CARRIES CARE VILLA

Official classification

Type B

Official code

87468.1(a)(1)

Regulation authority

CCR

What the official deficiency says

87468.1 Personal Rights of Residents... (a) ... shall have all of the following personal rights: (1) To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement is not met as evidenced by: Based on interviews the Licensee did not comply with the section cited above as two residents reported that the Administrator had spoken inappropriately towards them in the past which poses a potential personal rights risk to clients in care.

Official plan of correction

Administrator agreed to attend training which covers the personal rights of residents and the different forms of abuse conducted by an outside agency not associated to the facility. Administrator agreed to submit proof of the completed training to CCLD no later than POC due date.

Deadline recorded: Jul 8, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87303(e)(2)

Regulation authority

CCR

What the official deficiency says

(2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degrees C) and not more than 120 degree F (49 degrees C). 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 the facility's hot water temperature was measured to be 127.6 degrees F which poses an immediate health risk to persons in care.

Official plan of correction

POC Due Date: 06/17/2026 Plan of Correction Licensee Representative agreed to provide proof of an appropriate water temperature measured at the resident faucet to CCLD no later than POC due date.

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 as cleaning chemicals, detergents, and other toxic items were stored in the same storage area of the garage as the facility's emergency food supply which poses an immediate health risk to persons in care.

Official plan of correction

POC Due Date: 06/17/2026 Plan of Correction Licensee Representative agreed to remove the identified items from the food storage area and to relocate the items to appropriate locked storage. Licensee Representative agreed to send proof of the removed items to CCLD no later than POC due date.

Official classification

Type A

Official code

87309(f)

Regulation authority

CCR

What the official deficiency says

(f) Due to the physical arrangements in the facility, or the condition or the habits of other residents in the facility, or both, the licensee may require the items specified in subsections (a) and (c) to be centrally stored so as not to pose a safety hazard to others. 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 personal grooming supplies were left unsecured in the staff bedroom when one resident was determined by their physician to be at risk if allowed access to those items which poses an immediate health risk to persons in care.

Official plan of correction

POC Due Date: 06/16/2026 Plan of Correction Licensee Representative secured the items at the time of the visit. POC cleared.

Official classification

Type A

Official code

87465(h)(2)

Regulation authority

CCR

What the official deficiency says

(h) The following requirements shall apply to medications which are centrally stored: (2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. 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 multiple medications belonging to the Administrator and a former resident were left in an unsecured cabinet in the kitchen which posed an immediate health risk to persons in care.

Official plan of correction

POC Due Date: 06/16/2026 Plan of Correction Licensee Representative secured the items at the time of the visit. POC cleared.

Official classification

Type B

Official code

87307(d)(4)

Regulation authority

CCR

What the official deficiency says

(4) Stairways, inclines, ramps and open porches and areas of potential hazard to residents with poor balance or eyesight shall be made inaccessible to residents unless equipped with sturdy hand railings and unless well-lighted. 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 the railings attached to the emergency exit ramp and outdoor kitchen stairway were not properly secured which poses a potential safety risk to persons in care.

Official plan of correction

POC Due Date: 06/30/2026 Plan of Correction Licensee Representative agreed to submit proof of appropriately secured railings to CCLD no later than POC due date.

Official classification

Type B

Official code

87307(d)(6)

Regulation authority

CCR

What the official deficiency says

(6) All outdoor and indoor passageways and stairways shall be kept free of obstruction. 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 the emergency exit in bedroom # 3 was blocked from opening by a metal bar which posed a potential safety risk to persons in care.

Official plan of correction

POC Due Date: 06/30/2026 Plan of Correction Licensee Representative agreed to submit a statement of understanding confirming that they will not block any exits in the facility, Licensee Representative agreed to submit the statement to CCLD no later than POC due date.

Official classification

Type B

Official code

87412(c)(2)(C)

Regulation authority

CCR

What the official deficiency says

(c) Licensees shall maintain in the personnel records verification of required staff training and orientation. (2) Documentation of staff training shall include: (C) Date(s) of attendance; 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 as staff trainings were missing the dates of attendance for the trainings which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/30/2026 Plan of Correction The Licensee Representative agreed to submit a true and accurate training record for the identified employees to CCLD no later than POC due date.

Official classification

Type B

Official code

87219(a)

Regulation authority

CCR

What the official deficiency says

(a) Residents shall be encouraged to maintain and develop their quality of life through participation in a variety of planned activities. The activities made available shall include: This requirement is not met as evidenced by: Deficient Practice Statement Based on interviews, the licensee did not comply with the section cited above as interviews revealed that no activities are offered at the facility for residents to participate in which poses a potential personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/30/2026 Plan of Correction The Licensee Representative agreed to submit their plan on how they will ensure adequate activities are offered to residents at the facility. The Licensee Representative agreed to submit their plan to CCLD no later than POC due date.

