HARMONY HOME CARE

Official classification

Type B

Official code

87507(c)

Regulation authority

CCR

What the official deficiency says

87507 Admission Agreements (c) Admission agreements shall be signed and dated, acknowledging the contents of the document, by the resident or the resident’s representative...no later than seven days following admission... This requirement is not met as evidenced by: Based on interviews, observation, and record reviews, the Licensee admitted having falsified (R1’s) Admission Agreement by illegally signing another person's name or initials on the legal contract. This violation poses a potential health and safety risk to residents in care.

Official plan of correction

Licensee/Administrator shall review Tittle 22 87507 Admissions Agreement and submit in written statement have reviewed and will comply with the regulation requirements. The plan must be submitted by POC date 11/02/25 to ernand.dabuet@dss.ca.gov

Deadline recorded: Nov 2, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87623(a)(1-2)(B)

Regulation authority

CCR

What the official deficiency says

87623 Indwelling Urinary Catheter (a) The licensee shall be permitted to accept or retain a resident...requires the use of an indwelling catheter.. (1) Ensuring that insertion and irrigation of the catheter shall be performed by an appropriately skilled professional. (2) Ensuring that the bag and tubing are changed by an appropriately skilled professional... (B) There shall be written documentation by an appropriately skilled professional outlining the instruction... procedures delegated... This requirement is not met as evidenced by: Based on interviews, observation, and record reviews, the Licensee failed to provide as evidence a catheter care was performed by a skilled professional nor provided an outlining instruction of procedures in a written care plan. This violation poses a potential health and safety risk to residents in care.

Official plan of correction

Licensee/Administrator shall review Tittle 22 87623 Indwelling Urinary Catheter and submit in written statement have reviewed and will comply with the regulation requirements. The plan must be submitted by POC date 11/02/25 to ernand.dabuet@dss.ca.gov

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

Official classification

Type A

Official code

87466

Regulation authority

CCR

What the official deficiency says

87466 Observation of the Resident - The licensee shall ensure that residents are regularly observed for changes... and that appropriate assistance is provided... when such observation reveals unmet... When changes such as... deterioration of mental ability or a physical health condition... are observed, the licensee shall ensure that such changes are documented and brought to the attention of the resident's physician. This requirement is not met as evidenced by: Based on interviews, observation, and record reviews, the Licensee was aware of (R1's) history of pressure injuries and retained (R1) with a stage 3 prohibited health condition and failed to ensure proper care, such as hospice or home health care services, were provided for the wounds. This violation poses an immediate health and safety risk to residents in care.

Official plan of correction

Licensee/Administrator shall have a written plan to ensure that in addition to the resident's needs and services plan a specific plan is drafted for each resident's change in physical, mental, emotional and social functioning and that appropriate assistance is provided when such observation reveals unmet needs. The plan must be submitted by POC date 10/08/25 to ernand.dabuet@dss.ca.gov

Deadline recorded: Oct 8, 2025. 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

87615 Prohibited Health Conditions (a) Persons who require health services for or have a health condition including, but not limited to... shall not be admitted or retained in a residential care facility for the elderly: (1) Stage 3 and 4 pressure injuries. This requirement is not met as evidenced by: Based on interviews, observation, and record reviews, the Licensee was aware of (R1's) pressure injuries and retained (R1) with stage 3 wounds and failed to ensure proper care, such as hospice or home health care services, were not provided. This violation poses an immediate health and safety risk to residents in care.

Official plan of correction

Licensee/Administrator will review Title 22, Section 87615, of the regulation and submit a written review to ensure compliance with the regulations. Licensee will retrain staff on pressure injuries and submit completed training with staff name, and dated completed by POC date 10/08/25 to ernand.dabuet@dss.ca.gov

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

Official classification

Type B

Official code

87608(b)

Regulation authority

CCR

What the official deficiency says

87608 Postural Supports (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 This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and review the licensee did not comply with the section cited above. LPA identified Resident #3 had full bed rails and did not have physician’s orders on file. Resident was not on hospice. This violation 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 to adhere to Ttitle 22 87608(b) regulations and obtain a physicians orders for full bed rails. POC is due by 101/10/25 to LPA by fax 424-544-1016.

Official classification

Type B

Official code

87458(b)

Regulation authority

CCR

What the official deficiency says

87458 Medical Assessment (b) The licensee shall obtain an updated medical assessment when required by the Department. 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. LPA observed Resident #1 had no current Physicians Report since 2023. No current Medical Assessment LIC 602A and resident is diagnosed with NCD. This violation which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/27/2025 Plan of Correction Licensee agrees that a Plan of Correction will be submitted to CCLD by 10/10/25 with a current Medical Assessment LIC 602A for Resident #1 by POC must be fax to 424-544-1016.

