SIMPLY CARING ANGELS LLC

Official classification

Type A

Official code

87468.2(a)(1)

Regulation authority

CCR

What the official deficiency says

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: (1) To have a reasonable level of personal privacy in accommodations, medical treatment, personal care and assistance, visits, communications, telephone conversations, use of the Internet, and meetings of resident and family groups. This requirement was not met as evidenced by all residents in care being montiored by a baby monitor in residents rooms and baby monitors for staff to listen on kitchen counter which poses an immediate health safety and or personal rights risk to residents in care.

Official plan of correction

Licensee agrees to remove monitors by POC due date 10/8/25. LPA will return to clear POC.

Deadline recorded: Oct 8, 2025. A deadline is not proof that correction was completed.

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 (interview) (record review)], the licensee did not comply with the section cited above in not centrally storing or administering a medication for R3 that was prescribed on June, 18, 2025, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/08/2025 Plan of Correction Licensee agrees to submit in writing a new procedure on how this regulation will by met and LIcensee will train staff on procedures by POC due date 10/8/25.

Official classification

Type B

Official code

87405(d)

Regulation authority

CCR

What the official deficiency says

(d) The administrator shall have the qualifications specified in Sections 87405(d)(1) through (7). If the licensee is also the administrator, all requirements for an administrator shall apply. This requirement is not met as evidenced by: Deficient Practice Statement Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in Administrator receiving numerous repeated citations, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/24/2025 Plan of Correction Licensee will submit in writing how the facility plans on remaining in compliance to meet this regulation by POC due date

Official classification

Type B

Official code

87411(d)

Regulation authority

CCR

What the official deficiency says

(d) All personnel shall be given on the job training or have related experience in the job assigned to them. This training and/or related experience shall provide knowledge of and skill in the following, as appropriate for the job assigned and as evidenced by safe and effective job performance: This requirement is not met as evidenced by: Deficient Practice Statement Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in staff not having training for R3's hoyer lift, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/17/2025 Plan of Correction Licensee agrees to conduct hoyer lift training and submit to LPA by POC due date 10/17/25

Official classification

Type B

Official code

87613(a)(2)(B)

Regulation authority

CCR

What the official deficiency says

(2) Ensure that facility staff who will participate in meeting the resident's specialized care needs complete training provided by a licensed professional sufficient to meet those needs. (B) Training shall be completed prior to the staff providing services to the resident. This requirement is not met as evidenced by: Deficient Practice Statement Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in staff not having training for, R2 and R3's restricted health conditions, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/17/2025 Plan of Correction Licensee agrees to submit proof of training for R2's restricted health condition by POC due date 10/17/25

Official classification

Type B

Official code

87465(c)(3)

Regulation authority

CCR

What the official deficiency says

(c) If the resident's physician has stated in writing that the resident is unable to determine his/her own need for nonprescription PRN medication, but can communicate his/her symptoms clearly, facility staff designated by the licensee shall be permitted to assist the resident with self-administration, provided all of the following requirements are met: (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) (interview) (record review)], the licensee did not comply with the section cited above in facility staff not logging response from R1 after administering PRN, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/17/2025 Plan of Correction Licensee agrees conduct a staff training for medication records by POC due date 10/17/25.

Official classification

Type B

Official code

87465(e)

Regulation authority

CCR

What the official deficiency says

(e) For every prescription and nonprescription PRN medication for which the licensee provides assistance there shall be a signed, dated written order from a physician on a prescription blank, maintained in the resident's file, and a label on the medication. Both the physician's order and the label shall contain at least all of the following information. This requirement is not met as evidenced by: Deficient Practice Statement Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in administering an expired over the counter supplement to R1 that was not prescribed by a physician which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/17/2025 Plan of Correction Licensee agrees to submit a written statement on the understanding of the regulation and how this regulation will be met by POC due date 10/17/25

Official classification

Type B

Official code

87463(i)

