VICTOR JEM HAPPY HOMES

Official classification

Type A

Official code

87309(f)

Regulation authority

CCR

What the official deficiency says

(f) Due to the physical arrangements in the facility, or the condition or the habits of other residents in the facility, or both, the licensee may require the items specified in subsections (a) and (c) to be centrally stored so as not to pose a safety hazard to others. 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 storing chemicals and detergetns in unlocked cabinets and lanudry room, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/30/2026 Plan of Correction Licensee immedidately removed and locked all checmicals in laundry cabinets and will ensure all chemicals are always kept locked and inaccessible to residents in care.

Official classification

Type B

Official code

87555(b)(27)

Regulation authority

CCR

What the official deficiency says

(b) The following food service requirements shall apply: (27) All kitchen areas shall be kept clean and free of litter, rodents, vermin and insects. 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 , where small insects were observed in the kitchen and dining room, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/13/2026 Plan of Correction Licensee will hire a professional extermination company to come and address the pest issues and will submit proof of correction or invoices to LPA by POC date.

Official classification

Type B

Official code

87458(c)(1)(A)

Regulation authority

CCR

What the official deficiency says

(c) The medical assessment shall include, but not be limited to: (1) A physical examination of the resident indicating the licensed medical professional's diagnosis or diagnoses and results of an examination for all of the following: (A) Communicable tuberculosis. 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 in [2] out of [5] physician records did not have tuberculosis records, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/13/2026 Plan of Correction Licensee will ensure all resident medical records are current and will submit proof current medical documents to LPA by POC date.

Official classification

Type A

Official code

87309(f)

Regulation authority

CCR

What the official deficiency says

(f) Due to the physical arrangements in the facility, or the condition or the habits of other residents in the facility, or both, the licensee may require the items specified in subsections (a) and (c) to be centrally stored so as not to pose a safety hazard to others. 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 storing medications for the licensee, in the refrigerator, without locking them, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/30/2026 Plan of Correction Licensee immediately removed all the personal medications from the refrigerator, and will ensure no medication belonging to staff, will be accessible to residents. Licensee will ensure all resident medications are kept locked in the medication cabinet and no staff medications will be maintained in the facility.

Official classification

Type B

Official code

87305(a)

Regulation authority

CCR

What the official deficiency says

(a) Prior to construction or alterations, all facilities shall obtain a building permit. 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 using the garage space as intended. Garage is currently being used as an unpermitted Accessory Dwelling Unit (ADU) which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/13/2026 Plan of Correction Licensee will contact city agencies in order to obtain a permit for the ADU and will submit LIC200 to convert the garage into ADU for staff quarters or will clear the garage and use for storage space.

Official classification

Type B

Official code

87308(c)

Regulation authority

CCR

What the official deficiency says

(c) General storage space shall be maintained for equipment and supplies as necessary to ensure that space used to meet other requirements of these regulations is not also used for 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 using the garage space as intended. which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/13/2026 Plan of Correction Licensee will contact city agencies in order to obtain a permit for the ADU and will submit LIC200 to convert the garage into ADU for staff quarters or will clear the garage and use for storage space.

Official classification

Type A

Official code

87465(c)(2)

Regulation authority

CCR

What the official deficiency says

Incidental Medical and Dental Care: c) If the resident's physician has stated in writing... 2) Once ordered by the physician the medication is given according to the physician's directions. This requirement is not met as evidenced by: Based on record reviews and interviews, licensee did not comply with the section above failing to administer R1 eyedrops as prescribed. This poses an immediate health and safety risk to residents in care.

Official plan of correction

Administrator agreed to schedule vendorized training for all staff and submit to CCL the vendor information and scheduled date of training. Training certifications to be submitted to CCL upon completion

Deadline recorded: Feb 26, 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

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... This requirement is not met as evidenced by: Based on observation and interview the licensee did not comply with the section cited above by not assuring medications for R5 and the Administrator are kept locked and inaccessible to residents which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

Administrator agreed to schedule vendorized training for all staff and submit to CCL the vendor information and scheduled date of training. Training certifications to be submitted to CCL upon completion

Deadline recorded: Feb 26, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

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 requirement is not met as evidenced by: Based on inspection, and observation the Licensee did not ensure that the facility is safe and sanitary for wellbeing of residents and others. LPA observed cockroaches in the living room, dining room and kitchen areas. This poses a potential health, safety risk and personal rights violation to residents in care.

