Staffing, personnel, and trainingType B
- 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 observation, interview, record review, the licensee did not comply with the section cited above for 1 out of 6 staff which poses/posed a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 09/29/2025 Plan of Correction The licensee/administrator will submit proof of a LIC 503 Health Screening for Staff #5 via email at zina.brown@dss.ca.gov by the POC due date.
Fire safety and emergency preparednessType B
- Official classification
- Type B
- Official code
- 1569.695(e)(2)
- Regulation authority
- HSC
What the official deficiency says
(e) A facility shall have all of the following information readily available to facility staff during an emergency: (2) An appraisal of resident needs and services plan for each resident. 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 for 4 out of 6 residents which poses as a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 10/06/2025 Plan of Correction The licensee/administrator will submit proof of a LIC 625: Needs and Appraisal Service Plan for 2 out of 6 residents (Resident #1 and Resident #6) via email at zina.brown@dss.ca.gov by the POC due date.
Health conditions and treatmentsType B
- Official classification
- Type B
- Official code
- 87609(b)(4)(A)
- Regulation authority
- CCR
What the official deficiency says
(b) Incidental medical care may be provided to residents through a licensed home health agency provided the following conditions are met: (4) The licensee and home health agency agree in writing on the responsibilities of the home health agency, and those of the licensee in caring for the resident's medical condition(s). (A) The written agreement shall reflect the services, frequency and duration of care. 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 for 2 out of 2 residents which poses/posed a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 10/06/2025 Plan of Correction The licensee/administrator will submit proof of Home Health Plan of Care for Resident #3, and Resident #5 via email at zina.brown@dss.ca.gov by the POC due date.
Health conditions and treatmentsType B
- Official classification
- Type B
- Official code
- 87633(d)
- Regulation authority
- CCR
What the official deficiency says
87633(d) The licensee shall ensure that the hospice care plan is current, accurately matches the services, accurately matches the services actually being provided, and that the client's care need are being met at all times This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, iinterview and record review, the licensee did not comply with the section cited above in 2 out of 2 residents which poses/posed a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 10/06/2025 Plan of Correction The licensee/administrator will submit proof of Hospice of Care for Resident #1 and Resident #6 via email at zina.brown@dss.ca.gov by the POC due date.