MY LOVELY HOUSE

Official classification

Type B

Official code

87468(c)(2)(A)

Regulation authority

CCR

What the official deficiency says

(c) Licensees shall prominently post personal rights, nondiscrimination notice, and complaint information in areas accessible to residents, representatives, and the public. (2) Information on the appropriate reporting agency in case of a complaint or emergency, including procedures for filing confidential complaints, shall be posted as follows: (A) Licensees may use the Residential Care Facility for the Elderly (RCFE) Complaint Poster (PUB 475) or may develop their own poster as provided in this section. A poster developed by the licensee shall contain the same content as the PUB 475. The poster that is posted shall be 20” x 26” in size and be posted in the main entryway of the facility. PUB 475 may be accessed, downloaded, and printed from the www.ccld.ca.gov website. 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 no PUB 475 poster was observed at the facility which poses a potential personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/16/2026 Plan of Correction Designee agreed to obtain and install a PUB 475 poster of appropriate size and to send proof of the installed poster to CCLD no later than POC due date.

Official classification

Type B

Official code

87219(h)(2)

Regulation authority

CCR

What the official deficiency says

(h) The licensee shall provide sufficient space to accommodate both indoor and outdoor activities. Activities shall be encouraged by provision of: (2) Outdoor activity areas that are easily accessible to residents, protected from traffic, and have adequate shady areas. 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 no shade was observed in the outdoor seating/activity areas of the facility which poses a potential personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/16/2026 Plan of Correction Designee agreed to install some form of appropriate shade in the outdoor seating/activity areas of the facility and to send proof of the installed shade to CCLD no later than POC due date.

Official classification

Type B

Official code

87465(b)

Regulation authority

CCR

What the official deficiency says

(b) If the resident's physician has stated in writing that the resident is able to determine and communicate his/her need for a prescription or nonprescription PRN medication, facility staff shall be permitted to assist the resident with self-administration of his/her PRN medication. 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 no residents had written determinations of their ability to determine and communicate their need for a PRN medication completed by a physician located in their file which poses a potential health risk to persons in care.

Official plan of correction

POC Due Date: 07/16/2026 Plan of Correction Designee agreed to obtain a PRN authorization forms signed by a physician for each resident at the facility and to send proof of the signed forms 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

(B) Bed rails that extend the entire length of the bed are prohibited except for residents who are currently receiving hospice care and have a hospice care plan that specifies the need for full bed rails. 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 full bed rails were installed on a resident's bed who was not enrolled in hospice care which poses a potential personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/16/2026 Plan of Correction Designee agreed to remove the full bed rails and to send proof of the removed bed rails to CCLD no later than POC due date.

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...knives..., and other similar items... 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 cleaning chemicals and a knife were left accessible to clients in care and were not placed in a secured storage which posed an immediate health and safety risk to clients in care.

Official plan of correction

Administrator agreed to conduct staff training with all facility staff including the Administrator and Designee on the importance of securing cleaning chemicals, knives, and other dangerous objects. Administrator agreed to submit proof of completed training to CCLD no later than POC due date.

Deadline recorded: May 22, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(h)

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: This requirement is not met as evidenced by: Based on observation and record review, the licensee did not comply with the section cited above as a medication was observed to be outside of locked storage and two (2) resident's medications were not logged on their CSMDR which poses an immediate health and safety risk to persons in care.

Official plan of correction

Administrator agreed to conduct staff training with all facility staff including the Administrator and Designee on the importance of securing medications and accurately logging medications. Administrator agreed to submit proof of completed training to CCLD no later than POC due date.

Deadline recorded: May 22, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87458(a)

Regulation authority

CCR

What the official deficiency says

87458 Medical Assessment (a) Prior to a person's acceptance as a resident, the licensee shall obtain documentation of a medical assessment, signed by a licensed medical professional... This requirement is not met as evidenced by: Based on record review the licensee did not comply with the section cited above as one (1) resident did not have a completed medical assessment prior to their acceptance to the facility which poses a potential health and safety risk to clients in care.