Official plan of correction

The Administrator will take all measures to maintain the facility free from cockroaches. Administrator will submit updated documentation of Pest Control service agreement to LPA by POC date.

Deadline recorded: Apr 1, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87219(a)(1)(A-D)

Regulation authority

CCR

What the official deficiency says

Residents shall be encouraged to maintain and develop their quality of life... The activities made available shall include: (1) Socialization to promote or enhance personal relationships. Activities may include, but are not limited, to: This requirement is not met as evidenced by: Based on LPAs observation, the licensee did not comply with the section cited above by not providing planned activities. During the visit conducted on 01/29/25, LPAs observed five out of five residents watching TV from 10:00am-4:30pm. This poses a potential health, safety risk and personal rights violation to residents in care.

Official plan of correction

The Administrator will conduct an in-service meeting with all staff regarding this regulation and provide a daily activity to all residents. Copy of the training will be submitted to LPA by POC date

Deadline recorded: Apr 1, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87355(e)(3)

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: (3) Request a transfer of a criminal record clearance as specified in Section 87355(c) or 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. S3 is not associated with the facility which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/13/2025 Plan of Correction Administrator will associate S3 with the facility by the POC date.

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. Medications were found on the kitchen floor and in the refrigerator without being in a locked container, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/14/2025 Plan of Correction Administrator will lock and store all medications properly.

Official classification

Type A

Official code

87463(h)

Regulation authority

CCR

What the official deficiency says

(h) The licensee shall request that all residents receive an annual routine visit with a licensed medical professional once every twelve months, either in person or by video appointment. 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. There were no records for residents annual routine visit for 5 residents which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/14/2025 Plan of Correction Administrator will contact all residents phyiscian to obtain annual rountine visit.

Official classification

Type A

Official code

87463(h)(1)

Regulation authority

CCR

What the official deficiency says

(h) The licensee shall request that all residents receive an annual routine visit with a licensed medical professional once every twelve months, either in person or by video appointment. (1) Documentation of the annual routine visit, such as a visit summary, shall be added to the resident's record. 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. There were no records for residents annual routine visit for 5 residents which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/14/2025 Plan of Correction Administrator will contact all residents phyiscian to obtain annual rountine visit.

Official classification

Type A

Official code

1569.695(a)(7)(E)

Regulation authority

HSC

What the official deficiency says

(a)In addition to any other requirement of this chapter, a residential care facility for the elderly shall have an emergency and disaster plan that shall include, but not be limited to, all of the following: (7) Procedures that address, but are not limited to, all of the following: (E) Storage and preservation of medications, including the storage of medications that require refrigeration. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation the licensee did not comply with the section cited above. Medication were stored in the fridge without being in a locked container which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/14/2025 Plan of Correction Administrator will store and lock medications properly.

Official classification

Type A

Official code

1569.695(b)

Regulation authority

HSC

What the official deficiency says

(b) A facility shall provide training on the plan to each staff member upon hire and annually thereafter. The training shall include staff responsibilities during an emergency or disaster. 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. No training records in file which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/14/2025 Plan of Correction Administrator will provide proof of training to staff.

Official classification

Type A

Official code

1569.695(c)

Regulation authority

HSC

What the official deficiency says

(c) A facility shall conduct a drill at least quarterly for each shift. The type of emergency covered in a drill shall vary from quarter to quarter, taking into account different emergency scenarios. An actual evacuation of residents is not required during a drill. While a facility may provide an opportunity for residents to participate in a drill, it shall not require any resident participation. Documentation of the drills shall include the date, the type of emergency covered by the drill, and the names of staff participating in the drill. 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. LPAs didn't observe any documentation regading emergency drills which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/14/2025 Plan of Correction Administrator will provide proof of training.