Official classification

Type B

Official code

87555(a)

Regulation authority

CCR

What the official deficiency says

(a) The total daily diet shall be of the quality and in the quantity necessary to meet the needs of the residents an shall meet the Recommended Dietary Allowances of the Food and Nutrition Board of the National Research Council. All food shall be selected, stored, prepared and served in a safe and healthful manner. 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 the facility retained expired food items in the dry food storage and emergency food storage which poses a potential health risk to persons in care.

Official plan of correction

POC Due Date: 06/30/2026 Plan of Correction The Licensee Representative agreed to conduct an audit of all food items stored at the facility and to dispose of any expired food items. The Licensee Representative agreed to submit proof of the completed audit 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 two residents were observed to be missing proof of a negative TB test in their file which poses a potential health risk to persons in care.

Official plan of correction

POC Due Date: 06/30/2026 Plan of Correction Licensee Representative agreed to obtain proof of a negative TB test for the identified individuals and to send proof of the negative TB test to CCLD no later than POC due date.

Official classification

Type B

Official code

87458(c)(5)

Regulation authority

CCR

What the official deficiency says

(c) 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, Definitions, or bedridden as defined in Health and Safety Code section 1569.72. 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 as a resident's medical assessment was missing their ambulator status which poses a potential health risk to persons in care.

Official plan of correction

POC Due Date: 06/30/2026 Plan of Correction Licensee Representative agreed to obtain a medical assessment that accurately reflects the resident's ambulatory status and to send the updated medical assessment to CCLD no later than POC due date.

Official classification

Type B

Official code

87355(d)

Regulation authority

CCR

What the official deficiency says

87355 Criminal Record Clearance (d) All individuals subject to criminal record review shall be fingerprinted and sign a Criminal Record Statement (LIC 508 [Rev. 1/03]) under penalty of perjury. 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 employee did not have a signed LIC 508 in their file which poses a potential safety risk to persons in care.

Official plan of correction

POC Due Date: 06/30/2026 Plan of Correction Administrator agreed to obtain a signed LIC 508 for the identified staff member and to send proof of the signed statement to CCLD no later than POC due date.

Official classification

Type B

Official code

1569.153(d)

Regulation authority

HSC

What the official deficiency says

§1569.153 Theft and loss program; standards, property inventories and surrender of personal effects; secured areas (d) A written resident personal property inventory is established upon admission and retained during the resident's stay in the residential care facility for the elderly. Inventories shall be written in ink, witnessed by the facility and the resident or resident's representative, and dated. A copy of the written inventory shall be provided to the resident or the person acting on the resident's behalf. All additions to an inventory shall be made in ink, and shall be witnessed by the facility and the resident or resident's representative, and dated. Subsequent items brought into or removed from the facility shall be added to or deleted from the personal property inventory by the facility at the written request of the resident, the resident's family, a responsible party, or a person acting on behalf of a resident. The facility shall not be liable for items which have not been requested to be included in the inventory or for items which have been deleted from the inventory. A copy of a current inventory shall be made available upon request to the resident, responsible party, or other authorized representative. The resident, resident's family, or a responsible party may list those items which are not subject to addition or deletion from the inventory, such as personal clothing or laundry, which are subject to frequent removal from 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 4 resident files were observed to be missing completed records of property/valuables which poses a potential personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/30/2026 Plan of Correction Licensee Representative agreed to complete a record of property/valuables for the identified residents and to send proof of the completed records to CCLD no later than POC due date.

Official classification

Type B

Official code

87464(f)(1)

Regulation authority

CCR

What the official deficiency says

87464 Basic Services (f) Basic services shall at a minimum include: (1) Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). This requirement is not met as evidenced by: Based on observation, record review, and interviews the licensee did not comply with the section cited above as residents were left in soiled diapers and residents requests for assistance went unanswered for extended periods of time which posed a potential health or personal rights risk to persons in care.

Official plan of correction

Administrator conducted training with all current staff members discussing the importance of periodic checks on the residents to ask if they need assistance. Administrator sent CCLD their plan on how they will ensure adequate night supervision for residents between 06:00 PM to 06:00 AM. POC Cleared.

