NO HO RESIDENTIAL CARE, INC.

Official classification

Type A

Official code

87204(b)

Regulation authority

CCR

What the official deficiency says

Limitations - Capacity and Ambulatory Status-Resident rooms approved for 24-hour care of ambulatory residents only shall not accommodate nonambulatory residents. Residents whose condition becomes nonambulatory shall not remain in rooms restricted to ambulatory residents. This requirement was not met as evidenced by: Resident #1 was observed housed in the front bedroom previously identified on the facility sketch as the office and now identified as Bedroom #4.

Official plan of correction

The Licensee will relocate the resident into the approved non-ambulatory rooms or provide a plan of action by 3/27/26 as to how the faclity will come into compliance regarding the placement of a non-ambulatory resident in a room approved for ambulatory residents use only.

Deadline recorded: Mar 27, 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 water tested in front bathroom read 138.9 degrees Fahrenheit, the back bathroom read 135. 2 degrees Fahrenheit and the Kitchen water temperature read 137.4 degrees Fahrenheit which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/13/2026 Plan of Correction The Licensee will adjust the thermostat on the water heater to ensure that the water temperature is within Title 22 water range requirement of 105 - 120 degrees Fahrenheit. The Licensee will provide evidence that the water temperature is in compliance with Title 22 regulation by 3/13/26

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 drawer in the front bathroom was observed to be broken, the wall by the toilet had holes that needs to be patched up and the outside areas need general maintainance so that stored items along the home is discarded or stored away which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/19/2026 Plan of Correction Licensee will take steps to repair the drawer in the front bathroom, patch the holes on the wall and conduct general maintenance along the back and sides of the home. The pallets, mop, bucket, bricks, baskets of stored items and oxygen tanks need to be discarded, stored away or returned by 3/19/26

Official classification

Type B

Official code

87303(e)(4)

Regulation authority

CCR

What the official deficiency says

(4) Grab bars shall be maintained for each toilet, bathtub and shower used by residents. 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 there were no grab bars mounted in the shower located in the front bathroom which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/19/2026 Plan of Correction Licensee will ensure that grab bars shall be maintained for each toilet, bathtub and shower used by residents. A grab bar needs to be mounted in the shower located in the front bathroom by 3/19/26.

Official classification

Type B

Official code

87303(f)(1)

Regulation authority

CCR

What the official deficiency says

(f) All waste shall be located, stored, and disposed of in a manner that will not transmit communicable diseases or odors, pose a risk to health and safety, or provide a breeding place or food source for insects or rodents. (1) All containers storing waste shall be in good repair, free of leaks, and emptied in a timely 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 blue trash can was missing a lid and the green trash can was cracked and missing half of the lid] which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/19/2026 Plan of Correction Licensee will ensure that all trash cans are in good repair at all times. Licensee will contact the sanitation department and obtain new trash cans and provide evidence that the deficiency was corrected by 3/19/26

Official classification

Type A

Official code

87203

Regulation authority

CCR

What the official deficiency says

87203 Fire Safety All facilities shall be maintained in conformity with the regulations adopted by the State Fire Marshal for the protection of life and property against fire and panic. 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 fire rated door installed to separate the 3 back bedrooms and held open by a magnate connected to the hardwired smoke detectors did not activate the magnate to release the door to secure the area and did not close tightly which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/13/2026 Plan of Correction Licensee will take steps to ensure that the magnate that holds the fire rated door open ativiates when the smoke detectors are triggered and also ensure that the door closes tightly to seal off the resident area. Repairs will be conducted and evidence submitted to licensing by 3/13/26. IMMEDIATE CIVIL PENALTIES WERE ASSESSED.

Official classification

Type B

Official code

1569.618(b)

Regulation authority

HSC

What the official deficiency says

(b) At least one administrator, facility manager, or designated substitute who is at least 21 years of age and has qualifications adequate to be responsible and accountable for the management and administration of the facility pursuant to Title 22 of the California Code of Regulations shall be on the premises 24 hours per day. The designated substitute may be a direct care staff member who shall not be required to meet the educational, certification, or training requirements of an administrator. The designated substitute shall meet qualifications that include, but are not limited to, 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 per review of Staff #2 and Staff #3's files, there weren't any completed LIC308 designating the 2 staff as responsible staff during the day and night shift which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/18/2024 Plan of Correction The Licensee will complete an LIC308 Designation of Facility Responsibility for Staff #2 and Staff #3 and for any staff who is responsible for management of the facility in the absence of the facility administrator by 3/18/24.

