ALHAMBRA VILLA

Official classification

Type B

Official code

87303(e)(6)

Regulation authority

CCR

What the official deficiency says

(6) Toilet, handwashing and bathing facilities shall be maintained in operating condition. Additional equipment shall be provided in facilities accommodating physically handicapped and/or nonambulatory residents, based on the residents' needs. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above The toilet at the end of the facility towards the back is leaking which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/06/2026 Plan of Correction Administrator will fix leaking toilet and send proof to LPA by POC date.

Official classification

Type B

Official code

87555(b)(8)

Regulation authority

CCR

What the official deficiency says

(8) All food shall be of good quality. Commercial foods shall be approved by appropriate federal, state and local authorities. Food in damaged containers shall not be accepted, used or retained. 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. LPA observed several cans of food had expired which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/03/2026 Plan of Correction Licensee will dispose of all expired food items and send proof to LPA by POC date.

Official classification

Type B

Official code

87465(h)(4)

Regulation authority

CCR

What the official deficiency says

(h) The following requirements shall apply to medications which are centrally stored: (4) All centrally stored medications shall be labeled and maintained in compliance with state and federal laws. No persons other than the dispensing pharmacist shall alter a prescription label. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation AND record review, the licensee did not comply with the section cited above several resident's medications did not have labels (details provided to Licensee) which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/03/2026 Plan of Correction Licensee will make sure all PRN, medications and over the counter have labels and send proof to LPA.

Official classification

Type B

Official code

87465(c)(1)

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: (1) There is written direction from a physician, on a prescription blank, specifying the name of the resident, the name of the medication, all of the information specified in Section 87465(e), instructions regarding a time or circumstance (if any) when it should be discontinued, and an indication of when the physician should be contacted for a medication reevaluation. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and record review, the licensee did not comply with the section cited above. Several residents did not have labels on their medications which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/03/2026 Plan of Correction Licensee will apply labels to all medications and send proof to LPA

Official classification

Type B

Official code

87506(b)(17)(A)

Regulation authority

CCR

What the official deficiency says

(b) Each resident's record shall contain at least the following information: (17) Documents and information required by the following: (A) Section 87457, Pre-Admission Appraisal; This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and record review, the licensee did not comply with the section cited above. One resident's pre admission Appraisal was not completed and blank which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/03/2026 Plan of Correction Licensee will complete the Pre admission Appraisal for resident's (details provided to Licensee) and send proof to LPA

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This standard has not been met as evidence by: During initial and subsequent visits LPA inspected kitchen refrigerator and observed the kitchen refrigerator was in disrepair with the crack in the middle of the bottom shelf making it difficult to open the drawers beneath it.

Official plan of correction

Licensee/Administrator to repair bottom shelf of facility refrigerator and ensure that the drawers beneath the shelf are accessible with no issues. Photos of the repair shall be emailed to LPA by POC due date.

Deadline recorded: Oct 3, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(h)(5)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care (h) The following requirements shall apply to medications which are centrally stored: (5) Each resident's medication shall be stored in its originally received container. No medications shall be transferred between containers. This requirement was not met as evidence by: Based on record review, the licensee did not comply with the section cited above as, Medication for Resident #1 is outside of the original containers and prepacked for a total of 8 consecutive days in a separate medication container packaging dated Sunday through Mondays 8am,9am,2pm and bed, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

Licensee/Administrator shall no longer transfer medications between containers moving forward and email a completed a signed copy of the LIC9098 with this regulation noted on it, this will act as agreement to follow such regulation and as proof that the regulation was reviewed and understood. This shall be emailed to LPA by POC due date.

Deadline recorded: Jul 19, 2025. 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

87465 Incidental Medical and Dental Care (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 was not met as evidence by: Based on record review, the licensee did not comply with the section cited above as, Medication for Resident #1 is missing from facility, all original containers for routine medication were not at facility and it was expained that the medication is stored at Residents families residence, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

Licensee/Administrator to gain possession of all medication for Resident #1, all medication must be maintained at facility and not accessible to persons other than employees responsible for the supervision of the centrally stored medication, and email a completed a signed copy of the LIC9098 with this regulation noted on it, this will act as agreement to follow such regulation and as proof that the regulation was reviewed and understood. This shall be emailed to LPA by POC due date.

Deadline recorded: Jul 19, 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 (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 was not met as evidence by: Based on record review, the licensee did not comply with the section cited above as, Disinfectants and cleaning solutionswere observed to be stored under an unlocked cabinete under the kitchen sink, the door that separates kitchen from living room was observed to also be unlocked and open during visit from 11am-1:30pm, with staff entering and exiting kitchen, leaving area accessible to residents. which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

Licensee/Administrator to either remove disinfectants/chemicals from under sink and store in a locked/secure area or add a lock to cabinet under sink so chemicals/disinfectants are locked, staff are to ensure these items are no longer left unattened or accessible to residents a completed a signed copy of the LIC9098 with this regulation noted on it shall me emailed to LPA. *during visit Licensee removed all disinfectants/chemicals from unlocked kitchen cabinet and stored in a locked storage closet*

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

Official classification

Type A

Official code

1569.44

Regulation authority

HSC

What the official deficiency says

(a) A facility shall be deemed to be an “unlicensed residential care facility for the elderly” and “maintained and operated to provide residential care” if it is unlicensed and not exempt from licensure, and any one of the following conditions is satisfied: (1) The facility is providing care and supervision, as defined by this chapter or the rules and regulations adopted pursuant to this chapter. (2) The facility is held out as, or represented as, providing care and supervision, as defined by this chapter or the rules and regulations adopted pursuant to this chapter. (3) The facility accepts or retains residents who demonstrate the need for care and supervision, as defined by this chapter or the rules and regulations adopted pursuant to this chapter. (4) The facility represents itself as a licensed residential facility for the elderly. This requirement was not met as evidenced by: Current operator Kim, Hyo Sook stated she has taken over day to day operations of Evergreen Senior Care without an approved License. LPA observed Residents #1-#14 require elements of care and supervision. This poses a potential risk to the health and safety of the residents in care.

Official plan of correction

The unlicensed operator shall either cease operation of the unlicensed facility or submit an application to the licensing agency within 15 calendar days. Failure to comply will result in civil penalties of $200 per day until a completed application is submitted, operations cease, or relocate R1-R14 and provide relocation information. Operator has submitted application for Facility License on 07/05/2024

Deadline recorded: Sep 14, 2024. A deadline is not proof that correction was completed.