Deadline recorded: Jun 3, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87411(d)(3)

Regulation authority

CCR

What the official deficiency says

87411 Personnel Requirements - General (d) All personnel shall be given on the job training ,,,skill in the following... (3) Skill and knowledge required to provide necessary resident care... This requirement is not met as evidenced by: Based on interview the licensee did not comply with the section cited above as S1 was not trained on proper use of the facility's Hoyer lift which poses a potential safety risk to clients in care.

Official plan of correction

Administrator agreed to conduct a training with all facility staff on the proper use of the Hoyer lift. Administrator agreed to submit proof of the completed training to CCLD no later than POC due date.

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

Official classification

Type B

Official code

87464(f)(1)

Regulation authority

CCR

What the official deficiency says

87464 Basic Services (f) Basic services shall at a minimum include: (1) Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). This requirement is not met as evidenced by: Based on observation, record review, and interviews the licensee did not comply with the section cited above as residents were left in soiled diapers and residents requests for assistance went unanswered for extended periods of time which posed a potential health or personal rights risk to persons in care.

Official plan of correction

Administrator agreed to conduct training with all current staff members to discuss the importance of periodic checks on the residents to ask if they need assistance. Administrator agreed to send CCLD their plan on how they will ensure adequate night supervision for residents between 06:00 PM to 06:00 AM. Administrator agreed to send CCLD proof of the completed training, their plan on how often staff will conduct resident checks, and their plan for adequate night supervision no later than POC due date.

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

Official classification

Type A

Official code

87309(a)

Regulation authority

CCR

What the official deficiency says

87309 Storage Space and Access (a) ... the licensee shall ensure that disinfectants, cleaning solutions...are in locked storage and are not left unattended if outside the locked storage. This requirement is not met as evidenced by: Based on observation the licensee did not comply with the section cited above as the staff room was observed to be unlocked and contained unsecured cleaning supplies which posed an immediate safety risk to clients in care.

Official plan of correction

Licensee locked the staff room and secured the cleaning supplies at the time of the visit. Licensee agreed to conduct a training with staff on the importance of securing cleaning chemicals. Licensee agreed to submit proof of completed training to CCLD no later than POC due date.

Deadline recorded: Mar 18, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87211(a)(1)(D)

Regulation authority

CCR

What the official deficiency says

87211 Reporting Requirements (a) Each licensee shall furnish...: (1) A written report shall be submitted to... licensing...within seven days of... (D) Any incident which threatens the welfare, safety or health of any resident... This requirement is not met as evidenced by: Based on record review and interview the licensee did not comply with the section cited above as an incident report was not submitted to licensing within the required timeframe which posed a potential health, safety, or personal rights risk to clients in care.

Official plan of correction

Administrator agreed to submit a statement of understanding confirming that they will adhere to the required timeframe when reporting incidents to CCLD. Administrator agreed to submit the document to CCLD no later than POC due date.

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

Official classification

Type A

Official code

87355(e)

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) ... This requirement was not met as evidenced by: Based on record review, the licensee did not comply with the above cited section as 2 staff were not associated to the facility which poses an immediate health, safety, and personal rights risk to persons in care.

Official plan of correction

The Licensee will request a criminal record transfer and associate the 2 staff and send CCLD proof by POC due date.

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

Official classification

Type B

Official code

87633(b)

Regulation authority

CCR

What the official deficiency says

(b) A current and complete hospice care plan shall be maintained in the facility for each hospice resident and include the following: This requirement was not met as evidenced by: Based on interview and record review, the licensee did not comply with the above cited section as 4 residents did not have a hospice care plan on file whihc poses a potential health, safety, and personal rights risk to persons in care.

Official plan of correction

The Licensee will obtain hospice care plans for 4 residents and provide them to CCLD by POC due date.

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

Official classification

Type B

Official code

87411(d)(4)

Regulation authority

CCR

What the official deficiency says

87411 Personnel Requirements - General (d) All personnel shall be given on the job training... (4) Knowledge required to safely assist with prescribed medications... This requirement is not met as evidenced by: Based on record review and interview the licensee did not comply with the section cited above as S1 admitted to dispensing medication to R1 without appropriate medication training which poses a potential health and safety risk to clients in care.

Official plan of correction

Administrator agreed to submit signed statements from each current staff member confirming they will not handle resident medications without proper documented training. Administrator may conduct medication training with S1 and send proof of completed training to... ...CCLD no later than POC due date.

Deadline recorded: Oct 8, 2025. A deadline is not proof that correction was completed.

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...is maintained... This requirement is not met as evidenced by: Based on record review the licensee did not comply with the section cited above as R1's CSMDR was missing an accurate log of M1 which poses a potential health risk to clients in care.

