D & L RESIDENTIAL CARE HOME 2

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 A/C vents had excessive dust build up which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/25/2026 Plan of Correction Staff agreed to send LPA photos of cleaned vent via email by POC due date.

Official classification

Type B

Official code

87303(a)(1)

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. (1) Floor surfaces in bath, laundry and kitchen areas shall be maintained in a clean, sanitary, and odorless condition. 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 hall bathroom shower floor had rust from shower chair and mold around floor mat which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/25/2026 Plan of Correction Staff agreed to send LPA photos of clean shower floor via email by POC due date.

Official classification

Type B

Official code

87458(c)(1)(A)

Regulation authority

CCR

What the official deficiency says

Medical Assessment (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 1 out of 4 residents, R4 file did not have TB clearance for review, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/08/2026 Plan of Correction Staff agreed to provide proof of TB clearance and submit via email to LPA by POC due date.

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...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: Based on record review, there are no current logs for emergency drills conducted, last emergency drill logged was 12/2023, which poses a potential health and safety risk for residents in care.

Official plan of correction

Licensee will submit via email Documentation of the drill which shall include the date, the type of emergency covered by the drill, and the names of staff participating in the drill, by POC due date.

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

Official classification

Type B

Official code

87470(c)

Regulation authority

CCR

What the official deficiency says

A infection control plan shall be develoed by the licensee and shall be included in the plan of operation required by section 87208 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 Infection control plan was not provided at the time of visit which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/01/2025 Plan of Correction Administrator to email infection plan to LPA by 08/01/25.

Official classification

Type B

Official code

87506(b)

Regulation authority

CCR

What the official deficiency says

(b) each resident's record shall contain at least the following information: This requirement is not met as evidenced by: One resident file missing admissions agreement, pre-appraisal, physicians report. Deficient Practice Statement Based on record review, the licensee did not comply with the section cited above in missing R#3 admissions agreement, physicians' report which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/01/2025 Plan of Correction Administrator train staff on residents medical information guidelines and sent to LPA by due date.

Official classification

Type A

Official code

87355(e)(1)

Regulation authority

CCR

What the official deficiency says

Criminal Record Clearance 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 evidence was not met as required..during the meeting with the residents and administrator it appears that staff Bong Narcisco Jr. was not cleared/associated to the facility and posed a health and safety threat to the residents in care.

Official plan of correction

The facility shall make sure all staff all staff are fingerprint cleared and associated prior to working in a facility. Per the administrator Rita Herrera, staff Bong Narcisco Jr. is no longer working in the facilty. **Immediated $100 civll Penalty issued**

Deadline recorded: Mar 11, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

Maintenance and Operations 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 item was not met as required: When LPA arrived to the facility she observced space heaters in the living room dinning room of the faclity which poses a health and safety risk to the residents in care.

Official plan of correction

The Administrator shall have the centralized heater repaired and send proof of service to Attn Nicol Wesley, 323 980 4912 by POC due date 04/10/2025

Deadline recorded: Apr 10, 2025. 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 Based on observation, the licensee did not comply with the section cited above. Bathroom #2 grab bar in shower was broken Bathroom #2 was observed to have unlocked cleaning supplies.Based on observation two (2) out of six (6) resident rooms auditory devices were not working which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/19/2024 Plan of Correction Administrator will repair broken grab bar in shower and submit proof of correction by email by POC date. DSP worker locked cabinet During visit. Administrator will conduct traing with staff and eamil proof. Facility will repair all auditory devices and submit proof of correction by email by POC date.

Official classification

Type B

Official code

87470(c)

Regulation authority

CCR

What the official deficiency says

(c) An Infection Control Plan shall be developed by the licensee and shall be included in the Plan of Operation required by Section 87208. 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 . Infection Control Plan was not provided at time of visit which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/02/2024 Plan of Correction Administrator will send Infection Control Plan to LPA by POC date.

Official classification

Type B

Official code

87307(a)(3)(B)

Regulation authority

CCR

What the official deficiency says

(B) Bedroom furniture, which shall include, for each resident, a chair, night stand, a lamp, or lights sufficient for reading, and a chest of drawers. 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 two (2) out of six (6) residents did not have required chairs which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/02/2024 Plan of Correction Administrator will place chairs in bedrooms and provide proof to LPA.

