FLORESMA GUEST HOME

Official classification

Type A

Official code

87466

Regulation authority

CCR

What the official deficiency says

The licensee shall ensure that residents are regularly observed for changes in physical, mental, emotional and social functioning and that appropriate assistance is provided when such observation reveals unmet needs. When changes such as unusual weight gains or losses or deterioration of mental ability or a physical health condition are observed, the licensee shall ensure that such changes are documented and brought to the attention of the resident's physician and the resident's responsible person, if any. This requirement was not met as evidenced by: Based on interviews and records review facility staff failed to reposition R1 as required by residents Home Health which resulted in the R1 developing a stage 4 pressure injury. This poses an immediate health & safety risk to residents in care.

Official plan of correction

Licensee shall ensure all staff receiving training on personal rights, provisions for providing care and supervision and resident care plans. License shall submit proof of training by POC due date. Email proof to LPA Brown at Zina.Brown@dss.ca.gov An immediate $500 civil penalty assessed.

Deadline recorded: Jun 23, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87615(a)(1)

Regulation authority

CCR

What the official deficiency says

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 in a residential care facility for the elderly: Stage 3 and 4 pressure injuries. This requirement was not met as evidenced by: Based on records review and interviews conducted the facility failed to request an exception from Licensing when R1 developed a Stage 4 pressure injury, which is a prohibited health condition. This poses an immediate health & safety risk to residents in care.

Official plan of correction

Licensee shall ensure staff receive training on prohibited health conditions and submit proof of the training to the department by POC due date. Email proof to LPA Brown at Zina.Brown@dss.ca.gov

Deadline recorded: Jun 23, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87355(e)(2)

Regulation authority

CCR

What the official deficiency says

Criminal Record Clearance (e) 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: (2)Obtain a California clearance or a criminal record exemption as required by the Department This requirement was not met as evidenced by: Based on observation and interview, S1 Nancy Diocampos were not associated to the facility as the time of unannounced complaint investigation which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

The facility shall associate S1 Nancy Diocampos in Guardian and submit proof of update via email at zina.brown@dss.ca.gov by POC due date.

Deadline recorded: Jun 23, 2026. 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

(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 licensing agency staff. This requirement was not met as evidenced by: Based on observation, the facility had incomplete documentation such as LIC 603 Preplacement Appraisal, LIC 625 Appraisal/ Needs and Service Plans and Home Health Care Plan for Resident (R1) which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

The facility shall submit proof of updated resident records for all residents such as LIC 601, LIC 603, LIC 613, LIC 625 and all other required documentation per title 22 regulations via email at zina.brown@dss.ca.gov by POC due date.

Deadline recorded: Jul 6, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87411(c)(1)

Regulation authority

CCR

What the official deficiency says

87411 Personnel Requirements - General All RCFE staff who assist residents with personal activities of daily living shall receive initial and annual training as specified in Health and Safety Code sections 1569.625 and 1569.69 Staff providing care shall receive appropriate training in first aid from persons qualified by such agencies as the American Red Cross. Deficient Practice Statement Based on [(observation) (record review)], the licensee did not comply with the section cited above as LPA did not observe a current/active CPR/First aid certificate for staff 1-3 which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/01/2026 Plan of Correction Licensee/Administrator to ensure all staff who provide assistance to residents in care obtain a CPR/First aid certificate. Copies of certificates to be sent to LPA by POC due date. Lizeth.villegas@dss.ca.gov

Official classification

Type B

Official code

87411(f)

Regulation authority

CCR

What the official deficiency says

87411 Personnel Requirements - General All personnel, including the licensee and administrator, shall be in good health, and physically and mentally capable of performing assigned tasks. Good physical health shall be verified by a health screening, including a chest x-ray or an intradermal test, performed by a physician not more than six (6) months prior to or seven (7) days after employment or licensure. A report shall be made of each screening, signed by the examining physician. The report shall indicate whether the person is physically qualified to perform the duties to be assigned, and whether he/she has any health condition that would create a hazard to him/herself, other staff members or residents. A signed statement shall be obtained from each volunteer affirming that he/she is in good health. Personnel with evidence of physical illness or emotional instability that poses a significant threat to the well-being of residents shall be relieved of their duties. Deficient Practice Statement Based on [(observation) and (record review)], the licensee did not comply with the section cited above as LPA did not observe a health screening on file for staff #1-2 which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/01/2026 Plan of Correction Licensee/Administrator to obtain a health screening signed by a licensed physician and submit a copy to LPA by POC due date.

