BELOVED LIVING

Official classification

Type B

Official code

87211(c)

Regulation authority

CCR

What the official deficiency says

87211 Reporting Requirements: (c) … Any mandated reporter who... has observed or has knowledge of an incident … including an act or omission… shall report… immediately or as soon as practicably possible… This requirement was not met as evidenced by: Based on observation and review of evidence S2 was present during incident in which S1 is observed verbally abusing a resident in care and did not report the incident to the proper agencies which poses an immediate risk to the persons in care.

Official plan of correction

Licensee will provide training to staff regarding Mandated Reporter and will submit a copy of sign-in sheet with duration of training and topic, training material by POC due date: 7/4/26.

Deadline recorded: Jul 13, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87468.1(a)(3)

Regulation authority

CCR

What the official deficiency says

Personal Rights of Residents in All Facilities: (a)Residents in all residential care facilities for the elderly shall have all of the following personal rights: (3) To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature,… This requirement is not met as evidence by: Based on interviews and record review conducted licensee did not ensure S3 treats residents in care with dignity and respect which poses an immediate safety, health, and personal rights to the persons in care.

Official plan of correction

Licensee will provide in-service training to all staff regarding resident’s personal rights, de-escalation of behaviors, and will provide a copy to the department of training material, sign in sheet with time, date, and duration of training, and will certify in writing that will ensure the health and safety of each resident in care by POC due date: 7/1/26.

Deadline recorded: Jul 1, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87469(C)(1)

Regulation authority

CCR

What the official deficiency says

(1) Immediately telephone 9-1-1, present the advance directive and/or request regarding resuscitative measures form to the responding emergency medical personnel and identify the resident as the person to whom the order refers. This requirement was not met as evidenced by information received from LAFD and staff.

Official plan of correction

As POC, the licensee and staff shall obtain training to address this section of the regulation. As proof training was received, a copy of the training log addressing this section will be submitted to the licensing agency by 6.23.2026

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

Official classification

Type B

Official code

87465(i)

Regulation authority

CCR

What the official deficiency says

Prescription medications which are not taken with the resident upon termination of services, not returned to the issuing pharmacy, nor retained in the facility as ordered by the resident’s physician and documented in the resident’s record nor disposed of according to the hospice’s established procedures or which are otherwise to be disposed of shall be destroyed in the facility by the facility administrator and one other adult who is not a resident. Both shall sign a record, to be retained for at least three years, which lists the following: Based on observation, the licensee did not comply with the section cited above in 1 out of 1 medications were kept when resident passed or move out, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Licensee will dispose residents medications who are not at the facility.

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

Official classification

Type B

Official code

87465(i)

Regulation authority

CCR

What the official deficiency says

Prescription medications which are not taken with the resident upon termination of services, not returned to the issuing pharmacy, nor retained in the facility as ordered by the resident’s physician and documented in the resident’s record nor disposed of according to the hospice’s established procedures or which are otherwise to be disposed of shall be destroyed in the facility by the facility administrator and one other adult who is not a resident. Both shall sign a record, to be retained for at least three years, which lists the following: This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and record review, the licensee did not comply with the section cited above in 1 out of 1 medications were kept when resident passed on 5.2.2026, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/26/2026 Plan of Correction Medication should be disposed and discard when resident pass away or move-out.

Official classification

Type A

Official code

87355(e)(3)

Regulation authority

CCR

What the official deficiency says

(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: (3) Request a transfer of a criminal record clearance as specified in Section 87355(c) or 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 1 out of 1 S3 does not have criminall records cleared, fingerprint cleared and associate with Guardian, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/13/2026 Plan of Correction Licensee needs to have S3 criminal records cleared, fingerprint cleared, and associate with facility.

Official classification

Type B

Official code

1569.605

Regulation authority

HSC

What the official deficiency says

On and after July 1, 2015, all residential care facilities for the elderly, except those facilities that are an integral part of a continuing care retirement community, shall maintain liability insurance covering injury to residents and guests in the amount of at least one million dollars ($1,000,000) per occurrence and three million dollars ($3,000,000) in the total annual aggregate, caused by the negligent acts or omissions to act of, or neglect by, the licensee or its employees. 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 1 out of 1 facility does not have liability insurance, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/26/2026 Plan of Correction Licensee will obtain liability insurance and email to LPA.