Official classification

Type A

Official code

87608(a)(3)

Regulation authority

CCR

What the official deficiency says

(a) Based on the individual's preadmission appraisal, and subsequent changes to that appraisal, the facility shall provide assistance and care for the resident in those activities of daily living which the resident is unable to do for himself/herself. Postural supports may be used under the following conditions: (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 record review the licensee did not comply with the section cited above. LPAs didn't observe any appraisals for 5 residents which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/14/2025 Plan of Correction Administrator will provide 5 residents appraisals.

Official classification

Type A

Official code

87608(a)(5)(A)

Regulation authority

CCR

What the official deficiency says

(A) A bed rail that extends from the head half the length of the bed and used only for assistance with mobility shall be allowed. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation the licensee did not comply with the section cited above. Bedrails in Room 1 were still in place without a physician order which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/14/2025 Plan of Correction Administrator will provide physician order for R2 and R3 bedrails or remove them immediatley. Administrtaor will provide pictures to LPA by POC.

Official classification

Type B

Official code

1569.618(c)(3)

Regulation authority

HSC

What the official deficiency says

(c)The facility shall employ, and the administrator shall schedule, a sufficient number of staff members to do all of the following: (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 record review the licensee did not comply with the section cited above. CPR training were observed for all three staff which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/20/2025 Plan of Correction Administrator will provide CPR certificates for all staff working in the facility.

Official classification

Type B

Official code

87412(f)

Regulation authority

CCR

What the official deficiency says

(f) All personnel 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. Removal of records shall be subject to the following requirements: 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. Staff folders weren't available which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/20/2025 Plan of Correction Administrator will provide copies of all staff folders including the Administrator folder

Official classification

Type B

Official code

87506(b)(10)

Regulation authority

CCR

What the official deficiency says

(b) Each resident's record shall contain at least the following information: (10) Reports of the medical assessment specified in Section 87458 Medical Assessment, and of any special problems or precautions. 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. No medical assesment were observed which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/20/2025 Plan of Correction Administrator will povide medical assesment for all 5 residents.

Official classification

Type B

Official code

87506(b)(13)

Regulation authority

CCR

What the official deficiency says

(b) Each resident's record shall contain at least the following information: (13) Continuing record of any illness, injury, or medical or dental care, when it impacts the resident's ability to function or the services he needs. 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. No medical assesment were observed which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/20/2025 Plan of Correction Administrator will povide medical assesment for all 5 residents.

Official classification

Type B

Official code

87464(f)(7)

Regulation authority

CCR

What the official deficiency says

Basic services shall at a minimum include: (7) A planned activities program which includes social and recreational activities appropriate to the interests and capabilities of the resident, as specified in Section 87219, Planned Activities. This requirement is not met as evidenced by: Deficient Practice Statement Based on obervations and record review the licensee did not comply with the section cited above. No activity calendar in place which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/20/2025 Plan of Correction Administrator will provide activity calendar by the POC date.

Official classification

Type B

Official code

87507(c)

Regulation authority

CCR

What the official deficiency says

(c) Admission agreements shall be signed and dated, acknowledging the contents of the document, by the resident or the resident's representative, if any, and the licensee or the licensee's designated representative no later than seven days following admission. Attachments to the agreement may be utilized as long as they are also signed and dated as prescribed above. 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. Admission Agreements were incomplete which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/20/2025 Plan of Correction Administrator will submit complete admission agreement for all the residents

Official classification

Type A

Official code

87608(a)(5)(B)

Regulation authority

CCR

What the official deficiency says

Bed rails that extend the entire length of the bed are prohibited except for... hospice care and have a hospice care... This requirement is not met as evidenced by: Based on LPAs observation and record review, the licensee did not comply with the section cited above by not requesting an exception for a non hospice resident R3 to have a full bed rail. Moreover, no written Doctors' order was observed on file for R2's full bed rail and R1's and R5's 1/2 bed rails, which poses an immediate health and safety risk to persons in care.