Official classification

Type B

Official code

87458(a)

Regulation authority

CCR

What the official deficiency says

(a) Prior to a person's acceptance as a resident, the licensee shall obtain documentation of a medical assessment, signed by a licensed medical professional acting within the scope of their practice and made within the last year, to be kept in the resident's record. 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. LPA identified Resident #3 admitted without a Medical Assessment for Residential Care Facilities for the Elderly (LIC 602A) on file. This violation 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

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 is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above. LPA observed staff prescribed medications left exposed and accessible to residents in care in a vacant resident room. This violation which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/27/2025 Plan of Correction Licensee will ensure any hazardous items shall be stored in locke storage and not left unattended accessible to residents in care. POC is due by 10/27/25 to ernand.dabuet@dss.ca.gov.

Official classification

Type A

Official code

8733559(e)(1)

Regulation authority

CCR

What the official deficiency says

87355 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... (1) Obtain a California clearance or a criminal record exemption as required by the Department or This requirement is not met as evidenced by: Based on record review and interview, there's evidence Staff #3 is did not have Criminal Record Clearance prior to working at the facility. This violation which is an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

Licensee will ensure to adhere to Title 22 Reg. 873449 have all staff prior to working in a licensed faciltiy have been Criminal Record Clearance. Licensee will have staff #3 fingerprint clearance by POC 03/12/25. IMMEDICATE CIVIL PENALTIES

Deadline recorded: Mar 12, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87457(c)

Regulation authority

CCR

What the official deficiency says

(c) Prior to admission a determination of the prospective resident's suitability for admission shall be completed and shall include an appraisal of his/her individual service needs in comparison with the admission criteria specified in Section 87455, Acceptance and Retention Limitations. 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. LPA identified (Residentt #2) did not have an appraisal of individual service needs and CCL forms not fill out completely. This violation which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/22/2024 Plan of Correction Licensee will ensure that all resident " s have a complete resident file. Proof of correction will require for a complete fill out residents forms including needs/services plan appraisal. Proof of correction must be sent to LPA Dabuet by due date via email at ernand.dabuet@dss.ca.gov

Official classification

Type B

Official code

87303(a)(c)

Regulation authority

CCR

What the official deficiency says

(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. (c) All window screens shall be clean and maintained in good repair. 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 identified Room #5 window screen had a hole. The common bathroom shower area did not have a shower curtain for privacy. This violation which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/22/2024 Plan of Correction Licensee will adhere to Title 22 87303 Maintenance and Operation. Licensee will repair or replace window screen and purchase a shower curtain for the resident's bathroom. Proof of correction must be sent to LPA Dabuet by due date via email at ernand.dabuet@dss.ca.gov

Official classification

Type B

Official code

87705(c)(5)

Regulation authority

CCR

What the official deficiency says

87705 (c)(5) Care of Persons with Dementia(c) Licensees...shall be responsible for ensuring the following:(5)...an annual medical assessment...a reappraisal done at least annually...shall include...resident’s dementia care needs. This requirement was not met as evidenced by: This requirement is not met as evidenced by: Deficient Practice Statement Based on (observation) (record review)], the licensee did not comply with the section. LPA identified Resident #2 with dementia, did not have current annual medical and needs and appraisal assessement for 20223. This violation which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/11/2023 Plan of Correction The administrator agreed to obtain a medical assessment and needs and appraisal for Resident #2 and will create a plan to ensure that each resident with dementia shall have an annual medical assessment as specified in Section 87458, Medical Assessment. Proof of correction will be submitted to CCL via email at ernand.dabuet@dss.ca.gov. by 9/11/23. The administrator may ask for an extension if more time is needed via email.

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 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 cob webs in hallways. LPA identified old sofa in the driveway that has not been discarded in several years. These violaitons which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/11/2023 Plan of Correction The administrator agreed to do a deep cleaning of hallways. The old sofa will be discarded and scheduled for trash pick up. Proof of correction will be submitted to CCL via email at ernand.dabuet@dss.ca.gov by 09/11/23. The administrator may ask for an extension if more time is needed via email.

Official classification

Type B

Official code

87465(d)

Regulation authority

CCR

What the official deficiency says

(d) If the resident is unable to determine his/her own need for a prescription or nonprescription PRN medication, and is unable to communicate his/her symptoms clearly, facility staff designated by the licensee, shall be permitted to assist the resident with self-administration provided all the following requirements are met: This requirement is not met as evidenced by: Deficient Practice Statement Based on [(observation) (interview) (record revew)], the licensee did not comply with the section cited above. LPA identified Resident #3 was missing documentation of Gabapentin 300mg for the entire month of August 2023 in (MAR). This violation which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/11/2023 Plan of Correction The administrator will ensure to review Title 22 Reg 87465 and retrained staff on administration of medications to residents in care. Administrator will send a written plan stating Reg 87465 was reviewed and staff have been retrained. POC must be submitted before due date 09/11/23. Proof of correction must be sent to ernand.dabuet@dss.ca.gov.

Official classification

Type B

Official code

87505

Regulation authority

CCR

What the official deficiency says

7505 Documentation and Support Each facility shall document in writing the findings of the pre-admission appraisal and any reappraisal or assessment which was necessary in accordance with Sections 87457, Pre-admission Appraisal, and 87463, Reappraisals. If supporting documentation from a physician is required, this input shall also be obtained and may be the same assessment as required in Section 87458, Medical Assessment. 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 identified Resident #1 who was admitted in June 2023 was missing documentation and support in service file. This violation which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/11/2023 Plan of Correction The administrator will ensure to review Title 22 Reg 87505 and maintain all the required documentation and support records for Resident #1. Administrator will send proof of correction to LPA Dabuet by email at ernand.dabuet@dss.ca.gov by 09/11/23.

