Background checksType A
- Official classification
- Type A
- Official code
- 87355(e)(3)
- Regulation authority
- CCR
What the official deficiency says
(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (3) Request a transfer of a criminal record clearance as specified in Section 87355(c) or 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 4 out of 5 staff which poses an immediate health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 07/07/2026 Plan of Correction The facility submit (4) LIC 9182 Criminal Background Clearance Transfer Request for S2 Raymar Arana, S3 Robert Sinclair, S4 Patrice Antonio, S5 Majorie Brown to the Department via email at zina.brown@dss.ca.gov by POC due date for the employees S2, S3, S4, & S5 to be associated in Guardian.
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 which poses a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 07/27/2026 Plan of Correction The facility will document the time & date of the next emeregency disaster drill and via email at zina.brown@dss.ca.gov by POC due date
Health conditions and treatmentsType B
- Official classification
- Type B
- Official code
- 87608(a)(3)
- Regulation authority
- CCR
What the official deficiency says
(a) Based on the individual's preadmission appraisal, and subsequent changes to that appraisal, the facility shall provide assistance and care for the resident in those activities of daily living which the resident is unable to do for himself/herself. Postural supports may be used under the following conditions: (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 the order. 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 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: 07/27/2026 Plan of Correction The licensee will remove half-bedrails and or obtain a written order from a physician indicating the need for the postural support for the following Resident 3 (R3) Daniel Donovan, and submit proof to the department via email Zina.Brown@dss.ca.gov by POC due date.
Medication handling and storageType B
- Official classification
- Type B
- Official code
- 87465(h)(6)(A-F)
- Regulation authority
- CCR
What the official deficiency says
(h) The following requirements shall apply to medications which are centrally stored: (6) The licensee shall be responsible for assuring a record of centrally stored prescription medications for each resident is maintained ...(A-F) records for centrally stored medication… This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, the Department identified undocumented on the medication administrations record, for R2 - 6 PRN’s & Loratadine, R4’s Furosemide, & all of R5’s medication indicating medications were not documented as required, which poses a potential health, safety, and personal rights risk to persons in care.
Official plan of correction
POC Due Date: 07/27/2026 Plan of Correction The Administrator will ensure all entries of medication for all residents recorded on the MAR & must be signed & dated daily. The administrator will submit proof of update MARs for R2, R4, R5 and email proof to LPA Brown at Zina.Brown@dss.ca.gov by POC due date
Staffing, personnel, and trainingType B
- Official classification
- Type B
- Official code
- 87412(a)
- 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: 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 out for 5 out of 5 staff which poses/posed a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 07/27/2026 Plan of Correction The facility will submit proof of LIC 501, LIC 503 with TB Test, First Aid/CPR, Annual Staff Training for S1, S2, S3, S4, S5 via email at zina.brown@dss.ca.gov by POC due date.