GOLDEN CARE LIVING, INC.

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 observation and record review, the licensee did not comply with the section cited above in not having a CPR card on file from a care staff which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/31/2024 Plan of Correction Licensee will ensure all care staff have valid CPR cards on file. As POC, licensee will submitt missing CPR card to LPA via email before POC due date.

Official classification

Type B

Official code

80087(a)(1)

Regulation authority

CCR

What the official deficiency says

Buildings and Grounds (a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors. (1) The licensee shall take measures to keep the facility free of flies and other 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 in having fruit flies in the kitchen area which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/31/2024 Plan of Correction Licensee will ensure facility wii be free of flies at all times. As part of POC, licensee will show exterminator services. Proof of correction will be sent to LPA before POC due date.

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 having unlocked cleaning solutions on bathrrom sink and kitchen which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/18/2024 Plan of Correction Staff locked cleaning solutions while LPA was present. Licensee will ensure all cleaning solutions are locked at all times. As POC, licensee will re-train staff regarding keeping cleaning solutions locked at all times. Licensee will submitt training proof to LPA via email before POC due date.

Official classification

Type B

Official code

87411(f)

Regulation authority

CCR

What the official deficiency says

(f) All personnel, including the licensee and administrator, shall be in good health, and physically and mentally capable of performing assigned tasks. Good physical health shall be verified by a health screening, including a chest x-ray or an intradermal test, performed by a physician not more than six (6) months prior to or seven (7) days after employment or licensure. A report shall be made of each screening, signed by the examining physician. The report shall indicate whether the person is physically qualified to perform the duties to be assigned, and whether he/she has any health condition that would create a hazard to him/herself, other staff members or residents. A signed statement shall be obtained from each volunteer affirming that he/she is in good health.Personnel with evidence of physical illness or emotional instability that poses a significant threat to the well-being of residents shall be relieved of their duties. 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 in not having a TB test on file for one of the caregivers which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/31/2024 Plan of Correction Licensee will ensure all care staff have a TB test on file. As POC, licensee will submitt proof of correction to LPA via email before POC due date.

Official classification

Type B

Official code

87204(a)

Regulation authority

CCR

What the official deficiency says

(a) A licensee shall not operate a facility beyond the conditions and limitations specified on the license, including specification of the maximum number of persons who may receive services at any one time. An exception may be made in the case of catastrophic emergency when the licensing agency may make temporary exceptions to the approved capacity. 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 in having an extra hospice resident at the facility which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/26/2024 Plan of Correction Licensee will ensure not to exceed limit of hospice waiver. As POC, licensee will submit an increased of hopsice waiver to CCLD before POC due date.

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 observation record review, the licensee did not comply with the section cited above in not having a health screening for a care staff which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/31/2024 Plan of Correction Licensee will ensure all care staff has a health screening on file at all times. As POC, licensee will submitt proof of correction to LPA via email before POC due date.

Official classification

Type B

Official code

87468(b)(1)(A)

Regulation authority

CCR

What the official deficiency says

(b) At the time the admission agreement is signed, a resident and the resident's representative shall be personally advised of and given a copy of: (1) The personal rights of residents specified in Sections 87468.1, Personal Rights of Residents in All Facilities and 87468.2, Additional Personal Rights of Residents in Privately Operated Facilities, as applicable to the facility. (A) The licensee shall have each resident and the resident's representative sign a copy of these rights, and the signed copy shall be included in the resident's record. 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 in not having personal rights completed for one of the residents which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/31/2024 Plan of Correction Licensee will ensure all residents have personal rights completed in their files. As POC, licensee will submitt completed form to LPA via email before POC due date.

Official classification

Type B

Official code

87506(b)(16)

Regulation authority

CCR

What the official deficiency says

(b) Each resident's record shall contain at least the following information: (16) Records of resident's cash resources as specified in Section 87217, Safeguards for Resident Cash, Personal Property, and Valuables. 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 in not having a SPV form completed for one of the residents which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/31/2024 Plan of Correction Licensee will ensure all SPV forms are completed for residents. As part of POC, licensee will submit the completed form to LPA before POC due date via email.

