D & L RESIDENTIAL CARE HOME 1

Official classification

Type A

Official code

1569.311

Regulation authority

HSC

What the official deficiency says

Every residential care facility for the elderly shall have one or more carbon monoxide detectors in the facility that meet the standards established in Chapter 8 (commencing with Section 13260) of Part 2 of Division 12. The department shall account for the presence of these detectors during inspections. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and interview, the licensee did not comply with the section cited above in the carbon monoxide detector was not functional due to possibly needing a new battery, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/10/2026 Plan of Correction Staff agreed to replace the battery and email LPA a video of testing the carbon monoxide detector by POC due date.

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

(a) 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 that flooring in the front entry, hallway, room #3, room #4 and by the sliding door exit in the living room is worn and lifting at the seams which poses as a tripping hazard, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/07/2026 Plan of Correction Per staff, licensee has planned to replace flooring early next month. Proof in the form of photos shall be emailed to LPA by POC due date.

Official classification

Type B

Official code

87303(e)(5)

Regulation authority

CCR

What the official deficiency says

(5) Slip-resistant mats, strips, or flooring shall be used in all bathtub and shower floors. 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 2 out of 2 showers did not have slip-resistant mats, strips or flooring which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/23/2026 Plan of Correction Facility shall obtain slip-resistant mats, strips or flooring and send LPA proof in the form of photos by POC due date.

Official classification

Type B

Official code

87303(e)(6)

Regulation authority

CCR

What the official deficiency says

(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, the licensee did not comply with the section cited above in 2 out of 2 bathroom sinks had slow water drainage which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/23/2026 Plan of Correction Facility will make the necessary repairs and send LPA proof in the form of a video showing the water running by POC due date.

Official classification

Type B

Official code

87465(a)(8)(D)(E)

Regulation authority

CCR

What the official deficiency says

Incidental Medical and Dental 87465(a)(8)(D)(E) If a facility has no medical unit on the grounds, a complete first aid kit shall be maintained and be readily available in a specific location in the facility. The kit shall be a general type approved by the American Red Cross, or shall contain at least the following: (D) Scissors. (E) Tweezers. 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 first aid kit was incomplete and did not contain tweezers or scissors which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/09/2026 Plan of Correction Staff acquired scissors and tweezers and completed the first aid kit at the time of visit.

Official classification

Type B

Official code

87468.1(a)(6)

Regulation authority

CCR

What the official deficiency says

Personal Rights of Residents in All Facilities(a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (6) ...to not be locked into any room, building, or on facility premises by day or night. This does not prohibit a licensee from establishing house rules, such as locking doors at night to protect residents, or barring windows against intruders, with permission from the Department. 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 1 out of 4 bedroom doors had a latching lock on the exterior/hall door which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/09/2026 Plan of Correction Facility staff removed the lock at the time of visit.

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: Based on observation and record review, the licensee did not comply with the section cited above R1, R4 and R5 did not have a order for bed rails which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Licensee agrees to send LPA physician's orders for bedrails for R1 and R4 by POC due date or remove bedrails. Orders for R5 were obtained at time of visit

Deadline recorded: Jan 12, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87458(c)(1)(A)

Regulation authority

CCR

What the official deficiency says

87458 Medical Assessment (c)(1)(A) The medical assessment shall include, but not be limited to: 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: Communicable tuberculosis. This requirement is not met as evidenced by: Based on record review 3 out of 5 resident records did not contain TB clearance which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Licensee agrees to submit via email TB clearance for R1, R2, and R5 by POC due date

Deadline recorded: Jan 19, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87412(a)(11)

Regulation authority

CCR

What the official deficiency says

874129(a)(11)Personnel Records The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: A health screening as specified in Section 87411, Personnel Requirements - General. This requirement is not met as evidenced by: Based on record review one (1) out of three (3) staff records, S2 staff file did not contain a completed Health Screening with TB clearance which poses a potential health and safety risk to residents in care.

Official plan of correction

Licensee agrees to submit via email a completed health screening with TB clearance for S2.

