KOREAN SENIOR CARE

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, the licensee did not comply with the section cited above no carbon monoxide detector was observed during visit which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/08/2025 Plan of Correction Administrator will install carbon monoxide detector and send LPA picture by POC due date.

Official classification

Type A

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 three (3) out of three (3) staff did not have a current CPR which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/08/2025 Plan of Correction Administrator will send CPR for S1, S2, and S3 by POC due date.

Official classification

Type A

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 R6 had full bed rails with no order and not on hospice care which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/08/2025 Plan of Correction Administrator will remove bed rails and send LPA pictures 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 one room did not have working smoke detector in bedroom which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/08/2025 Plan of Correction Administrator changed battieries at time of visit deficiencie cleared.

Official classification

Type B

Official code

87303(e)(2)

Regulation authority

CCR

What the official deficiency says

(e) Water supplies and plumbing fixtures shall be maintained as follows: (2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degrees C) and not more than 120 degree F (49 degrees C). This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above resident and staff bathroom did not have hot wate R1 83.2 and R2 81.7 which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/14/2025 Plan of Correction Administrator will adjust water temperature and send LPA pictue by POC due date. Administrator will create one week water log and send to LPA.

Official classification

Type B

Official code

87305(a)

Regulation authority

CCR

What the official deficiency says

(a) Prior to construction or alterations, all facilities shall obtain a building permit. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above garage was turned into staff bedroom which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/21/2025 Plan of Correction Administrator will obtain permits for city or remove items from garage and send pictures or permits to LPA by POC due date.

Official classification

Type B

Official code

87463(h)

Regulation authority

CCR

What the official deficiency says

(h) The licensee shall request that all residents receive an annual routine visit with a licensed medical professional once every twelve months, either in person or by video appointment. 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 six (6) residents did not have an updated physicians report 602 which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/21/2025 Plan of Correction Administrator will send documents to LPA by POC due date. R1 updated 602, R2 updated 602, R3 updated 602 and appraisel needs and service, R4 updated 602 appraisel needs and service plan, R5 incomplete 602, R6 updated 602.

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 facility did conduct any drills which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/14/2025 Plan of Correction Administrator will conduct drills with staff and send 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. 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 as there was no record found for the last fire/emergency drill, Assistant Administrator stated that they have not conducted a drill in quite some time, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/16/2024 Plan of Correction Licensee/Administrator to conduct a fire/emergency drill and review the above regualtion in its entirety. A copy of the drill and the signed LIC9098 (which identifies that the regulation was reviewed and moving forward drills will be conducted per requirement) shall be emailed to LPA by POC due date. (tena.herrera@dss.ca.gov)

Official classification

Type B

Official code

87705(c)(6)

Regulation authority

CCR

What the official deficiency says

(c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following: (6) Appraisals are conducted on an ongoing basis pursuant to Section 87463, Reappraisals. 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 as 1 out of 4 client files reviewed during todays visit did not have an updated needs and service appraisal done since admission into the facility in 2017, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/16/2024 Plan of Correction Licensee/Administrator to complete an updated need and service appraisal per the requirement and send a copy to LPA via email by POC due date. Additionally, Licensee/Administrator shall review the above regulation in its entirety and complete the LIC9098 provided during todays visit and email the signed form to LPA by POC due date (a signed LIC 9098 will identify that the regulation was reviewed and moving all clients will have thier appraisals completed on a regular basis). - tena.herrera@dss.ca.gov

Official classification

Type A

Official code

87468.2(a)(4)

Regulation authority

CCR

What the official deficiency says

87468.2 Additional Personal Rights of Residents in Privately Operated Facilities (a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (4) To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs. The requirement was not met as evidenced : By LPA's interview, the staff let residents unattended which posed an immediate risk to residents in care

Official plan of correction

The administrator will provide to training staff about the regualtion and send the training log to LPA by POC due date.

Deadline recorded: Apr 5, 2023. A deadline is not proof that correction was completed.