Hazardous items and storageType A
- 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, the licensee did not comply with the section cited above in 1 out of 1 accessible storage unit unlocked containing multiple cans of paint and toxins which poses an immediate health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 09/30/2025 Plan of Correction The Licensee will email LPA Segovia a photo of the storage unit with a lock on it.
Licensing and administrationType A
- 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 observation, interview, record review, the licensee did not comply with the section cited above in Staff 1 the only staff member present upon LPA’s initial arrival (8-26-25) did not have proof of First-Aid/CPR training which poses an immediate health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 09/30/2025 Plan of Correction The Licensee will email LPA Segovia S1's current First-Aid/CPR training.
Health conditions and treatmentsType A
- Official classification
- Type A
- Official code
- 87633(b)(4)
- Regulation authority
- CCR
What the official deficiency says
(b) A current and complete hospice care plan shall be maintained in the facility for each hospice resident and include the following: (4) A description of the licensee's area of responsibility for implementing the plan including, but not limited to, facility staff duties; record keeping; and communication with the hospice agency, resident's physician, and the resident's responsible person(s), if any. This description shall include the type and frequency of the tasks to be performed by the facility. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview and record review, the licensee did not comply with the section cited above in 2 out of 2 residents did not have their current and complete hospice care plan which poses an immediate health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 09/30/2025 Plan of Correction The Licensee will review the entire regualtion and email LPA Segovia a statement of understanding.
Records and plan of operationType B
- 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, interview and record review, the licensee did not comply with the section cited above in 3 out of 4 residents missing needs/service and have been in the facility for longer than 2 weeks. Found under Needs and Service Plan located within the plan of operation/program. which poses/posed a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 10/13/2025 Plan of Correction The Licensee will email LPA Segovia the needs/services plans for all 3 residents.
Facility condition and maintenanceType B
- 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, the licensee did not comply with the section cited above in the shaded area located in the backyard not to be clean and safe. LPA observed debris and the chairs not to be in proper condition which poses/posed a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 10/13/2025 Plan of Correction The Licensee will email LPA Segovia a photo of the backyard showcasing the area to be clean and safe for residents.
Hazardous items and storageType B
- Official classification
- Type B
- Official code
- 87309(b)
- Regulation authority
- CCR
What the official deficiency says
(b) Residents may have access to items specified in subsection (a) for personal use unless there is documentation, as specified in Section 87457, Pre-Admission Appraisal or Section 87463, Reappraisals, that indicates the resident's or other residents’ safety would be at risk if allowed access. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview and record review, the licensee did not comply with the section cited above in 1 of 4 residents cannot have access to personal hygiene items documented on their Physcian's order which poses/posed a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 10/13/2025 Plan of Correction The Licensee will review the regulation and email LPA Segovia a statement of understanding, Additionally the Licensee will ensure the personal hygienes made available in the hallway's passageway will be stored and inaccessible to the resident.
Staffing, personnel, and trainingType B
- Official classification
- Type B
- Official code
- 87412(a)
- 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: This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview and record review, the licensee did not comply with the section cited above in S1's file not maintained and/or current which poses/posed a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 10/13/2025 Plan of Correction The Licensee will review the regulation and email a statement of understanding listing the required documentation that must be mantained for staff records.
Staffing, personnel, and trainingType B
- Official classification
- Type B
- Official code
- 87412(d)
- Regulation authority
- CCR
What the official deficiency says
(d) The licensee shall maintain documentation that an administrator has met the certification requirements specified in Section 87406, Administrator Certification Requirements or the recertification requirements in Section 87407, Administrator Recertification Requirements. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview and record review, the licensee did not comply with the section cited above in the Administrator’s certificate expired on 7/05/2024 which poses/posed a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 10/13/2025 Plan of Correction The Licensee will email LPA Segovia their renewal of their Administrator certificate.
