HIGH DESERT HAVEN

Official classification

Type B

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. 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: Based on observation, interview, and record review the facility did not comply with the regulation listed abovedue to facility not notifying Licensing of changes made to fire clearance, which poses a potential health and safety risk to residents in care.

Official plan of correction

Administartor will provide proper documentation to Licensing by POC due date regarding changes in fire clearance.

Deadline recorded: Jul 31, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87307(a)

Regulation authority

CCR

What the official deficiency says

87307 Personal Accommodations and Services (a) Living accommodations and grounds shall be related to the facility's function. The facility shall be large enough to provide comfortable living accommodations and privacy for the residents, staff, and others who may reside in the facility. The following provisions shall apply: (2) Resident bedrooms shall be provided which meet, at a minimum, the following requirements: (C) No bedroom of a resident shall be used as a passageway to another room, bath or toilet. This requirement is not met as evidenced by: Based on observation, interview, and record, the facility did not comply with the regulation listed above due to R1 having to go into R2's bedroom to access the bathroom, which poses a potential health and safety risk to residents in care.

Official plan of correction

Administrator has moved R1 and R2 to indiviual rooms. This was verified during today's visit.

Deadline recorded: Jul 31, 2026. 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

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: (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: Based on observation, interview, and record, the facility did not comply with the regulation listed above due to R1's centerally stored medication log to not be completed correctly, which poses a potential health and safety risk to residents in care.

Official plan of correction

Administrator will conduct new staff training on meds and ceneranllt stored log. Statement will be provided indicating when training will be completed.

Deadline recorded: Jul 31, 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

(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 is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above in LPAs observed cleaning supplies, scissors, and lighter unlocked and accessible to facility residents, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

Administrator will reach out to doctor regarding physican report for R1. Inservice will be conducted. A statement will be provided to the Dept by POC due date explaining action to be taken to correct deficiency.

Deadline recorded: Jul 21, 2026. 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

(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: Based on LPA observation, the licensee did not comply with the section cited above due to R1 having Ibuprofen 200 mg, and Diclofenac Sodium 1% in night stand unlocked and accessible, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

Administrator will conduct in-service with staff. A statement will be provided to the Dept by POC due date explaining action to be taken to correct deficiency.

Deadline recorded: Jul 21, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87468.2

Regulation authority

CCR

What the official deficiency says

87468.2 Additional Personal Rights of Residents in Privately Operated Facilities (a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (4) To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs. This requirement is not met as evidenced by: Based on observation, interview, and record, the facility did not comply with the regulation listed above, which poses an Immediate health and safety risk to residents in care.

Official plan of correction

Facility will provide a statement regarding R2's needs being met and the possiblity of reassessing R2.

Deadline recorded: Jul 16, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87618(b)(3)(B)

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: (B) " No Smoking-Oxygen in Use " signs shall be posted in the appropriate areas. This requirement is not met as evidenced by: Based on observation, interview, and record, the facility did not comply with the regulation listed above, which poses an Immediate health and safety risk to residents in care.

Official plan of correction

During the visit facility posted a " No smoking- Oxygen in use " sign posted. POC cleared today.

Deadline recorded: Jul 20, 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

(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 is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above in LPA's observed cleaning supplies unlocked and accesible to facility residents, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/13/2026 Plan of Correction Administrator will conduct staff training on ensuring toxins, cleaning supplies, and chemicals are locked an inaccesible to residents.

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 LPA observation, the licensee did not comply with the section cited above in Resident 5 has multiple over the couner medications in bathroom vanity unlocked and accesible, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/13/2026 Plan of Correction Administrator will conduct training with facility staff on ensuring medications are locked and inaccesible to facility residents and submit to LPA by POC date of 05/13/2026.

