NO PLACE LIKE HOME FOR GOLDEN AGES 2 LLC

Official classification

Type A

Official code

87412(a)(13)

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: 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 [1] out of [4] [staff did not have criminal record clearance. Which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/20/2025 Plan of Correction Administrator will submit staff # 1 (S1) criminal record clearance paperwork to LPA by POC date.

Official classification

Type A

Official code

87355(j)

Regulation authority

CCR

What the official deficiency says

(j) The licensee shall maintain documentation of criminal record clearances or criminal record exemptions of employees in the individual's personnel file as required in Section 87412, Personnel Records. 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 [1] out of [4] [staff did not have criminal record clearance. Which poses an immediate health, safety or personal rights risk to persons in care.Administrator has the paperwork at another facility and will email the document to LPA.

Official plan of correction

POC Due Date: 08/20/2025 Plan of Correction Administrator will submit staff # 1 (S1) criminal record clearance paperwork to LPA by POC date. Administrator has the paperwork at another facility and will email the document to LPA.

Official classification

Type B

Official code

1569.618(c)(3)

Regulation authority

HSC

What the official deficiency says

(c)The facility shall employ, and the administrator shall schedule, a sufficient number of staff members to do all of the following: (3) Ensure that at least one staff member who has cardiopulmonary resuscitation (CPR) training and first aid training is on duty and on the premises at all times. This paragraph shall not be construed to require staff to provide CPR. 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 [total 2] , both staff on duty did not have copy of first aid/CPR certificates available to be reviewed. Which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/22/2025 Plan of Correction Admininistrator will email staff 1 and 2, who were missing first aid/CPR certificates during today's visit.

Official classification

Type B

Official code

87411(c)(1)

Regulation authority

CCR

What the official deficiency says

(1) Staff providing care shall receive appropriate training in first aid from persons qualified by such agencies as the American Red Cross. 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 [total 2] , both staff on duty did not have copy of first aid/CPR certificates available to be reviewed. Which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/22/2025 Plan of Correction Admininistrator will email staff 1 and 2, who were missing first aid/CPR certificates during today's visit.

Official classification

Type B

Official code

1569.695(e)(2)

Regulation authority

HSC

What the official deficiency says

(e) A facility shall have all of the following information readily available to facility staff during an emergency: (2) An appraisal of resident needs and services plan for each resident. 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 [2] out of [5] record review for residents 1 and 2, who were missing an needs and service plan in there which pose a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/22/2025 Plan of Correction Administrator will submit needs and service plans for residents 1 and 2.

Official classification

Type B

Official code

87608(a)(1)

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: (1) Postural supports shall be limited to appliances or devices such as braces, spring release trays, or soft ties, used to achieve proper body position and balance, to improve a resident's mobility and independent functioning, or to position rather than restrict movement including, but not limited to, preventing a resident from falling out of bed, a chair, etc. 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 had full bed rails. Which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/02/2025 Plan of Correction Administrator will provide medical documentation to LPA for all residents that have full bed rails. If can't provide documentation, bed rails will be removed from beds.

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) the licensee did not comply with the section cited above in [5] out of [5] residents had full bed rails. Which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/02/2025 Plan of Correction Administrator will provide medical documentation to LPA for all residents that have full bed rails. If can't provide documentation, bed rails will be removed from beds.

Official classification

Type B

Official code

1569.73(b)

Regulation authority

HSC

What the official deficiency says

§1569.73 Terminally ill residents... (b) At any time that… the facility... determines that the resident's condition has changed ... the facility may initiate procedures for a transfer. This requirement was not met as evidenced by:This requirement was not met as evidenced by: Based on interviews and record review, the licensee did not comply with the section cited above by retaining Resident #1 (R1) with a worsening prohibited health condition and not applying for an exception which posed a potential Health, Safety, or Personal Rights risk to persons in care.

Official plan of correction

Licensee has agreed to apply for an exception for Resident #2 (R2) who has a worsening Stage 2 pressure injury to demonstrate and establish compliance with the cited section by the POC due date.

Deadline recorded: May 30, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87615(a)

Regulation authority

CCR

What the official deficiency says

87615 Prohibited Health Conditions-(a) Persons who require health services for or have a health condition including but not limited to, those specified below shall not be admitted or retained at a residential care for the elderly. (1) Stage 3 and 4 pressure injuries. This requirement was not met as evidenced by: Based on interviews and records review, the administrator retained a resident with stage 3 and 4 pressure injuries in the facility. This posses an immediate health and safety risk to residents in care.

Official plan of correction

The administrator will submit in writing to CCL by 3/13/24, how they will correct the cituation and to ensure that moving forward residents with stage 3 or 4 pressure injuries are not accepted or retained in the facility.

Deadline recorded: Mar 26, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87705(c)(5)

Regulation authority

CCR

What the official deficiency says

87705(c)(5) Care of Persons with Dementia-Each resident with dementia shall have an annual 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 was not met as evidenced by: Based on records review, the Licensee did not have a resident with dementia annually medically assessed. R1's last medical assessment was conducted in 2019. This posses a potential health and safety risk to residents in care.

Official plan of correction

The Licensee shall submit in writing to the Department by 3/26/2024 how they will ensure that all residents with dementia are medically assessed annually and reappraised annually or when a change in condition has been observed.

