LEO'S ASSISTED LIVING II

Official classification

Type A

Official code

1569.10

Regulation authority

HSC

What the official deficiency says

1569.10 RCFE; license or permit; necessity No person, firm, partnership, association, or corporation within the state.....without a current valid license or current valid special permit... This requirement is not met as evidenced by: Based on interviews conducted, LPAs were informed that R1, R2, R3, were receiving elements of care and supervision, which posed an immediate health and safety risk or personal rights risk to residents in care.

Official plan of correction

Operator will submit an application to CCL by the POC due date of 8/22/2025.

Deadline recorded: Aug 22, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87355(c)(1)

Regulation authority

CCR

What the official deficiency says

87355 Criminal Record Clearance (c) A licensee... may... transfer of a criminal record clearance... by providing... (1) A signed Criminal Background Clearance Transfer Request, LIC 9182 This requirement was not met as evidenced by: Based on interview and record review, the licensee did not comply with the section cited above by not submitting the LIC 9182 for Staff #1 (S1) which poses an immediate Health, Safety, or Personal Rights risk to persons in care.

Official plan of correction

Licensee to submit S1's LIC 9182 to the Woodland Hills Regional Office by tomorrow, 06/20/25 in order to associate S1 to the facility.

Deadline recorded: Jun 20, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87412(g)

Regulation authority

CCR

What the official deficiency says

87412 Personnel Records (g) All personnel records shall be maintained at the facility and shall be available to the licensing agency for review. This requirement was not met as evidenced by: Based on interview and record review, the licensee did not comply with the section cited above by not producing recent staff trainings for audit which poses a potential Health, Safety, or Personal Rights risk to persons in care.

Official plan of correction

Licensee to email proof of staff training certificates to the Department and make copies available within the facilty by POC due date.

Deadline recorded: Jul 4, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87458(c)(1)

Regulation authority

CCR

What the official deficiency says

87458 Medical Assessment (c) The medical assessment shall include, but not be limited to: (1) A physical examination of the resident indicating the licensed medical professional's diagnosis or diagnoses. Based on interview and record review, the licensee did not comply with the section cited above by not ensuring the diagnoses of Resident #1 (R1) were listed in their medical assessment which poses a potential Health, Safety, or Personal Rights risk to persons in care.

Official plan of correction

Licensee to obtain an updated physican report and submit updates by the POC due date.

Deadline recorded: Jul 4, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87411(d)(3)

Regulation authority

CCR

What the official deficiency says

87411-Personnel Requirements - General-(d):experience shall provide knowledge of and skill in the following, as appropriate for the job....effective job performance.. Skill and knowledge required to...supervision,. This requirement is not met as evidenced by: Based on LPA interview with staff, the administrator did not have staff available to communicate with residents and emergency personnel effectively which poses a potential risk to the residents in care.

Official plan of correction

Administrator/Licensee agrees to put in writing their plan for hiring or ensuring English Speaking staff are always on shift and submit the plan by the POC date. Additionally, Administrator shall submit an updated LIC500 to reflect all staff.

Deadline recorded: Oct 28, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87608(a)(5)(A)

Regulation authority

CCR

What the official deficiency says

87608(a)(5)(A). (a) ... Postural supports may be used under the following conditions.(5)Under no circumstances shall postural supports include tying, depriving, or limiting the use of a resident's hands or feet. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation during physical plant tour at 11:25 AM, one (1) out of four (4) residient was observed to have a bed rail in bed and there is no physician's order on file which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/14/2024 Plan of Correction Administrator agreed to remove half size bed rails. POC cleared during the visit. Administrator agreed to review the section and e-mail LPA verifying it.

Official classification

Type B

Official code

87458(a)

Regulation authority

CCR

What the official deficiency says

87458 Medical Assessment (a) 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. The licensee shall be permitted to use the form LIC 602 (Rev. 9/89), Physician's Report, to obtain the medical assessment. 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 (2) out of (4) residents did not have a physician's report on file which poses a potential health and safety risk to persons in care.which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/20/2024 Plan of Correction The Administrator shall submit a current physician's report for Resident # 1 and Residient # 3 to LPA by the 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 record review, the licensee did not comply with the section cited above in (1) out of (4) physical assessment/TB test which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/20/2024 Plan of Correction Physical assessment needs to done with TB test.

Official classification

Type B

Official code

87211(a)(1)

Regulation authority

CCR

What the official deficiency says

(a) Each licensee shall furnish to the licensing agency such reports... (1) A written report shall be submitted to the licensing agency and to the person... ... any of the events specified in (A), (B) & (D)... This requirement is not met as evidenced by: Deficient Practice Statement Based on interviews and record reviews, conducted by LPA, the licensee did not comply with the section cited above by failing to notify CCLD regarding R4's hospitalization on or before 12/23/2024, which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 08/20/2024 Plan of Correction Licensee shall ensure a written report is submitted to the licensing agency and to the person responsible for the resident within seven (7) days of the occurrence of any of the events. Licensee provided incident report during the visit POC cleared during the visit.