Regulation authority

CCR

What the official deficiency says

(i) When there is significant change in condition, as defined in Section 87101, Definitions, or once every 12 months, whichever occurs first, the licensee shall arrange an in-person or virtual meeting or conference call to share the reappraisal with the resident, the resident's representative, if applicable, and appropriate facility staff, as specified in Section 87467, Resident Participation in Decision Making. This requirement is not met as evidenced by: Deficient Practice Statement Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in R3 removing R3's restricted health condition and facility not obtaining a reappraisal regarding the change in condition, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/10/2025 Plan of Correction Licensee agrees schedule and submit an appointment date for R3 with R3's primary care physician to determine R3's updated condition by POC due date 10/10/25. Licensee will submit reappraisal after scheduled appointment.

Official classification

Type B

Official code

87609(b)(4)

Regulation authority

CCR

What the official deficiency says

(b) Incidental medical care may be provided to residents through a licensed home health agency provided the following conditions are met: (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 [(observation) (interview) (record review)], the licensee did not comply with the section cited above in not having current home health care plans for R1, R2 and R3 and not having a Home Health Care Plan for R4, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/24/2025 Plan of Correction Licensee agrees submit care plans for R1, R2, R3 and R4 by POC due date 10/24/25

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) (record review)], the licensee did not comply with the section cited above in Licensee did not administer R1's medication every 12 hours as prescribed, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/25/2024 Plan of Correction Licensee agrees to conduct a medication training on administering medication by POC due date 10/25/24. Civil Penalty Issued.

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) (record review)], the licensee did not comply with the section cited above in Licensee did not have medications locked when LPA's arrived at the facility and medications were left unattended on the kitchen counter, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/25/2024 Plan of Correction Licensee agrees to conduct training to meet this regulation by POC due date10/25/24.

Official classification

Type A

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 record review, the licensee did not comply with the section cited above in 2 out of 4 residents observed with full bed rails with no physicians orders, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/17/2024 Plan of Correction Licensee agrees to submit a statement of intent to remove full bed rails until a physicians order is obtained.

Official classification

Type B

Official code

87412(a)

Regulation authority

CCR

What the official deficiency says

(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: This requirement is not met as evidenced by: Deficient Practice Statement Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in Licensee did not have a personnel file for Administrator and stated it was lost, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/25/2024 Plan of Correction Licensee agrees to provide a copy of the Administrator's personnel file containing all LIC forms by POC due date 10/25/24.

Official classification

Type B

Official code

87555(b)(26)

Regulation authority

CCR

What the official deficiency says

(b) The following food service requirements shall apply: (26) Supplies of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days shall be maintained on the premises. This requirement is not met as evidenced by: Deficient Practice Statement Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in Licensee did not have any milk or eggs and was very low on other perishable items, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/18/2024 Plan of Correction Licensee agrees to submit a photo of a 2 day supply of perishable food by POC due date 10/18/24.

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) (record review)], the licensee did not comply with the section cited above in Licensee did not keep an accurate centrally stored log for R1 by logging a future start date of 10/18/24, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/25/2024 Plan of Correction Licensee agrees to conduct a staff training on logging medications and submit a written statement on how this regulation will be met by POC due date 10/25/24.

Official classification

Type B

Official code

87458(b)(1)

Regulation authority

CCR

What the official deficiency says

(b) The medical assessment shall include, but not be limited to: (1) A physical examination of the resident indicating the physician's primary diagnosis and secondary diagnosis, if any and results of an examination for communicable tuberculosis, other contagious/infectious or contagious diseases or other medical conditions which would preclude care of the person by the facility. This requirement is not met as evidenced by: Deficient Practice Statement Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in Licensee did not have a primary or secondary diagnosis for R3 on the physician report, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/18/2024 Plan of Correction Licensee agrees to update R3's physician report to include a primary and secondary diagnosis by POC due date 10/18/24.

