DAY & NIGHT ASSISTED LIVING

Official classification

Type B

Official code

87415(a)

Regulation authority

CCR

What the official deficiency says

(a) The following persons providing night supervision from 10:00 p.m. to 6:00 a.m. shall be familiar with the facility's planned emergency procedures, shall be trained in first aid as required in Section 87465, Incidental Medical and Dental Care Services, and shall be available as indicated below to assist in caring for residents in the event of an emergency: This requirement is not met as evidenced by: Deficient Practice Statement Based on observation. nterview, record review, the licensee did not comply with the section cited above. 2 of 3 staff did not have current CPR/first aid certificates. ] which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/21/2026 Plan of Correction Administrator will obtain CPR/first aid certificate for all staff and sent to LPA by POC date.

Official classification

Type B

Official code

87412(f)

Regulation authority

CCR

What the official deficiency says

(f) All personnel records shall be available to the licensing agency to inspect, audit, and copy upon demand during normal business hours. Records may be removed if necessary for copying. Removal of records shall be subject to the following requirements: This requirement is not met as evidenced by: Deficient Practice Statement Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above. 3 of 6 residents files where not at facility which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/21/2026 Plan of Correction Administrator will send proof that the 3 residents files are at facility.

Official classification

Type B

Official code

1569.625(c)(4)

Regulation authority

HSC

What the official deficiency says

(c) The training shall include, but not be limited to, all of the following: (4) Policies and procedures regarding medications. This requirement is not met as evidenced by: Deficient Practice Statement Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above. 2 of 3 staff had no proof of medication administrating which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/21/2026 Plan of Correction Administrator will send proof of ongoing medication training to LPA by POC date,

Official classification

Type B

Official code

87555(b)(27)

Regulation authority

CCR

What the official deficiency says

(27) All kitchen areas shall be kept clean and free of litter, rodents, vermin and insects. 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 observe dead insects in refrigerator which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/21/2026 Plan of Correction Administrator will clean refrigerator of all insects and send proof to LPA by POC date.

Official classification

Type B

Official code

87465(a)(5)(A)

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: (A) Medications usually prescribed for self-administration which have been authorized by the person's physician. 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. Resident 3, 4, and 5 did not have medication record to reviewed which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/21/2026 Plan of Correction Administrator will send proof that all resident's have medication records to review.

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 observation, record review)], the licensee did not comply with the section cited above, No doctor's orders for medications for R3,4,5.which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/21/2026 Plan of Correction Administrator will send proof of correction to LPA by POC date.

Official classification

Type B

Official code

87465(c)(1)

Regulation authority

CCR

What the official deficiency says

(c) If the resident's physician has stated in writing that the resident is unable to determine his/her own need for nonprescription PRN medication, but can 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: (1) There is written direction from a physician, on a prescription blank, specifying the name of the resident, the name of the medication, all of the information specified in Section 87465(e), instructions regarding a time or circumstance (if any) when it should be discontinued, and an indication of when the physician should be contacted for a medication reevaluation. 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. No DC orders for R1. according to administrator, all his medications have been discontinued which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/21/2026 Plan of Correction Administrator will send proof that all medications have been discontinued for R1 and send to LPA proof,

Official classification

Type B

Official code

87506(a)

Regulation authority

CCR

What the official deficiency says

(a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview, record review, the licensee did not comply with the section cited above. Three resident files where not at facility for review which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/21/2026 Plan of Correction Administrator will send proof that the resident files are at facility,

Official classification

Type B

Official code

1569.605

Regulation authority

HSC

What the official deficiency says

HSC 1569.605 shall maintain liability insurance covering injury to residents and guests in the amount of at least one million dollars ($1,000,000) per occurrence and three million dollars ($3,000,000). This requirement is not met by: Based on the record review, the licensee did not comply with the section cited above in one documentation not showing required liability insurance which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

The licensee/administrator will send copy of liability insurance that is required to LPA by POC Due Date: 03/12/25.

