ALTA LOMA GARDENS RESIDENTIAL CARE #2

Official classification

Type A

Official code

87303(e)(2)

Regulation authority

CCR

What the official deficiency says

(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 Based on observation, the licensee did not comply with the section cited above in 4 out of 4 bathrooms observed, hot water temperature measured 140°F and above which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/29/2026 Plan of Correction Licensee shall immediately adjust the hot water temperature to ensure it remains within the required range of 105°F–120°F in all resident bathrooms. Licensee shall also submit a written plan describing how ongoing monitoring of water temperatures will be conducted to ensure continued compliance by POC due date. Licensee shall monitor and document water temperature readings daily for one (1) week and submit the temperature log to LPA by 06/05/2026.

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 as the refrigerator in the kitchen had medication that was not locked and made accessible to residents in care which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/29/2026 Plan of Correction Licensee shall ensure all refrigerated medications are stored in a locked container or locked refrigerator inaccessible to residents in care. Licensee shall submit proof of correction to LPA by the POC due date, including photographs showing refrigerated medications secured in a locked storage area. ***LPA observed correction during visit. Medication was placed in refrigerator located in the garage. Inaccessible to residents.***

Official classification

Type B

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 record review, the licensee did not comply with the section cited above in 2 out of 4 resident files reviewed, as residents R1 and R3 did not have physician orders for the use of bed rails maintained in their files. which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/18/2026 Plan of Correction Licensee shall obtain physician orders for the use of bed rails for residents R1 and R3 and maintain the documentation in each resident’s file. Licensee shall submit copies of the physician orders to LPA by the POC due date.

Official classification

Type B

Official code

87618(b)(3)(B)

Regulation authority

CCR

What the official deficiency says

(3) Ensuring that the use of oxygen equipment meets the following requirements: (B) “No Smoking-Oxygen in Use” signs shall be posted in the appropriate areas. 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 oxygenuse was observed. Required oxygen warning signs were not posted in the facility. which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/18/2026 Plan of Correction Licensee shall post required oxygen warning signs in all applicable oxygen-use areas within the facility. Licensee shall submit proof of correction to LPA by the POC due date, including photographs showing the oxygen warning signs posted.

Official classification

Type B

Official code

87463(a)

Regulation authority

CCR

What the official deficiency says

(a) The pre-admission appraisal, as specified in Section 87457, Pre-Admission Appraisal, shall be updated in writing as frequently as necessary or once every 12 months, whichever occurs first, to note significant changes in condition, as defined in Section 87101, Definitions, and to keep the appraisal accurate. For the purposes of this section, the updated pre-admission appraisal shall be referred to as the reappraisal. 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 in 3 out of 4 resident files reviewed, as residents R1–R3 did not have updated annual re-appraisals maintained in their files. which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/18/2026 Plan of Correction Licensee shall complete updated annual re-appraisals for residents R1–R3 and maintain the documents in each resident’s file. Licensee shall submit copies of the completed re-appraisals to LPA by the POC due date.

Official classification

Type B

Official code

87411(a)

Regulation authority

CCR

What the official deficiency says

(a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. In facilities licensed for sixteen or more, sufficient support staff shall be employed to ensure provision of personal assistance and care as required in Section 87608, Postural Supports. Additional staff shall be employed as necessary to perform office work, cooking, house cleaning, laundering, and maintenance of buildings, equipment and grounds. The licensing agency may require any facility to provide additional staff whenever it determines through documentation that the needs of the particular residents, the extent of services provided, or the physical arrangements of the facility require such additional staff for the provision of adequate services. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview and record review, staff were unaware R1 required all foods to be mechanical soft and meats chopped, LPA Ramirez observed R1 eating a whole sausage patty and orange slices during breakfast, the licensee did not comply with the section cited above in 1 out of 5 residents requires mechanical soft foods, chopped meats, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/05/2025 Plan of Correction Administrator will retrain all staff on needs and services that meet each residents needs and ensure staff is competent to provide these needs. Proof of staff re-training and topics covered in training is due by 8/5/25 by the close of business. Proof must be emailed to LPA Ramirez.