Deadline recorded: Jan 12, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87208(a)

Regulation authority

CCR

What the official deficiency says

87208(a)Plan of Operation. The licensee shall have and maintain a current, written definitive plan of operation for the facility. The licensee shall operate the facility in accordance with the terms specified in the plan of operation and may be cited for not doing so pursuant to Health and Safety Code section 1569.49…Any significant changes in the plan of operation which would affect the services to residents shall be submitted to the licensing agency for approval. This requirement is not met as evidenced by: Based on observation construction of an additional structure in the backyard has begun without prior notification and approval from licensing, which may affect services to residents and which may pose a health and safety risk to residents in care.

Official plan of correction

Licensee will submit an updated plan of operation, advise how residents may be affected, a timeline for contruction completion and building permits for construction by POC due date.

Deadline recorded: Jan 12, 2026. 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

(a) 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 bottles of pills and vitamins were found in unlocked drawer in kitchen which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/29/2025 Plan of Correction Caregiver removed bottles at time of visit. Caregiver agreed to let Administrator know that a training with staff needs to be conducted and sent to LPA.

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 one (1) out of two (2) bathrooms water was at 122.1 which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/29/2025 Plan of Correction Caregiver will lower water temperature and send LPA picture. Water log will be tested for one week and sent to LPA.

Official classification

Type A

Official code

1569.69(e)(3)

Regulation authority

HSC

What the official deficiency says

(e) Each person who provides employee training under this section shall meet the following education and experience requirements: (3) The licensed residential care facility for the elderly shall maintain the following documentation on each person who provides employee training under this section: 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 two staff did not have current CPR which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/29/2025 Plan of Correction Two staff who have direct care with residents will obtain CPR.

Official classification

Type A

Official code

87465(a)(6)

Regulation authority

CCR

What the official deficiency says

(6) When requested by the prescribing physician or the Department, a record of dosages of medications which are centrally stored shall be maintained by the facility. 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 residents did not have a record of any kind of what medications were stored which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/29/2025 Plan of Correction Facility will send LPA a centrally stored medication list to LPA by POC due date.

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 record review, the licensee did not comply with the section cited above Administrator did not have file at facility which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/04/2025 Plan of Correction Administrator will send file to LPA by POC due date.

Official classification

Type B

Official code

1569.625(b)(2)

Regulation authority

HSC

What the official deficiency says

(2) In addition to paragraph (1), training requirements shall also include an additional 20 hours annually, eight hours of which shall be dementia care training, as required by subdivision (a) of Section 1569.626, and four hours of which shall be specific to postural supports, restricted health conditions, and hospice care, as required by subdivision (a) of Section 1569.696. This training shall be administered on the job, or in a classroom setting, or both, and may include online training. 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 staff did not have annual training which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/11/2025 Plan of Correction Annual training for S1 and S2 will be conducted and sent to LPA.

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 five (5) out of five (5) residents files were missing documents which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/04/2025 Plan of Correction R1 missing admission agreement, conset form, pre placemnt, appraisel needs and service plan,and 601 incomplete with TB.R2 No TB, and 603 missing signatures.R3 603 not signed.R4 New 602 every year, 603 not signed, and 601. R5 601,603 needs to be signed.

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, the licensee did not comply with the section cited above last drill was conducted in June of 2024 which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/04/2025 Plan of Correction Facility will conduct drills and send to LPA by POC due date.

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, the licensee did not comply with the section cited above R3, and R4 did not have a order for bed rails which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/28/2025 Plan of Correction Facility will send LPA doctors order for bed rails.

Official classification

Type B

Official code

87608(a)(5)(B)

Regulation authority

CCR

What the official deficiency says

(B) Bed rails that extend the entire length of the bed are prohibited except for residents who are currently receiving hospice care and have a hospice care plan that specifies the need for full bed rails. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above R1 had full bed rails which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/28/2025 Plan of Correction Facility will remove full bed rails for R1 and send LPA pictures by POC due date.

Official classification

Type B

Official code

87633(a)(1)

Regulation authority

CCR

What the official deficiency says

(a) The licensee shall be permitted to accept or retain residents who have been diagnosed as terminally ill by his or her physician and surgeon and who may or may not have restrictive and/or prohibited health conditions, to reside in the facility and receive hospice services from a hospice agency in the facility, when all of the following conditions are met: (1) The licensee has received a hospice care waiver from the department. 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 facility has hospice waiver for two (2) residents but have three (3) residents under care which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/28/2025 Plan of Correction Facility will request hospice waiver from department.