Deadline recorded: Mar 12, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87412(a)(11)

Regulation authority

CCR

What the official deficiency says

(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: (11) A health screening as specified in Section 87411...This requirement is not met as evidenced by: Based on the record review, the licensee did not comply with the section cited above in one out of three staff not having a health screening which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

The health screening of S2 is to be sent to the LPA. POC Due Date 03/12/25

Deadline recorded: Mar 12, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

1569.605

Regulation authority

HSC

What the official deficiency says

On and after July 1, 2015, all residential care facilities for the elderly, except those facilities that are an integral part of a continuing care retirement community, shall maintain liability insurance covering injury to residents and guests in the amount of at least one million dollars ($1,000,000) per occurrence and three million dollars ($3,000,000) in the total annual aggregate, caused by the negligent acts or omissions to act of, or neglect by, the licensee or its employees. This requirement is not met as evidenced by: Deficient Practice Statement Based on the record review, the licensee did not comply with the section cited above in one documentation out of one documentation which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/12/2024 Plan of Correction Licensee/Administrator will need to provide documentation of insurance to LPA.

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 in several cleaning supplies left exposed and accessible to the residents which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/12/2024 Plan of Correction All disinfectants, cleaning solutions shall be immediately locked and inaccessible to all residents. A picture is to be taken and sent to the LPA.

Official classification

Type A

Official code

1569.618(c)(3)

Regulation authority

HSC

What the official deficiency says

(c)The facility shall employ, and the administrator shall schedule, a sufficient number of staff members to do all of the following: (3) Ensure that at least one staff member who has cardiopulmonary resuscitation (CPR) training and first aid training is on duty and on the premises at all times. This paragraph shall not be construed to require staff to provide CPR. 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 in one out of one staff which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/12/2024 Plan of Correction Cardiopulmonary resuscitation (CPR) training and first aid training shall be conducted immediately and send proof to LPA for staff working at the facility-Karen Mesropyan only staff present at the time of visit.

Official classification

Type A

Official code

87413(a)(1)

Regulation authority

CCR

What the official deficiency says

(1) When regular staff members are absent, there shall be coverage by personnel with qualifications adequate to perform the assigned tasks. 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 in one out of two staff which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/12/2024 Plan of Correction there shall be coverage by personnel with qualifications adequate to perform the assigned tasks and it shall be sent to the LPA.

Official classification

Type A

Official code

87412(f)

Regulation authority

CCR

What the official deficiency says

(f) All personnel records shall be available to the licensing agency to inspect, audit, and copy upon demand during normal business hours. Records may be removed if necessary for copying. Removal of records shall be subject to the following requirements: This requirement is not met as evidenced by: Deficient Practice Statement Based on the record review, the licensee did not comply with the section cited above in personnel records in two out of two staff which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/12/2024 Plan of Correction All personnel records shall be available to the licensing agency to inspect, audit, and copy upon demand during normal business hours.

Official classification

Type A

Official code

87412(a)(13)

Regulation authority

CCR

What the official deficiency says

(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: (13) For employees that are required to be fingerprinted pursuant to Section 87355, Criminal Record Clearance: 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 in one out of two staff which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/12/2024 Plan of Correction The criminal record of the staff currently working-Karen Mesropyan shall be conducted immediately and sent to the LPA

Official classification

Type A

Official code

87465(h)(2)

Regulation authority

CCR

What the official deficiency says

(h) The following requirements shall apply to medications which are centrally stored: (2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. This requirement is not met as evidenced by: Deficient Practice Statement Based on the observation, the licensee did not comply with the section cited above in three out of three residents which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/12/2024 Plan of Correction All medication from all residents shall be locked and inaccessbile to all residents immediately. A picture of locked medication and inaccessibility to residents is to be sent to the LPA.

Official classification

Type A

Official code

87705(f)(1)

Regulation authority

CCR

What the official deficiency says

(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: Deficient Practice Statement Based on the observation, the licensee did not comply with the section cited above in sharps being locked and inaccessible to all residents which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/12/2024 Plan of Correction All sharps are to be locked immediately inaccessible to all residents. The cabinet that needs to be repaired for the sharps has to be fixed and repairs sent to LPA.

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

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 the observation, the licensee did not comply with the section cited above in two areas-the garage and the sharps cabinet being broken which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/30/2024 Plan of Correction The cabinet in the kitchen and the garage have to be repaired and a picture or/and the receipt has to be sent to the LPA.