Official plan of correction

Licensee/Administrator will request a current and updated hospice care plan for R2 and which indicates the need for the full rails. Administrator will remove R3's full bed rail and request 1/2 bed rail for R1's, R3's and R5's physicians. Copy of the Hospice care plan fro R2 and physician orders will be submitted as POC.

Deadline recorded: Jan 31, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87506(a)

Regulation authority

CCR

What the official deficiency says

Resident Records. The licensee shall ensure that... current record is maintained... readily available.... This requirement is not met as evidenced by: Based on record review the licensee did not comply with the section cited above by not maintaining complete facility files for 5 out of 5 residents which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Licensee/Administrator will complete files for all residents. Once completed licensee/administrator will submit a signed, dated self certification that all resident files have been, reviewed, updated and complete as required by the cited regulation.

Deadline recorded: Feb 5, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

Personal Accommodations and Services: Living accommodations and grounds shall be related to the facility's function... This requirement is not met as evidenced by: Based on interview, the licensee did not comply with the section cited above by allowing staff to sleep in residents’ rooms, which poses a potential personal rights risk to persons in care.

Official plan of correction

Licensee/Administrator will notify the LPA/Department in writing how this deficiency is cleared. In-service training will be also provided to all current and future staff members. Copy of the in-service training will be submitted to LPA by POC date

Deadline recorded: Feb 5, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87355(e)(1)

Regulation authority

CCR

What the official deficiency says

This requirement is not met as evidenced by: Criminal Record Clearance. Prior to working, residing or volunteering in a licensed facility, all individuals subject to a criminal record review shall obtain a clearance or criminal record exemption. This requirement was not met by evidence of: Based on records review Staff 1 and Staff 2 are not cleared. Civil penalties are being assessed in the amount of $500.00 for each staff.

Official plan of correction

Administrator shall ensure that all staff obtain a Criminal Record Background Clearance and are associated to the facility prior to employment. Uncleared persons cannot return to work until they are cleared and associated to the facility. Submit copies of Livescan and transfer requests by POC due date (tomorrow).

Deadline recorded: Jul 16, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87533(e)(2)

Regulation authority

CCR

What the official deficiency says

Criminal Record Clearance. 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: Request a transfer of a criminal record clearance as specified in Section 87355(c) This requirement was not met by evidence of: Based on records review S1 and S2 are NOT associated to this facility. Licensee shall ensure all staff are cleared and associated to the facility prior to beginning employment.

Official plan of correction

Administrator will provide proof of association for S1 and S2 by the POC date

Deadline recorded: Jul 16, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

80061(b)

Regulation authority

CCR

What the official deficiency says

80061(b) Reporting Requirements. Upon the occurrence…a report shall be made to the licensing agency..., a written report ...within seven days following the occurrence of such event. This requirement was not met as evidence by Based on file document review, the Licensee did not comply with the section cited above. Lincesee didn't submit a death report for R1 since they passed away on or around October or November 2023. This poses a potential health and safety risk to clients in care

Official plan of correction

Administrator will submit death report for R1 by the POC date.

Deadline recorded: Jul 29, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

1569.652

Regulation authority

HSC

What the official deficiency says

Termination of admission agreement upon death of resident; ...and refunds (c) A refund of any fees paid in advance covering the time after the resident’s personal property has been removed from the facility shall be issued to the individual …responsible for the fees within 15 days after the personal property is removed. This requirement is not met as evidenced by; Based on the interviews and record review. The Licensee has not issue a refund of the prorated portion of the rent paid in advance. This poses potential risk to the personal rights of the residents in care.

Official plan of correction

Administrator will refund R1's responsible party with the amount of $2,000 via check. Administartor will sent a copy of the front and back of the check by the POC date

Deadline recorded: Jul 29, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87507(g)(5)

Regulation authority

CCR

What the official deficiency says

87507 Admission Agreements; (g) Admission agreements shall specify the following: (5) Refund conditions. (A) Facility policy concerning refunds, including the conditions under which a refund for advanced monthly fees will be returned in the event of a resident’s death…This requirement is not met as evidenced by Based on interviews and record review the Licensee failed to assure that the admission agreement includes condition of refund upon death of the resident. R1’s admission agreement does not indicates the procedure of the refund of payments upon death of the resident. This poses potential risk to the personal rights of the residents in care.