Official classification

Type B

Official code

87465(h)

Regulation authority

CCR

What the official deficiency says

(h) The following requirements shall apply to medications which are centrally stored: 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 in Resident 5's Centrally Stored Medication record is not accurate, including resident name not listed, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/26/2026 Plan of Correction Administrator will audit Centrally Stored medication records and ensure all are correct forms, and re train medication technicians on Centrally Stored record documentation and submit proof to LPA by POC date of 05/26/2026.

Official classification

Type B

Official code

87506(b)(15)

Regulation authority

CCR

What the official deficiency says

(b) Each resident's record shall contain at least the following information: (15) The admission agreement and pre-admission appraisal, specified in Sections 87507, Admission Agreements and 87457, Pre-admission Appraisal. 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 in Resident 1 and 2's admission agreement does not have resident name listed, Resident 4's admission agreement does not have accurate monthly rate is not accurate, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/26/2026 Plan of Correction Administrator will re train staff on admissions, and audit admission paperwork and submit proof to LPA by POC date of 05/26/2026.

Official classification

Type B

Official code

87463(a)

Regulation authority

CCR

What the official deficiency says

(a) The pre-admission appraisal, as specified in Section 87457, Pre-Admission Appraisal, shall be updated, in writing as frequently as necessary or once every 12 months, whichever occurs first, to note significant changes in condition, as defined in Section 87101, Definitions, and to keep the appraisal accurate. For the purposes of this section, the updated pre-admission appraisal shall be referred to as the reappraisal. 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 in Resident 3's Needs and Services plan is not completed, updated annually as required, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/26/2026 Plan of Correction Administrator will audit resident needs and services, and re train staff on admissions, and submit proof to LPA by POC date of 05/26/2026.

Official classification

Type B

Official code

87468.2(a)(20)

Regulation authority

CCR

What the official deficiency says

Personal Rights of Residents in Privately Operated Facilities (a) In addition to the rights listed in Section 87468.1…residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (20)To be protected from involuntary transfers, discharges, and evictions. A licensee shall not involuntarily transfer or evict residents for reasons other than those permitted by state law or regulations and shall comply with all eviction and relocation protections for residents… This requirement was not met as evidenced by: Based on interviews and record review, the Licensee did not comply with section 87468.2 when facility staff transferred R1 to a hospital and refused to accept R1 back once R1 was discharged, which is a potential health and safety risk to residents in care.

Official plan of correction

Licensee agrees to conduct a staff training on resident's personal rights by POC due date 02/13/26.

Deadline recorded: Mar 13, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87457(c)(1)(A)

Regulation authority

CCR

What the official deficiency says

87457 Pre-Admission Appraisal (c) Prior to admission a determination of the prospective resident's suitability for admission shall be completed and shall include an appraisal of their individual service needs in comparison with the admission criteria specified in Section 87455, Acceptance and Retention Limitations. (1) The appraisal shall document, at a minimum: (A) An evaluation of the prospective resident's functional capabilities, mental condition, and social factors as specified in Sections 87459, Functional Capabilities and 87462, Social Factor. This requirement is not met as evidenced by: Based on observation, interview, and record review, the licensee did not properly conduct a pre-admission appraisal which poses a potential Health and Safety or Personal Rights risk to persons in care. R1 was taken to the hospital due to behaviors and staff not being able to meet R1's needs. R1 does not have a completed pre-admission appraisal and did not have a re-appraisal completed when R1 returned to the facility.

Official plan of correction

Licensee will conduct staff training to cover pre-apprasials and reapprasials. Verification of training and topics coveed will be provided to LPA by POC date 12/22/2025

Deadline recorded: Dec 22, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87506(d)

Regulation authority

CCR

What the official deficiency says

87506 Resident Records (d) All resident records shall be available to the licensing agency to inspect, audit, and copy upon demand during normal business hours. Records may be removed if necessary for copying. This requirement is not met as evidenced by: Based on observation, interview, and record review, the licensee did not provide the records being requested in a timely manner which poses a potential Health and Safety or Personal Rights risk to persons in care. On 11/18/2025 LPA verbally requested a printout of resident's call button log and via email on 11/25/2025. Verification was not provided until 12/10/2025.

