ROSE VALLEY GARFIAS

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 due to kitchen cabinets doors observed with grease mildew, kitchen drawers have crumbs and other food particles, laundry area was observed cluttered with bedding and towels and laundry area cabinet door hinge broken. which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/22/2025 Plan of Correction Administrator will send photos of cleaned kitchen door cabinets, cleaned out kitchen drawers and repaired laundry area cabinet door by POC due date. Administrator will conduct monitoring of the facility's cleanliness daily for the next week and log it. The log will be sent to LPA

Official classification

Type B

Official code

87303(a)(1)

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. (1) Floor surfaces in bath, laundry and kitchen areas shall be maintained in a clean, sanitary, and odorless condition. 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 floor in laundry area was observed cluttered with bedding, towels and clothing, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/22/2025 Plan of Correction Administrator will send photos of decluttered laundry area by POC due date.

Official classification

Type B

Official code

87303(f)

Regulation authority

CCR

What the official deficiency says

(f) All waste shall be located, stored, and disposed of in a manner that will not transmit communicable diseases or odors, pose a risk to health and safety, or provide a breeding place or food source for insects or rodents. This requirement is not met as evidenced by: Deficient Practice Statement Based on, the licensee did not comply with the section cited above due to passageway by the garage was observed with discarded mobility equipment, broken furniture and paper waste/boxes, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/22/2025 Plan of Correction Administrator will order removal of all items and submit photo of cleaned area by POC due date.

Official classification

Type B

Official code

87307(d)(6)

Regulation authority

CCR

What the official deficiency says

(6) All outdoor and indoor passageways and stairways shall be kept free of obstruction. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above due to side passage way of garage being obstructed by debris like broken furniture, discarded mobility equiment and paper waste, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/22/2025 Plan of Correction Administrator will order removal of all items and submit photo of cleared passage way area by POC due date.

Official classification

Type B

Official code

87555(a)

Regulation authority

CCR

What the official deficiency says

(a) The total daily diet shall be of the quality and in the quantity necessary to meet the needs of the residents an 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. 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 one container of cottage cheese was observed with an expiration date of 12/2/2025, one ketchup and one mustard bottle observed with " best if used date " of 10/28/25 and 8/20/25, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/15/2025 Plan of Correction Items were removed from the cabinet and refirgerator and discarded at the time of visit.

Official classification

Type B

Official code

87555(b)(21)

Regulation authority

CCR

What the official deficiency says

General Food Service Requirements This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above due to: refrigerator temperature was observed at 52 degrees F. and refrigerator door did not close tightly which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/22/2025 Plan of Correction Administrator will send LPA, service invoice of the repairs on the refrigerator. Also, administrator will log the temperatures daily and send LPA photos of the log and thermostat until POC due date.

Official classification

Type B

Official code

87407(e)(1)

Regulation authority

CCR

What the official deficiency says

87407(e)(1) Administrator Recertification Requirements (e) To apply for recertification after the expiration date of the certificate, but within four (4) years of the certificate expiration date, the certificate holder shall submit to the Department’s Administrator Certification Section: (1) A completed Application for Administrator Certification form LIC 9214. 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 that Staff 1's facility file did not contain a current Administrator Certificate and certificate on file expired on 9/2025. Check on CCL application status did not have a pendding application for Staff 1, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/22/2025 Plan of Correction Administrator will send LPA, proof of submission of Administrator Certificate application by forms of certified mail receipt and a copy of the application by POC due date.

Official classification

Type B

Official code

87506(d)

Regulation authority

CCR

What the official deficiency says

87506(d) Resident Records. All resident records shall be available to the licensing agency to inspect, audit, and copy upon demand during normal business hours...... This requirement was not met by evidence of R1 records were not at facility when LPA requested them which poses a potential health, safety, or personal rights risk to persons in care.

Official plan of correction

Administrator agreed to send all of resident's records including care plan to LPA my POC date which is 07/02/2025

Deadline recorded: Jul 2, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(a)(5)

Regulation authority

CCR

What the official deficiency says

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:(5) The licensee shall assist residents with self-administered medications as needed. This requirement is not met as evidenced by: Deficient Practice Statement Resident #5 did not receive their medication (Amiodarone) from Jan. 06, 2024, to Jan 09 2024 because facility was not able to obtain refills from husband of R5

Official plan of correction

POC Due Date: 01/10/2024 Plan of Correction Licensee shall submit written plan on how this will be addressed and provide additional training to all staff responsible for medication assistance and provide proof to the department by the POC date. Licensee will obtain R5 medication by POC date and send proof to LPA by POC date.

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 and interview, the licensee did not comply with the section cited above in which the kitchen and four (4) bathrooms hot water readings were not within the required 105-120 deg F. which poses an immediate health, safety or personal rights risk to residentsin care. The hot water readings were: Kitchen 116.5 deg F, Bathroom #1 131.6 deg F, Bathroom #2 128.9 deg F, Bathroom #3 126.7 deg F and Bathroom #4 125.5 deg F which are not within the required 105 - 120 degrees.

Official plan of correction

POC Due Date: 12/05/2022 Plan of Correction Administrator will provide CCLD a hot water log temperature for seven (7) days, starting Mon., 12/05/2022. The log will show the daily readings and will be emailed to LPA Pena no later than 12/12/2022.

Official classification

Type A

Official code

87355(e)

Regulation authority

CCR

What the official deficiency says

(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: 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 which one (1) of the caregivers, Waldeck Pierre who was present in the facility during the visit is not associated to the facility which poses an immediate health, safety or personal rights risk to residents in care.

Official plan of correction

POC Due Date: 12/05/2022 Plan of Correction Administrator will associate the staff in question to the facility via Guardian and provide a copy of the association list as proof. This will be emailed to LPA Pena by the POC due 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 and interview the licensee did not comply with the section cited above in which the LPA was not able to review staff files due to the Licensee and staff do not have the key/access to the files which poses posed a potential health, safety or personal rights risk to residents in care.

Official plan of correction

POC Due Date: 12/09/2022 Plan of Correction Administrator will ensure that all staff records shall be available for licensing agency to inspect and the administrator will come up with a plan and send the plan to LPA by POC due date.

Official classification

Type A

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 5 out of 5 residetns which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/31/2022 Plan of Correction Administrator brought the 5 resident files at time of inspection.

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 and interview with Administrator the licensee did not comply with the section cited above in 7 of 7 persons which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/01/2022 Plan of Correction Administrator will bring personnel files over to facility and self certify that files are at facility.

Official classification

Type A

Official code

80019(e)

Regulation authority

CCR

What the official deficiency says

This requirement is not met as evidenced by: LPA Lopez observed 2 staff Ana Gasper, Giovani Escamilla working at facility and not associated to facility. Also, Giovani has to have exemption with facility in order to work at facility. Deficient Practice Statement Criminal Record Clearance-per section cited, all employees must be associated to the facility. Based on observation, interview, the licensee did not comply with the section cited above in 2 out of 2 persons which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/01/2022 Plan of Correction Administrator associated both staff during inspection. Administrator will contact Sacramento in order to get the exemption to work at this home. All staff shall be properly associated to facility. Criminal Record Transfer Request-and Photo I.D. must be sent for all previous cleared individual staff and a copy kept on file for validation that request was sent.