WEST PICO TERRACE ASSISTED LIVING CENTER LP

Official classification

Type A

Official code

87309(a)(1)

Regulation authority

CCR

What the official deficiency says

(a) Except as specified in subsection (b), the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances, knives, matches, tools, sharp objects, and other similar items which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage. (1) Disinfectants, cleaning solutions, and poisonous substances shall be stored in areas separate from food supplies as specified in Section 87555, General Food Service Requirements. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation], the licensee did not comply with the section cited above. LPA Dabuet identified in rooms #230, #307 and #324 disinfectant spray, gas fluid, and clorox powder. This violation which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/02/2026 Plan of Correction Licensee shall ensure the health and safety at all times of resident in care and to ensure that all toxic and hazardous solutions are stored away from residents in care. Proof of correction must be completed and submitted by POC date to LPA Dabuet ernand.dabuet@dss.ca.gov *Corrected during the visit.

Official classification

Type B

Official code

87468.1

Regulation authority

CCR

What the official deficiency says

87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all...(2) To be accorded safe, healthful and comfortable accommodations... This requirement is not met as evidenced by: Based on records reviewed, and interviews conducted, the Licensee failed to adequately supervise (R1) on 09/17/25, and 09/29/25, allowing them to wander the community unaccompanied by staff, which resulted in R1 suffering two unwitnessed falls and sustaining a head injury and a laceration of scalp that led to hospitalization. This violation poses an immediate health and safety risk to residents in care.

Official plan of correction

Licensee/Administrator shall ensure that all staff are trained on fall prevention and resident-specific care plans. Documentation of staff training will be submitted to the Department by 06/10/26 to Elvira.Gonzalez@DSS.CA.GOV

Deadline recorded: Jun 10, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87465(a)(4)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care. (4) The licensee shall assist residents with self-administered medications as needed. This requirement was not met as evidenced by: Based on records reviewed on 3/17/2026, LPA Shirley reviewed facility medication administration records (MAR) for R1 and noted that for the date of 3/16/2026, MAR had no initials for pantoprazole, but medication was not in bubble pack. For 3/17/2026, MAR had no initials for pantoprazole AM dose and medication was still in the bubble pack. This action poses as a potential health and safety risk to persons in care.

Official plan of correction

The Administrator shall submit plan informing the department medication training has been performed with all staff. A written proof of correction must included along with date, time and participants names. Correction must be submitted by due date: 3/31/26 to LPA's email: felisa.shirley@dss.ca.gov or fax attn: to LPA Felisa Shirley to 424-544-1016.

Deadline recorded: Mar 31, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.1

Regulation authority

CCR

What the official deficiency says

87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all...(2) To be accorded safe, healthful and comfortable accommodations... This requirement is not met as evidenced by: Based on records reviewed, and interviews conducted, the Licensee failed to adequately supervise (R1) on 09/17/25, and 09/29/25, resulting in unwitnessed falls and sustaining injuries. This violation poses an immediate health and safety risk to residents in care.

Official plan of correction

Licensee/Administrator shall ensure that all staff are trained on fall prevention and resident-specific care plans. Documentation of staff training will be submitted to the Department by 04/29/26 to Elvira.Gonzalez@DSS.CA.GOV

Deadline recorded: Apr 29, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87465(a)(4)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care (a) A plan for incidental medical...care shall be developed by each facility. The plan shall encourage routine medical...care...by compliance with the following: (4) The licensee shall assist...medications as needed. This requirement is not met as evidenced by: Based on interviews conducted, the licensee did not comply with the section cited above in not providing Resident 1 (R1), R2, R3, R5 with medications as prescribed, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

The facility shall retrain staff on ordering refill medications in a timely manner and ensuring that a pharmacy will deliver medication in a timely manner on, or prior to, POC due date which is 03/27/26.