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 record review, the licensee did not comply with the section cited above in five (5) out of five(5) staff files all missing employee rights, tb tests, and criminal statements which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/02/2024 Plan of Correction Administrator will email all documents to LPA.

Official classification

Type B

Official code

1569.696(a)

Regulation authority

HSC

What the official deficiency says

(a) All residential care facilities for the elderly shall provide training to direct care staff on postural supports, restricted conditions or health services, and hospice care as a component of the training requirements specified in Section 1569.625. The training shall include all of 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 in five (5) out of five (5) staff did not have any traing in files which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/02/2024 Plan of Correction Administrator will email all required training to LPA by POC due date.

Official classification

Type B

Official code

87506(b)

Regulation authority

CCR

What the official deficiency says

(b) Each resident's record shall contain at least the following information: 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 five (5) out of five (5) residents did not have updated physicians reports, personal rights and conset for medical treatments forms which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/02/2024 Plan of Correction Administrator will submit all required documentation 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, the licensee did not comply with the section cited above in last emergency drill was conducted in April of 2023 which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/02/2024 Plan of Correction Administrator will conduct required drills and submit documentation to LPA.

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 the appraisal, the facility shall provide assistance and care for the resident in tose 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 residents record. The licensing agency shall be authorized to require other additional documents if needed. 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 four (4) out of six (6) residents did not have a physicians 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: 07/02/2024 Plan of Correction Administrator will obtain a physicians order for bedrails and provide proof to LPA.

Official classification

Type A

Official code

87606(c)

Regulation authority

CCR

What the official deficiency says

(c) To accept or retain a bedridden person, other than for a temporary illness or recovery from surgery, a facility shall obtain and maintain an appropriate fire clearance as specified in Section 87202(a). 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. Facility has 3 bedridden residents and only permitted one which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/16/2023 Plan of Correction Facility will contact Fire department to get Fire Clearance for 2 additional residents and send proof to LPA by POC date.

Official classification

Type A

Official code

1569.72(c)

Regulation authority

HSC

What the official deficiency says

(c) Notwithstanding paragraph (2) of subdivision (a), bedridden persons may be admitted to, and remain in, residential care facilities for the elderly that secure and maintain an appropriate fire clearance. A fire clearance shall be issued to a facility in which one or more bedridden persons reside if either of the following conditions are met: 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. Facility has 3 bedridden residents and only permitted one which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/16/2023 Plan of Correction Facility will contact Fire department to get Fire Clearance for 2 additional residents and send proof to LPA by POC date.

Official classification

Type B

Official code

87208(a)(12)

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: (12) The Infection Control Plan pursuant to Section 87470. 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 at facility which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/21/2023 Plan of Correction Administrator will provide Plan of Operation to LPA by POC date.

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, the licensee did not comply with the section cited above. Shower faucet is leaking which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/21/2023 Plan of Correction Administrator will repair or replace shower facet and send proof to LPA by POC date.

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. Resident files are missing updated Admission Agreements which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/21/2023 Plan of Correction Administrator will send Admission Agreements for all residents and update then when changes in the agreement have changed and send proof to LPA by POC date.

Official classification

Type B

Official code

87458(b)(5)

Regulation authority

CCR

What the official deficiency says

(b) The medical assessment shall include, but not be limited to: (5) The determination whether the person is ambulatory or nonambulatory as defined in Section 87101(a) or (n), or bedridden as defined in Section 87455(d). The assessment shall indicate whether nonambulatory status is based upon the resident's physical condition, mental condition or both. 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 failed to update residents records that define the resident as ambulatory or non ambulatory or bedridden which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/21/2023 Plan of Correction Administrator will obtain updated status of ambulatory or non ambulatory or bedridden status on all residents that are missing the updated status (R3,R4,R5) and send proof to LPA by POC date.

Official classification

Type A

Official code

87465(h)(5)

Regulation authority

CCR

What the official deficiency says

Each resident's medication shall be stored in its originally received container. No medications shall be transferred between containers. This requirement is not met as evidenced by: LPA observed R1 has medications which were pre-poured for 7 days in a morning/afternoon/evening in a 7-day pill container. The 7-day pill container and original bubble packs were locked and unable to be accessed. Deficient Practice Statement Based on observation and medication review, 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 Licensee agrees to ensure that medication stays in its originally received container. Licensee will provide in-service trainings to staff on handling medication. Administrator agrees to review regulation 87465 and send a letter stating Licensee understand and will in compliance with regulation to CCL by POC due date.

