TLC GUEST HOME II

Official classification

Type B

Official code

87555(b)(5)

Regulation authority

CCR

What the official deficiency says

87555(b)(5) General Food Service Requirements (b) The following food service requirements shall apply: (5) Meals shall consist of an appropriate variety of foods and shall be planned with consideration for cultural and religious background and food habits of residents. This has not been met as evidenced by: Based on record reviews and interviews conducted the licensee did not ensure that an appropriate variety of foods has been provided to three (3) residents, #1, #2, & #4 which poses a potential health risk to residents in care

Official plan of correction

CDSS and S1 have agreed that the facility will update their meal plan, with input from residents in care; on, or before, the POC due date. Facility will email updates to LPA at MARIO.LEON@DSS.CA.GOV

Deadline recorded: May 12, 2026. 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:Resident #1 (R1) sustained a pressure injury on the right heel while residing at the facility. This violation poses an immediate health and safety risk to residents in care.

Official plan of correction

The licensee agrees to ensure that staff receive training on Observation of the Resident and will submit documentation verifying that staff have been re-trained by the Plan of Correction (POC) due date of 10/22/2025.

Deadline recorded: Oct 22, 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

(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 LPA observation, the licensee did not comply with the section cited above in one(1) out of one (1) facility in disrepair due to the wall being opened which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/15/2025 Plan of Correction LPA and STAFF ONE Rino Santos, house manager (S1), have agreed to have the walls repaired in order to improve the water temperature and water pressure quality on or prior to the POC due date. S1 will inform LPA, via email, at MARIO.LEON@DSS.CA.GOV

Official classification

Type B

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 LPA's measurement, the licensee did not comply with the section cited above in two (2) out of three (3) water sources being measured at a maximum temperature of 96.8°F which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/15/2025 Plan of Correction LPA and STAFF ONE Rino Santos, house manager (S1), have agreed to increase the water temperature and water pressure quality on or prior to the POC due date. S1 will inform LPA, via email, at MARIO.LEON@DSS.CA.GOV

Official classification

Type B

Official code

87555(b)(23)

Regulation authority

CCR

What the official deficiency says

(b) The following food service requirements shall apply: (23) All readily perishable foods or beverages capable of supporting rapid and progressive growth of micro-organisms which can cause food infections or food intoxications shall be stored in covered containers at appropriate temperatures. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA observation the licensee did not comply with the section cited above in one (1) out of one (1) lack of proper food storage which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/10/2025 Plan of Correction LPA and STAFF ONE Rino Santos, house manager (S1), have agreed to store food appropriately, in order to prevent progressive growth of micro-organisms to prevent residents from experiencing food intoxication.

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 is not met as evidenced by: Deficient Practice Statement Based on LPA observation, the licensee did not comply with the section cited above in having stove's left rear burner remaining in disrepair which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/12/2024 Plan of Correction LPA and House Manager have agreed that the broken stove left rear burner remaining in disrepair. Facility will send video/photo evidence to LPA, via email at Mario.Leon@DSS.CA.GOV, on or prior to the POC due date which is 08/12/2024.

Official classification

Type B

Official code

87303(c)

Regulation authority

CCR

What the official deficiency says

(c) All window screens shall be clean and maintained in good repair. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA's observation, the licensee did not comply with the section cited above in having screens in room #4 were observed to be in disrepair and the screen in bathroom #1 needing to be cleaned/sanitized. Furthermore, sections of the blinds in room #1 and room #4 were observed to be in disrepair which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/06/2024 Plan of Correction LPA and House Manager have agreed that the screen in room #4 will be replaced and screen in bathroom #1 will be cleaned/disinfected and that sections of the blinds in room #1 and room #4 will be replaced/repaired. Facility will send video/photo evidence to LPA, via email at Mario.Leon@DSS.CA.GOV, on or prior to the POC due date which is 08/06/2024.