Official classification

Type B

Official code

87463(a)

Regulation authority

CCR

What the official deficiency says

(a) The pre-admission appraisal shall be updated, in writing as frequently as necessary to note significant changes and to keep the appraisal accurate. The reappraisals shall document changes in the resident's physical, medical, mental, and social condition. Significant changes shall include but not be limited to: This requirement is not met as evidenced by: Deficient Practice Statement Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in Licensee did not update the medical reappraisal for 3 out of 4 residents who's condition changed which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/25/2024 Plan of Correction Licensee agrees to update the medical assessments for 3 out of 4 residents that require updated assessments by POC due date 10/25/24.

Official classification

Type B

Official code

87606(f)(1)

Regulation authority

CCR

What the official deficiency says

(f) To accept or retain a bedridden person, a facility shall ensure the following: (1) The facility's Plan of Operation includes a statement of how the facility intends to meet the overall health, safety and care needs of bedridden persons. This requirement is not met as evidenced by: Deficient Practice Statement Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in Licensee did not have bedridden in the facility's plan of operation, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/25/2024 Plan of Correction LIcensee agrees to submit the facility's entire plan of operation to Licensing by POC due date 10/25/24.

Official classification

Type B

Official code

87633(b)(4)

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: (4) A description of the licensee's area of responsibility for implementing the plan including, but not limited to, facility staff duties; record keeping; and communication with the hospice agency, resident's physician, and the resident's responsible person(s), if any. This description shall include the type and frequency of the tasks to be performed by the facility. This requirement is not met as evidenced by: Deficient Practice Statement Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in Licensee does not have current and complete hospice care plans for 3 out of 4 residents in care, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/18/2024 Plan of Correction Licensee agrees to submit Hospice Care Plans for R1, R2 and R4 by POC due date 10/18/24.

Official classification

Type B

Official code

87633(b)(6)

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: (6) Identification of the training needed, which staff members need this training, and who will provide the training relating to the licensee's responsibilities for implementation of the hospice care plan. This requirement is not met as evidenced by: Deficient Practice Statement Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in Licensee did not have hospice training for each residents specific needs, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/25/2024 Plan of Correction Licensee agrees to submit copies of training for each resident R1, R2, and R4 by POC due date 10/25/24. Civil Penalty issued.

Official classification

Type B

Official code

87405(a)

Regulation authority

CCR

What the official deficiency says

(a) All facilities shall have a qualified and currently certified administrator. The licensee and the administrator may be one and the same person. The administrator shall have sufficient freedom from other responsibilities and shall be on the premises a sufficient number of hours to permit adequate attention to the management and administration of the facility as specified in this section. When the administrator is not in the facility, there shall be coverage by a designated substitute who shall have qualifications adequate to be responsible and accountable for management and administration of the facility as specified in this section. The Department may require that the administrator devote additional hours in the facility to fulfill his/her responsibilities when the need for such additional hours is substantiated by written documentation. This requirement is not met as evidenced by: Deficient Practice Statement Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in Licensee does not have a qualified Administrator, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/14/2024 Plan of Correction Licensee agrees to submit paperwork for a qualified Administrator by POC due date 11/14/24

Official classification

Type A

Official code

87465(h)(3)

Regulation authority

CCR

What the official deficiency says

(h) The following requirements shall apply to medications which are centrally stored: (3) Each container shall carry all of the information specified in (6)(A) through (E) below plus expiration date and number of refills. This requirement is not met as evidenced by: Deficient Practice Statement Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in Licensee did not have prescriptions with labels for R1's medications, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/17/2024 Plan of Correction Licensee agrees to submit copies of prescriptions for all of R1's medications by POC due date 10/17/24.

Official classification

Type B

Official code

1560.75(a)(4)

Regulation authority

HSC

What the official deficiency says

(a) A residential care facility for the elderly may permit incidental medical services to be provided through a home health agency, licensed pursuant to Chapter 8 (commencing with Section 1725), when all of the following conditions are met: (4) There is ongoing communication between the home health agency and the residential care facility for the elderly about the services provided to the resident by the home health agency and the frequency and duration of care to be provided. This requirement is not met as evidenced by: This requirement is not met as evidenced by: Deficient Practice Statement Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in Licensee did not have a care plan for R3 or home health notes of care being provided, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/18/2024 Plan of Correction Licensee agrees to submit in writing a care plan and proof of services provided and frequency and duration of home health visits by POC due date 10/25/24.