Official classification

Type B

Official code

87458(b)

Regulation authority

CCR

What the official deficiency says

87458 Medical Assessment The licensee shall obtain an updated medical assessment when required by the Department. Deficient Practice Statement Based on [(observation) and (record review)], the licensee did not comply with the section cited above as LPA did not observe a current physicians report for Resident #1 which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/01/2026 Plan of Correction Licensee/Administrator to obtain a current medical assessment/physicians report and submit a copy to LPA by POC due date.

Official classification

Type B

Official code

87458(c)(1)(A)

Regulation authority

CCR

What the official deficiency says

87458 Medical Assessment 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. Deficient Practice Statement Based on [(observation) and (record review)], the licensee did not comply with the section cited above as LPA did not observe documentation that TB test was conducted for resident #2 which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/01/2026 Plan of Correction Licensee/Administrator to obtain a tb test for resident #2 and sent LPA a copy of test conducted with results by POC due date.

Official classification

Type B

Official code

1569.625(b)(2)

Regulation authority

HSC

What the official deficiency says

HSC 1 569.625 Staff training; legislative findings; contents 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. Deficient Practice Statement Based on [(observation) and (record review)], the licensee did not comply with the section cited above as LPA did not observe training logs or certificates for staff #1-3 on file which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/01/2026 Plan of Correction Licensee to ensure all staff are trained yearly as per regulation cited above. LPA to receive by POC due date copies of any insrevices and/or online traingings conducted. Name of staff in attendance, Time, date, length, and training topics to be included .

Official classification

Type B

Official code

1569.695(c)

Regulation authority

HSC

What the official deficiency says

1569.695 Emergency Plans 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 [(observation) (interview) (record review)], the licensee did not comply with the section cited above as there was no emergency drill log/documentation for LPA to review nor was staff aware of the last drill conducted which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/01/2026 Plan of Correction Licensee/Administrator to conduct emergency drills each quater and document tthe drill date, time, and participants. Facility to conduct a drill and send copy of documentation to LPA by POC due date.

Official classification

Type B

Official code

87411(f)

Regulation authority

CCR

What the official deficiency says

(f) All personnel, including the licensee and administrator, shall be in good health, and physically and mentally capable of performing assigned tasks. Good physical health shall be verified by a health screening, including a chest x-ray or an intradermal test, performed by a physician not more than six (6) months prior to or seven (7) days after employment or licensure. A report shall be made of each screening, signed by the examining physician. The report shall indicate whether the person is physically qualified to perform the duties to be assigned, and whether he/she has any health condition that would create a hazard to him/herself, other staff members or residents. A signed statement shall be obtained from each volunteer affirming that he/she is in good health.Personnel with evidence of physical illness or emotional instability that poses a significant threat to the well-being of residents shall be relieved of their duties. 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 for two out of five persons which poses a potential health risk to persons in care. LPA Cloyd did not observe Health Screening Reports (LIC 503) for Staff #1 and Staff #5. Staff #1 was on site.

Official plan of correction

POC Due Date: 05/03/2024 Plan of Correction Licensee/Administrator will submit health screening reports with TB results to regina.cloyd@dss.ca.gov by the POC due date.

Official classification

Type A

Official code

87355(C)(1)

Regulation authority

CCR

What the official deficiency says

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 in [count] out of [total count] [(objects) (persons)] [identifiers] which poses an immediate health, safety or personal rights risk to persons in care. 87355Criminal Record Clearance(a)The Department shall conduct a criminal record review...

Official plan of correction

POC Due Date: 06/19/2023 Plan of Correction Licensee to associated staff Doloris Delrosario to facility going foward