Official classification

Type B

Official code

87412(c)

Regulation authority

CCR

What the official deficiency says

(c) Licensees shall maintain in the personnel records verification of required staff training and orientation. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, LPA Ranirez did not observe verification of required staff training and orientation in personnel records, the licensee did not comply with the section cited above in 2 out of 2 personnel records, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/05/2025 Plan of Correction Licensee will be required to develop and certify a compliance plan outlining the specific steps they will take to meet the above regulation. Plan must be recieved via email to LPA Ramirez no later than the close of business on 8/5/25.

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 resident record review, LPA Ramirez did not observe a medical assessment for R3 in their resident record, the licensee did not comply with the section cited above in 1 out of 5 residents', which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/05/2025 Plan of Correction Licensee will obatain a copy of R3's medical assessment and place in R3's resident file. Proof of R3's medical assessment must be emailed to LPA Ramirez by the close of business on 8/5/25.

Official classification

Type B

Official code

87412(a)(13)(B)

Regulation authority

CCR

What the official deficiency says

(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: (13) For employees that are required to be fingerprinted pursuant to Section 87355, Criminal Record Clearance: (B) Documentation of either a criminal record clearance or a criminal record exemption as required by Section 87355(e). 1. For Certified Administrators, a copy their current and valid Administrative Certification meets this requirement. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation & record review, Administrator certificate for Ana Stark Pleitez has been exipred since 2021, the licensee did not comply with the section cited above in 6 out of 6 residents, and/or staff and visitors, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/18/2024 Plan of Correction Licensee will re-train staff on this regulation by 06/18/2024 and provide LPA Ramirez with current Administrator Certificate by 06/18/2024.

Official classification

Type B

Official code

87506(a)

Regulation authority

CCR

What the official deficiency says

(a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, R3 file was not located by staff during inspection, the licensee did not comply with the section cited above in 1 out of 6 residents which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/18/2024 Plan of Correction Licensee will re-train staff on this regulation and LPA Ramirez will return to inspect R3's resident record.

Official classification

Type B

Official code

87705(c)(5)

Regulation authority

CCR

What the official deficiency says

(c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following: (5) Each resident with dementia shall have an annual medical assessment as specified in Section 87458, Medical Assessment, and a reappraisal done at least annually, both of which shall include a reassessment of the resident's dementia care needs. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, R1 & R2 did not have annual medical assessments, the licensee did not comply with the section cited above in 2 out of 6 residents which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/18/2024 Plan of Correction Licensee will email LPA Ramirez R1 and R2 medical assessment by06/18/24.

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…. This requirement is not met as evidenced by: Based on observation and interviews, the licensee did not comply with the section cited above, which poses an immediate health, safety, or personal rights risk to persons in care. Facility was over capacity due to having a 7th resident.

Official plan of correction

Licensee will ensure that Title 22 Section Code 87204 are met at all times. Additionally, Licensee will write a statement that they will comply with this regulation and submit statement by 03/08/2024. This deficiency will result in an immediate civil penalty for operating beyond the approved capacity.

Deadline recorded: Mar 8, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87307(a)(2)(B)

Regulation authority

CCR

What the official deficiency says

87307 Personal Accommodations and Services. (a) Living accommodations and grounds shall be related to the facility's function. The facility shall be large enough to provide comfortable living accommodations and privacy for the residents, staff, and others who may reside in the facility. The following provisions shall apply: (2) Resident bedrooms shall be provided which meet, at a minimum, the following requirements: (B) No room commonly used for other purposes shall be used as a sleeping room for any resident. This includes any hall, stairway, unfinished attic, garage storage area, shed or similar detached building. This requirement is not met as evidenced by: Based on observation and interviews, the licensee did not comply with the section cited above, which poses a potential health, safety or personal rights risk to persons in care. Resident 6 was residing in a room licensed as " Office " .

Official plan of correction

Licensee will ensure that Title 22 Section Code 87307 are met at all times. Additionally, Licensee will write a statement that they will comply with this regulation and submit the statement to CCLD by 03/08/2024.

