YMZ ASSISTED LIVING

Official classification

Type A

Official code

87355(e)(2)

Regulation authority

CCR

What the official deficiency says

Criminal Record Clearance: 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: 2) Obtain a California clearance or a criminal record exemption as required by the Department or...This requirement was not met as evidenced by: Shazada A. Zholdoshova, Staff does not have an employee file and no evidence of a criminal record clearance. Per staff, it is her first day covering for Staff #2. Civil penalties were assessed.

Official plan of correction

The Licensee shall read Title 22, Section 87355 and write a statement that the section was read and understood and a written plan of action is provided that will state how the facility will ensure that all staff present at the facility has received a criminal record clearance and requested a criminal record transfer by 10/29/25

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

Official classification

Type A

Official code

87355(e)(3)

Regulation authority

CCR

What the official deficiency says

Criminal Record Clearance: 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 requiement was not met as evidenced by: Svetlana Petrosian, an employee of the licensee at North Care Residential, Inc was observed at the home as staff from the licensees other facilities are used as backup staff and was not associated to the home

Official plan of correction

The Licensee shall read Title 22, Section 87355 and write a statement that the section was read and understood and a written plan of action is provided that will state how the facility will ensure that all staff present at the facility has received a criminal record clearance and requested a criminal record transfer by 10/29/25.

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

Official classification

Type B

Official code

87632(d)(2)

Regulation authority

CCR

What the official deficiency says

Hospice Care Waiver: If the Department grants a hospice care waiver it shall stipulate terms and conditions of the waiver as necessary to ensure the well-being of terminally ill residents and of all other facility residents, which shall include, but not be limited to, the following requirements. The licensee shall notify the Department in writing within five working days of the initiation of hospice care services for any terminally ill resident in the facility or within five working days of admitting a resident already receiving hospice care services...... R1 through R4 are on hospice and was not reported

Official plan of correction

Licensee will read Title 22 Section 87632 and 87633 and submit a written statement that the sections were read and understood and that the Licensee will comply with all requirements noted in the Section. Licensee will also submit written hospice notification letters containing all the required information noted in the Section being cited for resident #1 through resident #4 to the Department by 11/4/25

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

Official classification

Type A

Official code

87465(g)

Regulation authority

CCR

What the official deficiency says

Incidental Medical and Dental Care :The licensee shall immediately telephone 9-1-1 if an injury or other circumstance has resulted in an imminent threat to a resident’s health including, but not limited to, an apparent life-threatening medical crisis except as specified in Sections 87469(c)(2), (c)(3), or (c)(4). This requirement was not met as evidenced by: Resident #1 slipped and fell from their bed and sustained a humeral fracture to the left arm, bruising and swelling to the forearm and elbow on 2/16/25 and 911 was not called to assess the resident and transported to the hospital until 2/21/25, 5 days after the fall.

Official plan of correction

The licensee will provide the Department with a written plan of action that will be implemented to ensure that all residents get timely medical attention when a resident refuses to seek medical attention that threatens their life, limb and overall wellbeing by 10/29/25.

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

Official classification

Type A

Official code

87465(c)(2)

Regulation authority

CCR

What the official deficiency says

Incidental Medical and Dental care: .......(2) Once ordered by the physician the medication is given according to the physician's directions. Staff failed to dispense R1's Oxycodone at 12am and 4am as prescribed. This requirement was not met as evidenced by Staff dispensed R1's Oxycodone at 8am, 12pm,4pm, 8pm and failed to dispense R1's Oxycodone at 12am and 4am as prescribed

Official plan of correction

The licensee will ensure that the residents are given their medications as prescribed. Licensee will submit a written plan of action to the Department as to how they will ensure that all residents are given their medication as prescribed or what actions will be taken to ensure prescribed medications are not missed. Submit the plan of action to the Department by 8/6/25.

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

Official classification

Type A

Official code

87465(c)(3)

Regulation authority

CCR

What the official deficiency says

Incidental Medical and Dental care: If the resident's physician has stated in writing that the resident is unable to determine his/her own need...A record of each dose is maintained in the resident's record. The record shall include the date and time the PRN medication was taken, the dosage taken, and the resident's response.This requirement was not met as evidenced by: Resident #1 was prescribed PRN Oxycodone while under the care of Elara Hospice and was dispensed by staff. However, the facility did not document the date, time, dose given and the response.

Official plan of correction

The licensee will read Title 22, Section 87465 in entirety and provide a written statement that the section was read and provide a written plan of action as to how they will ensure that dispensed PRN medications are documented and available to the Department for review. by 8/6/25 of the resident

Deadline recorded: Aug 6, 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 ... knives, ... 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: Based on observation, the licensee did not comply with the section cited above in the drawer containing knives were accessible which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

Staff secured the drawer during the visit. The Licensee will review regulations, update Staff training, and submit a statement of understanding with Staff and Licensee signatures by POC due date.