Official classification

Type B

Official code

87412(a)(13)

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: (13) For employees that are required to be fingerprinted pursuant to Section 87355, Criminal Record Clearance: 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 1 out of 1 S3 does not have criminall records cleared, fingerprint cleared and associate with Guardian, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/13/2026 Plan of Correction Licensee needs to have S3 criminal records cleared, fingerprint cleared, and associate with facility.

Official classification

Type B

Official code

87456(a)(2)

Regulation authority

CCR

What the official deficiency says

(a) Prior to accepting a resident for care and in order to evaluate his/her suitability, the facility shall, as specified in this article 8: (2) Perform a pre-admission appraisal. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and record review, the licensee did not comply with the section cited above in 1 out of 1, R2 has been at the facility since 5.1.2026 and no pre-admission appraisa or admission agreementl was done, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/26/2026 Plan of Correction Licensee will email LPA for appraisal and admission agreement.

Official classification

Type B

Official code

87507(c)

Regulation authority

CCR

What the official deficiency says

(c) Admission agreements shall be signed and dated, acknowledging the contents of the document, by the resident or the resident's representative, if any, and the licensee or the licensee's designated representative no later than seven days following admission. Attachments to the agreement may be utilized as long as they are also signed and dated as prescribed above. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and record review, the licensee did not comply with the section cited above in 1 out of 1, R2 has been at the facility since 5.1.2026 and no pre-admission appraisa or admission agreementl was done, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/26/2026 Plan of Correction Licensee will email LPA for appraisal and admission agreement.

Official classification

Type B

Official code

87495(a)

Regulation authority

CCR

What the official deficiency says

Administrator - Qualifications and Duties All facilities shall have a qualified and currently certified administrator. The licensee and the administrator may be one and the same person. The administrator shall have sufficient freedom from other responsibilities and shall be on the premises a sufficient number of hours to permit ...This requirement was not met as evidenced by: facility administrator is never at the facility, residents and staff is not even aware what they look like.

Official plan of correction

The facility administrator will provide an updated LIC 500 with corrected time for administrator, LIC 308, and a written certification that administrator will be at the facility a sufficient amount of hours and available for emergencies to the department by POC due date.

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

Official classification

Type B

Official code

87411(a)

Regulation authority

CCR

What the official deficiency says

Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. This requirement was not met as evidenced by: Based on interviews the facility does not have adequate staff to care for residents. This pose a potential health & safety risk to the residents in care. S2 would be working off the clock (24/7).

Official plan of correction

Administrator will email LPA LIC500 showing adequate staff coverage by the POC date.

Deadline recorded: Mar 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

A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below. This report shall include the resident's name, age, sex and date... This requirement was not met as evidenced by: Based on record review R3 sustanined scratched on their face from R1. Facility staff did not report to RO about the incident. This pose a potential health & safety risk to the residents in care.

Official plan of correction

Facility staff will send incident report to RO before POC date.

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

Official classification

Type B

Official code

87457(c)(1)(a)

Regulation authority

CCR

What the official deficiency says

(a) An evaluation of the prospective resident's functional capabilities, mental condition, and social factors as specified in Sections 87459, Functional Capabilities and 87462, Social Factor. This requirement was not met as evidenced by: Based on record review the facility does not have R1 appraisal needs and service plan (LIC 625), R1 was admitted to the facility on 1.27.2026. This pose a potential health & safety risk to the residents in care.

Official plan of correction

Facility staff will send R1 LIC 625 to LPA by the due the POC date.

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

Official classification

Type B

Official code

1569.618(a)

Regulation authority

HSC

What the official deficiency says

(a) The administrator designated by the licensee pursuant to paragraph (11) of subdivision (a) of Section 1569.15 shall be present at the facility during normal working hours. A facility manager designated by the licensee with notice to the department, shall be responsible for the operation of the facility when the administrator is temporarily absent from the facility. This requirement was not met as evidenced by: Based on record review the facility does not have S1 does have LIC 308.