Official plan of correction

Administrator will provide a copy of revised admission agreement and submit to the Licensing Office for review and approval by the POC date.

Deadline recorded: Jul 29, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.1(A)(9)

Regulation authority

CCR

What the official deficiency says

Residents in all residential care facilities for the elderly shall have all of the following personal rights: (9) To have communications to the licensee from their representatives answered promptly and appropriately This requirement is not met as evidenced by;. Based on interviews, the Administrator did not respond to authorized representative.

Official plan of correction

Administrator will provide a statement of understanding this section of the CCR by the POC date.

Deadline recorded: Jul 29, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

1569.311

Regulation authority

HSC

What the official deficiency says

This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above as the smoke and carbon monoxide detectors in the hallway and rear exit are missing, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/05/2024 Plan of Correction Facility shall install smoke detectors in missing areas immediately.

Official classification

Type A

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above as the smoke detectors are not operational which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/05/2024 Plan of Correction Facility shall install smoke detectors in missing areas immediately.

Official classification

Type A

Official code

87355(f)(e)(1)

Regulation authority

CCR

What the official deficiency says

Criminal Record Clearance(f)Violation of Section 87355(e)... an immediate asse- ssment of civil penalties of one hundred dollars($100) per violation per day... (1) Subsequent violations within a 12 month period will result in a civil penalty of $100 per violation per day for a maximum of 30 days. Based on interview and review of Guardian Background System Check facility staff S1 and S2 are not criminal background clearenced and association to this facility. No documentation has been submitted to Community Care Lisensing. This poses a potential risk to residents in care.

Official plan of correction

Administrator has agreed to email the completed criminal background clearance and associate staff S1 and S2 to facility by POC due date

Deadline recorded: Jan 9, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(h)(C)(2)

Regulation authority

CCR

What the official deficiency says

Incidental Medical and Dental Care(h)The following requirements shall apply to medications which are centrally stored(C) Because...dangers related to the medication itself(2)...medicines shall be kept in a safe and locked place that is not accessible to persons other than employees… Based on inspection LPA discovered that medication cabinet lock is broken, and medications are accessible to the residents. This poses a potential risk to resident in care.

Official plan of correction

Administrator has agreed to replace the lock on the medication cabinet and email pictures of new lock and proof of purchase receipt by POC due date.

Deadline recorded: Jan 10, 2024. 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

All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working... in a licensed facility: (2) Request a transfer of a criminal record clearance as specified in Section 87355(c)... This requirement is not met as evidence by: Based on interview and review of licensing report summary staff #1 and #2 are not associated to the facility. No documentation to associate staffs has not been submitted. This poses a potential risk to residents in care.

Official plan of correction

The facility Administrator has agreed to get background clearance and request a transfer of criminal record clearance for staff #1 and #2. Within 24h Submit criminal record clearance and/or association form and clear copy of an ID to the Licensing Office.

Deadline recorded: Aug 24, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

Maintenance and Operation. 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 requirement is not met as evidenced by: Deficient Practice Statement Based on observation the licensee did not comply with the section cited above. LPA observed the backyard had discarded furniture (shovels, gardening tools, pieces of wood, chairs) and other hazards.

Official plan of correction

POC Due Date: 02/22/2022 Plan of Correction Cleared during the visit. No further action needed.

Official classification

Type B

Official code

87412(a)

Regulation authority

CCR

What the official deficiency says

Personnel Records. The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. 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 which poses/posed a potential health, safety or personal rights risk to persons in care. LPA did not observe a file for Administrator.

Official plan of correction

POC Due Date: 03/08/2022 Plan of Correction Administrator shall maintain a complete Administrator file on the premises and submit proof by POC due date.