Deadline recorded: Jul 25, 2025. 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

(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 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 in the resident's restroom sink delivered water at 149 degrees F which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/24/2025 Plan of Correction The Licensee will call a technician to check and adjust the water heater and send CCLD proof of water temperature within the required range by POC due date.

Official classification

Type A

Official code

87204(a)

Regulation authority

CCR

What the official deficiency says

(a) A licensee shall not operate a facility beyond the conditions and limitations specified on the license, including specification of the maximum number of persons who may receive services at any one time. An exception may be made in the case of catastrophic emergency when the licensing agency may make temporary exceptions to the approved capacity. This requirement is not met as evidenced by: Deficient Practice Statement Based on interview, the licensee did not comply with the section cited above in 1 Staff lives on the premises and sleeps on the living room futon which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/24/2025 Plan of Correction The Licensee will create a written plan to address the living arrangements of the Staff and how they will enforce it. The Licensee will send CCLD the plan by POC due date.

Official classification

Type A

Official code

87307(d)(2)

Regulation authority

CCR

What the official deficiency says

(2) The premises shall be maintained in a state of good repair and shall provide a safe and healthful environment. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above. The facility's side yard has exposed electrical wiring and a hole in the wooden ramp utilized by residents which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/24/2025 Plan of Correction The Licensee secured the electrical wiring during the visit. The Licensee will contact a technician and schedule an appointment to repair the wooden ramp and notify CCLD of the appointment date. The Licensee will then send proof of the repair after it has been completed.

Official classification

Type A

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 and interview, the licensee did not comply with the section cited above in 1 bed frame was obstructing the passageway of the emergency side exit which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/24/2025 Plan of Correction The Licensee will discard of the bed frame or relocate the bed frame where it is not a hazard or obstructing any passageways. The Licensee will send proof to CCLD by POC due date.

Official classification

Type A

Official code

87307(e)(2)(A)

Regulation authority

CCR

What the official deficiency says

(e) The licensee shall supervise residents as needed and as determined by the resident's appraisal pursuant to Section 87457, Pre-Admission Appraisal or Section 87463, Reappraisals, when residents are in proximity to or when there is use of the following items: (2) Fishponds, wading pools, hot tubs, swimming pools, or similar larger bodies of water. (A) The licensee shall ensure that the bodies of water specified above are inaccessible through fencing, covering, or other means when not in active use by residents. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and interview, the licensee did not comply with the section cited above in 2 out of 2 pool gates were unsecured which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/23/2025 Plan of Correction The Licensee secured the pool gate and reinstalled the side gate during the visit. POC Cleared.

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 and interview, the licensee did not comply with the section cited above in 1 restroom cabinet containing cleaning supplies was unlocked which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/23/2025 Plan of Correction Staff secured and locked the restroom cabinet during the visit. POC Cleared.

Official classification

Type A

Official code

87465(a)(5)(D)

Regulation authority

CCR

What the official deficiency says

(5) Facility staff, except those authorized by law, shall not administer injections, but staff designated by the licensee may assist persons with self-administration as needed. Assistance with self-administered medications shall be limited to the following: (D) Assistance with self-administration does not include forcing a resident to take medications, hiding or camouflaging medications in other substances without the resident's knowledge and consent, or otherwise infringing upon a resident's right to refuse to take a medication. 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. The facility's Staff crushes 1 resident's medications without a physician's order which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/24/2025 Plan of Correction The Licensee will contact the Physician and obtain the crush order. The Licensee will send CCLD the Physician's crush order by 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 and interview, the licensee did not comply with the section cited above in 1 kitchen drawer's face panel was falling off the screws and 1 fire door latch was jammed which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/24/2025 Plan of Correction The Licensee will have a technician repair the kitchen drawer and send CCLD proof by POC due date. The Licensee repaired the fire door latch during the visit.

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 interview and record review, the licensee did not comply with the section cited above in 2 out of 2 residents receiving PRN Medications do not have a PRN Authorization Letter or PRN administration log which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/30/2025 Plan of Correction The Licensee will obtain PRN Authorization Letters and send CCLD the letters by POC due date. The Licensee will update Staff training and submit a statement of understanding on recording PRN medications and send it to CCLD by POC due date.

