HARMONY HOME CARE

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 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.*