Official classification

Type A

Official code

Not listed

Regulation authority

Not listed

What the official deficiency says

Care of Persons with Dementia. The following initial and continuing requirements shall be met for the licensee to lock exterior doors or perimeter fence gates: The licensee shall ensure that the fire clearance includes approval of locked exterior doors or locked perimeter fence gates. This requirement is not met as evidenced by: At 10:15AM, LPAs observed the exterior door located on the gate near the patio area was being locked by using a privacy lock from the inside preventing residents from exiting the facility in case of an emergency. This poses an immediate health and safety concern for the residents in care.

Deadline recorded: Jul 19, 2021. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

Not listed

Regulation authority

Not listed

What the official deficiency says

Care of Persons with Dementia. Outdoor facility space used for resident recreation and leisure shall be completely enclosed by a fence with self-closing latches and gates, or walls, to protect the safety of residents. This requirement is not met as evidenced by: At 10:15AM, LPAs observed the self closing mechanism/latch on the exit gate near the patio area was in disrepair as the gate would not self-close. This poses an immediate health and safety concern for the residents in care.

Deadline recorded: Jul 9, 2021. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

Not listed

Regulation authority

Not listed

What the official deficiency says

Care of Persons with Dementia. 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; During today’s visit, LPAs observed the auditory chimes on the sliding doors in bedrooms 1, 2 and 4 were missing. The auditory chime in bedroom #7 was inoperable. This poses health and safety risk for the residents in care.

Deadline recorded: Jul 9, 2021. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

Not listed

Regulation authority

Not listed

What the official deficiency says

Care of Persons with Dementia. The following shall be stored inaccessible to residents with dementia:Knives,matches, firearms, tools and other items that could constitute a danger to the resident(s).This requirement is not met as evidenced by; s. At 10:45AM, LPAs found a sharp knife underneath the kitchen cabinet left accessible to residents. This poses health and safety risk for the residents in care

Deadline recorded: Jul 8, 2021. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

Not listed

Regulation authority

Not listed

What the official deficiency says

Care of Persons with Dementia. The following shall be stored inaccessible to residents with dementia: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; At 10:35AM, LPAs observed bleach, pine sol, bathroom cleaner, Xtra detergent, WD40, and glass cleaner in the laundry area left unlocked and accessible to the residents. This poses health and safety risk for the residents in care.

Deadline recorded: Jul 8, 2021. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

Not listed

Regulation authority

Not listed

What the official deficiency says

Postural Supports. Under no circumstances shall postural supports include tying, depriving, or limiting the use of a resident's hands or feet. 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; During today’s visit, LPAs observed full bed rails in bedrooms 4, 5 and 7. Per staff, Residents in bedrooms 4, 5 and 7 are not enrolled in hospice and are not receiving hospice services. This poses an immediate health and safety risk to the residents in care.

Deadline recorded: Jul 9, 2021. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

Not listed

Regulation authority

Not listed

What the official deficiency says

Incidental Medical and Dental Care Services. The licensee shall assist residents with self-administered medications as needed. This requirement is not met as evidenced by; At 10:50AM, LPAs observed Docusate Sodium 100 MG Capsule (Take one capsule by mouth twice daily) was not administered to R4 on 7/7/21, evening dose.

Deadline recorded: Jul 9, 2021. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

Not listed

Regulation authority

Not listed

What the official deficiency says

Hospice Waiver. In order accept or retain terminally ill residents and permit them to receive care from a hospice agency, the licensee shall have obtained a facility hospice care waiver from the Department. To obtain this waiver the licensee shall submit a written request for a waiver to the Department on behalf of any residents who may request retention, and any future residents who may request acceptance, along with the provision of hospice services in the facility.This requirement is not met as evidenced by: During today’s visit, LPAs observed facility to have 3 residents on hospice (R1 – R3), but the facility has an approved hospice waiver on file for 2 residents.

Deadline recorded: Jul 22, 2021. A deadline is not proof that correction was completed.