Official plan of correction

Administrator agreed to obtain a completed medical assessment for the identified individual and to submit proof of the completed medical assessment to CCLD no later than POC due date.

Deadline recorded: Jun 4, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87457(c)

Regulation authority

CCR

What the official deficiency says

87457 Pre-Admission Appraisal (c) Prior to admission a determination of the prospective resident's suitability for admission shall be completed... This requirement is not met as evidenced by: Based on record review the licensee did not comply with the section cited above as one (1) resident did not have a completed pre admission appraisal prior to their acceptance to the facility which poses a potential health and safety risk to clients in care.

Official plan of correction

Administrator agreed to complete a pre-admission appraisal for the identified individual and to submit proof of the completed appraisal to CCLD no later than POC due date.

Deadline recorded: Jun 4, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87307(d)(6)

Regulation authority

CCR

What the official deficiency says

87307 Personal Accommodations and Services (d) The following...shall apply to all facilities: (6) All outdoor and indoor passageways and stairways shall be kept free of obstruction. This requirement is not met as evidenced by: Based on observation the licensee did not comply with the section cited above as the sliding door exit in the living room of the facility was observed to be blocked by two large chairs which poses a potential safety risk to clients in care.

Official plan of correction

Administrator agreed to remove the chairs from in front of the exit and to provide proof of a clear exit in the living room to CCLD no later than POC due date.

Deadline recorded: Jun 4, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

1569.153

Regulation authority

HSC

What the official deficiency says

§1569.153 Theft and loss program... ...The program shall include... (d)...Subsequent items brought into or removed from the facility shall be added to or deleted from the personal property inventory by the facility... This requirement is not met as evidenced by: Based on interview and record review the licensee did not comply with the section cited above as 3 outerwear, 6 socks, and 2 underwear were not at the facility and were not listed as removed from the resident's property list which poses a potential personal rights risk to clients in care.

Official plan of correction

Administrator provided proof that they have ordered the missing pants and underwear. Designee agreed to submit a statement of understanding confirming that they understand the importance of safeguarding personal property and valuables and the importance of logging removed items. Designee agreed to submit the statement of understanding no later than POC due date.

Deadline recorded: Aug 7, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87463(f)

Regulation authority

CCR

What the official deficiency says

(f) The licensee shall immediately, or as soon as reasonably possible, communicate...the recommendation...of the appropriate licensed medical professiona...Documentation...shall be added to the resident’s record.This requirement is not met as evidenced by: Based on interview and record review, the licensee did not comply with the section cited above asR1 and R2 did not have an updated medical assessment that accurately reflected their current conditions following a change in condition which poses a potential health risk to persons in care.

Official plan of correction

Administrator agreed to obtain updated medical assessments for the identified individuals and send proof of the completed medical assessment no later than POC due date.

Deadline recorded: Aug 4, 2025. 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

87211 Reporting Requirements (a) Each licensee shall... (1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days... This requirement is not met as eviednced by: Based on interviews and record review the licensee did not comply with the section cited above as R2's recent hospitalization was not reported to CCLD within the required timeframe which poses a potential health, safety, or personal rights risk to clients in care.

Official plan of correction

Administrator agreed to submit the incident report to licensing no later than POC due date.

Deadline recorded: Aug 4, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

1569.149

Regulation authority

HSC

What the official deficiency says

§1569.149 Fire clearance... ...the facility shall secure and maintain a fire clearance approval from the local fire enforcing agency, as defined in Section 13244, or the State Fire Marshal... 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 and R2 need assistance with repositioning in bed and did not reside in the bedridden approved room which poses an immediate safety risk to clients in care.

Official plan of correction

The Administrator agreed to notify the local fire department of the bedridden residents residing in the non-ambulatory room. The Administrator agreed to move one resident to the bedridden approved room. The Administrator understood that the facility is approved for one bedridden resident only.

Deadline recorded: Jul 22, 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 a backyard shed which contained tools, saw blades, paints, and pesticides was observed to be unlocked and accessible to clients in care which poses an immediate safety risk to persons in care.