Official classification

Type A

Official code

87309(a)

Regulation authority

CCR

What the official deficiency says

(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 by having the cleaning supplies cabinet unlocked and accessible to residents with dementia, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/25/2023 Plan of Correction Licensee agrees to lock cleaning supplies and keep them inaccessible to residents in care. Cabinet was locked 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 record review, the licensee did not comply with the section cited above in by Licensee did not administer R1's medications correctly after conducting a pill count and comparing to centrally stored log R1s medication should have started on 10/17/23 not 10/20/23, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/25/2023 Plan of Correction Licensee agrees to conduct staff training on medications and agrees to submit training agenda, who provided the training and staff that was trained by POC due date 11/20/23

Official classification

Type B

Official code

87465(e)

Regulation authority

CCR

What the official deficiency says

(e) For every prescription and nonprescription PRN medication for which the licensee provides assistance there shall be a signed, dated written order from a physician on a prescription blank, maintained in the resident's file, and a label on the medication. Both the physician's order and the label shall contain at least all of the following information. 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 Licensee did not have a written order for R2's medication which Licensee stated is a PRN however it states to be administered daily, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/25/2023 Plan of Correction Licensee was able to provide physician order stating R2's medication was a PRN and not a medication to be administered daily. Corrected during visit.

Official classification

Type B

Official code

1569.39(b)

Regulation authority

HSC

What the official deficiency says

(b) A residential care facility for the elderly that accepts or retains residents with restricted health conditions, as defined by the department, shall ensure that residents receive medical care as prescribed by the resident’s physician and contained in the resident’s service plan by appropriately skilled professionals acting within their scope of practice. An appropriately skilled professional may not be required when the resident is providing self-care, as defined by the department, and there is documentation in the resident’s service plan that the resident is capable of providing self-care. 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 Licensee did not have a plan of care or physician care documentation for R1, R2, or R3 which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/20/2023 Plan of Correction Licensee agrees to submit a written understanding of this regulation and how it will be met in the future by POC due date 11/20/23.

Official classification

Type B

Official code

87616(b)(1)

Regulation authority

CCR

What the official deficiency says

(b) Written requests shall include, but are not limited to, the following: (1) Documentation of the resident's current health condition including updated medical reports, other documentation of the current health, prognosis, and expected duration of condition. 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 Licensee did not have any documentation from the physician or from home health regarding the stage of R1's wounds, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/27/2023 Plan of Correction Licensee agrees to submit a written understanding of this regulation and an exception if the wound is over a stage 2 by POC due date 10/27/23.

Official classification

Type B

Official code

87463(a)(3)

Regulation authority

CCR

What the official deficiency says

(a) The pre-admission appraisal shall be updated, in writing as frequently as necessary to note significant changes and to keep the appraisal accurate. The reappraisals shall document changes in the resident's physical, medical, mental, and social condition. Significant changes shall include but not be limited to: (3) Any illness, injury, trauma, or change in the health care needs of the resident that results in a circumstance or condition specified in Sections 87455(c) or 87615, Prohibited Health Conditions. This requirement is not met as evidenced by: 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 by not having R1's reappraisal complete with change in condition which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/27/2023 Plan of Correction Licensee agrees to submit a reappraisal of R1 by POC due date 11/20/23.

