LA CASITA RESIDENTIAL CARE INC.

Official classification

Type B

Official code

87465(a)(6)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care(a)A plan for incidental medical ...shall be developed by each facility... and provide for assistance in obtaining such care, by compliance with the following:(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: Based on observation, interview and record review there was not a record of dosages of medications which were centrally stored for R1 maintained by the facility, which poses a potential health and safety risk for residents.

Official plan of correction

Licensee agree to review the regulation and submit to LPA statement of understanding. Licensee also will submit a Centrally Stored medication list for R1.

Deadline recorded: Jul 9, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87211(a)(1)

Regulation authority

CCR

What the official deficiency says

87211 Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following:(1)A written report shall be submitted to the licensing agency...within seven days of the occurrence of any of the events specified in (A) through (D) below.... This requirement is not met as evidenced by: Based on interviews and record review, it was noted that on 06/21/26 R1 was ill and R1's family took R1 to the doctor. Administrator did not submit an incident to licensing which poses a potential health and safety risk for residents.

Official plan of correction

Licensee agreed to submit to LPA an incident report for R1's illness and subsequent doctor visit.

Deadline recorded: Jul 9, 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

(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: (11) A health screening as specified in Section 87411, Personnel Requirements - General. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, S3 health screening was not maintained in personnel record, the licensee did not comply with the section cited above in 1 out of 3 staff, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/01/2025 Plan of Correction Licensee will submit proof of S3 health screening via FAX by 7/1/25.

Official classification

Type A

Official code

87608(a)(2)

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. (2) Postural supports shall be fastened or tied in a manner that permits quick release by the resident. This requirement is not met as evidenced by: LPA observed 4 residents wearing gait belts without a quick release which poses/pose a health and safety hazard for residents in care.

Official plan of correction

Administrator will obtain quick release belts that are used as postural supports and send proof to LPA by POC date.

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

Official classification

Type B

Official code

87618(b)(3)(a)

Regulation authority

CCR

What the official deficiency says

(a) Except as specified in Section 87611(a), the licensee shall be permitted to accept or retain a resident who requires the use of oxygen gas administration under the following circumstances: (b) In addition to Section 87611(b), the licensee shall be responsible for the following: (A) A report shall be made in writing to the local fire jurisdiction that oxygen is in use at the facility. This requirement is not met as evidenced by: LPA observed one resident using oxygen and no written report has been submitted to fire department.

Official plan of correction

Administrator will send written report to fire department and send proof to LPA by POC date.

Deadline recorded: Apr 5, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87211(a)(1)(A)

Regulation authority

CCR

What the official deficiency says

87211 Reporting Requirements; (a) Each licensee shall furnish...: (1) A written report shall be submitted to the licensing agency...within seven days of the occurrence... (A) Death of any resident from any cause regardless of where the death occurred... This requirements is not met as evidence by: Based on documents reviewed, and facility failed to report death of R#1 within the seven days of occurrence which poses a potential Health, Safety, and Personal Risk to persons in care.

Official plan of correction

Facility will submit death report for R#1. Licensee and administrator to review reporting requirements regulations section 87211 by POC due date 4/05/2024

Deadline recorded: Apr 5, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87632(d)(2)

Regulation authority

CCR

What the official deficiency says

Hospice Care Waiver The licensee shall notify the Department in writing within five working days of the initiation of hospice care services for any terminally ill resident in the facility or within five working days of admitting a resident already receiving hospice care services. The notice shall include the resident's name and date of admission to the facility and the name and address of the hospice. This requirement is not met as evidenced by: Facility has four residents currently on Hospice and failed to notify the department which poses a potential Health, Safety, and Personal Risk to persons in care.

Official plan of correction

Administrator will send notifications of initiation of hospice for four residents currently on Hospice.

Deadline recorded: Apr 10, 2024. 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

(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: (11) A health screening as specified in Section 87411, Personnel Requirements - General. 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) of (6) staff missing health screening on file, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/19/2024 Plan of Correction (2) Staff in question will obtain a Health Screening and a copyof the completed report will be provided to LPA, via email, by POC due date.

Official classification

Type B

Official code

87468.2(a)(1)

Regulation authority

CCR

What the official deficiency says

87468.2 Additional Personal Rights of Residents in Privately Operated Facilities (a) …Residents shall have…the following personal rights: (1)To have a reasonable level of personal privacy in accommodations, medical treatment, personal care and assistance, visits, communications, telephone conversations, use of the Internet, and meetings of resident and family groups. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview, and record review, the licensee did not comply with the section cited above in surveillance cameras in use, without proper waiver/approval from the department, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/19/2024 Plan of Correction Licensee has turned off the surveillance cameras and will submit a written request for a waiver to the department by POC dute. LPA has provided the Licensee with guidance on the waiver request.

Official classification

Type B

Official code

87465(h)(6)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care (h)The following requirements shall apply to medications which are centrally stored: (6)The licensee shall be responsible for assuring that a record of centrally stored prescription medications for each resident is maintained for at least one year… 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 several of R5's medications without record of centrally stored medications, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/19/2024 Plan of Correction Licensee will obtain record of R5's centrally stored prescribed medications and submit to LPA, via email by POC due date.

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... 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. This requirement is not met as evidenced by: 1/11/2022 4 p.m. LPA observed S1 was present at the facility but does not have a California clearance or criminal record exemption as required by the Department. Based on observation and interview, 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

Administrator will provide proof S1 has a California clearance or criminal record exemption as required by the Department to LPA by POC date.

Deadline recorded: Jan 12, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87202(a)

Regulation authority

CCR

What the official deficiency says

Fire Clearance 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. This requirement was not met as evidenced by: LPAs learned through interviews with 3 out of 4 staff, and review of resident roster that the facility had 7 residents up until Oct 2021. Also the facility fire clearance is approved for only 6 residents. This poses a health and safety risk to residence in care.

Official plan of correction

Administrator will ensure that the facility will abide by fire clearance and operate within licensing regulations. Administrator shall review section 87202 and provide a wrriten statement stating that he understands and will follow the regulation.

Deadline recorded: Nov 16, 2021. A deadline is not proof that correction was completed.