ALONDRA GUEST HOME

Official classification

Type A

Official code

87203

Regulation authority

CCR

What the official deficiency says

Fire Safety All facilities shall be maintained in conformity with the regulations adopted by the State Fire Marshall 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 in that bedroom #3/ R2's bed is blocking the room exit door that leads to the exterior of the facility, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/07/2025 Plan of Correction Licensee shall ensure bedroom exit doors that lead outside are not blocked, as it is a Fire Safety hazard. 1. Submit picture proof evidence that shows bedroom #3's bed was moved and is no longer blocking the exit door that leads to the side yard.

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 that kitchen sink measured 125.7 and bathrooms measured 126.6, 124.1, and 123.7, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/07/2025 Plan of Correction Administrator agreed to adjust the hot water temperature and test the hot water temperature each shift today and tomorrow. Submit the temperature log by tomorrow.

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 observation, the licensee did not comply with the section cited above in that R3's medications [ Hydrocodone 5 mg, bisacodyl 5mg, Acetaminophen, and allergy medications] were observed unlocked on top of the table next to the bed, as well as S3's medications were observed unlocked in a pill box in the garage, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/07/2025 Plan of Correction Administrator shall submit by tomorrow a written plan of correction that states how the deficiency was corrected. In addition, all staff shall obtain medication training.

Official classification

Type B

Official code

87208(a)

Regulation authority

CCR

What the official deficiency says

(a) The licensee shall have and maintain a current, written definitive plan of operation for the facility. The licensee shall operate the facility in accordance with the terms specified in the plan of operation and may be cited for not doing so pursuant to Health and Safety Code section 1569.49. The plan and related materials shall be on file in the facility and shall be submitted to the licensing agency with the license application. Any significant changes in the plan of operation which would affect the services to residents shall be submitted to the licensing agency for approval. The plan and related materials shall contain the following: 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 that bedroom #1 is being used by licensee but the facility sketch states it is resident bedroom #1, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/22/2025 Plan of Correction Licensee shall: 1. Submit a plan of operation amendment specifying the physical plant changes related to resident bedrooms and staff rooms., i.e. bedroom #1. 2. Submit an updated facility sketch

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, the licensee did not comply with the section cited above in that R3 is a family member of licensee and is being cared for by staff but does licensee does not have a file for the resident with required Title 22 documents, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/22/2025 Plan of Correction Administrator agreed to create a file for R3 and submit to LPA copies of all required resident documents.

Official classification

Type B

Official code

87211(a)

Regulation authority

CCR

What the official deficiency says

87211 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: (1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below. This report shall include the resident's name, age, sex and date of admission; date and nature of event; attending physician's name, findings, and treatment, if any; and disposition of the case. Based on record review R1 refuses to take Famotidine 40 MG one tablet daily, Docusate 250 MG once daily, and Constulose twice a day and Facility has never reported to licensing or to R1’s physician. which poses a potential risk to resident in care.

Official plan of correction

Administaror agrees to complete an special incident report (SIR) and fax to licensing when R1 refuses medication and to contact physician.

Deadline recorded: Jul 22, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87555(b)(8)

Regulation authority

CCR

What the official deficiency says

87555 General Food Service Requirements (b) The following food service requirements shall apply: (8) All food shall be of good quality. Commercial foods shall be approved by appropriate federal, state and local authorities. Food in damaged containers shall not be accepted, used or retained. Based on observation facility had expired sour cream, milk, cheese, bread and vegetables in refrigerator.LPA observed gnats on food. This poses an immediate health and safety risk to residents in care.

Official plan of correction

Administrator will purchase fresh fruit, meat and produce and send LPA pictures as proof. Administrator will create a log and check food for expiration dates and ensure food is free from gnats.

Deadline recorded: Jul 9, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87555(a)

Regulation authority

CCR

What the official deficiency says

87555 General Food Service Requirements (a) The total daily diet shall be of the quality and in the quantity necessary to meet the needs of the residents and shall meet the Recommended Dietary Allowances of the Food and Nutrition Board of the National Research Council. All food shall be selected, stored, prepared and served in a safe and healthful manner. Based on observation LPA observed Administrator serve R1 Three month expired sour cream for lunch. This poses an immediate health and safety risk to residents in care.

Official plan of correction

Administrator will conduct a training for herself and staff of the importance of serving a nutritional well-balanced meal and send training to LPA by POC due date. Administrator also agrees to check for expiration dates before serving residents.

Deadline recorded: Jul 9, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.1(a)(16)

Regulation authority

CCR

What the official deficiency says

87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (16) To receive or reject medical care or other services. Based on record review R1 was given two referrals for ophthalmologist and urologist appointments were never made which poses a potential risk to residents in care.

Official plan of correction

Administrator will contact physician for new referrals and send LPA dates for appointments.