Official classification

Type B

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 LPA observation, the licensee did not comply with the section cited above in LPA's observation of " Tilex " and what appeared to be " Fabuloso " underneath the sink in bathroom #2, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/01/2024 Plan of Correction Cleaning solutions were relocated, without LPA's observation, while LPA was on-site.

Official classification

Type B

Official code

87555(b)(27)

Regulation authority

CCR

What the official deficiency says

(b) The following food service requirements shall apply: (27) All kitchen areas shall be kept clean and free of litter, rodents, vermin and insects. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA's observation, the licensee did not comply with the section cited above in having numerous flies about the kitchen and dining room area of the facility which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/06/2024 Plan of Correction LPA and House Manager have agreed that the facility will install a screen across the door leading to the attached garage in order to keep out future insects. Facility will send video/photo evidence to LPA, via email at Mario.Leon@DSS.CA.GOV, on or prior to the POC due date which is 08/06/2024.

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. LPA identified hazardous items such as paint, decreaser, cleaning solutions accessible to residents with dementia. This violation poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/12/2023 Plan of Correction Licensee will adhere to Title 22 regulations 87309 and ensure to keep all hazardous material in locked storage. Proof of correction must be completed by POC 08/12/23. Citation cleared during visit.

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. Staff #1-#4 did not have current CPR/First Aid certificates. This violation which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/25/2023 Plan of Correction Licensee will adhere to HSC 1569.618 regulations and ensure that all staff are current with CPR/First Aid training. Proof of correction must be sent by POC date: 08/25/23.

Official classification

Type B

Official code

87555(b)(27)

Regulation authority

CCR

What the official deficiency says

(b) The following food service requirements shall apply: (27) All kitchen areas shall be kept clean and free of litter, rodents, vermin and 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.LPA identified residue of roaches in ktichen. This violation which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/25/2023 Plan of Correction Licensee will ensure to adhere to Title 22 87555 and ensure pest control service is completed in kitchen area. Proof of correction must be sent by POC due date: 08/25/23.

Official classification

Type B

Official code

1569.695(c)

Regulation authority

HSC

What the official deficiency says

(c) A facility shall conduct a drill at least quarterly for each shift. The type of emergency covered in a drill shall vary from quarter to quarter, taking into account different emergency scenarios. An actual evacuation of residents is not required during a drill. While a facility may provide an opportunity for residents to participate in a drill, it shall not require any resident participation. Documentation of the drills shall include the date, the type of emergency covered by the drill, and the names of staff participating in the drill. 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. The faciilty has not conducted emergency fire/earthquake drills. No record logs were available. This violation] which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/25/2023 Plan of Correction Licensee will ensure to adhere to HSC 1569.695 and ensure to conduct emergency drills for fire and earthquake in a quarterly basis. Proof of correction must be sent by POC due date: 08/25/23.

Official classification

Type B

Official code

87406(a)(g)

Regulation authority

CCR

What the official deficiency says

87406 Administrator Certification Requirements (a) All individuals shall be residential care facility for the elderly certificate holders prior to being employed as an administrator. (g) Certificates issued under this section shall be renewed every two (2) years provided the certificate holder has complied with all renewal requirements. 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. Administrator Certification for Muqeet Dadabhoy and Teresita Castaneda had expired certificates. This violation which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/25/2023 Plan of Correction Licensee will ensure to adhere to Title 22 87406 regulations and sent a renewal for CCLD Administrators Certification Program. Proof of correction must be sent by POC due date: 08/25/23.

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

87303 Maintenance and Operation (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. LPA identified exposed wiring in room #1 without electrical wall covering. Stove left rear burner and front middle burner not working as well as oven door. This violation which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/11/2023 Plan of Correction Licensee will ensure to adhere to Title 22 87303 and ensure the facilty is in good repair at all times. Stove burners and oven door must be repaired and an electrical wall cover must be placed to cover exposed wires. Proof of correction must be sent by POC due date: 09/11/23.