Deadline recorded: Mar 8, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87208(a)(7)(A)

Regulation authority

CCR

What the official deficiency says

87208 Plan of Operation. (a) Each facility shall have and maintain a current, written definitive plan of operation. The plan and related materials shall be on file in the facility and shall be submitted to the licensing agency with the license application. Any significant changes in the plan of operation which would affect the services to residents shall be submitted to the licensing agency for approval. The plan and related materials shall contain the following: (7) Sketches, showing dimensions, of the following: (A) Building(s) to be occupied, including a floor plan that describes the capacities of the buildings for the uses intended and a designation of the rooms to be used for nonambulatory residents and for bedridden residents, other than for a temporary illness or recovery from surgery as specified in Sections 87606(d) and (e). This requirement is not met as evidenced by: Based on observation and interviews, the licensee did not comply with the section cited above, which poses a potential health, safety or personal rights risk to persons in care. The garage is being used as a sleeping area for staff and there is no permits allowing this. Also, the garage was not licensed as a living/sleeping area for staff.

Official plan of correction

Licensee will ensure that Title 22 Section Code 87208 are met at all times. Additionally, Licensee is to request a building permit to operate the garage as a staff room, and will submit permit and updated facility sketch to CCLD for approval or remove the bed from the garage and write a statement that they will use the garage as intended.

Deadline recorded: Mar 15, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87307(d)(4)

Regulation authority

CCR

What the official deficiency says

87307 Personal Accommodations and Services (d) The following space and safety provisions shall apply to all facilities: (4) Stairways, inclines, ramps and open porches and areas of potential hazard to residents with poor balance or eyesight shall be made inaccessible to residents unless equipped with sturdy hand railings and unless well-lighted. This requirement is not met as evidenced by: Based on observation and interviews, the licensee did not comply with the section cited above, which poses a potential health, safety or personal rights risk to persons in care. There is a step down when opening a door in the kitchen area leading to a hallway that leads to the garage. This step down is not noticeable and can be a tripping hazard. This door was unlocked when LPA visited the facility.

Official plan of correction

Licensee will ensure that Title 22 Section Code 87307 are met at all times. Additionally, Licensee will write a statement of how they will address the tripping hazard issue and submit the statement to CCLD by 03/08/2024.

Deadline recorded: Mar 8, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87705(j)

Regulation authority

CCR

What the official deficiency says

87705 Care of Persons with Dementia (j) The licensee shall have an auditory device or other staff alert feature to monitor exits, if exiting presents a hazard to any resident. This requirement is not met as evidenced by: Based on observation and interviews, the licensee did not comply with the section cited above, which poses a potential health, safety or personal rights risk to persons in care. All exit doors did not have an auditory device.

Official plan of correction

Licensee will ensure that Title 22 Section Code 87705 are met at all times. Additionally, Licensee will install auditory devices on all exit doors by 03/08/2024.

Deadline recorded: Mar 8, 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

Criminal Record Clearance. ... prior to working, residing or volunteering in a licensed facility: (1) Request a transfer of a criminal record clearance. This requirement is not met as evidenced by: Staff #4 Mark Jeremy Barrica, DOB 08/31/91 was not associated with the facility and working at the facility. 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: 08/30/2023 Plan of Correction The facility will ensure that a criminal record clearance/exemption has been transferred and associated for all staff prior to working or being present at the facility. Administrator would submit evidence to Licensing that a criminal record clearance transfer and association of an individual Mark Jeremy Barrica by POC due date on 9/5/23.

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: 08/30/2023 Plan of Correction Administrator provided a daily water temperature log dated 8/30/23 and a weekly log, dated 09/05/23 to Licensing indicating water temperature was in a range of 105 - 120 degree Fahrenheit. POC due date 9/5/23.

Official classification

Type B

Official code

87506(d)

Regulation authority

CCR

What the official deficiency says

All resident records shall be available to the licensing agency to inspect, audit, and copy upon demand during normal business hours. This requirement is not met as evidenced by: All resident files from resident #1 to resident #6 were missing consent forms, weight records, needs and service plan, and TB test results. Deficient Practice Statement Based on observation and file review, it poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/05/2023 Plan of Correction Administrator would have all residents files complete with consent forms, weight records, needs and service plan, and TB test results by POC due date on 9/5/23.

Official classification

Type B

Official code

87412(f)

Regulation authority

CCR

What the official deficiency says

All personnel records shall be available to the licensing agency to inspect, audit, and copy upon demand during normal business hours. This requirement is not met as evidenced by: All staff files from staff #1 to staff#3 were missing Tb test results, 1st aide certificates, employee’s right and medical training verifications. Deficient Practice Statement Based on observation and file review, it poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/05/2023 Plan of Correction Administrator would have all staff files complete with Tb test results, 1st aide certificates, employee’s right and medical training verifications by POC due date on 9/5/23.

