HAPPY HOME CARE FOR ELDERLY

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 observation, interview, record review, the licensee did not comply with the section cited above in which the facility accepted (1) resident, (R3) who is bedridden but did not notify Licensing and did not obtain an appropriate fire clearance approved by the city/county fire departmen which poses an immediate health, safety or personal rights risk to residents in care.

Official plan of correction

POC Due Date: 10/03/2025 Plan of Correction Licensee agreed to call the fire department today to notify them of one (1) bedridden resident. Licensee will also obtain an updated physician's report showing the resident's ambulatory status and submit proof to CCL/LPA by POC due date.

Official classification

Type B

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 that the water temperature readings in bathroom #1 were 99.5 degf (9:55am), 99.3 deg F (10:02am) and 93.3 deg F (10:09am) and bathroom #2 were 95.9 deg F and 95.5 deg F which did not meet the Title 22 regulation which poses/posed a potential health, safety or personal rights risk to residents in care.

Official plan of correction

POC Due Date: 10/02/2025 Plan of Correction Licensee adjusted the water temperature and the readings met the Title 22 regulation after LPA re-checked the temperature. ****DEFICIENCY CLEARED DURING THE VISIT.***

Official classification

Type A

Official code

87411(a)

Regulation authority

CCR

What the official deficiency says

87411 Personnel Requirements - General (a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. This requirement is not met as evidenced by: Staff #1 did not have the competency to provide care to meet the needs of the residents which poses an immediate health, safety, and personal rights to residents in care.

Official plan of correction

The licensee shall ensure all employees have related job experience and sufficient training to work with this population. A statement acknowledging this regulation has been read and understood will be submitted to LPA by 10/18/24.

Deadline recorded: Oct 18, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87405(h)(8)

Regulation authority

CCR

What the official deficiency says

(h) The administrator shall have the responsibility to:(8) Have the personal characteristics, physical energy and competence to provide care and supervision and, where applicable, to work effectively with social agencies. This requirement was not met as evidence by: Licensee provided unauthentic CPR/First Aid training for S1.

Official plan of correction

Licensee will certify all training will be authenticated and verified.

Deadline recorded: Jul 4, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

1569.269(a)(21)

Regulation authority

HSC

What the official deficiency says

1569.269 Enumerated rights; severability (a) Residents of residential care facilities for the elderly shall have...(21)To have prompt access to review all of their records...not to exceed two business days... This requirement is not met as evidenced by: The licensee did not provide Resident #1's record to legal representative within 2 working days which poses a potential personal rights risk to resident in care.

Official plan of correction

The licensee shall develop a plan to get the records to the legal representative and provide proof to show records were given to them. This POC is due 12/1/23.

Deadline recorded: Dec 1, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87468.2(a)(4)

Regulation authority

CCR

What the official deficiency says

87468.2 Additional Personal Rights of Residents in Privately Operated Facilities (a) (4) To care, supervision, and services that meet their individual needs...delivered by staff... This requirement is not met as evidenced by: Based on interviews, the licensee did not ensure that the residents are provided with care, supervision, and services that meet their needs which poses an immediate health, safety, and personal rights to residents in care.

Official plan of correction

The licensee shall ensure each staff member is qualified to provide care and supervision to all residents. The licensee shall provide in-service training to all staff regarding the care plan for each resident and ensuring there is sufficient staffing to meet their needs. This POC is due by 10/11/23.

Deadline recorded: Oct 11, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87355(e)(1)

Regulation authority

CCR

What the official deficiency says

87355 Criminal Record Clearance (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: (1) Obtain a California clearance or a criminal record exemption as required by the Department or This requirement is not met as evidence by: Licensee Jung Kim failed to obtain required criminal record clearance or a criminal record exemption from the State Department of Social Services before S1’s gainful employment at the facility, direct contact with residents in the facility and residing in the facility.

Official plan of correction

Licensee shall certify in writing to this licensing agency, all future staff will be subject to a criminal clearance and obtain clearance before staff begins employment, resides at facility or has direct contact with residents in care. LIC 421BG-Civil Penalty of $500 was assessed on 6/30/23.