Fire safety and emergency preparednessType B
- Official classification
- Type B
- Official code
- 1569.69(a)(2)
- Regulation authority
- HSC
What the official deficiency says
(a) Each residential care facility for the elderly licensed under this chapter shall ensure that each employee of the facility who assists residents with the self-administration of medications meets all of the following training requirements: (2) In facilities licensed to provide care for 15 or fewer persons, the employee shall complete 10 hours of initial training. This training shall consist of 6 hours of hands-on shadowing training, which shall be completed prior to assisting with the self-administration of medications, and 4 hours of other training or instruction, as described in subdivision (f), which shall be completed within the first two weeks of employment. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview and record review, the licensee did not comply with the section cited above in S1 did not have any documentated training and stated they help residents with their medication and ADLs which poses/posed a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 10/13/2025 Plan of Correction The Licensee will review the regulation and email LPA Segovia a statement of understanding.
Medical and dental careType B
- Official classification
- Type B
- Official code
- 87465(a)(8)(A)
- Regulation authority
- CCR
What the official deficiency says
(8) If a facility has no medical unit on the grounds, a complete first aid kit shall be maintained and be readily available in a specific location in the facility. The kit shall be a general type approved by the American Red Cross, or shall contain at least the following: (A) A current edition of a first aid manual approved by the American Red Cross, the American Medical Association or a state or federal health agency. 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 LPA observed the First-Aid Manuel to be missing which poses/posed a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 10/13/2025 Plan of Correction The Licensee will email LPA Segovia the confiirmation of purchase of the First-Aid Manuel.
Admission, assessment, and evictionType B
- 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 observation, interview and record review, the licensee did not comply with the section cited above in 2 out of 2 residents were missing their pre-appraisal which poses/posed a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 10/13/2025 Plan of Correction The Licensee will email LPA Segovia the pre-appraisal for both (2) residents.
Health conditions and treatmentsType B
- Official classification
- Type B
- Official code
- 87608(a)(3)
- Regulation authority
- CCR
What the official deficiency says
(a) Based on the individual's preadmission appraisal, and subsequent changes to that appraisal, the facility shall provide assistance and care for the resident in those activities of daily living which the resident is unable to do for himself/herself. Postural supports may be used under the following conditions: (3) A written order from a physician indicating the need for the postural support shall be maintained in the resident's record. The licensing agency shall be authorized to require other additional documentation if needed to verify the order. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview and record review, the licensee did not comply with the section cited above in 1 of 1 resident who has full bed rails does not have a written order for postural support which poses/posed a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 10/13/2025 Plan of Correction The Licensee will email LPA Segovia the physician's order for resident's full bedrail.
Dementia careType B
- Official classification
- Type B
- Official code
- 87705(b)(1)(A)
- Regulation authority
- CCR
What the official deficiency says
(b) Licensees shall be responsible for the following: (1) Ensuring staff receive the following training as part of the training requirements specified in Section 87208 Plan of Operation: (A) Dementia care, including, but not limited to, knowledge about hydration, nutrition, skin care, communication, therapeutic activities, behavioral challenges, the environment, and assisting with activities of daily living; This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview and record review, the licensee did not comply with the section cited above in S1 did not have dementia training and was the only staff present with all residents which poses/posed a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 10/13/2025 Plan of Correction The Licensee will email LPA Segovia S1's proof of dementia training.
Dementia careType B
- Official classification
- Type B
- Official code
- 87705(b)(2)
- Regulation authority
- CCR
What the official deficiency says
(b) Licensees shall be responsible for the following: (2)For facilities with fewer than 16 residents, ensuring there is at least one night staff person awake and on duty if any resident with dementia is determined through a pre-admission appraisal, reappraisal, or observation, to require awake night supervision. This requirement is in addition to requirements specified in Section 87415, Night Supervision. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview and record review, the licensee did not comply with the section cited above in 2 out of 4 residents require awake staff through physician's report indicating " elopment " and " wandering " for each resident, additionally LPA observed one of the resident's to leave the facility without staff being aware which poses/posed a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 10/13/2025 Plan of Correction The Licensee will email LPA Segovia an updated LIC 500 with staff schedule showcasing hours to ensure care for residents are provided day and night.