Resident rightsType B
- Official classification
- Type B
- Official code
- 87468(b)
- Regulation authority
- CCR
What the official deficiency says
(b) At the time the admission agreement is signed, a resident and the resident's representative shall be personally advised of and given a copy of: This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview, and record review, the licensee did not comply with the section cited above for 1 out of 5 resident R3 had no LIC 613 on file which poses/posed a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 05/09/2026 Plan of Correction The facility will submit the proof of correction to the CCLD/El Segundo ASC Office via fax at 424-544-1016 Attn: Zina Brown or via email at zina.brown@dss.ca.gov by the POC due date.
Records and plan of operationType B
- Official classification
- Type B
- Official code
- 87506(b)
- Regulation authority
- CCR
What the official deficiency says
(b) Each resident's record shall contain at least the following information: This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview, & records review, the licensee did not comply with the section cited above for 5 out of 5 residents did not have the following records on R1: TB Test & LIC 601/ 625, R2: LIC 601/602/603/625, R3: LIC602/613/ 625, R4: LIC 625 & R5: LIC 603/ 625 & TB Test which poses/posed a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 05/16/2026 Plan of Correction The facility will submit the proof of correction for all residents such as 1: TB Test & LIC 601/ 625, R2: LIC 601/602/603/625, R3: LIC 602/613/ 625, R4: LIC 625 & R5: LIC 603/ 625 & TB Test to the CCLD/El Segundo ASC Office via fax at 424-544-1016 Attn: Zina Brown or via email at zina.brown@dss.ca.gov by the POC due date.
Fire safety and emergency preparednessType B
- Official classification
- Type B
- 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 observation, interview, record review, the licensee did not comply with the section cited above by not conducting nor having documentation on file for when the last quarterly emergency drill was conducted which poses/posed a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 05/09/2026 Plan of Correction The facility will conduct a quarterly emergency drill by the POC due date and submit proof to the CCLD/El Segundo ASC Office via fax at 424-544-1016 Attn: Zina Brown or via email at zina.brown@dss.ca.gov
Health conditions and treatmentsType B
- Official classification
- Type B
- Official code
- 87633(a)(4)
- Regulation authority
- CCR
What the official deficiency says
A written hospice care plan which specifies the care, services, and necessary medical intervention related to the terminal illness as necessary to supplement the care and supervision provided by the facility is developed for each terminally ill resident or prospective resident by that resident’s hospice agency and agreed to by the licensee and the resident, or prospective resident, or the resident’s or prospective resident’s Health Care Surrogate Decision Maker, if any, prior to the initiation of hospice services in the facility for that resident, and all hospice care plans are fully implemented by the licensee and by the hospice(s). 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 for 1 out 5 residents by not having a hospice care plan on file for Resident 2 (R2) which poses/posed a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 05/23/2026 Plan of Correction The facility will obtain Resident 2 (R2) Hospice Care Plan from the company that is providing services to R2 by the POC due date and submit proof to the CCLD/El Segundo ASC Office via fax at 424-544-1016 Attn: Zina Brown or via email at zina.brown@dss.ca.gov