Deadline recorded: Jul 1, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

1569.605

Regulation authority

HSC

What the official deficiency says

On and after July 1, 2015, all residential care facilities for the elderly, except those facilities that are an integral part of a continuing care retirement community, shall maintain liability insurance covering injury to residents and guests in the amount of at least one million dollars ($1,000,000) per occurrence and three million dollars ($3,000,000) in the total annual aggregate, caused by the negligent acts or omissions to act of, or neglect by, the licensee or its employees. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, proof of liability insurance did not meet the above mentioned limits, the licensee did not comply with the section cited above in 4 out of 4 residents and guests, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/28/2023 Plan of Correction Licensee agreed to submit plan by 6/28/23 to address liability insurance. Proof of liability insurance that meets liability limits per HSC 1569.605 must be submitted to LPA by 7/5/23.

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

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, kitchen cabinets contained caked yellowish and brown spatter stain, 3-inch crack in bedroom #4, 3x3 inch circular hole on shared bathroom#2, overgrowth of weeds and grass in backyard, the licensee did not comply with the section cited above in 4 out of 4 residents which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/11/2023 Plan of Correction Licensee will clean and disinfect surrounding kitchen cabinets above stove and ceiling, repair crack on wall of bedroom #4, repair hole shared bathroom #2, rid backyard of weed and grass overgrowth. LPA Ramirez will return to the facility to ensure corrections have been made.

Official classification

Type B

Official code

87412(d)

Regulation authority

CCR

What the official deficiency says

(d) The licensee shall maintain documentation that an administrator has met the certification requirements specified in Section 87406, Administrator Certification Requirements or the recertification requirements in Section 87407, Administrator Recertification Requirements. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, Licensee/Administrator Kim could not provide LPA Ramirez with proof of renewed certificate, the licensee did not comply with the section cited above in 4 out of 4 residents which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/11/2023 Plan of Correction Licensee/Administrator will submit proof of Administrator certificate renewal to LPA Ramirez via email. Licensee/Administrator will maintain certification as required.

Official classification

Type B

Official code

87412(c)(2)(C)

Regulation authority

CCR

What the official deficiency says

(c) Licensees shall maintain in the personnel records verification of required staff training and orientation. (2) Documentation of staff training shall include: (C) Date(s) of attendance; and This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, the licensee did not record complete dates regarding training, the licensee did not comply with the section cited above in 4 out of 4 residents which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/11/2023 Plan of Correction Licensee will ensure full dates are recorded on all future staff required training. Licensee will develop a plan and submit to LPA by 7/11/23 via email.

Official classification

Type B

Official code

87555(b)(26)

Regulation authority

CCR

What the official deficiency says

(b) The following food service requirements shall apply: (26) Supplies of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days shall be maintained on the premises. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, LPA Ramirez did not observe sufficent two day supply of perishable foods for four residents, the licensee did not comply with the section cited above in 4 out of 4 residents which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/28/2023 Plan of Correction Receipt from grocery store with sufficent perishable food for 4 residents for a minimum of two days, must be submitted via email to LPA.

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 record review, licensee could not provide LPA Ramirez with proof of any drill, the licensee did not comply with the section cited above in 4 out of 4 residnets which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/28/2023 Plan of Correction Licensee will provide plan to address quartely drill. Licensee will submit final plan and proof of drill by 7/11/23 via email.

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

Maintenance and Operation 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: LPA observed outside gate locked with a locking mechanism that can only be opened with a numerical code. Based on observation and interview, the licensee did not comply with the section cited, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

Administrator removed lock at time of visit, no further action needed Deficiency cleared..

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

Official classification

Type A

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

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 LPAs observed both outside gates locked with a locking mechanism that can only be opened with a numerical code. Based on observation and interview, the licensee did not comply with the section cited, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/10/2021 Plan of Correction Administrator removed locks at time of visit, no further action needed.

Official classification

Type B

Official code

87465(h)(4)

Regulation authority

CCR

What the official deficiency says

(h) The following requirements shall apply to medications which are centrally stored: (4) All centrally stored medications shall be labeled and maintained in compliance with state and federal laws. No persons other than the dispensing pharmacist shall alter a prescription label. This requirement is not met as evidenced by: Deficient Practice Statement LPAs observed medication discrepancies for R1, R1 is being administered Vitamin D without a prescription, Vitamin C without a prescription label, and Probiotic without a prescription label. LPAs observed medication discrepancies for R2, R2 Nattokinase 2,000 FUS without a label and C-1000 Antioxidant without a label. Based on observation, interview and record review, the licensee did not comply with the section cited above in which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/17/2021 Plan of Correction Administrator will provide photo proof of medication with prescription label for R1 and R2 and will provide proof of prescription for Vitamin D by doctor for R1.