Deadline recorded: Jul 22, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87506(a)

Regulation authority

CCR

What the official deficiency says

87506 Resident Records (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. Based on record review R1 has not had an updated physician’s (602) report since 2020. R1’s appraisal needs, and service plan is incomplete.

Official plan of correction

Administrator will submit new physicians report LIC 602 and complete an appraisal needs and service plan by POC due date.

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

Official classification

Type A

Official code

87465(a)(4)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following: (4) The licensee shall assist residents with self-administered medications as needed. Based on record review R1 di not have Atrovent NFA Inhaler 2 puffs by mouth every 4 hours with spacer (routinely). This poses an immediate health and safety risk to residents in care.

Official plan of correction

Administrator will contact pharmacy for inhaler and send LPA picture once inhaler is received.

Deadline recorded: Jul 9, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

Maintenance and Operation. The facility shall be clean, safe, sanitary and in good repair at all times. This requirement is not met as evidenced by; LPA and Administrator observed ants, spiders and spider webs in residents room which pose/poses a health and safety hazard to people in care.

Official plan of correction

Administrator will do a deep clean and send LPA proof in form of pictures and write a statement that the ants and spiders have been addressed and no longer in resident's room or facility.

Deadline recorded: Oct 4, 2024. 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

87465 Incidental Medical and Dental Care (g) 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... This requirement is not met as evidence by: R1 had a fall on the September 24, 2024 and S1 did not call 911 until 3 days later. The resident was not given immediate medical attention for the injuries which poses/posed health and safety hazard to people in care.

Official plan of correction

Administrator will read section 87465(g) and send letter to LPA by POC date stating she understand section 87465(g) and what Administrator will do to prevent this from happening again. .

Deadline recorded: Oct 2, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87463(c)

Regulation authority

CCR

What the official deficiency says

(c) The licensee shall arrange a meeting with the resident, the resident's representative, if any, appropriate facility staff, and a representative of the resident's home health agency, if any, when there is significant change in the resident's condition, or once every 12 months, whichever occurs first, as specified in Section 87467, Resident Participation in Decision Making. 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 in (3) of (3) resident files reviewed had appraisails over a year old which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/03/2024 Plan of Correction Facility to update resident appraisals and provide LPA copies by POC due date.

Official classification

Type A

Official code

87468.1(a)(2)

Regulation authority

CCR

What the official deficiency says

Residents in all residential care facilities for the elderly shall have all of the following personal rights:To be accorded safe, healthful and comfortable accommodations, furnishings and equipment.This requirement was not met as evidenced by During the tour of the facilty, LPA observed a camera with audio in resident #2's room, which pose a personal rights violation to persons in care.

Official plan of correction

Administrator removed the camera from the resident #1 bedroom during visit. 02/02/24. Licensee/Administrator is to send a letter stating that Licensee will comply with section 87468.1 Personal Rights by not violating the residents privacy and send proof of service that your read this section by POC date 02/09/24.

Deadline recorded: Feb 2, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87411(c)(1)

Regulation authority

CCR

What the official deficiency says

(1) Staff providing care shall receive appropriate training in first aid from persons qualified by such agencies as the American Red Cross. 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 2 out of 5 staff members because 2 staff member's CPR/AED/First Aid Training certificates expired on 2/7/2023, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/07/2023 Plan of Correction Administrator will ensure that CPR/First Aid certificates for all staff members will be kept up-to-date at all times. Administrator is to provide LPA photogrpahic proof that the 2 staff members have updated the CPR/First Aid training by 9/7/2023.

Official classification

Type A

Official code

87202(a)

Regulation authority

CCR

What the official deficiency says

This requirement is not met as evidenced by: LPA observed a bed, microwave, toaster in the garage which Administrator stated is for use as a staff bedroom. Facility was unable to provide an approved fire clearance or permit to convert the garage into a bedroom. Deficient Practice Statement Based on observations, the licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/08/2022 Plan of Correction Licensee shall immediately remove the bed, unplug the microwave and toaster and stop the usage of the garage as a staff bedroom. Licensee shall provided proof to the department by the POC date.

Official classification

Type A

Official code

87303(e)(2)

Regulation authority

CCR

What the official deficiency says

This requirement is not met as evidenced by: Hot water temperature measured at 121.8 degrees F in bathroom #1. Deficient Practice Statement Based on observations, the licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/08/2022 Plan of Correction Licensee shall immediately adjust water temperature to measure within Title 22 guidelines and provided proof to the department by the POC date.

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 has not been met as evidence by: During the visit on 09/02/21 and 09/30/21 LPA observed bedroom #1 bedroom #4 to be in need of cleaning/organizing, the window seals in the bedroom windows to be dirty and in need of cleaning which poses a potential health and safety risk for the residents in care.

Official plan of correction

The Administrator shall have all of the items removed by poc date 10/30/21, and submit LIC 9098(proof of correction) to LPA Wesley via US mail or fax.

Deadline recorded: Oct 30, 2021. A deadline is not proof that correction was completed.