Official plan of correction

POC Due Date: 07/09/2025 Plan of Correction Administrator locked the shed at the time of the visit. POC cleared.

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 record review, the licensee did not comply with the section cited above as one staff member had fingerprint clearance but was not associated to the facility which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/10/2025 Plan of Correction Administrator agreed to associate the identified staff member to the facility no later than POC due date.

Official classification

Type A

Official code

87465(h)

Regulation authority

CCR

What the official deficiency says

(h) The following requirements shall apply to medications which are centrally stored: 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 medications were observed to be outside of locked storage accessible to clients in care, medications were prepared for one (1) month utilizing Mon-Sun pill organizers, and prescription numbers were incorrect for one (1) resident's medications on their CSMDR which poses an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 07/10/2025 Plan of Correction Administrator agreed to secure the medications, cease usage of Mon-Sun pill organizers, and conduct an audit of resident's CSMDRs to ensure accurate information 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 an opened and expired food jar was observed in the dry food storage which posed a potential health risk to persons in care.

Official plan of correction

POC Due Date: 07/23/2025 Plan of Correction Administrator agreed to conduct an audit of the facility's food supplies and discard of any expired food items. Administrator agreed to submit proof of the audit to CCLD no later than POC due date.

Official classification

Type B

Official code

87458(a)

Regulation authority

CCR

What the official deficiency says

(a) Prior to a person's acceptance as a resident, the licensee shall obtain documentation of a medical assessment, signed by a licensed medical professional acting within the scope of their practice and made within the last year, to be kept 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 one residents medical assessment was observed to be completed more than 12 months prior to admission into the facility which poses a potential health risk to persons in care.

Official plan of correction

POC Due Date: 07/23/2025 Plan of Correction Administrator agreed to obtain an updated medical assessment for the identified individual and send proof of the completed medical assessment no later than POC due date.

Official classification

Type B

Official code

87463(f)

Regulation authority

CCR

What the official deficiency says

(f) The licensee shall immediately, or as soon as reasonably possible, communicate with the resident and, if applicable, the resident's representative, about any significant change in condition and the recommendation, if any, 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. 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 did not have an updated medical assessment that accurately reflected their current condition following a change in condition which poses a potential health risk to persons in care.

Official plan of correction

POC Due Date: 07/23/2025 Plan of Correction Administrator agreed to obtain an updated medical assessment for the identified individual and send proof of the completed medical assessment no later than POC due date.

Official classification

Type A

Official code

87355(e)

Regulation authority

CCR

What the official deficiency says

87355 Criminal Record Clearance (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: This requirement is not met as evidenced by: Based on record review the licensee did not comply with the section cited above as S1 is not associated to the facility on Guardian or LIS which poses an immediate health, safety, or personal rights risk to clients in care.

Official plan of correction

Licensee will submit proof of S1's association to the facility no later than POC due date.

Deadline recorded: Apr 16, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87507(g)(3)(A)

Regulation authority

CCR

What the official deficiency says

87507 Admission Agreements (g) Admission agreements shall specify the following: (3) Payment provisions, including... (A) Rate for all basic services... This requirement is not met as eviednced by: Based on record review the licensee did not comply with the section cited above as two residents had incomplete admission agreements that were missing the amount charged for basic services which poses a potential personal rights risk to clients in care.

Official plan of correction

Licensee will submit proof of two completed admission agreements for the identified residents no later than POC due date.

Deadline recorded: Apr 29, 2025. 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

87211 Reporting Requirements (a) Each licensee shall... (1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days... This requirement is not met as eviednced by: Based on interviews and record review the licensee did not comply with the section cited above as residents experienced three falls at the facility which were not reported to the resident's responsible parties or CCLD which poses a potential health, safety, or personal rights risk to clients in care.

Official plan of correction

Licensee will subimt a statement of understanding confirming that they understand the improtance of timely reporting to CCLD no later than POC due date.

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