Official plan of correction

Administrator completed M1's entry on R1's CSMDR at the time of the visit. Administrator agreed to submit a statement of understanding confirming that they understand the importance of accurately logging resident medications on their CSMDR no later than POC due date.

Deadline recorded: Oct 8, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87412(g)

Regulation authority

CCR

What the official deficiency says

87412 Personnel Records (g) All personnel records shall be maintained at the facility and shall be available to the licensing agency for review. This requirement is not met as evidenced by: Based on record review the licensee did not comply with the section cited above as S2's file was missing from the facility which poses a potential health, safety, or personal rights risk to clients in care.

Official plan of correction

Administrator agreed to submit a statement of understanding confirming that they will maintain accurate files on staff and residents of the facility for a minimum of 3 years, Administrator agreed to submit this statement no later than POC due date.

Deadline recorded: Oct 8, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(a)(4)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental... (a) A plan for incidental medical and dental care shall be developed...by compliance with the following: (4) The licensee shall assist residents with self-administered medications as needed... This requirement is not met as evidenced by: Based on observation, interview, and record review the licensee did not comply with the section cited above as R1's M1 medication was not administered as prescribed by their physician on at least 3 separate occasions with at minimum 7 pills missing which poses an immediate health risk to clients in care.

Official plan of correction

Administrator agreed to submit a statement of understanding confirming that they will adhere to physician's orders for medication administration. Additionally, Administrator agreed to submit signed statements from each current employee confirming that they will not handle resident medications without... ...Appropriate medication training. Administrator agreed to submit the required documents to CCLD no later than POC due date.

Deadline recorded: Sep 25, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87705(d)

Regulation authority

CCR

What the official deficiency says

87705 Care of Persons with Dementia (d) The licensee shall ensure that the facility has an auditory device or other staff alert feature to monitor exits on exterior doors and perimeter fence gates accessible to those residents who may be at risk for elopement... This requirement is not met as evidenced by: Based on observation and interview the licensee did not comply with the section cited above as three auditory alarms were non-functional during the visit and one alarm was reported to be turned off when R1 eloped from the facility which poses a potential safety risk to clients in care.

Official plan of correction

Licensee agreed to replace/repair the auditory alarms on the bedroom, front door, and back kitchen exits no later than POC due date.

Deadline recorded: Sep 29, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

1569.312(a)

Regulation authority

HSC

What the official deficiency says

§1569.312 Basic services requirements Every facility required to be licensed under this chapter shall provide at least the following basic services: (a) Care and supervision as defined in Section 1569.2. This requirement is not met as evidenced by: Based on interview the licensee did not comply with the section cited above as R1 eloped from the facility while under the care of staff and was found by law enforcement away from the facility approximately 30 minutes later which poses a potential safety risk to clients in care.

Official plan of correction

Licecnsee agreed to submit their plan on how they will ensure adequate monitoring of facility exits to prevent future elopements. Licensee will submit this plan no later than POC due date.

Deadline recorded: Sep 29, 2025. A deadline is not proof that correction was completed.

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 an under-sink storage in the resident bathroom contained cleaning chemicals and was unlocked which poses an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 06/27/2025 Plan of Correction Licensee Representative secured the chemicals at the time of the visit. POC cleared.

Official classification

Type B

Official code

1569.153(d)

Regulation authority

HSC

What the official deficiency says

(d) A written resident personal property inventory is established upon admission and retained during the resident’s stay in the residential care facility for the elderly. Inventories shall be written in ink, witnessed by the facility and the resident or resident’s representative, and dated. A copy of the written inventory shall be provided to the resident or the person acting on the resident’s behalf. All additions to an inventory shall be made in ink, and shall be witnessed by the facility and the resident or resident’s representative, and dated. Subsequent items brought into or removed from the facility shall be added to or deleted from the personal property inventory by the facility at the written request of the resident, the resident’s family, a responsible party, or a person acting on behalf of a resident. The facility shall not be liable for items which have not been requested to be included in the inventory or for items which have been deleted from the inventory. A copy of a current inventory shall be made available upon request to the resident, responsible party, or other authorized representative. The resident, resident’s family, or a responsible party may list those items which are not subject to addition or deletion from the inventory, such as personal clothing or laundry, which are subject to frequent removal from 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 six residents had incomplete personal property inventory records which poses a potential personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/11/2025 Plan of Correction Licensee Representative agreed to complete the personal property records for the six identified residents no later than POC due date.

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

(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 is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above as the resident bathroom toilet was observed to be missing a large portion of the ceramic on the water tank leaving a sharp edge exposed which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 07/11/2025 Plan of Correction Licensee Representative agreed to replace the toilet no later than POC due date.

