ASSISTED LIVING & WELLNESS - NAOMI

Official classification

Type B

Official code

87305(b)

Regulation authority

CCR

What the official deficiency says

87305 Alterations to Existing Building or New Facilities (b)The licensing agency may require the facility to acquire a local building inspection where the agency determines that a suspected hazard to health and safety exists. This requirement has not been met with evidence: The licensee did not furnish the department with a final inspection report, city permits for the occupancy class code, therefore, an updated fire safety inspection will be requested with the City of Arcadia Fire Department to ensure the residents health and safety.

Official plan of correction

Licensee will submit proof of corrections and final City of Arcadia inspection permits to the Department by 04/30/26.

Deadline recorded: Apr 30, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87355(e)(2)

Regulation authority

CCR

What the official deficiency says

(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (2) Request a transfer of a criminal record clearance as specified in Section 87355(c) This requirement has not been met by evidence of: Based on record review of the LIC 500 and the LIS Facility Personnel Report Summary that staff #1 (S1 S7) is not cleared to work at facility which poses an immediate health risk to persons in care.

Official plan of correction

The Licensee will ensure that all individuals subject to a criminal record review and associated prior to working, residing or volunteering in a licensed facility. Licensee will submit proof of clearance and association for staff #1 (S1 -S7) by POC due date.

Deadline recorded: Dec 4, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87204(a)

Regulation authority

CCR

What the official deficiency says

87204 Limitations - Capacity and Ambulatory Status (a) A licensee shall not operate a facility beyond the conditions and limitations specified on the license, including specification of the maximum number of persons who may receive services at any one time. An exception may be made in the case of catastrophic emergency when the licensing agency may make temporary exceptions to the approved capacity. This requirement has not been met by evidence of: Based on observations LPA observed a total of (7) residents. LPAs observed with staff #1 (S1) that Resident #1 (R1 - R7) are receding under Assisted Living and Wellness -Naomi. The facility is licensed for an age range 60 and over. Approved for one (1) ambulatory and five (5) bedridden in rooms numbers 1,2,3,5, and 6 only. Hospice waiver approved for six (6). Facility is operating beyond the conditions and limitations specified on the license. Facility is providing care and supervision for (7) residents despite being licensed and approved for (6) residents. This poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

Licensee will notify the local fire department of the over capacity and assist with resident relocation. Licensee will submit proof of contact with fire department and details of the residents relocation will be provided to LPA. Licnesee agrees to abiding to capciity limit.

Deadline recorded: Dec 4, 2024. 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

Water temperature ..(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 degree C) and not more than 120 degree F (49 degree C). This requirement is not met as evidenced by: Hot water temperature is in a range of 128.5 to 129.5 degrees Fahrenheit which was NOT within Title 22 Regulation guidelines. Deficient Practice Statement Based on observation and file review, it poses/posed an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/22/2024 Plan of Correction

Official classification

Type A

Official code

87465(h)(6)

Regulation authority

CCR

What the official deficiency says

Incidental Medical and Dental Care 87465(h)(6) The licensee shall be responsible for assuring that a record of centrally stored prescription medications for each resident is maintained. This requirement is not met as evidenced by: Upon reviewing medication and medication records for Residents #2, #3 and #4, LPA observed the medication logs were not logged: R#2 -Omeprazoles for 4 days; R#3 - Mirtazapine, Senna, Carvedialol and Queitapine for 3 days; R#4- Amlodipine Besylate, Metoprolol Succinate and Atorvastation for 3 days while medication was administered. LPA did not see any documentation in regard to missing medication log. LPA was unable to determine medication log was updated accordingly. Deficient Practice Statement Based on medication review, the Licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/22/2023 Plan of Correction Administrator agreed to provide (1) additional medication administration assistance training to all staff and provide proof to the department; (2) review Title 22, Section 87465 and provide a signed statement indicating the review of this section detailing how to prevent future medication errors by the POC date

Official classification

Type A

Official code

87303(e)(2)

Regulation authority

CCR

What the official deficiency says

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 Hot water temperature was in a range of 151.1 degrees Fahrenheit at the kitchen sink and 131.4 degrees Fahrenheit at the bathroom sink which was not within Title 22 Regulation guidelines Based on observation, the licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/21/2022 Plan of Correction Administrator will ensure the water temperature will remain in a range of 105 - 120 degree Fahrenheit; a water temperature log dated 10/21/22 will provide to Licensing. Licensee will maintain a weekly water temperature log to ensure water temp is within Title 22 Regulation guidelines. Plan of Corrections (POC) must be corrected by POC date.