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 interview and record review, the licensee did not comply with the section cited above in Licensee does not have a hospice care plan for R2 which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/27/2023 Plan of Correction Licensee agrees to submit a hosipice care plan for R1 that meets this regulation by POC due date of 10/27/23

Official classification

Type B

Official code

87633(b)(6)

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: (6) Identification of the training needed, which staff members need this training, and who will provide the training relating to the licensee's responsibilities for implementation of the hospice care plan. 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 Licensee did not have any documentation of staff training from hospice for R2, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/27/2023 Plan of Correction Licensee agrees to submit staff training which shows hospice trained facility staff on how to care for R2 by POC due date 10/27/23

Official classification

Type A

Official code

87615(a)(1)

Regulation authority

CCR

What the official deficiency says

Prohibited Health Conditions (a) Persons who require health services for or have a health condition including, but not limited to, those specified below shall not be admitted or retained in a residential care facility for the elderly. (1)Stage 3 and 4 pressure injuries. **This was not met as evidenced by R1 has a Stage 3 pressure injury being treated by Home Health.

Official plan of correction

Licensee will submit an exception request to the Department for the prohibited condition that the licensee requests to retain. A care plan will be submitted with the expeption request by the Plan of Correction date.

Deadline recorded: Dec 6, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87608(5)(A)

Regulation authority

CCR

What the official deficiency says

5) Under no circumstances shall postural supports include tying, depriving, or limiting the use of a resident's hands or feet.(A) 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 was not met as evidenced by R1 has full bed rails and not on hospice

Official plan of correction

Licensee will submit hospice exception request which includes a hospice care plan to Department for R1 by POC due date.

Deadline recorded: Dec 6, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87608(5)(A)

Regulation authority

CCR

What the official deficiency says

5) Under no circumstances shall postural supports include tying, depriving, or limiting the use of a resident's hands or feet.(A) 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 was not met as evidenced by 5 of 6 residents have full bed rails and not on hospice

Official plan of correction

Licensee will submit hospice exception request to Department for R4 & R5. Licensee will remove bed rails for R2 & R6 and request a Dr orders for half bed rails for R3. All corrections to be completed by POC due date **Immediate Civil Penalty Assessed

Deadline recorded: Oct 25, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87615(a)(1)

Regulation authority

CCR

What the official deficiency says

Prohibited Health Conditions (a) Persons who require health services for or have a health condition including, but not limited to, those specified below shall not be admitted or retained in a residential care facility for the elderly. (1)Stage 3 and 4 pressure injuries. **This was not met as evidenced by R5 has a Stage 3 pressure injury being treated by Home Health.

Official plan of correction

Licensee will submit hospice exception request to Department for R5 by POC due date.

Deadline recorded: Oct 25, 2022. 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

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: (5) The licensee shall assist residents with self-administered medications as needed. This requirement was not met as evidenced by: Based on records review and observation Licensee did not administer R1's medications for 12/9/21 which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

Plan of Correction POC Licensee agrees to provide staff training on administering and logging medications. Licensee will submit agenda and signed sheet by staff by POC due date 12/31/21.

Deadline recorded: Dec 31, 2021. 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

87705 Care of Persons with Dementia (d) In addition to requirements specified in Section 87303, Maintenance and Operation, safety modifications shall include, but not be limited to, inaccessibility of ranges, heaters, wood stoves, inserts, and other heating devices to residents with dementia. This requirement was not met as evidenced by: Based on observation Licensee did not have the stove knobs locked which were accessible to residents in care which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

Plan of Correction POC Licensee removed stove knobs and locked them making the knobs inaccessible to residents in care. POC was corrected during visit.

Deadline recorded: Dec 10, 2021. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87458(a)

Regulation authority

CCR

What the official deficiency says

87458 Medical Assessment (a) Prior to a person's acceptance as a resident, the licensee shall obtain and keep on file, documentation of a medical assessment, signed by a physician, made within the last year. The licensee shall be permitted to use the form LIC 602 (Rev. 9/89), Physician's This requirement was not met as evidenced by: Based on records review and observation R1 did not have a completed LIC 602 Physicians Report or TB test in the residents file which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Plan of Correction POC Licensee agrees to submit R1's physicians report and a written understanding of the regulation by POC due date.

Deadline recorded: Dec 31, 2021. A deadline is not proof that correction was completed.