Official plan of correction

Licensee is able to use flash drive to download documents and print when needed.

Deadline recorded: Dec 22, 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

87309 Storage Space and Access (a) Except as specified in subsection, 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 is not met as evidenced by: Based on observation and interview, the licensee did not comply with the regulation listed above, which poses an immediate Health and Safety or Personal Rights risk to persons in care. LPA observed an unoccupied housekeeping cart with chemicals and cleaning supplies being accessible to residents in care.

Official plan of correction

Licensee will talk with housekeeping and metal lock boxes will be bought to store chemicals and cleaning supplies on cart.

Deadline recorded: Nov 19, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

1569.655

Regulation authority

HSC

What the official deficiency says

§1569.655 Increase in fee rates for elderly residents; 90 days’ written notice standing amount of reasons for increase; application of section (a) If a licensee of a residential care facility for the elderly increases the rates of fees for residents or makes increases in any of its rate structures for services, the licensee shall provide no less than 90 days’ prior written notice to the residents or the residents’ representatives setting forth the amount of the increase and the reason or reasons for the increase, including a description of the additional costs, except for an increase in the rate due to a change in the level of care of the resident. This requirement is not met as evidenced by: Based on observation, interview, and record review, the licensee did not comply with the regulation listed above, which poses a potential Health and Safety, Personal Rights risk to persons in care. LPA observed a letter informing residents on a rent increase which did not have a date, providing 90-day notice.

Official plan of correction

Facility will give residents letters that the inital increase notice is not valid. Proper notice will be provided and given to resdients with correct dates. Facility will provide LPA copies of the letters.

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

Official classification

Type A

Official code

87468.1(a)(3)

Regulation authority

CCR

What the official deficiency says

87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights:(3) To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature, such as withholding residents’ money or interfering with daily living functions such as eating, sleeping, or elimination. intimidation, abuse, or other actions of a punitive nature, such as withholding residents’ money or interfering with daily living functions such as eating, sleeping, or elimination. This requirement was not met as evidenced by Licensee did not ensure R1 was free from abuse due to R1 being hit by R2 causing R1 to be hospitalized, which poses an immediate health safety and or personal rights risk to residents in care.

Official plan of correction

Plan of Correction Licensee agrees to submit in writing a plan to ensure how this regulation will be met by POC due date 10/16/25.

Deadline recorded: Oct 16, 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 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 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 Licensee did not submit incident reports timely. For example Licensee submitted incident reports that occurred on 09/6/25 and 09/7/25 on 09/19/25 which poses a potential health safety and or personal rights risk to residents in care.

Official plan of correction

POC LIcensee agrees submit a plan in writing on how this regulation will be met by POC due date 10/16/25.

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

Official classification

Type A

Official code

87303(e)(2)

Regulation authority

CCR

What the official deficiency says

(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 degrees C) and not more than 120 degree F (49 degrees C). 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 LPA's observed water in Resident 3's bedroom measured to be 130 degrees, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/17/2025 Plan of Correction Administrator will ensure water temperature in Resident 4's bedroom and send proof to LPA by POC date of 07/17/2025.

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, the licensee did not comply with the section cited above in medications unlocked and accessible to Resident 2 despite Physicians report documenting they are not to administer own medications, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/17/2025 Plan of Correction Administrator will provide medication administration training to facility staff by POC date of 07/17/2025.

Official classification

Type B

Official code

87633(b)

Regulation authority

CCR

What the official deficiency says

(b) A current and complete hospice care plan shall be maintained in the facility for each hospice resident and include the following: 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 Resident 4 does not have required hospice care plan, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/30/2025 Plan of Correction Administrator will provide hospice care plan to LPA's by POC date of 07/30/2025.