Official plan of correction

S1 will fill-up LIC 308 and email LPA by POC date.

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

Official classification

Type B

Official code

87458(c)(1)

Regulation authority

CCR

What the official deficiency says

(c) The medical assessment shall include, but not be limited to: (1) 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: 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 1 out of 1 R2 and R4 physician report/ TB test is missing which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/14/2025 Plan of Correction Licensee will email LPA physician report w/ TB test.

Official classification

Type B

Official code

87458(c)(1)(A)

Regulation authority

CCR

What the official deficiency says

(c) The medical assessment shall include, but not be limited to: (1) 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: (A) Communicable tuberculosis. 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 1 out of 1 R2 and R4 physician report/ TB test is missing which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/14/2025 Plan of Correction Licensee will email LPA physician report w/ TB test.

Official classification

Type A

Official code

1569.695(a)(7)(E)

Regulation authority

HSC

What the official deficiency says

(a)In addition to any other requirement of this chapter, a residential care facility for the elderly shall have an emergency and disaster plan that shall include, but not be limited to, all of the following: (7) Procedures that address, but are not limited to, all of the following: (E) Storage and preservation of medications, including the storage of medications that require refrigeration. 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 1 out of 1 medication was not locked and accessible to residents which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/11/2024 Plan of Correction Medication needs to locked at all times.

Official classification

Type B

Official code

87470(a)(2)(A)

Regulation authority

CCR

What the official deficiency says

(a) A licensee shall ensure that infection control practices are maintained as follows: (2) Environmental cleaning and disinfection activities shall be performed following the manufacturers' instructions for proper use of the cleaning and disinfecting products. These activities shall be completed, at a minimum, as follows: (A) Surfaces such as floors, chairs, toilets, sinks, counters and tabletops shall be cleaned and disinfected on a regular basis to ensure they are safe and sanitary. These surfaces shall also be disinfected when these surfaces are contaminated and visibly soiled with blood or body fluids or other potentially infectious material. 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 1 out of 1 bathrooms needs to be cleaned, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/11/2024 Plan of Correction Bathroom toilet needs to be cleaned and bathroom skid mat needs to be changed.

Official classification

Type B

Official code

1569.17(b)(1)(C)

Regulation authority

HSC

What the official deficiency says

(C) Any person who provides client assistance in dressing, grooming, bathing, or personal hygiene. Any nurse assistant or home health aide meeting the requirements of Section 1338.5 or 1736.6, respectively, who is not employed, retained, or contracted by the licensee, and who has been certified or recertified on or after July 1, 1998, shall be deemed to meet the criminal record clearance requirements of this section. A certified nurse assistant and certified home health aide who will be providing client assistance and who falls under this exemption shall provide one copy of their current certification, prior to providing care, to the residential care facility for the elderly. The facility shall maintain the copy of the certification on file as long as the care is being provided by the certified nurse assistant or certified home health aide at the facility. Nothing in this paragraph restricts the right of the department to exclude a certified nurse assistant or certified home health aide from a licensed residential care facility for the elderly pursuant to Section 1569.58. 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 1 out of 1 fingerprint clearance which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/11/2024 Plan of Correction Fingerprint clearance needs to be upon hire.

Official classification

Type B

Official code

87506(b)(17)(A)

Regulation authority

CCR

What the official deficiency says

(b) Each resident's record shall contain at least the following information: (17) Documents and information required by the following: (A) Section 87457, Pre-Admission Appraisal; 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 1 out of 1 appraisals which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/11/2024 Plan of Correction Appraisal needs to be done and signed.

Official classification

Type B

Official code

87506(b)(17)(B)

Regulation authority

CCR

What the official deficiency says

(b) Each resident's record shall contain at least the following information: (17) Documents and information required by the following: (B) Section 87459, Functional Capabilities; 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 1 out of 1 functional capability which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/11/2024 Plan of Correction Functional capability needs to be done and signed.

Official classification

Type B

Official code

87506(b)(17)(C)

Regulation authority

CCR

What the official deficiency says

(b) Each resident's record shall contain at least the following information: (17) Documents and information required by the following: (C) Section 87461, Mental Condition; 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 1 out of 1 condition which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/11/2024 Plan of Correction Mental condition needs to done and signed.

