall submit documentation of steps the facility will take to ensure facility meets the regulation to Fresno CCL office by POC due date 06/19/24. All staff in-service training shall be completed on Medications. Licensee will submit proof of training materials and staff attendance rooster to the Fresno CCL office by 07/01/24.

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 was observed with purchased date 04/10/22, which poses an immediate health and safety risk to the residents.

Official plan of correction

POC Due Date: 06/07/2023 Plan of Correction Licensee states fire extinguisher will be replaced or serviced with a current date. Proof of correction will be submitted to the CCL office by the 06/07/23.

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 observation, LPA reviewed all residents’ MARS and observed MARS was not initialed after medications was administered to residents. MARS was observed not initialed after medication administered for date 05/30/23 for 2 residents, date 05/31/23 for 4 residents, and date 06/06/23 AM for 4 residents. This is a potential health and safety risk for the residents in care.

Official plan of correction

POC Due Date: 06/19/2023 Plan of Correction Licensee will submit documentation of staff training with staff rooster of attendance for training. Training shall include completing resident’s MARs after each medication is administered to the residents. Documentation and rooster shall be submitted to CCL by the POC due date of 6/19/23.

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 interview and record review, the licensee did not comply with the section cited above when 1 out of 1 personnel did not have a health screen within in 7 days after employment which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/06/2022 Plan of Correction Licensee agreed to have S1 obtain a health screen and will provide proof that S1 obtained a health screen to the Fresno CCL office by the POC due date.

Official classification

Type B

Official code

87755(c)

Regulation authority

CCR

What the official deficiency says

Inspection Authority of the Licensing Agency (c) The Licensee shall have the authority to inspect, audit, and copy resident or facility records upon demand during normal business hours..**This requirement was not met as evidenced by Licensee not responding to a request for audit from Licensing. This poses a potential risk to residents in care.

Official plan of correction

Licensee will submit the records requested, to Licensing, by the POC due date.

Deadline recorded: Mar 4, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87407(a)

Regulation authority

CCR

What the official deficiency says

Administrator Recertification Requirements (a) Administrators shall complete at least forty (40 classroom hours of continuing education during each two (2)-year ceritication period...**This requirement was not met as evidenced by Licensee not having a current Administrator certificate. This poses a potential risk to residents in care.

Official plan of correction

Licensee will submit proof of current certification by the date or will appoint a qualified administrator who holds a current certification and shall submit a request to change the administrator, along with qualifying documents to make that change.

Deadline recorded: Mar 4, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87608(a)(3)

Regulation authority

CCR

What the official deficiency says

Postural Supports. A written order from a physician indicating the need for postural support shall be maintained in the resident’s record. **There is no Physician's order on file for R1's full bedrails. Immediate risk to resident in care.

Official plan of correction

By tomorrow's due date, Licensee will submit a Physician's order for the bed rails or submit proof that the rails were removed from R1's bed. Proof may be a picture.

Deadline recorded: Feb 17, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87611(b)

Regulation authority

CCR

What the official deficiency says

General Requirements for Allowable Health Conditions (b) The licensee shall complete and maintain a current, written record of care for each resident that includes, but is not limited to, the following: (1)Documentation from the physician of the following: (A) Stability of the medical condition(s); (B) Medical condition(s) which require incidental medical services; (C) Method of intervention; (D) Resident's ability to perform the procedure; and (E) An appropriately skilled professional shall be identified who will perform the procedure if the resident needs assistance. (2) The names, address and telephone number of vendors, if any, and all appropriately skilled professionals providing services. (3) Emergency contacts. **R2 was observed to have a colostomy bag and catheter and no plan of care for these were on file. Immediate risk to resident in care.

Official plan of correction

By tomorrow's due date, Licensee will submit a Plan of Care for R1, that includes the required elements as listed herein.

Deadline recorded: Feb 1, 333. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87755(c)

Regulation authority

CCR

What the official deficiency says

87755 Inspection Authority of the Licensing Agency (c) The licensing agency shall have the authority to inspect, audit, and copy resident or facility records upon demand during normal business hours. Records may be removed if necessary for copying. Removal of records shall be subject to the requirements in Sections 87412(f), 87506(d), and 87508(b). This requirement was not met evidenced by: Licensee did not respond to request for audit from Licensing which poses a potential health, safety and personal rights risk to residents in care.

Official plan of correction

Plan of Correction POC - LPA will provide licensee with copy of CCLD's request for audit documentation by 01/12/2022. Licensee agrees to submit documenation requested by Auditor by POC date.

Deadline recorded: Jan 24, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87407(a)

Regulation authority

CCR

What the official deficiency says

87407 Administrator Recertification Requirements (a) Administrators shall complete at least forty (40) classroom hours of continuing education during each two (2)-year certification period, including. This requirement was not met as evidenced by: Licensee does not have a current Administrator certificate which poses a potential health, safety and personal rights risk to residents in care.

Official plan of correction

Plan of Correction POC Licensee agrees to complete Administrator certification by POC due date.

Deadline recorded: Jan 24, 2022. A deadline is not proof that correction was completed.