Official classification

Type B

Official code

87705(j)

Regulation authority

CCR

What the official deficiency says

87705 Care of Persons with Dementia: (j) The licensee shall have an auditory device or other staff alert feature to monitor exits, if exiting presents a hazard to any resident. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above per tour of the facility, the auditory devices mounted on all three exit doors located in the front, the back door and in bedroom #2 were all tested and were not operational. The batteries were all depleted poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/12/2024 Plan of Correction The Licensee will do monthly testing on all 3 exit doors to ensure that the batteries are not depleted, to ensure that the auditory devices are operational at all times. *****************batteries were replaced in the auditory devices during today's visit***************

Official classification

Type B

Official code

87506(a)

Regulation authority

CCR

What the official deficiency says

87506(a) Resident Records. A separate, complete, and current record shall be maintained for each resident in the facility, readily available to facility staff and to licensing agency staff and shall contained specified 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 per review of all Resident's files,consent forms were not completed, Identification and Emergency Forms(LIC9020) were not completed, a couple of Appraisal/Needs and services were not completed, missing Centrally Stored Medication Destruction Records, .which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/18/2024 Plan of Correction Licensee will review all resident files to ensure that the resident files contain all the documents/information referenced in Section 87506(a) are in place by 3/18/24

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above per tour of the facility, Bedroom #1 and Bedroom #3 are missing closet doors which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/18/2024 Plan of Correction Licensee will ensure that all facility closet doors are repaired and replaced when damaged. Licensee will replace the closet doors in bedroom #1 and bedroom #3 and submit evidence of correction by 3/18/24.

Official classification

Type B

Official code

87506(a)

Regulation authority

CCR

What the official deficiency says

87506 Resident Records: Resident Records. A separate, complete, and current record shall be maintained for each resident in the facility, readily available to facility staff and to licensing agency staff and shall contained specified information. This requirement was not met as evidenced by: Files for Resident #1 - Resident #6 were missing information noted on the LIC809 report and this is a potential risk to the personal rights and a health risk to the residents in care.

Official plan of correction

The Licensee will read Title 22, Section 87506 in its entirety to ensure that all resident files contain the required information noted in the section. Licensee will reivew all resident files for completeness and submit a signed written statement that the Section was read and all files were reviewed and contains all the required information by 2/27/24

Deadline recorded: Feb 27, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87303(e)

Regulation authority

CCR

What the official deficiency says

Maintenance and Operation (e) Water supplies and plumbing fixtures shall be maintained as follows: (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 degree C) and not more than 120 degree F (49 degree C). This requirement was not met as evidenced by This requirement is not met as evidenced by: Deficient Practice Statement Based on test of the water, the licensee did not comply with the section cited above in 2 out of 2 tests which poses an immediate health, safety or personal rights risk to persons in care. Water temperature tested 140.6 degrees in the front bathroom and 137.4 degrees in the back bathroom

Official plan of correction

POC Due Date: 02/25/2023 Plan of Correction The Licensee will adjust the thermostat to bring the temperature to the required Title 22 requirements of 105 degrees to 120 degrees Fahrenheit by 2/25/23 and if not doable sumbit a plan as to how the licensee will ensure the safety of the residents until a contractor can correct the problem by 2/25/23

Official classification

Type B

Official code

87303(e)(4)

Regulation authority

CCR

What the official deficiency says

Maintenance and Operations: (4) Grab bars shall be maintained for each toilet; bathtub and shower used by residents. This requirement is not met as evidenced by: The front bathroom was observed without a grab bar Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above in 1 count out of 1 count which posesa potential health, safety risk to the residents in care

Official plan of correction

POC Due Date: 03/03/2023 Plan of Correction The Licensee will take action to ensure that a grab bar is placed in the front bathroom and any bathroom that does not have a grab bar by 3/3/23. Provide evidence to licensing that the correction has been made.

Official classification

Type B

Official code

87307(3)(B)

Regulation authority

CCR

What the official deficiency says

Personal Accommodations and Services: 3) Equipment and supplies necessary for personal care and maintenance of adequate hygiene practice shall be readily available to each resident. B) Bedroom furniture, which shall include, for each resident, a chair, night stand, a lamp, or lights sufficient for reading, and a chest of drawers. This requirement is not met as evidenced by: Bedroom #3 was observed with 2 night stands and does not have a regulation sized dresser. Deficient Practice Statement Based on observation the licensee did not comply with the section cited above in 1 out of 6 which poses a potential personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/03/2023 Plan of Correction Licensee will provide the resident in Bedroom #3 with a regulation sized dresser and provide Licensing with evidence that the dresser was provided

Official classification

Type A

Official code

87411(a)

Regulation authority

CCR

What the official deficiency says

87411(a) Personnel Requirements – General: Facility personnel shall at all times be.. competent to provide the services necessary to meet resident needs.. facility require such additional staff for the provision of adequate services. This requirement is not met as evidenced by: Based on interviews and documents reviewed, the Licensee did not comply with the section cited above, as the Licensee failed to ensure that staff are able to communicate effectively with the residents while in care, which poses a potential health and safety risk to residents in care.

Official plan of correction

The Licensee has agreed to do the following: 1.Submit proof of staff training to communicate with residents through the use of communication boards. 2.Submit proof of staff’s translating devices and apps, for basic English.

Deadline recorded: Jan 7, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87705(f)(2)

Regulation authority

CCR

What the official deficiency says

87705(f)(2) Care of Persons with Dementia. The following shall be stored inaccessible to residents with dementia: Over-the-counter medication, nutritional supplements or vitamins, alcohol, cigarettes, and toxic substances such as... cleaning supplies ... This requirement is not met as evidenced by: Based on LPAs observation, the licensee did not comply with the section cited above, as ointments, and multiple medications were accessible to residents with dementia, which poses an immediate health and safety risk to residents in care.