Official classification

Type B

Official code

87506(b)(17)(D)

Regulation authority

CCR

What the official deficiency says

(b) Each resident's record shall contain at least the following information: (17) Documents and information required by the following: (D) Section 87462, Social Factors; 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 1 out of 1 condition which poses/posed a social factors, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/11/2024 Plan of Correction Social factors needs be done and signed.

Official classification

Type B

Official code

87506(b)(17)(E)

Regulation authority

CCR

What the official deficiency says

(b) Each resident's record shall contain at least the following information: (17) Documents and information required by the following: (E) Section 87463, Reappraisals; and 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 1 out of 1 reappraisals which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/11/2024 Plan of Correction Reappraisals needs to be done and signed.

Official classification

Type B

Official code

87456(a)(2)

Regulation authority

CCR

What the official deficiency says

(a) Prior to accepting a resident for care and in order to evaluate his/her suitability, the facility shall, as specified in this article 8: (2) Perform a pre-admission appraisal. 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 1 out of 1 pre-appraisal which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/11/2024 Plan of Correction Pre-apprisal needs to be signed and dated.

Official classification

Type B

Official code

87456(a)(3)

Regulation authority

CCR

What the official deficiency says

(a) Prior to accepting a resident for care and in order to evaluate his/her suitability, the facility shall, as specified in this article 8: (3) Obtain and evaluate a recent medical assessment. 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 1 out of 1 physician report which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/11/2024 Plan of Correction Physician report needs to be done and signed.

Official classification

Type B

Official code

87457(c)

Regulation authority

CCR

What the official deficiency says

(c) Prior to admission a determination of the prospective resident's suitability for admission shall be completed and shall include an appraisal of his/her individual service needs in comparison with the admission criteria specified in Section 87455, Acceptance and Retention Limitations. 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 1 out of 1 retention limitation which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/11/2024 Plan of Correction Acceptance and retention limitation needs to be done and signed.

Official classification

Type B

Official code

87458(b)(1)

Regulation authority

CCR

What the official deficiency says

(b) The medical assessment shall include, but not be limited to: (1) A physical examination of the resident indicating the physician's primary diagnosis and secondary diagnosis, if any and results of an examination for communicable tuberculosis, other contagious/infectious or contagious diseases or other medical conditions which would preclude care of the person by the facility. 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 1 out of 1 phyical assesment which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/11/2024 Plan of Correction Physicial assesment needs to done with TB test.

Official classification

Type B

Official code

87458(b)(5)

Regulation authority

CCR

What the official deficiency says

(b) The medical assessment shall include, but not be limited to: (5) The determination whether the person is ambulatory or nonambulatory as defined in Section 87101(a) or (n), or bedridden as defined in Section 87455(d). The assessment shall indicate whether nonambulatory status is based upon the resident's physical condition, mental condition or both. 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 1 out of 1 physical and mental assesment needs to be done which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/11/2024 Plan of Correction Physicial and mental assesment needs to be done and signed.

Official classification

Type B

Official code

87463(a)

Regulation authority

CCR

What the official deficiency says

(a) The pre-admission appraisal shall be updated, in writing as frequently as necessary to note significant changes and to keep the appraisal accurate. The reappraisals shall document changes in the resident's physical, medical, mental, and social condition. Significant changes shall include but not be limited to: 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 1 out of 1 reappraisals which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/11/2024 Plan of Correction Reappraisals needs to be done and signed.

Official classification

Type B

Official code

1569.695(e)(3)

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: (3) A resident medication list for residents with centrally stored medications. 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 1 out of 1 CSMDR which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/11/2024 Plan of Correction CSMDR needs to be done for every resident. Facility should not just rely on Hospice med lists.

Official classification

Type B

Official code

87608(a)(5)(A)

Regulation authority

CCR

What the official deficiency says

(A) A bed rail that extends from the head half the length of the bed and used only for assistance with mobility shall be allowed. 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 1 out of 1 condition for bed rails which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/11/2024 Plan of Correction Bedrails needs to be prescription or doctor orders.