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, dresser in bedrooms#2 and 3 were in disrepair, 7inX12in tear on loveseat in living room, the licensee did not comply with the section cited above in 5 out of 5 residents, staff or visitors which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/01/2024 Plan of Correction Licensee will repair or replace dressers and loveseat. Licensee will send pictures of correction by 8/1/24 via email.

Official classification

Type B

Official code

87307(a)(3)(A)

Regulation authority

CCR

What the official deficiency says

(A) A bed for each resident, except that married couples may be provided with one appropriate sized bed. Each bed shall be equipped with good springs, a clean and comfortable mattress, available pillow(s) and lightweight warm bedding. Fillings and covers for mattresses and pillows shall be flame retardant. Rubber sheeting shall be provided when necessary. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and record review, R2 does not have a bed in their room, the licensee did not comply with the section cited above in 1 out of 5 residnets which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/01/2024 Plan of Correction Licensee will apply for an exception for R2 and submit by 8/1/2024 via email.

Official classification

Type B

Official code

1569.625(b)(2)

Regulation authority

HSC

What the official deficiency says

(2) In addition to paragraph (1), training requirements shall also include an additional 20 hours annually, eight hours of which shall be dementia care training, as required by subdivision (a) of Section 1569.626, and four hours of which shall be specific to postural supports, restricted health conditions, and hospice care, as required by subdivision (a) of Section 1569.696. This training shall be administered on the job, or in a classroom setting, or both, and may include online training. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, S1 and S2 did not have required annual training documented in personnel file, the licensee did not comply with the section cited above in 2 out of 4 staff which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/01/2024 Plan of Correction Licensee will send proof of re-training by 8/1/24 via email.

Official classification

Type B

Official code

87608(a)(5)(B)

Regulation authority

CCR

What the official deficiency says

(B) Bed rails that extend the entire length of the bed are prohibited except for residents who are currently receiving hospice care and have a hospice care plan that specifies the need for full bed rails. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and record review, R5 is not on hospice, 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: 08/01/2024 Plan of Correction Licensee will apply for an exception for bed rails or remove bed rails. Proof must be submitted by 8/1/24 via email.

Official classification

Type A

Official code

87468.1(a)(6)

Regulation authority

CCR

What the official deficiency says

87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (6) To leave or depart the facility at any time and to not be locked into any room, building, or on facility premises by day or night. This does not prohibit a licensee from establishing house rules, such as locking doors at night to protect residents, or barring windows against intruders, with permission from the Department. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, LPA observed a double-key deadbolt which can only be unlocked by staff with a key from the outside and inside, the licensee did not comply with the section cited above in 5 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: 07/26/2024 Plan of Correction Licensee will apply for a new fire clearance or remove double-keyed deadbolt. Proof must be submitted via email.

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. Water measured 144.3 degrees F which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/11/2023 Plan of Correction Caregiver adjusted the water at time of visit. ***No further action is required****

Official classification

Type B

Official code

87208(a)

Regulation authority

CCR

What the official deficiency says

(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: 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. Facility did not have plan of operation on file which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/18/2023 Plan of Correction Administrator will send plan of operation to LPA by POC date.

Official classification

Type B

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, the licensee did not comply with the section cited above. Facility did not have evidence of liability insurance which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/18/2023 Plan of Correction Administrator will provide proof of liability insurance to LPA by poc date.

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. One smoke alarm needs replacement, small oven on counter is not functioning and needs to be discarded. Outside umbrella for shade needs to be repaired or replaced which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/18/2023 Plan of Correction Administrator will replace smoke alarm, discard small oven, repair or replace outside umbrella and send proof to LPA by POC date.

Official classification

Type B

Official code

87415(a)

Regulation authority

CCR

What the official deficiency says

(a) The following persons providing night supervision from 10:00 p.m. to 6:00 a.m. shall be familiar with the facility's planned emergency procedures, shall be trained in first aid as required in Section 87465, Incidental Medical and Dental Care Services, and shall be available as indicated below to assist in caring for residents in the event of an emergency: This requirement is not met as evidenced by: Deficient Practice Statement Based on interview, record review, the licensee did not comply with the section cited above. No staff have current training in facility emergency procedures which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/18/2023 Plan of Correction Administrator will conduct training on emergency procedures and send proof to LPA by POC.

