BLYTHE SENIOR ASSISTED LIVING

Official classification

Type A

Official code

87202(a)

Regulation authority

CCR

What the official deficiency says

(a) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, or the State Fire Marshal. Prior to accepting or retaining any of the following types of persons, the applicant or licensee shall notify the licensing agency and obtain an appropriate fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, or the State Fire Marshal: This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above as three of the facility's fire alarms in the dining area, living room, and hallway were not hardwired and did not contain a battery rendering them non-functional. Additionally the fire extinguisher was purchased more than 12 months from the inspection date which poses an immediate safety risk to persons in care.

Official plan of correction

POC Due Date: 12/23/2025 Plan of Correction Administrator agreed to purchase a new fire extinguisher and to replace the batteries in all fire alarms and to ensure all fire alarms are hard wired. Administrator agreed to submit proof of correction no later than POC due date.

Official classification

Type A

Official code

87309(a)

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. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above as knives and under-sink cleaning chemicals in the kitchen, disinfectant spray in the hallway, and paints, lighter fluid, and bug spray were left unsecured in the outdoors of the facility which poses an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 12/23/2025 Plan of Correction Administrator agreed to secure the items and send proof to CCLD no later than POC due date.

Official classification

Type B

Official code

87412(g)

Regulation authority

CCR

What the official deficiency says

(g) All personnel records shall be maintained at 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 as the Administrator's and S1's records were not located at the facility at the time of the inspection which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/05/2026 Plan of Correction Administrator agreed to obtain the complete staff files for the identified individuals and submit proof of the completed files located at the facility to CCLD no later than POC due date.

Official classification

Type B

Official code

87412(a)

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: 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 the Administrator and S1's files were incomplete and were missing documentation including but not limited to LIC 501, 503, 508, TB test, trainings Etc. which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/05/2026 Plan of Correction Administrator agreed to submit the complete staff files for the identified individuals to CCLD no later than POC due date.

Official classification

Type B

Official code

1569.625(b)(1)

Regulation authority

HSC

What the official deficiency says

(1) The department shall adopt regulations to require staff members of residential care facilities for the elderly who assist residents with personal activities of daily living to receive appropriate training. This training shall consist of 40 hours of training. A staff member shall complete 20 hours, including six hours specific to dementia care, as required by subdivision (a) of Section 1569.626 and four hours specific to postural supports, restricted health conditions, and hospice care, as required by subdivision (a) of Section 1569.696, before working independently with residents. The remaining 20 hours shall include six hours specific to dementia care and shall be completed within the first four weeks of employment. The training coursework may utilize various methods of instruction, including, but not limited to, lectures, instructional videos, and interactive online courses. The additional 16 hours shall be hands-on training. This requirement is not met as evidenced by: Deficient Practice Statement Based on interview and record review, the licensee did not comply with the section cited above as staff had not received the required 40 hours of initial training or the 20 hours of continuing training prior to working with residents which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/05/2026 Plan of Correction Administrator agreed to conduct the required trainings with staff members and will submit proof of the completed trainings to CCLD no later than POC due date.

Official classification

Type B

Official code

87468(b)(1)(A)

Regulation authority

CCR

What the official deficiency says

(b) At the time the admission agreement is signed, a resident and the resident's representative shall be personally advised of and given a copy of: (1) The personal rights of residents specified in Sections 87468.1, Personal Rights of Residents in All Facilities and 87468.2, Additional Personal Rights of Residents in Privately Operated Facilities, as applicable to the facility. (A) The licensee shall have each resident and the resident's representative sign a copy of these rights, and the signed copy shall be included in the resident's record. 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 three resident files did not contain a signed copy of the resident's rights which poses a potential personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/05/2026 Plan of Correction Administrator agreed to obtain a signed copy of the resident's personal rights for the identified individuals and agreed to submit signed copies to CCLD no later than POC due date.

Official classification

Type B

Official code

87465(e)

Regulation authority

CCR

What the official deficiency says

(e) For every prescription and nonprescription PRN medication for which the licensee provides assistance there shall be a signed, dated written order from a physician on a prescription blank, maintained in the resident's file, and a label on the medication. Both the physician's order and the label shall contain at least all of the following information. 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 three resident medications and files observed did not contain up to date prescription information or physician's orders which poses a potential health risk to persons in care.