Official classification

Type B

Official code

1569.695(a)(2)

Regulation authority

HSC

What the official deficiency says

(a)In addition to any other requirement of this chapter, a residential care facility for the elderly shall have an emergency and disaster plan that shall include, but not be limited to, all of the following: (2) Plans for the facility to be self-reliant for a period of not less than 72 hours immediately following any emergency or disaster, including, but not limited to, a short-term or long-term power failure. If the facility plans to shelter in place and one or more utilities, including water, sewer, gas, or electricity, is not available, the facility shall have a plan and supplies available to provide alternative resources during an outage. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and interview, the licensee did not comply with the section cited above. The facility did not have emergency water which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/23/2025 Plan of Correction The Licensee purchased emergency water during the visit. POC Cleared.

Official classification

Type B

Official code

87632(d)(2)

Regulation authority

CCR

What the official deficiency says

Hospice Care Waiver: If the Department grants a hospice care waiver it shall stipulate terms and conditions of the waiver as necessary to ensure the well-being of terminally ill residents and of all other facility residents, which shall include, but not be limited to, the following requirements. The licensee shall notify the Department in writing within five working days of the initiation of hospice care services for any terminally ill resident in the facility or within five working days of admitting a resident already receiving hospice care services...... R1, R4 & R5 are on hospice and was not reported

Official plan of correction

Licensee will read Title 22 Section 87632 and 87633 and submit a written statement that the sections were read and understood and that the Licensee will comply with all requirements noted in the Section. Licensee will also submit written hospice notification letters containing all the required information noted in the Section being cited to the Department by 9/4/24.

Deadline recorded: Sep 4, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87211(a)(1)(A)

Regulation authority

CCR

What the official deficiency says

Reporting Requirements: (a)Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: A written report shall be submitted to the licensing agency and to the person responsible for the resident within 7 days of the occurrence of any of the events specified in (A) through (D) below. A) Death of any resident from any cause regardless of where the death occurred, including..... a hospital, en route to or from a hospital, or visiting away from the facility. Resident #1's death was not reported to the Department

Official plan of correction

The Licensee will ensure that all resident deaths, whether it occurred in the faciity or away from the facility in a hospital is reported to the Depatment. Licensee will complete an LIC624A for the death of Resident #1 and submit to the Department by no later than 8/30/24

Deadline recorded: Aug 30, 2024. 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

Reporting Requirements: (a)Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: A written report shall be submitted to the licensing agency and to the person responsible for the resident within 7 days of the occurrence of any of the events specified in (A) through (D) below. Any incident which threatens the welfare, safety or health of any resident, such as psychological abuse of a resident by staff or other residents, or unexplained absence of any resident. R1's hospitalization wasn't reported

Official plan of correction

Licensee will ensure that all incidents which threatens the welfare, safety or health of any resident, including hospitalizations are reported to the Department. Licensee will complete an LIC624 to report the hospitalization of R1 by 8/30/24.

Deadline recorded: Aug 30, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87608(a)(5)(B)

Regulation authority

CCR

What the official deficiency says

Postural Support: Based on the individual's preadmission appraisal, and subsequent changes to that appraisal.... Postural supports may be used under the following conditions.Under no circumstances shall postural supports include tying, depriving, or limiting the use . of a resident's hands or feet.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. R7's hospital bed was observed equipped with a full bed rail. (not on hospice)

Official plan of correction

Licensee will immediately remove the full bed rail and submit evidence that the full bed rails have been removed by 8/29/24.

Deadline recorded: Aug 29, 2024. 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

(e) Water supplies and plumbing fixtures shall be maintained as follows: (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 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 in 1 count out of 2 bathroom where the water temperature was tested, the water temperature tested in the private bathroom tested 121.4 degrees Fahrenheit which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/20/2024 Plan of Correction The Licensee will adjust the water heater thermostat and re-test the water in the private bathroom to ensure that the water temperature reads 105 - 120 degrees Fahrenheit as required by Title 22 The Licensee will fax over a self certification that the water temperature meets Title 22 requirements by 7/20/24

Official classification

Type A

Official code

87309(a)

Regulation authority

CCR

What the official deficiency says

(a) Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients. 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 observation of items stored in the cabinet of the private bathroom in bedroom #2 was a can of Lysol and cleaning solution and a can of lighter fluid was observed left on the barbecue grill located by the swimming pool which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/20/2024 Plan of Correction Licensee will ensure that all disinfectants, cleaning solutions, fire arms and other items which could pose a danger to the residents in care are stored when it is inaccessible to the residents. LIcnesee will remove the items noted and place them in a place where it is inaccessible to the residents by 7/20/24

Official classification

Type B

Official code

87303(e)(4)

Regulation authority

CCR

What the official deficiency says

e) Water supplies and plumbing fixtures shall be maintained as follows: (e) Water supplies and plumbing fixtures shall be maintained as follows: (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 it was observed that the shower stall and toilet in the private bathroom did not have grab bars installed which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/26/2024 Plan of Correction Licensee will install a grab bar in the shower stall and toilet located in the private bathroom in bedroom #2

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 as the blinds on the front window in bedroom #3 were broken which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/26/2024 Plan of Correction Licensee will replace the blinds on the front window located in bedroom #3. Evidence of the repair will be faxed over to the Department by 7/26/24.

