GIANA'S HOME #1

Official classification

Type A

Official code

87202(a)(2)

Regulation authority

CCR

What the official deficiency says

(a) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, or the State Fire Marshal. Prior to accepting or retaining any of the following types of persons, the applicant or licensee shall notify the licensing agency and obtain an appropriate fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, or the State Fire Marshal: (2) Bedridden persons 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, as the Licensee did not adhere to the approved fire clearance permitting one (1) bedridden resident; however, the facility had two (2) bedridden residents.

Official plan of correction

POC Due Date: 02/25/2026 Plan of Correction The Administrator will request updated physician’s reports for Residents R2 and R6. The Administrator will ensure that bedridden residents are placed in the approved bedridden room, identified as Bedroom 4, in accordance with the facility’s fire clearance, or will request an updated fire clearance if needed.

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 during the facility walkthrough, LPA tested the hot water temperatures in three (3) restrooms. Two (2) restrooms accessible to residents measured hot water temperatures exceeding 130°F, which is outside the required range of 105°F–120°F.

Official plan of correction

POC Due Date: 02/25/2026 Plan of Correction The Administrator will lower the hot water temperature to meet regulatory requirements and maintain a temperature log for Restroom 1 and Restroom 2 for one (1) week.

Official classification

Type A

Official code

87309(a)

Regulation authority

CCR

What the official deficiency says

(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, as the kitchen cabinet door and kitchen cabinet drawer did not have a lock, which posed an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 02/25/2026 Plan of Correction Licensee shall ensure that disinfectants, cleaning solutions and sharp items (knives) be locked at all times. Licensee is to add locks to cabinet, kitchen drawer or replace in a locked area. ***POC cleared at the time of visit.***

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 record review the licensee did not comply with the section cited above in two (2) out of six (6) residents did not have TB test on file which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/20/2026 Plan of Correction Administrator will obtain TB test results for residents R2 and R5 and submit results by POC date.

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 observation and record review, licensee did not comply with the section cited above in one (1) out of six (6) residents, R4 did not have a physician’s order for a bed rail, which posed a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 03/20/2026 Plan of Correction Administrator shall obtain a physician’s order for the use of bed rails for R4. ***POC cleared at time of visit***

Official classification

Type A

Official code

87303(e)(2)

Regulation authority

CCR

What the official deficiency says

(e) Water supplies and plumbing fixtures shall be maintained as follows: (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 5 out of 5 residents, staff and or visitors, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/06/2024 Plan of Correction Staff lowered water temperature during visit. **This will clear 24hr POC** Licensee will retrain staff on above regulation by 3/19/24. Proof of re-training must be sent by 3/19/24.

Official classification

Type A

Official code

87705(f)(2)

Regulation authority

CCR

What the official deficiency says

(f) The following shall be stored inaccessible to residents with dementia: (2) Over-the-counter medication, nutritional supplements or vitamins, alcohol, cigarettes, and toxic substances such as certain plants, gardening supplies, cleaning supplies and disinfectants. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, keys to unlock cleaning supplies was observed to be resting on top of vanity mirror, the licensee did not comply with the section cited above in 2 out of 5 residents, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/06/2024 Plan of Correction Staff removed keys and placed in secure location. **This will clear 24hr POC** Licensee will retrain staff on above regulation by 3/19/24. Proof of re-training must be sent by 3/19/24.

Official classification

Type B

Official code

87305(a)

Regulation authority

CCR

What the official deficiency says

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, interview, and record review, the licensee did not comply with the section cited above in 5 out of 5 residents, staff and or visitors, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/19/2024 Plan of Correction Licensee/Administrator agreed to comply with city and state regulations: 1. Apply for a city permit 2. Update the Plan of Operation (include that a permit request was submitted to the city) 3. Update the facility sketch or tear down ADU and send picture proof.

Official classification

Type B

Official code

87305(a)

Regulation authority

CCR

What the official deficiency says

Alterations to Existing Building or New Facilities. Prior to construction or alterations, all facilities shall obtain a building permit. This requirement was not met evidenced by: Based on physical plant inspection it was observed that the Office room was converted into a live-in staff room for 2, and a additional live-in staff room was constructed inside the garage without obtaining a city permit or notifying Community Care Licensing; which pose a potential health and safety risk to persons in care.

Official plan of correction

Licensee/Administrator agreed to comply with city and state regulations: 1. Apply for a city permit 2. Update the Plan of Operation (include that a permit request was submitted to the city) 3. Update the facility sketch

Deadline recorded: Nov 28, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(e)

Regulation authority

CCR

What the official deficiency says

(e) For every prescription and nonprescription PRN medication for which the licensee provides assistance there shall be a signed, dated written order from a physician on a prescription blank, maintained in the resident's file, and a label on the medication. Both the physician's order and the label shall contain at least all of the following information. 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 4 of 5 counts which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/21/2022 Plan of Correction Administrator will contact phycisian and get PRN orders for R1 -R4 and email proof by POC date to LPA.

Official classification

Type B

Official code

87303(e)(6)

Regulation authority

CCR

What the official deficiency says

(e) Water supplies and plumbing fixtures shall be maintained as follows: (6) Toilet, handwashing and bathing facilities shall be maintained in operating condition. Additional equipment shall be provided in facilities accommodating physically handicapped and/or nonambulatory residents, based on the residents' needs. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation. LPA and administrator observed 2 bathroom sinks that were back up which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/22/2022 Plan of Correction Administrator will repair drain and send video and certify that it the sinks have been repiaired by POC date.

Official classification

Type B

Official code

87307(d)(2)

Regulation authority

CCR

What the official deficiency says

(2) The premises shall be maintained in a state of good repair and shall provide a safe and healthful environment. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation. the side door latch to the door on the right side of the home is broken which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/11/2022 Plan of Correction Administrator will repair door and send pictures as proof of correction to LPA by POC date.