WELLNESS ASSISTED LIVING

Official classification

Type B

Official code

87405(a)

Regulation authority

CCR

What the official deficiency says

When the administrator is not in the facility, there shall be coverage by a designated substitute who shall have qualifications adequate to be responsible and accountable for management and administration of the facility as specified in this section. This requirement is not met as evidenced by: Based on interviews, Licensee/ Administrator does not have a designated substitute for managing the facility when the Licensee/Administrator is not on the premises. This poses a potential health and safety risk to residents in care

Official plan of correction

Administrator/License agreed to complete LIC 308, naming a designee for the facility by the POC date.

Deadline recorded: Aug 17, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87465(a)(6)

Regulation authority

CCR

What the official deficiency says

(6) When requested by the prescribing physician or the Department, a record of dosages of medications which are centrally stored shall be maintained by the facility. 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. Centrally stored Medication Records (LIC22) was not updated for 6 out of 6 residents. This poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/30/2026 Plan of Correction Administrator designee agreed to provide updated Centrally stored Medication Records (LIC22) for all six (6) residents by the POC date.

Official classification

Type B

Official code

87412(a)

Regulation authority

CCR

What the official deficiency says

This requirement is not met as evidenced by: (a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: Deficient Practice Statement Based on interview and record review, the licensee did not comply with the section cited above. S2 has Insufficient qualifications. LIC 501 is incomplete which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/12/2025 Plan of Correction Administrator will provide proof of suffient qualifications of S2 and email complete LIC 501 to LPA by the POC date.

Official classification

Type B

Official code

87411(d)(3)

Regulation authority

CCR

What the official deficiency says

87411-Personnel Requirements - General-(d)(3)Skill and knowledge required to provide necessary resident care and supervision, including the ability to communicate with residents.,.This requirement is not met as evidenced by Deficient Practice Statement Based on interview, the licensee did not comply with the section cited above. S1 couldn't answer any of LPA's questions. This poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/12/2025 Plan of Correction Administrator/Licensee agrees to put in writing their plan for hiring or ensuring English Speaking staff are always on shift and submit the plan by the POC date.

Official classification

Type B

Official code

87307(a)(2)(B)

Regulation authority

CCR

What the official deficiency says

(2) Resident bedrooms shall be provided which meet, at a minimum, the following requirements: (B) No room commonly used for other purposes shall be used as a sleeping room for any resident. This includes any hall, stairway, unfinished attic, garage, storage area, shed or similar detached building. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above. LPA observed that staff are using resident closet in Room#2 to store clothes and other personal items which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/12/2025 Plan of Correction Administrator will remove all staff clothes and personal items from Resident closet. Administrator will email a picture by the POC date.

Official classification

Type B

Official code

87465(d)(2)

Regulation authority

CCR

What the official deficiency says

(d) If the resident is unable to determine his/her own need for a prescription or nonprescription PRN medication, and is unable to communicate his/her symptoms clearly, facility staff designated by the licensee, shall be permitted to assist the resident with self-administration, provided all of the following requirements are met: (2) The date and time of each contact with the physician, and the physician's directions, shall be documented and maintained in the resident's facility 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. LPA observed that medication records are inconsistent with medication audit which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/12/2025 Plan of Correction Administrator will provide accurate medication records by the POC date.

Official classification

Type B

Official code

87411(d)(3)

Regulation authority

CCR

What the official deficiency says

87411-Personnel Requirements - General-(d)(3)Skill and knowledge required to provide necessary resident care and supervision, including the ability to communicate with residents.,.This requirement is not met as evidenced by: Based on interviwes staff was unable to communicate with LPA, Staff was using translation device. This poses a potential risk to the residents in care.

Official plan of correction

Administrator/Licensee agrees to put in writing their plan for hiring or ensuring English Speaking staff are always on shift and submit the plan by the POC date. Additionally, Administrator shall submit an updated LIC500 to reflect all staff.

Deadline recorded: Nov 28, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87411(d)(5)

Regulation authority

CCR

What the official deficiency says

87411-Personnel Requirements - General-(d)(5) Knowledge necessary in order to recognize early signs of illness and the need for professional help Based on interviwes staff were unable to recoginze ealrly signs of illness which led R1 to hospitalization.

Official plan of correction

Administrator will conducted training to address this section of the regulation. Attendace sheet will submitted to the LPA by the POC date.

Deadline recorded: Nov 28, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87464(f)(1)

Regulation authority

CCR

What the official deficiency says

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 has not been met as evidenced by The licensee failed to ensure staff provided adequate observation regarding R1’s change in condition, and adequate records pertaining to R1’s health and care which led to R1’s hospitalization. This poses as an immediate health and safety risk to the resident in care.

Official plan of correction

Licensee will submit a written plan stating how the facility will ensure that all residents in care are provided with adequate care and supervision to ensure their safety and their needs are being met. Plan to be submitted to CCL by the POC due date

Deadline recorded: Nov 8, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87411(d)

Regulation authority

CCR

What the official deficiency says

87411-Personnel Requirements (d)All personnel shall be given on the job training or have related experience in the job assigned to them. This requirement has not been met as evidenced by: Based on records review S2 doesn't have in service training. This poses a potential risk to the residents in care.