Official plan of correction

Staff locked and secured items during visit. The Licensee has agreed to do the following: 1. Submit staff training log of section 87705(f)(2) to CCL by 12/31/2021.

Deadline recorded: Dec 31, 2021. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87555(b)(8)

Regulation authority

CCR

What the official deficiency says

87555(b)(8) General Food Service Requirements(b)The following food service requirements shall apply:(8)All food shall be of good quality.. Food in damaged containers shall not be accepted, used or retained. This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above, as expired food was observed in one (1) out of two (2) facility kitchen refrigerators, which poses a potential health, and safety risk to persons in care.

Official plan of correction

The Licensee agreed to do the following: 1. Audit all food, and submit proof of completion to CCLD by 12/31/2021.

Deadline recorded: Dec 31, 2021. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87411(a)

Regulation authority

CCR

What the official deficiency says

87411(a) Personnel Requirements – General: Facility personnel shall at all times be.. competent to provide the services necessary to meet resident needs.. facility require such additional staff for the provision of adequate services. This requirement is not met as evidenced by: Based on LPAs observations, the Licensee did not comply with the section cited above, as the Licensee failed to ensure Facility personnel is competent to provide the services necessary to meet resident needs, as the front door had the facility key in the doorknob and a resident had to open the door for the LPAs due to staff being occupied with another resident, which poses a potential health and safety risk to residents in care.

Official plan of correction

The Licensee has agreed to do the following: 1. Submit proof of staff retraining on section 87411(a) to CCLD by 12/29/2021.

Deadline recorded: Dec 29, 2021. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87705(f)(1)

Regulation authority

CCR

What the official deficiency says

87705(f)(1) Care of Persons with Dementia: (f)The following shall be stored inaccessible to residents with dementia: (1)Knives, matches, firearms, tools and other items that could constitute a danger to the resident(s). This requirement is not met as evidenced by: Based on LPAs observation, the licensee did not comply with the section cited, as culinary knives and additional sharp items were accessible during physical plant tour to residents with Dementia, which poses an immediate health and safety risk to residents in care.

Official plan of correction

S1 secured the culinary knives and sharp items upon observation. Plan of correction met.

Deadline recorded: Dec 29, 2021. 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

87633(b) Hospice Care of Terminally Ill Residents: (b) A current and complete hospice care plan shall be maintained in the facility for each hospice resident and include the following: This requirement is not met as evidenced by: Based on record review, the licensee did not comply with the section cited above, as two (2) out of five (5) resident files did not contain the resident Hospice care plan, which poses a potential health, and safety risk to persons in care.

Official plan of correction

The administrator provided a copy of R3's Hospice Care plabn during the visit. The Licensee agreed to do the following: 1. Submit required Hospice records for R2 to CCLD by 12/31/2021.

Deadline recorded: Dec 31, 2021. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87507(a)(g)(A)

Regulation authority

CCR

What the official deficiency says

87507 Admission Agreements (a) The licensee shall complete an individual written admission agreement,...(g) Admission agreements shall specify the following:(A) Rate for all basic services which the facility is required to provide in order to obtain and maintain a license. This requirement is not met as evidenced by: Based on record review, the licensee failed to comply with the section cited above, as three (3) out of five (5) residents files were incomplete, which poses a potential personal rights risk to residents in care.

Official plan of correction

The Licensee agreed to the following: 1. Submit proof R1, R2, and R3 completed and signed forms identified in the report to CCLD by 12/31/2021.

Deadline recorded: Dec 31, 2021. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87355(e)(2)

Regulation authority

CCR

What the official deficiency says

87355(e)(2) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working... in a licensed facility: (2) Request a transfer of a criminal record clearance… This requirement is not met as evidenced by: Based on interviews and observations, the licensee did not comply with the section cited above, as two individuals (S1, S2) have been working at the facility without a background clearance, which poses an immediate safety risk to residents in care.

Official plan of correction

The Administrator has agreed to do the following: 1. Submit documentation for S1, and S2 to be associated with the facility with background clearance by 09/17/21. Zero tolerance violation; immediate civil penalty assessed of $1000

Deadline recorded: Sep 14, 2021. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87411(a)

Regulation authority

CCR

What the official deficiency says

87411(a) Personnel Requirements – General: Facility personnel shall at all times be.. competent to provide the services necessary to meet resident needs.. facility require such additional staff for the provision of adequate services. This requirement is not met as evidenced by: Based on interviews and documents reviewed, the Licensee did not comply with the section cited above, as the Licensee failed to ensure that staff are able to communicate effectively with the residents while in care, which poses a potential health and safety risk to residents in care.

Official plan of correction

The Licensee has agreed to do the following: 1.The Licensee will document a plan of action, ensuring that the staff can communicate effectively and thus meeting the needs of the residents. This plan of action will be submitted to the LPA by 09/21/21.

Deadline recorded: Sep 14, 2021. A deadline is not proof that correction was completed.