Deadline recorded: Mar 26, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87633(h)(3)

Regulation authority

CCR

What the official deficiency says

87633(h)(3) Hospice Care of Terminally Ill Residents (h) For each terminally ill resident receiving hospice services in the facility, the licensee shall maintain the following in the resident's record (3) A copy of the written certification statement of the resident's terminal illness from the medical director of hospice... This requirement was not met as evidenced by: The licensee did not provide the Department representative with this documentation. This poses a potential health and safety risk to residents in care.

Official plan of correction

The licensee shall submit in writing by 3/26/24 to Licensing Office, how they will ensure that residents in hospice have complete hospice records.

Deadline recorded: Mar 26, 2024. 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

87506 Resident Records (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 the licensing agency staff. This requirement was not met as evidenced by: The Licensee did not present to Licensing agent complete resident records for R2. This poses a potential health and safety risk to residents in care.

Official plan of correction

The Licensee shall submit in writing by 3/26/24 to the Department how they will ensure that all resident files are complete.

Deadline recorded: Mar 26, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87211(a)(1)(B)

Regulation authority

CCR

What the official deficiency says

87211(a)(B) Reporting Requirements-(a) Each licensee shall furnish to the licensing agency such reports as the Department may require...(1) A written report shall be submitted to the licensing agency for (B) any serious injury as determined by the attending physician and occurring while the resident is under facility supervision. This requirement was not met as evidenced by: The Licensee did not notify the Department that residents had entered hospice care and did not submit incident reports for residents. This poses a potential health and safety risk for residents in care.

Official plan of correction

The Licensee shall submit in writing by 3/26/24, how they ensure that any serious incident reports and hospice notifications are submitted to licensing in a timely manner.

Deadline recorded: Mar 26, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87405(d)(1)(2)

Regulation authority

CCR

What the official deficiency says

87405(d)(1)(2) Administrator Qualifications and Duties-The Administrator shall have the qualifications specified in Sections 87405(d)(1) through (7). (2) Knowledge of the ability to conform to the applicable laws, rules, and regulations... This requirement was not met as evidenced by: Licensee did not ensure that the Administrator has enough knowledge to comply with Title 22 Regulations. Based on interviews and record review, the facility is not in compliance with Title 22 Regulations. This poses a potential health and safety risk to residents in care.

Official plan of correction

The administrator will enroll and take more administrator courses and provide proof of enrollment to CCLD by 3/26/24.

Deadline recorded: Mar 26, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

1569.58(a)(5)

Regulation authority

HSC

What the official deficiency says

1569.58 Persons prohibited from being a licensee, owning beneficial interest in licensed facility-(a) The Department may prohibit any person from being a licensee...or being an administrator, member, or manager of a licensee...and my further prohibit any licensee from employing, or continuing the employment of...or allowing contact with clients of a licensed facility...who has done any of the following: (5) Engaged in acts of financial malfeasance concerning the operaton of a facility, including but not limited to, improper use or embezzlement of client moneys and property or fraudulent appropiattion for personal gain of facility moneys and property. This requirement was not met as evidenced by: Based on interviews and records review, the Licensee became R1's health care and financial power of attorney. This posses an immidiate health and safety risk to resident in care.

Official plan of correction

The Licensee will submit written sttement explaining the steps she will take to remedy the cituation. The document must be submitted to the Licensing Department within 24 hours,

Deadline recorded: Mar 13, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87217(d)(2)(f)

Regulation authority

CCR

What the official deficiency says

87217(d)(2)(f) Safeguards for Resident Cash, Personal Property, and Valuables (d)(2)...no licensee or employee of a facility shall; accept any general or special power of attorney for any resident. This requirement was not met as evidenced by: Based on interviews and records review the Licensee became R1's POA. This poses an immediate health and safety risk to residents in care.

Official plan of correction

The Licensee will submit written sttement explaining the steps she will take to remedy the cituation. The document must be submitted to the Licensing Department within 24 hours,

Deadline recorded: Mar 13, 2024. A deadline is not proof that correction was completed.

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 B1 water temperature tested at 133.5, B2 water temperature tested at 133.2 and B3 water temperature tested at 133.3 which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/28/2022 Plan of Correction Licensee will ensure water temperature is within the required 105 - 120 degrees F., at all times will certify on LIC 9098 by POC due date 7/28/22.

Official classification

Type A

Official code

87309(a)

Regulation authority

CCR

What the official deficiency says

(a) Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients. 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 LPA observed knives and cleaning solutions cabinet unlocked, bleach solution on top of toilet in B2 which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/28/2022 Plan of Correction Licensee will ensure that all sharps, and cleaning supplies are unaccessible to the residents at all times and will certify in LIC 9098 by POC date 7/28/22.

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, the licensee did not comply with the section cited above in B1 shower floor was observed damaged and in disrepair, lightbulbs out in R1, boxes in the backyard piled, large toys hanging by the pool gate, and grass was umkept, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/03/2022 Plan of Correction Licensee will ensure facility is maintain clean and in good repair at all times. Licensee will submit pictures of repairs and cleaning to the department by POC date 8/3/22.

Official classification

Type B

Official code

87412(f)

Regulation authority

CCR

What the official deficiency says

(f) All personnel records shall be available to the licensing agency to inspect, audit, and copy upon demand during normal business hours. Records may be removed if necessary for copying. Removal of records shall be subject to the following requirements: 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 staff files were not available for review during the visit which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/03/2022 Plan of Correction Licensee will ensure files are at the facility at all times and will provide the department a statement to certify the above by POC date 8/3/22.