Official plan of correction

POC Due Date: 01/05/2026 Plan of Correction Administrator agreed to obtain physician's orders for all resident medications and agreed to place copies of the prescription orders in the resident's files. Administrator agreed to submit proof of the up to date prescription orders to CCLD no later than POC due date.

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 as three residents did not have proof of a negative TB test located in their files which poses a potential health risk to persons in care.

Official plan of correction

POC Due Date: 01/05/2026 Plan of Correction Administrator agreed to obtain a negative TB test for the identified individuals and agreed to submit proof of the negative TB tests to CCLD no later than POC due date.

Official classification

Type B

Official code

87507(b)

Regulation authority

CCR

What the official deficiency says

(b) The licensee shall complete and maintain in the resident's file a Telecommunications Device Notification form (LIC 9158, 11/04) for each resident whose pre-admission appraisal or medical assessment indicates he/she is deaf, hearing-impaired, or otherwise disabled in accordance with Public Utilities Code sections 2881(a) and (c). 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 one hearing impaired resident did not have a signed telecommunication device notification form located in their file which poses a potential personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/05/2026 Plan of Correction Administrator agreed so complete the LIC 9158 form with the identified resident and agreed to submit proof of the completed form to CCLD no later than POC due date.

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 record review, the licensee did not comply with the section cited above as one resident's file did not contain a completed admission agreement which poses a potential personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/05/2026 Plan of Correction Administrator agreed to submit proof of the completed admission agreement for the identified individual to CCLD no later than 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 interview and record review, the licensee did not comply with the section cited above as the facility had not been conducting disaster drills which poses a potential safety risk to persons in care.

Official plan of correction

POC Due Date: 01/05/2026 Plan of Correction Administrator agreed to conduct disaster drills quarterly. Administrator agreed to submit proof of a completed disaster drill to CCLD no later than POC due date.

Official classification

Type B

Official code

87507(f)

Regulation authority

CCR

What the official deficiency says

87507 Admission Agreements (f) The licensee shall comply with all applicable terms and conditions set forth in the admission agreement, including all modifications and attachments. 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 as the admission agreements that resident's signed stated, “Under no circumstances video surveillance will be permitted or utilized at Blythe assisted living.” while the facility had RING cameras installed in the dining room and living room of the facility which poses a potential personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/05/2026 Plan of Correction Administrator removed the cameras at the time of the visit. Administrator agreed to submit a statement of understanding confirming that they would comply with all items of the admission agreement. Administrator agreed to submit the document no later than POC due date.

Official classification

Type B

Official code

87465(h)(6)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care (h) The following requirements shall apply to medications which are centrally stored: (6) The licensee shall be responsible for assuring that a record of centrally stored prescription medications for each resident is maintained for at least one year and includes: 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 resident files did not contain an updated record of medications and were missing information including but not limited to: dosage, quantity, prescription numbers, date filled etc. which poses a potential health risk to persons in care.

Official plan of correction

POC Due Date: 01/05/2026 Plan of Correction Administrator agreed to complete a CSMDR for all residents. Administrator agreed to submit proof of the completed CSMDRs to CCLD no later than POC due date.

Official classification

Type B

Official code

87608(a)(5)(B)

Regulation authority

CCR

What the official deficiency says

87608 Postural Supports (a) ...Postural supports may be used under the following conditions. (5) ... (B) Bed rails that extend the entire length of the bed are prohibited except for... hospice care... This requirement is not met as evidenced by: Based on observation, interview, and file review the licensee did not comply with the section cited above as R1 was observed to have full bed rails without a hospice care plan and without a physician's orders which poses a potential personal rights risk to clients in care.

Official plan of correction

Administrator replaced the full bed rails with a half bed rail on the head half of R1's bed at the time of the visit. Administrator stated they would provide R1 with a call button to ask staff for assistance with getting out of bed. POC cleared during visit.

Deadline recorded: Jun 6, 2025. A deadline is not proof that correction was completed.