Official classification

Type B

Official code

87463(a)

Regulation authority

CCR

What the official deficiency says

(a) The pre-admission appraisal shall be updated, in writing as frequently as necessary to note significant changes and to keep the appraisal accurate. The reappraisals shall document changes in the resident's physical, medical, mental, and social condition. Significant changes shall include but not be limited to: 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. No resident has appraisal or reappraisals which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/18/2023 Plan of Correction Administrator will provide pre-admission appraisal and reappraisals and for all clients and send to LPA by POC

Official classification

Type B

Official code

87468(c)(1)

Regulation authority

CCR

What the official deficiency says

(c) Licensees shall prominently post personal rights, nondiscrimination notice, and complaint information in areas accessible to residents, representatives, and the public. (1) The personal rights of residents specified in Sections 87468.1, Personal Rights of Residents in All Facilities and 87468.2, Additional Personal Rights of Residents in Privately Operated Facilities shall be posted as applicable to the facility. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above. LET US KNOW and personal rights poster is not posted at facility which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/18/2023 Plan of Correction Administrator will post a LET US KNOW and personal rights poster and send proof to LPA by POC date.

Official classification

Type B

Official code

1569.267(d)

Regulation authority

HSC

What the official deficiency says

(d) The licensee shall provide initial and ongoing training for all members of its staff to ensure that residents’ rights are fully respected and implemented. 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 facility had no documentation that personal rights training was conducted with staff which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/18/2023 Plan of Correction Administrator will provide training on personal rights and send proof to LPA by POC date.

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 Based on observation, interview, record review, the licensee did not comply with the section cited above 4 of 5 residents did not have labels on over the counter or PRN which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/18/2023 Plan of Correction Administrator will obtained labels for all PRN and over the counter medications and send proof to LPA by POC date.

Official classification

Type B

Official code

87465(d)

Regulation authority

CCR

What the official deficiency says

(d) If the resident is unable to determine his/her own need for a prescription or nonprescription PRN medication, and is unable to communicate his/her symptoms clearly, facility staff designated by the licensee, shall be permitted to assist the resident with self-administration, provided all of the following requirements are met: This requirement is not met as evidenced by: Deficient Practice Statement Based on interview and record review, the licensee did not comply with the section cited above All resident files are missing PRN authorization letters which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/18/2023 Plan of Correction Administrator will obtain PRN authorization letters for all PRN and over the counter medication and send proof to LPA by POC date.

Official classification

Type B

Official code

1569.695(a)(6)

Regulation authority

HSC

What the official deficiency says

(a) In addition to any other requirement of this chapter, a residential care facility for the elderly shall have an emergency and disaster plan that shall include, but not be limited to, all of the following: (6) The location of utility shut-off valves and instructions for use. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation the licensee did not comply with the section cited above. Staff are not trained in how to shut off gas or other utilities which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/18/2023 Plan of Correction Administrator will provide instructions to staff on how to turn off utilities and provided proof to LPA by POC date.

Official classification

Type A

Official code

87303(e)(2)

Regulation authority

CCR

What the official deficiency says

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: Hot water temperature was in a range of 133.5 degrees Fahrenheit which was not within Title 22 Regulation guidelines. Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/23/2022 Plan of Correction Administrator will ensure the water temperature will remain in a range of 105 - 120 degree Fahrenheit; a water temperature log dated 7/23/22 will provide to Licensing. Licensee will maintain a weekly water temperature log to ensure water temp is within Title 22 Regulation guidelines. Plan of Corrections (POC) must be corrected by POC date.

Official classification

Type B

Official code

87705(j)

Regulation authority

CCR

What the official deficiency says

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: Auditory alarm device at the exit to the garage is missing. Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/27/2022 Plan of Correction Administrator will ensure the auditory alarm device is installed at the exit to the garage and send picture of the exit with auditory device to Licensing. Plan of Corrections (POC) must be corrected by POC date.

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. This requirement is not met as evidenced by: Hallway flooring and kitchen flooring are un-even. Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/04/2022 Plan of Correction Administrator agrees to repair the uneven flooring at the hallway and kitchen and send pictures of the repaired / evened flooring to Licensing. Plan of Corrections (POC) must be corrected by POC date.