Deadline recorded: Mar 27, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87465(a)(4)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care. (4) The licensee shall assist residents with self-administered medications as needed. This requirement was not met as evidenced by: Based on interviews and records reviewed, records revealed that the medication Pantoprazole, with the date of 3/16/26 had no initials for a.m. dose but pill was dispensed, the date 3/17/26 had no initial for a.m. dose and pill is still in the bubble pack. This action poses as an immediate health and safety risk to persons in care.

Official plan of correction

The Administrator shall submit plan informing the department medication training has been performed with all staff. A written proof of correction must included along with date, time and participants names. Correction must be submitted by due date: 3/31/26 to LPA's email: felisa.shirley@dss.ca.gov or fax attn: to LPA Felisa Shirley to 424-544-1016.

Deadline recorded: Mar 31, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468(b)

Regulation authority

CCR

What the official deficiency says

Personal Rights To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. (3) To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature, This requirement was not met as evidence by: Staff did not ensure a safe and healthful accommodations for resident in care. Which poses a potential health and safety risk to clients in care

Official plan of correction

Administrator agrees to Develop a plan that ensures that Resident #1 rights are not violated and All staff shall attend a training on Personal Rights of the residents in care by the POC date. 12/20/2024 A copy of the training logs and development plan will be sent to LPA :Sparkle Day Sparkle.day@dss.ca.gov

Deadline recorded: Dec 20, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468(b)

Regulation authority

CCR

What the official deficiency says

Personal Rights To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. (3) To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature, This requirement was not met as evidence by: Staff did not ensure a safe and healthful accommodations for resident in care. Which poses a potential health and safety risk to clients in care

Official plan of correction

Administrator agrees to Develop a plan that ensures that Resident #1 rights are not violated and All staff shall attend a training on Personal Rights of the residents in care by the POC date. 12/20/2024 A copy of the training logs and development plan will be sent to LPA : Sparkle Day @ Sparkle.day@dss.ca.gov

Deadline recorded: Dec 17, 2024. 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

87303 Maintenance and Operation (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. The licensee did not comply with the section cited above in staff stating that bed bugs were reported in room #312, and were treated by Terminix Commercial on 03/29/24. Although they were treated, it did not give proper treatment for bed bugs as there should be continuous treatment for bed bugs, not just one spray. This poses a potential Health, Safety or Personal rights risk to residents in care.

Official plan of correction

Licensee will ensure that bed bug activity in the facility is eradicated. Licensee will provide LPA with a copy of Pest Elimination Service Plan for bed bugs, along with invoice via email to Elvira.Gonzalez@dss.ca.gov

Deadline recorded: Apr 26, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

159.695(f)(1)

Regulation authority

HSC

What the official deficiency says

(f) A facility shall have both of the following in place: (1) An evacuation chair at each stairwell, on or before July 1, 2019. Based on observation, the licensee did not comply with the section cited above in not having an evacuation chair in each stairwell. Which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Licensee will place an evacuation chair at each stairwell and email proof of corrections to Elvira.Gonzalez@dss.ca.gov

Deadline recorded: May 3, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87355(e)(1)

Regulation authority

CCR

What the official deficiency says

All individuals subject to a criminal record review...shall prior to working...in a licensed facility: obtain a California clearance or a criminal record exemption as required... This requirement was not met as evidenced by: LPA observed Staff #2 to be working at the facility but not cleared in Guardian nor associated to the facility.

Official plan of correction

The Administrator immediately added Staff #2 (S2) into Guardian and provided Staff #2 with the CDSS Live Scan Form. S2 will not return to work until S2 is cleared. Administrator will ensure that all staff members listed on LIC 500 are cleared and associated. Proof of evidence to be emailed to regina.cloyd@dss.ca.gov by POC due date.

Deadline recorded: Mar 22, 2024. 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

The facility shall be...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 was not met as evidenced by: Based on interviews and observations, the facility has three damaged doors and one damaged garage gate which poses a safety risk to the residents in care.