Official plan of correction

Administrator will conduct training for S2 and submit attendance sheet by the POC date.

Deadline recorded: Nov 28, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(a)(4)

Regulation authority

HSC

What the official deficiency says

The licensee shall assist residents with self-administered medications as needed Deficient Practice Statement Based on observation and record review, the licensee did not comply with the section cited above. which poses an immediate health, safety or personal rights risk to persons in care. R1's centrally stored medication and destruction record is missing all information regarding the medication name and start date. R2's centrally stored medication and destruction record is missing the start date. R3 Buprenorphine Medication was missing doses for March 11,12,13, and 14. The medication is instructed to take one tablet daily. LPA also observed that Quetiapine is missing 56 tablets.

Official plan of correction

POC Due Date: 03/08/2024 Plan of Correction Administrator Designee agreed to provide complete Centrally Stored Medication Records for R1, R2, and R3 and in writing an explanation of the reason for missing doses of R3 of Buprenorphine and Quetiapine medication. Administrator designee will email LPA proof of corrections by the POC date.

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

This requirement is not met as evidenced by:87303(a) Maintenance and Operation. The facility shall be clean, safe, sanitary and in good repair at all times. Deficient Practice Statement Based on observation the licensee did not comply with the section cited above. LPA observed dining room ceiling had water stains and cracks in ceiling. This poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/14/2024 Plan of Correction Administrator will sent pictures of fixed roof by the POC date.

Official classification

Type B

Official code

87412(g)

Regulation authority

HSC

What the official deficiency says

This requirement is not met as evidenced by: 87412 Personnel Records (g) All personnel records shall be maintained at the facility and shall be available to the licensing agency for review. Deficient Practice Statement Based on observation , the licensee did not comply with the section cited above. Administrator designee had no physical file at the facility. This poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/14/2024 Plan of Correction Administrator will provide scan copy of Administrator Designee folder by the POC date.

Official classification

Type B

Official code

87411

Regulation authority

CCR

What the official deficiency says

This requirement is not met as evidenced by: 87411 Personnel Requirements - General (d) All personnel shall be given on the job training or have related experience in the job assigned to them. This training and/or related experience shall provide knowledge of and skill in the following, as appropriate for the job assigned and as evidenced by safe and effective job performance: Deficient Practice Statement Based on observation and record review the licensee did not comply with the section cited above in. LPA observed missing training for S1 and S2. This poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/14/2024 Plan of Correction The administrator will provide proof that S1 and S2 took February training on infection control and on Dementia behavioral changes. Administrator will conduct appropriate medication training will be provided for all medication staff members. Administrator will submit the training documentation to LPA.

Official classification

Type A

Official code

87705(f)

Regulation authority

CCR

What the official deficiency says

87705(f) The following shall be stored inaccessible to residents...(1) Knives, matches, firearms...(2) Over-the-counter medication... cleaning supplies and disinfectants. 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 one (1) out of 3 (three) facility bathrooms having cleaning chemicals under an unlocked sink cabinet which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/22/2022 Plan of Correction Caregiver removed cleaning chemicals immediately. No POC required at this time.

Official classification

Type B

Official code

Not listed

Regulation authority

Not listed

What the official deficiency says

87411 Personnel Requirements - General (a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. In facilities licensed for sixteen or more, sufficient support staff shall be employed to ensure provision of personal assistance and care as required in Section 87608, Postural Supports. Additional staff shall be employed as necessary to perform office work, cooking, house cleaning, laundering, and maintenance of buildings, equipment and grounds. The licensing agency may require any facility to provide additional staff whenever it determines through documentation that the needs of the particular residents, the extent of services provided, or the physical arrangements of the facility require such additional staff for the provision of adequate services. This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above. One staff member was observed to take care of all 6 residents at once which poses a potential health, safety or personal rights risk to residents in care.

Deadline recorded: Mar 3, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

Not listed

Regulation authority

Not listed

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 evidence by: Based on observation, the licensee did not comply with the section cited above. The large black leather sectional seats were peeling and was observed to be in overall poor repair.

Deadline recorded: Mar 3, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87307(d)(6)

Regulation authority

CCR

What the official deficiency says

87307(d)(6) Personal Accommodations and Services (6) All outdoor and indoor passageways and stairways shall be kept free of obstruction. This requirement is not met as evidence by: Based on a credible source and the acknowledgement by the Administrator; There was a lock installed on the top right corner of the front exit door. The lock obstructs the exit should the exit be needed due to an emergency. This is an immediate health and safety risk to all residents in care.

Official plan of correction

The Administrator has completed the plan of correction, and has removed the lock on the front exit door.

Deadline recorded: Jan 21, 2022. A deadline is not proof that correction was completed.