Official classification

Type B

Official code

87457(c)

Regulation authority

CCR

What the official deficiency says

(c) Prior to admission a determination of the prospective resident's suitability for admission shall be completed and shall include an appraisal of his/her individual service needs in comparison with the admission criteria specified in Section 87455, Acceptance and Retention Limitations. 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 in not having Appraisal & Needs Services Plan completed for 2 residnets which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/31/2024 Plan of Correction Licensee will ensure all residents files have an Appraisal & Needs Services Plan completed. As part of POC, licensee will submitt completed plans to LPA via email before POC due date.

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 observation and record review, the licensee did not comply with the section cited above in not having an active TB test on file for one of the residents which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/31/2024 Plan of Correction Licensee will ensure all residents have a TB test on file. As part of POC, licensee will submitt resident's TB to LPA via email before POC due date.

Official classification

Type B

Official code

80072(a)(2)

Regulation authority

CCR

What the official deficiency says

80072 Personal Rights (a) Except for children’s residential facilities, each client shall have personal rights...(2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs.This requirement was not met as evidence by: Licensee did not ensure that resident room was clean and free of odor.This poses an immediate health and safety risk to all residents in care.

Official plan of correction

Licensee will confirm staff cleans residents room and controls the odor for room. Licensee will confirm resident room free of odor by 12/22/2023

Deadline recorded: Dec 22, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

80072(e)(3)

Regulation authority

CCR

What the official deficiency says

80072 Personal Rights (a) Except for children’s residential facilities, each client shall have personal rights...(2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs.This requirement was not met as evidence by: LIcensee did not change the bed and sheets This poses an immediate health and safety risk to all residents in care. This requirement was not met as evidence by:

Official plan of correction

Licensee will make sure that resident mattress is replaced and a plastic sheet is put on bed to control resident urine.

Deadline recorded: Dec 22, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

80069.2(a)(1)

Regulation authority

CCR

What the official deficiency says

80069.2 Functional Capabilites Assessment (a) In order to determine whether the facility's program meets a client's services needs,(A) Does not bathe or shower self. This requirement was not met as evidence by: LIcensee did not ensure resident took a shower. This poses an immediate health and safety risk to all residents in care.

Official plan of correction

Licensee will ensure resident take a show and keep shower log notes and show LPA proof of shower logs bu POC date

Deadline recorded: Dec 22, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

80061(b)(1)(e)

Regulation authority

CCR

What the official deficiency says

80061 Reporting Requirements (b) Upon the occurrence, during the operation of the facility, (1) Events reported shall include the following:(E) Any unusual incident or client absence which threatens the physical or emotional health or safety of any client.This requirement was not met as evidence by: Licensee did not generate incident reports for resident refusal to shower, clean resident room or change the bed sheets. This poses an immediate health and safety risk to all

Official plan of correction

Licensee shall keep detailed records and incident repots for resodent care.

Deadline recorded: Dec 22, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.1(a)(2)

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: (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This requirement is not met as evidenced by: Resident #1 was not accorded a comfortable accomdations and did not have access to to personal clothing items. This violation is a potential risks to resident in care.

Official plan of correction

Licensee & Administrator shall read Title 22, Section 87468.1 and send a written statement to CCLD by the POC date that they will ensure that all residents in care are provided Personal Rights. A plan to address the behavior without violating the resident's rights. POC is due to the CCLD/El Segundo ASC Office by the POC date of 03/27/23,.

Deadline recorded: Mar 27, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87307(E)

Regulation authority

CCR

What the official deficiency says

87307 Personal Accommodations and Services (E) Portable or permanent closets and drawer space in the bedrooms for clothing and personal belongings. A minimum of eight (8) cubic feet (.743 cubic meters) of drawer space per resident shall be provided. This requirement is not met as evidenced by: Resident #1 was not accorded a comfortable accomdations and did not have a closet space as required by Title 22 Sec 87307. This violation is a potential risks to resident in care.

Official plan of correction

Licensee & Administrator shall read Title 22, Section 87307 and send a written statement to CCLD by the POC date that they will ensure that all residents in care are provided a comfortable enviroment. A plan to address the missing closet space. POC is due to the CCLD/El Segundo ASC Office by the POC date of 03/27/23,.