Official classification

Type B

Official code

87307(a)(2)(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. The facility shall be large enough to provide comfortable living accommodations and privacy for the residents, staff, and others who may reside in the facility. The following provisions shall apply: (2) Resident bedrooms shall be provided which meet, at a minimum, the following requirements: (A) Bedrooms shall be large enough to allow for easy passage between and comfortable usage of beds and other required items of furniture specified below, and any resident assistant devices such as wheelchairs or walkers. 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 two bedrooms had furniture and personal items cluttering the area where residents would traverse which poses/posed a potential safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/11/2025 Plan of Correction Licensee representative agreed to rearrange the rooms and remove personal clutter to allow for easy passage of residents 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 two staff members who were providing assistance to residents without the supervision of the Administrator or Licensee Representative did not have a minimum of 20 hours of training prior to providing assistance which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/11/2025 Plan of Correction Licensee Representative agreed to conduct the initial 20 hours of training for the identified staff 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 were missing signed copies of The personal rights of residents which poses a potential personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/11/2025 Plan of Correction Licensee representative agreed to complete the forms for the identified residents no later than POC due date.

Official classification

Type B

Official code

87555(b)(8)

Regulation authority

CCR

What the official deficiency says

(b) The following food service requirements shall apply: (8) All food shall be of good quality. Commercial foods shall be approved by appropriate federal, state and local authorities. Food in damaged containers shall not be accepted, used or retained. 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 the garage was observed to contain expired food items in the emergency food storage which poses a potential health risk to persons in care.

Official plan of correction

POC Due Date: 07/11/2025 Plan of Correction Licensee representative agreed to conduct an audit of all stored food items and to remove any expired food items from storage no later than POC due date.

Official classification

Type B

Official code

87463(e)

Regulation authority

CCR

What the official deficiency says

(e) The licensee shall immediately, or as soon as reasonably possible, bring any significant change in condition, as defined in Section 87101, Definitions, to the attention of the appropriate licensed medical professional and if applicable, other specialized care provider. Documentation of such communication shall be added to the resident's record and shall include: 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 one resident had a significant change in condition that was not reflected on their most up-to-date physicians report which poses a potential health to persons in care.

Official plan of correction

POC Due Date: 07/11/2025 Plan of Correction Licensee representative agreed to obtain an updated medical assessment for the identified resident 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 record review, the licensee did not comply with the section cited above as the facility did not have record of the last completed emergency disaster drill which poses a potential safety risk to persons in care.

Official plan of correction

POC Due Date: 07/11/2025 Plan of Correction Licensee agreed to conduct an emergency disaster drill and send documentation to CCLD no later than POC due date.

Official classification

Type B

Official code

87705(c)(5)

Regulation authority

CCR

What the official deficiency says

(c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following: (5) Each resident with dementia shall have an annual medical assessment as specified in Section 87458, Medical Assessment, and a reappraisal done at least annually, both of which shall include a reassessment of the resident's dementia care needs. 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 in two (2) out of three (3) residents diagnosed with dementia need updated annual medical assessments which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/28/2024 Plan of Correction The Licensee stated that the medical assessments will be completed for the three (3) residents.

Official classification

Type A

Official code

87202(a)(2)

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: (2) Bedridden persons 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 Resident #1 (R1) is bedridden and does not reside in the bedridden room, which poses an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 06/14/2024 Plan of Correction The Licensee agreed to do the following: 1. Within 24 hours, the licensee will relocate the R1 to the room identified for bedridden residents only. Proof to be submitted to CCL by due date. This is a zero tolerance violation, resulting in a civil penalty in the amount of $500

Official classification

Type A

Official code

87468.2(a)(20)(a)

Regulation authority

CCR

What the official deficiency says

87468.2 (a)(20)(a) Personal Rights of Residents ... residents in privately operated residential care facilities for ... shall have all of the following personal rights:(20) To be protected from involuntary transfers, discharges, and evictions. A licensee shall not involuntarily transfer or evict residents for ...regulations and shall comply... For purposes of this paragraph, " involuntary " means a transfer, discharge, or eviction that is initiated by the licensee...and which poses an immediate health and safety or personal rights risk. This requirement was not met as evidenced by: Based on the investigation and information obtained. The administrator refused resident back to facility at the time resident was discharged, which poses an immediate risk to persons in care.

Official plan of correction

Administrator admitted R1 same day, but three hours later after R1 was discharged from hospital. The Licensee/Administrator will submit a written explanation to the Regional Office for their actions pertaining to Resident 1 (R1).

Deadline recorded: Dec 11, 2023. A deadline is not proof that correction was completed.