Official classification

Type B

Official code

87411(f)

Regulation authority

CCR

What the official deficiency says

(f) All personnel, including the licensee and administrator, shall be in good health, and physically and mentally capable of performing assigned tasks. Good physical health shall be verified by a health screening, including a chest x-ray or an intradermal test, performed by a physician not more than six (6) months prior to or seven (7) days after employment or licensure. A report shall be made of each screening, signed by the examining physician. The report shall indicate whether the person is physically qualified to perform the duties to be assigned, and whether he/she has any health condition that would create a hazard to him/herself, other staff members or residents. A signed statement shall be obtained from each volunteer affirming that he/she is in good health. Personnel with evidence of physical illness or emotional instability that poses a significant threat to the well-being of residents shall be relieved of their duties. This requirement is not met as evidenced by: Deficient Practice Statement Based on records reviewed, the licensee did not comply with the section cited above in 2 out of 2 staff files which poses a potential health, safety or personal rights risk to persons in care. S1 and S2 did not have a health screening on file.

Official plan of correction

POC Due Date: 07/27/2022 Plan of Correction Administrator agreed to submit proof of health screenings by 7/27/22.

Official classification

Type B

Official code

87506(b)(15)

Regulation authority

CCR

What the official deficiency says

(b) Each resident's record shall contain at least the following information: (15) The admission agreement and pre-admission appraisal, specified in Sections 87507, Admission Agreements and 87457, Pre-admission Appraisal. 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 in 2 out of 4 resident records which poses a potential health, safety or personal rights risk to persons in care. Resident #1 (R1) and Resident (R2) did not have a pre-admission appraisal on file. R1 also did not have an admission agreement on file.

Official plan of correction

POC Due Date: 07/27/2022 Plan of Correction Administrator agreed to submit documents by 7/27/22.

Official classification

Type A

Official code

87411(g)(1)

Regulation authority

CCR

What the official deficiency says

Personnel requirements: Prior to employment or initial presence in the facility, all employees and volunteers subject to a criminal record review shall: Obtain a California clearance or a criminal record exemption as required by law or Department regulations This requirement was not met as evidenced by: The following staff was not associated to the facility (Oliver Velasco hired in January 2021). Immediate Civil Penalties were assessed.

Official plan of correction

The facility will ensure all staff members are fingerprint cleared and associated prior to working at the facility. (1) The licensee will submit evidence staff has submitted to a live scan and have been associated by 12/17/21.

Deadline recorded: Dec 17, 2021. 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

The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff This requirement was not met as evidenced by: Staff did not provide complete resident or staff files during a complaint visit.

Official plan of correction

License will ensure all required staff and resident files are maintained at the facility and are made available upon request. Licensee will submit a written statement as to how Licensee will comply with this regulation by to LPA Irra by POC due date of 12/20/21.

Deadline recorded: Dec 20, 2021. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(h)(6)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care (h) The following requirements shall apply to medications which are centrally stored: (6) The licensee shall be responsible for assuring that a record of centrally stored prescription medications for each resident is maintained for at least one year and includes: (A)-(F) This requirement was not met as evidence by: The licensee was giving resident #1 a multi-vitamin and Stool softener (DOCUSATE SODIUM 100mg) with out a physcians order.

Official plan of correction

Licensee will ensure all medication and vitamins given to residents have an order in place prior to dispencing the medication and that it is logged when given. Licensee will read CCR 87465 and will send a signed written statement stating she has read and understands the full section and will to LPA by POC due sate

Deadline recorded: Sep 8, 2021. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87465(c)(2)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care (c) If the resident's physician has stated in writing that the resident is unable to determine his/her own need for nonprescription PRN medication but can communicate his/her symptoms clearly, ......provided all of the following requirements are met: (2) Once ordered by the physician the medication is given according to the physician's directions. This requirement was not met as evidence by: Licensee failed to give resident #1, 10 and 11 their medication as prescribed by their physcians orders.

Official plan of correction

Licensee will have a pharmacy conduct training with all staff who administer medication and herself. Licensee will send material of subjects covered and sign in sheet of attendees by POC due date.

Deadline recorded: Sep 13, 2021. A deadline is not proof that correction was completed.