DREAM CARE HOME LLC

Official classification

Type B

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 as there was 1 out of 3 work shifts covered without a staff member who possessed a current CPR certification present. This poses a potential health and safety risk to 4 out of 4 residents in care.

Official plan of correction

POC Due Date: 12/12/2025 Plan of Correction Licensee will send proof to LPA Mallet via the CCLD Fax that either Administrator Mona Castro or Staff 3 (S3) has completed CPR training by POC Due date. Administrator completed online CPR course during visit. POC Cleared.

Official classification

Type B

Official code

87211(a)(1)(D)

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. (D) 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. This requirement was not met as evidence by: During conversation with LPAs Herrera and Mallett, and Administrator, it was confirmed that on both 8/26/25 and 9/15/25 they were informed of the possible death of R1, in addition the conversation with R1’s emergency contact stating that R1’s SSI funds had not been accessed which brought the concern of a possible death; LPA’s review of SIR’s received by facility and administrator not reporting these updates to the department as required, this poses a potential health and safety, or personal rights risk to persons in care.

Official plan of correction

LPA provided a copy of the LIC9098-Proof of Correction form to Administrator during visit and Administrator is to review the Reporting Requirement Regulations and administer an in-service training to all staff on Reporting Requirements. Once review of regulation and in-service training is completed Administrator is to send a copy of the completed and signed LIC9098 and a copy of the in-service training log with names of participants, their signatures and date of training to LPA by POC due date. (email address: tena.herrera@dss.ca.gov)

Deadline recorded: Oct 30, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87204(b)

Regulation authority

CCR

What the official deficiency says

Limitations - Capacity and Ambulatory Status.Resident rooms approved for 24-hour care of ambulatory residents only shall not accommodate nonambulatory residents. Residents whose condition becomes nonambulatory shall not remain in rooms restricted to ambulatory residents. This requirement was not met as evidence by: On 04/10/25 Lisa Hicks called and spoke to Mrs. Castro and 04/15/25 LPA's Wesley and Trueman went to the facilty and asked the Licensee's have they issued the 30 day notice, or tried to locate facilities for the resident to reside and they answered no.

Official plan of correction

The licensee is to remove the Resident from the facility ASAP, no later than 04/27/25, and give the resident their 30 day notice to vacate, or show proof that they have contacted facilities for the resident to move into by 04/15/25.

Deadline recorded: Apr 15, 2025. A deadline is not proof that correction was completed.

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 observations and record review , the licensee did not comply with the section cited above LPA received a copy of the facility liability insurance. LPA observed upon record review of medication resident #1 (R1) was missing Cough Syrup Liquid PRN (Take Five (5) ML By Oral Route Every 4 hours as Needed). Administrator Castro was unable to locate missing medication and stated a caregiver possibly disposed of medication which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/16/2024 Plan of Correction Administrator will esnure all residents medication is centrally stored and kept locked and safe. Administator shall order and replace missing medication immediately and provide proof to the department by POC Due Date.