Deadline recorded: Mar 27, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87615(a)(1)

Regulation authority

CCR

What the official deficiency says

Section 87615(a)(1) Prohibited Health Conditions: Persons who require health services or have a health condition including... shall not be... retained in a... care facililty sores (dermal ulcers). This requirement is not met as evidenced by: Resident #1 was diagnosed with Unstageable and Stage 3 dermal ulcers on 08/21/22 and Administrator retained Resident #1 at the facility following Resident #1’s discharge from the hospital on 08/24/22 with “Unstageable” and “Stage III” wounds. This violation poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

Licensee/Administrator shall read Title 22, Section " Prohibited Health Conditions " ...send a written statement to CCLD that they will ensure to stay in constant communication with medical professional(s) and if the resident's medical condition elevates; meaning they require a higher level of care, they will ensure the resident is relocated to a skilled-nursing facility (SNF) or hospital... Civil penalties are assessed in the amount of Five-hundred Dollars ($500) for retaining Resident #1 with a prohibited health condition. This plan is due to CCLD/El Segundo ASC Office by POC date of 02/12/23.

Deadline recorded: Feb 12, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87466

Regulation authority

CCR

What the official deficiency says

87466 Observation of the Resident: The licensee shall ensure that residents are regularly observed for changes in physical, mental, emotional, and social functioning and that appropriate assistance is provided when such observation reveals unmet needs... This requirement is not met as evidenced by: Home Health Agency skilled nurse was aware that Resident #1 was not being repositioned overnight because there was no nighttime caregiver available to do so and recommended Resident #1 to a higher level of care. This violation poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

Licensee/Administrator shall read Title 22, Section 87466 “Observation of the Resident” and send a written statement to CCLD that you have read and understand this section. This plan is due to CCLD/El Segundo ASC Office by POC date of 02/12/23.

Deadline recorded: Feb 12, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87405(a)

Regulation authority

CCR

What the official deficiency says

Section 87405(a)–(c) Administrator - Qualifications and Duties:(a) All Facilities shall have a qualified and currently certified administrator...The administrator shall have sufficient freedom from other responsibilities and shall be on the premises a sufficient number of hours... to permit adequate attention to the management and administration of the facility as specified in this...have qualifications adequate to be responsible and accountable for management and administration... (b) The administrator of a facility or facilities shall have the responsibility and authority to carry out the policies of the licensee. (c) Failure to comply with all licensing requirements... may constitute cause for revocation of the license of the facility. This requirement is not met as evidenced by: Resident #1 was transported to the hospital on 08/21/21 and hospital staff noted Stage II pressure injury to their right hip. By November 2020, Resident #1’s right hip developed from a Stage II to Unstageable/Stage III. This violation poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Licensee/Administrator shall read Title 22, Section 87405(a)–(c) “Administrator - Qualifications and Duties” and send a written statement to CCLD that you have read and understand this section. This plan is due to CCLD/El Segundo ASC Office by POC date of 02/27/23

Deadline recorded: Feb 27, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87609(C)

Regulation authority

CCR

What the official deficiency says

87609(c) Allowable Health Conditions and the Use of Home Health Agencies: (c) The use of home health agencies to care for a resident’s medical condition(s) does not expand the scope of care and supervision that the licensee is required to provide. This requirement is not met as evidenced by: Home Health Agency skilled nurse provided training to facility staff on how to turn and reposition resident every two (2) hours; of which, facility staff failed to turn and reposition Resident #1 every two (2) hours over night. This violation poses an immediatel health, safety or personal rights risk to persons in care.

Official plan of correction

Licensee/Administrator shall read Title 22, Section 87609(c) " Allowable Health Conditions " and send a written statement to CCLD that licensee and home health agency agree (in writing) on the responsibilities of the home health agency and those of the licensee in caring for the resident’s medical condition. This plan due to CCLD/El Segundo ASC Office by POC date of 02/12/23.