Official classification

Type B

Official code

87412(a)(11)

Regulation authority

CCR

What the official deficiency says

(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: (11) A health screening as specified in Section 87411, Personnel Requirements - General. This requirement is not met as evidenced by: Deficient Practice Statement Based on the record review, the licensee did not comply with the section cited above in one out of two staff which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/30/2024 Plan of Correction The health screening of the staff Karen Mesropyan is to be sent to the LPA immediately upon completing the necessary paperwork to work with residents.

Official classification

Type B

Official code

87506(a)

Regulation authority

CCR

What the official deficiency says

(a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff. This requirement is not met as evidenced by: Deficient Practice Statement Based on on the record review, the licensee did not comply with the section cited above in three out of three residents which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/30/2024 Plan of Correction All resident files is to be available to the licensing department for immediate review. All resident files is to be sent to the LPA upon completion.

Official classification

Type B

Official code

87506(b)(13)

Regulation authority

CCR

What the official deficiency says

(b) Each resident's record shall contain at least the following information: (13) Continuing record of any illness, injury, or medical or dental care, when it impacts the resident's ability to function or the services he needs. This requirement is not met as evidenced by: Deficient Practice Statement Based on the record review, the licensee did not comply with the section cited above in three out of three residents which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/30/2024 Plan of Correction Resident records showing illness, injurt and/or medical services that they need is to be kept in a file in the facility for review of the licensing department and staff/administrator to determine the resident's needs. The paperwork of the Needs and Appraisal shall be sent to the LPA.

Official classification

Type B

Official code

87506(b)(15)

Regulation authority

CCR

What the official deficiency says

(b) Each resident's record shall contain at least the following information: (15) The admission agreement and pre-admission appraisal, specified in Sections 87507, Admission Agreements and 87457, Pre-admission Appraisal. This requirement is not met as evidenced by: Deficient Practice Statement Based on the record review, the licensee did not comply with the section cited above in three out of three residents which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/30/2024 Plan of Correction The admission agreement and pre-admission appraisal, specified in Sections 87507, Admission Agreements and 87457, Pre-admission Appraisal shall be kept in a file at the facility and Admission Agreement is to be sent to the LPA for each resident.

Official classification

Type B

Official code

87506(b)(17)(E)

Regulation authority

CCR

What the official deficiency says

(b) Each resident's record shall contain at least the following information: (17) Documents and information required by the following: (E) Section 87463, Reappraisals; and This requirement is not met as evidenced by: Deficient Practice Statement Based on the record review, the licensee did not comply with the section cited above in three out of three residents which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/30/2024 Plan of Correction Documents and information required by the following: (E) Section 87463, Reappraisals; shall be kept at the above facility in a file and be sent to the LPA for all three residents.

Official classification

Type B

Official code

87456(a)(2)

Regulation authority

CCR

What the official deficiency says

(a) Prior to accepting a resident for care and in order to evaluate his/her suitability, the facility shall, as specified in this article 8: (2) Perform a pre-admission appraisal. This requirement is not met as evidenced by: Deficient Practice Statement Based on the record review, the licensee did not comply with the section cited above in three out of three residents which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/30/2024 Plan of Correction The Pre-admission appraisal for each resident is to be kept in a file and the licensee/administrator is to review the paperwork to determine if they can take care of the residents currently living at the above facility and the pre-admission is to be sent to the LPA

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 and keep on file, documentation of a medical assessment, signed by a physician, made within the last year. The licensee shall be permitted to use the form LIC 602 (Rev. 9/89), Physician's Report, to obtain the medical assessment. This requirement is not met as evidenced by: Deficient Practice Statement Based on the record review, the licensee did not comply with the section cited above in three out of three residents which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/30/2024 Plan of Correction The Physcian's report showing what the resident's medical diagnosis is, is to be kept at the facility and sent to the LPA.

Official classification

Type B

Official code

87458(b)(1)

Regulation authority

CCR

What the official deficiency says

(b) The medical assessment shall include, but not be limited to: (1) A physical examination of the resident indicating the physician's primary diagnosis and secondary diagnosis, if any and results of an examination for communicable tuberculosis, other contagious/infectious or contagious diseases or other medical conditions which would preclude care of the person by the facility. This requirement is not met as evidenced by: Deficient Practice Statement Based on the record review, the licensee did not comply with the section cited above in three out of three residents which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/30/2024 Plan of Correction The Physician's report showing an examination for communicable tuberculosis is to be kept at the above facility and sent to the LPA.