Official plan of correction

The administrator will provide evidence that the damaged doors and garage gate were repaired. The administrator will also provide a written plan for ensuring the safety of the residents in care. Evidence and plan should be emailed to regina.cloyd@dss.ca.gov by the POC due date.

Deadline recorded: Feb 26, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

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. This was not met as evidenced by: Based on LPA’s observations and interviews, four residents admitted they use the call button for help, and they wait between 5-45 minutes, while one resident stated the wait is up to an hour and 20 minutes. Two staff admitted the call button should be answered within 5-10 minutes, beyond that is unacceptable. Based on LPA’s observation on 11/8/2023 at around 1:03 PM while testing the call button in room #229B with S2, staff did not respond to the call button within 10 minutes. S2 aborted the test immediately after 10 minutes and called staff by using a walkie talkie. Per LPA’s observations, staff do not answer residents’ call buttons in a timely manner. This poses a potential risk to residents’ health, safety and/or personal rights to residents in care.

Official plan of correction

POC: Administrator shall review the cited section and shall self-certify understanding and compliance with the regulation. Administrator shall conduct an in-service training to staff on this regulation. POC shall be submitted to CCLD by faxing to 424-544-1016 by the POC due date.

Deadline recorded: Jan 22, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

85060(a)(3)

Regulation authority

CCR

What the official deficiency says

85060Basic Services (a) For SSI/SSP recipients who are residents...(3) An extra charge to the resident shall be allowed for provision of special food services or products beyond that specified in Section 80076(a)(2) and (a)(4) when the resident wishes to purchase the services and agrees to the extra charge in the admissions agreement. This requirement is not met as evidenced by: Based on interview, observation, and record review, the administrator failed to provide a new admission agreement with the aditional food service fees which poses a health risk to residents in care.

Official plan of correction

Administrator will provide a new admission agreement with the additional 5 dollar food tray fee for room service or send written notice that additional fee will not longer be charged. Administator will refund any resident that has paid the service fee. Administrator will email new agreement to LPA Calderon by POC date.

Deadline recorded: Sep 15, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87307(a)

Regulation authority

CCR

What the official deficiency says

87307 Personal Accommodations and Services (a) Living accommodations and grounds shall be related to the facility's function. This requirement is not met as evidenced by: Based on interview, observation, and record review, the licensee failed to ensure that the facility is safe and healthful for residents in care as result roaches were found in room #210 and #307 which poses a health risk to residents in care.

Official plan of correction

Administrator will have pest control spray the affected rooms and provide LPA Calderon pest control reports monthly as to progress in taking care of roach issues.

Deadline recorded: Sep 8, 2023. 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

87303 Maintenance and Operation (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 was not met as evidence by: Based on interviews, records review, and physical tour, the licensee failed to ensure that the AC unit needed to be fixed throughout the facility. During today's visit, on 7/26/23, LPA toured 9 rooms and noticed the AC vents didn not blow cool air. The AC unit was in disrepair, and LPA did not observe fans in the rooms where AC was not working. Based on the interviews conducted, LPA learned that some of the AC units are inoperable on the side of the building where room #212 is located

Official plan of correction

Licensee will ensure the AC unit will be in good repair and will sent proof of repaired AC unit to LPA vai email before POC due date. in addition Licensee will provide fans to the resident's rooms where the AC vents are not blowing cool air.

Deadline recorded: Aug 2, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87405(a)

Regulation authority

HSC

What the official deficiency says

(a) when the administrator is not in the facility, there shall be coverage by a designated substitute who shall have the qualifications adequate to be responsible and accountable for management and administratin of the facility as specified in this section. This requirement is not met as evidenced by: Based on records review, the facility does not have documentation making S1 as a designated substitute for the administrator. This is a potential health and safety risk to residents in care.

Official plan of correction

Licensee will submit an LIC308: Designation of facility responsibility form for S1 or appropriately trained staff as a back up administrator to CCLD via fax or email by POC due date.

Deadline recorded: Jul 14, 2023. A deadline is not proof that correction was completed.