Official classification

Type B

Official code

87307(d)(7)

Regulation authority

CCR

What the official deficiency says

(7) Fireplaces and open-faced heaters shall be adequately screened. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above in 1 out of 1 count which poses/posed a potential health, safety or personal rights risk to persons in care. which poses/posed a potential health, safety or personal rights risk to persons in care. The fire place located in the living room is covered by a glass screen but is not made inaccessible to the residents in care, Per Administrator, they don't use the fireplace.

Official plan of correction

POC Due Date: 07/28/2023 Plan of Correction LIcensee will take steps to make the fire place inaccessible to the residents in care. A screen placed in front of the fire place will meet the intent. Provide evidence that the deficiency has been corrected by 7/28/23

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

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 in 1 out of 13 rooms inspected, the blinds in the bedroom located to the right of the common bathroom are broken and do not provide privacy to the residents assigned to the room, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/28/2023 Plan of Correction Licensee will replace the blinda and provide a copy of the receipt or self certify that the blinds have been replaced by 7/28/23.

Official classification

Type B

Official code

87307(a)(3)(E)

Regulation authority

CCR

What the official deficiency says

Personal Accommodations and Services: (c) E) Portable or permanent closets and drawer space in the bedrooms for clothing and personal belongings. A minimum of eight (8) cubic feet (.743 cubic meters) of drawer space per resident shall be provided. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation in 2 out of 3 rooms inspected, the 2 bedrooms located in the back by the common bathroom did not contain the appropriate number of dressers for the 4 residents' use, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/28/2023 Plan of Correction The Licensee will purchase/provide the required dressers to the residents located in the 2 back bedrooms by the common bathroom by 7/28/23. Provide evidence that the deficienciy has been corrected.

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 in 1 out of 6 count of smoke detectors tested, the smoke detector in front of the kiitchen was observed to be dismantled and the wires were left hanging, poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/28/2023 Plan of Correction The Licensee will replace the smoke detector and provide evidence that the smoke detector has been replaced by providing a copy of the receipt or self certify by 7/28/23

Official classification

Type A

Official code

87303(e)(2)

Regulation authority

CCR

What the official deficiency says

87303 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 is not met as evidenced by: Deficient Practice Statement Based on observation the licensee did not comply with the section cited above in 1 out 2 tests conducted for the water temperature taken in the private bathroom read 152.5 degrees Fahrenheit and the water temperature in the common bathroom read 147.6 degrees Fahrenheit which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/22/2023 Plan of Correction The Licensee will immediately adjust the water heater thermostat to reduce the water temperature to Title 22 requirements ranging between 105 degrees to 120 degrees Fahrenheit. Provide evidence that the deficiency has been corrected by 7/22/23.

Official classification

Type A

Official code

87468.1(a)(3)

Regulation authority

CCR

What the official deficiency says

87468.1 Personal Rights of Residents in All Facilities (3) To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature, such as withholding residents’ money or interfering with daily living functions such as eating, sleeping, or elimination. 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 food pantry and cabinets located in the kitchen, containing foods were observed locked with a padlock and child locks,] which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/22/2023 Plan of Correction Licensee will remove the locks off the food pantry and kitchen cabinets to allow the residents access to food. Provide evidence that the padlocks were removed by 7/22/23

Official classification

Type A

Official code

87555(b)(26)

Regulation authority

CCR

What the official deficiency says

General Food Service Requirements (b) The following food service requirements shall apply (26) Supplies of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days shall be maintained on the premises This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above, insufficient perishables such as vegetables and fruits were observed in the refrigerator. Per staff, Administrator is purchasing more food today - 7/21/23 which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/22/2023 Plan of Correction Licensee will provide a copy of the receipt for the food purchased by 7/22/23

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. the back yard and front yard needs general cleaning, unused washing maching, dryer, bedrails, fence needs to be stored away, cardboard boxes discarded, and the wire hanging directly in front of the sliding glass door of the back room is addressed, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/28/2023 Plan of Correction Licensee will conduct generall cleaning, store all unused items noted above and sweep up all the dried leaves. Provide evidence of correction by 7/28/23.