Official classification

Type B

Official code

87466

Regulation authority

CCR

What the official deficiency says

87466 Observation of the Resident: The licensee shall ensure that residents are regularly observed for changes in physical, mental, emotional, and social functioning and that appropriate assistance is provided when such observation reveals unmet needs... This requirement is not met as evidenced by: Based on interview and record reviews, (S1) admitted such changes in (R1’s) health condition failed to seek timely medical attention on 05/08/23 and 05/23/22, which poses a potential health and safety risk to residents in care.

Official plan of correction

Licensee/Administrator shall read Title 22, Section 87466 “Observation of the Resident” and send a written statement to CCLD that you have read and understand this section. This plan is due to CCLD/El Segundo ASC Office by POC date of 03/17/23. *Citations not cleared by the due date will be a $100 fine assessed for each citation until it is cleared. Civil penalties will continue to accrue until POCs are cleared.*

Deadline recorded: Mar 17, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87405

Regulation authority

CCR

What the official deficiency says

87405(b)(2) Administrator - Qualifications and Duties. (b)The administrator of a facility or facilities shall have the responsibility and authority to carry out the policies of the licensee. (2) Knowledge of and ability to conform to the applicable laws, rules and regulations. This requirement was not met as evidenced by: Based on interview and record reviews the Licensee/Administrator failed to adhere to Title 22 regulations, resulting to multiple deficiencies cited, which poses a potential health and safety risk to residents in care.

Official plan of correction

Licensee/Administrator shall read Title 22, Section 87405(b)(2) “Administrator - Qualifications and Duties” and send a written statement to CCLD that you have read and understand this section. This plan is due to CCLD/El Segundo ASC Office by POC date of 03/17/23. *Citations not cleared by the due date will be a $100 fine assessed for each citation until it is cleared. Civil penalties will continue to accrue until POCs are cleared.*

Deadline recorded: Mar 17, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87507(e)

Regulation authority

CCR

What the official deficiency says

87507 Admission Agreements (e) The licensee shall provide a copy of the signed and dated current admission agreement, and all subsequent signed and dated modifications, to the resident or the resident's representative... This requirement is not met as evidenced by: Based on the interview and record review and interviews, the administrator did not comply with the section cited above. The facility failed to provide a copy of the admissions agreement to (R1's) family representative. This violation poses a potential health, safety, or personal rights risk to persons in care.

Official plan of correction

The administrator will review Title 22 Sec. 87507 and agreed to send a copy of the contract to (R1's) family representative by USPS Certified Mail. The Administrator will send proof of correction to LPA by POC due date: 11/14/22.

Deadline recorded: Nov 14, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

82711(a)(B)(D)

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... (B) Any serious injury... occurring while the resident is under facility supervision. (D) Any incident which threatens the welfare, safety or health of any resident... This requirement is not met as evidenced by: Based on interview and record review, and interviews, the administrator did not comply with the section cited above. The facility failed to send written incident reports to CCLD. This violation poses a potential health, safety, or personal rights risk to persons in care.

Official plan of correction

The administrator will review Title 22 Sec. 87211 and agreed to send incident reports for (R1) for dates 05/08/22 & 05/23/22. The administrator will send the correction to LPA by POC due date: 11/14/22.

Deadline recorded: Nov 14, 2022. 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) 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. LPA identified cleaning solutions and sharp kitchen ojects in unlocked drawers and cabinets accessible to residents in care. This violation which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/09/2022 Plan of Correction The licensee will adhere to regulations 87309 and ensure to have medications are in locked storage units at all times. The licensee will send proof of correction by POC 10/09/22. *This violation is corrected during visit.*

Official classification

Type B

Official code

87303(c)

Regulation authority

CCR

What the official deficiency says

(c) All window screens shall be clean and maintained in good repair. 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 identified bathroom #2 with a missing window screen. This violation which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/22/2022 Plan of Correction The licensee will adhere to regulations 87303 and ensure to repair/replace missing screen. The licensee will send proof of correction by POC 10/22/22.

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 . LPA identified stove hood, oven, and dishwasher filled with dirt grime and grease. The appliances are unsanitary. This violation which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/08/2022 Plan of Correction The licensee will adhere to regulations 87555 and deep clean stove hood, oven and dishwasher. The licensee will send proof of correction by POC 11/08/22.

Official classification

Type A

Official code

87465(2)

Regulation authority

CCR

What the official deficiency says

(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. LPA identified at 2:02pm mediation closet was unlocked and accessible to residents in care. This violation poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/09/2022 Plan of Correction The licensee will adhere to regulations 87465 and ensure to have medications are in locked storage units at all times. The licensee will send proof of correction by POC 10/09/22. *This violation is corrected during visit.*