Deadline recorded: Feb 12, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87411(a)

Regulation authority

CCR

What the official deficiency says

Section 87411(a) Personnel Requirements – General: (a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. In facilities licensed for sixteen or more, sufficient support staff... ensure provision of ...care as required in Section 87608, Postural Supports. This requirement is not met as evidenced by: There is no overnight staff to assist residents with personal hygiene (incontinence care) needs. This violation poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Licensee/Administrator shall read Title 22, Section 87411(a) “Personnel Requirements – General” and send a written statement to CCLD that licensee has read and understands that facility personnel shall at all times be sufficient in numbers and competent to provide the services necessary to meet resident’s needs. This plan due to CCLD/El Segundo ASC Office by POC date of 02/27/23.

Deadline recorded: Feb 27, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87309(a)

Regulation authority

CCR

What the official deficiency says

Storage Space 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 was not met as evidenced by: Based on observation, at 11:33am LPA Cifuentes observed kinfe in container on kitchen counter and at 11:38am, 11:46am and 11:50am LPA Cifuentes observed toxins in two of the bathrooms and R1's room. This is an immediate health and safety hazard for residents in care.

Official plan of correction

Administrator will store toxins an knives in a locked area inaccesible to clients and will review regulation 87309 with staff. POC will be submitted to CCLD via fax by POC due date.

Deadline recorded: Jul 29, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87309(a)(1)

Regulation authority

CCR

What the official deficiency says

Storage Space Storage areas for poisons, and firearms and other dangerous weapons shall be locked. This requirement is not met as evidenced by: Based on observation, 11:33 LPA observed unlocked drawer in the kitchen where knives are stored. At 12:02pm LPA observed lock to closet were toxins are stored was not locked. This is an immediate health and safety hazard for residents in care.

Official plan of correction

Adminstrator will lock all storage areas containing knives, toxins/poisons. POC will be submitted to CCLD via fax by POC due date.

Deadline recorded: Jul 29, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87458(a)

Regulation authority

CCR

What the official deficiency says

Medical Assessment 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... This requirement is not met as evidenced by: Based on observation, At 10:20am LPA Cifuentes noted that Physician's Report for Resident 1 (R1) is not signed by a physician. This is a potentail health and safety risk to residents in care.

Official plan of correction

Adminsitrator will obtain a Physician's report for R1 and review with staff regulaition section 87458 and write a statement confirming they have read and understood regulation. Facility will submit POC to CCLD via fax by POC due date.

Deadline recorded: Aug 18, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87458(b)(1)

Regulation authority

CCR

What the official deficiency says

Medical Assessment 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...which would preclude care of the person by the facility. This requirement is not met as evidenced by: Based on observation, At 10:18am LPA Cifuentes observed that R1and R2 do not have a TB test. This is a potential heath and safety risk to residents in care.

Official plan of correction

Adminsitrator will obtain TB tests for R1 and R2 and send POC to CCLD by POC due date.

Deadline recorded: Aug 18, 2022. 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. 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: Based on observation, at 11:18am LPA Cifuentes noted an assortment of empty boxes, boards and electrical parts around perimeter of facility. At 11:26am and 11:58am LPA noted that lights in bathroom 1 and 2 are in disrepair. At 11:30am LPA Cifuentes observed pests in facility kitchen. This is a potential health and safety risk for the clients in care.

Official plan of correction

Administrator will fix lights and make and implement a plan for pest control involving a pest control companh and send proof of correction to CCLD via fax by POC due date.

Deadline recorded: Aug 18, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87608(a)

Regulation authority

CCR

What the official deficiency says

Postural Supports 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: Based on observation, At 11:42 am and 11:44am LPA Cifuentes observed half-bed rails in bedrooms of R1, resident 2(R2) and resident 3 (R3) and a lap belt on R3 and no physicians order was found in residents files.

Official plan of correction

Administrator will remove rails from beds and lap belt from resident until a physicians order is obtained and plan of correction is submitted to CCLD via fax by POC due date.

Deadline recorded: Aug 18, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87507(a)

Regulation authority

CCR

What the official deficiency says

Resident Records 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: Based on observation, at 11:56am LPA Cifuentes noted medication administration record was not marked for resident R3 from dates of 7/22/2022 until 7/28/2022.

Official plan of correction

Administrator will review medication adminstration practices with staff and submit a sign in sheet and summary of topics covered to CCLD via fax by POC due date.

Deadline recorded: Aug 18, 2022. A deadline is not proof that correction was completed.