Official classification

Type A

Official code

87465(c)(2)

Regulation authority

CCR

What the official deficiency says

87465- Incidental Medical and Dental Care: c) If the resident's physician has stated in writing... 2) Once ordered by the physician the medication is given according to the physician's directions. 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 not assuring that R1's prescibed medications were given as prescribed, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/18/2024 Plan of Correction Administrator agreed to schedule vendorized training for all staff by 03/18/2024 and submit to CCL the vendor information and scheduled date of training. Training certifications to be submitted to CCL upon completion. Administrator also agreed to notify doctor and submit LIC 624 to CCL regarding the incident.

Official classification

Type A

Official code

87355(e)(2)

Regulation authority

CCR

What the official deficiency says

All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working... in a licensed facility: (2)Request a transfer of a criminal record clearance as specified in Section 87355(c)... This requirement is not met as evidence by:Based on interviews and review of the personnel file one staff(S3) is not associated to the facility. This poses a potential risk to residents in care.

Official plan of correction

Admnistrator agreed to transfer Staff 3(S3) and assosiate them to the facility.

Deadline recorded: Oct 20, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87355(e)(1)

Regulation authority

CCR

What the official deficiency says

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: (1) Obtain a California clearance or a criminal record exemption as required by the Department This requirement is not met as evidence by:Based on interviews and review of the personnel file one staff(S2) is not background cleared to the facility. This poses a potential risk to residents in care.

Official plan of correction

Administrator will remove S2 immedatley and will not allow them to return until they obtain background clearance and assosition to the facility. Administrator will sumbit all documents to LPA when complete.

Deadline recorded: Oct 20, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87211(a)(1)

Regulation authority

CCR

What the official deficiency says

Requirements (a) Each licensee shall furnish to the licensing agency such reports... (1) A written report shall be submitted to the licensing agency and to the person... ... any of the events specified in (A), (B) & (D)... This requirement is not met as evidenced by: Based on interviews and record reviews, conducted by LPA, the licensee did not comply with the section cited above by failing to notify CCLD regarding the five (5) incidents that occured on 10/3/23 and 10/6/23 which poses a potential health and safety risk to persons in care.

Official plan of correction

Licensee shall ensure a written report is submitted to the licensing agency and to the person responsible for the resident within seven (7) days of the occurrence of any of the events. Copies of 2 incidents, shall be submitted to LPA by POC date.

Deadline recorded: Oct 25, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87506(a)

Regulation authority

CCR

What the official deficiency says

87506 Resident Records: (a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility... This requirement is not met as evidenced by: Based on record review, the licensee did not comply with the section cited above. Resident records were incomplete and or missing documents, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Administrator will sumbit a written explanation on how to manage residents files for future addmissions.

Deadline recorded: Oct 25, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87355(e)(2)

Regulation authority

CCR

What the official deficiency says

All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working... in a licensed facility: (2)Request a transfer of a criminal record clearance as specified in Section 87355(c)... This requirement is not met as evidence by: Based on interview and review of licensing report summary facility Designee is not associated to the facility. No documentation to associate staff/designee has not been submitted. This poses a potential risk to residents in care.

Official plan of correction

The facility designee has agreed to provide the LPA with copies of documentation to associate to the facility. Today LPM collected documentation for staff 1. Staff #2 documentation is needed. Submit transfer form and clear copy of ID.

Deadline recorded: Jul 28, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

1569.605

Regulation authority

CCR

What the official deficiency says

§1569.605 Liability insurance; coverage requirements On and after July 1, 2015... This requirement is not met as evidence by: Based on records reviewed, and interview with the administrator facility does not have current liability insurance coverage.

Official plan of correction

Licensee will review the health and safety code, obtain liability insurance as required by the health and safety code. Copy of the current liability insurance certificate will need to be submitted as POC.

Deadline recorded: Jul 28, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87631(a)(1)

Regulation authority

CCR

What the official deficiency says

Except as specified in Section 87611(a), the licensee shall be permitted to accept or retain a resident who has a healing wound under the following circumstances: (1) When care is performed by or under the supervision of an appropriately skilled professional. This requirement is not met as evidence by: Based on interview staff are providing wound care and staff are not appropriate skilled wound care professionals. This poses a potential risk to residents in care.

Official plan of correction

Administrator has agreed to have hospice document that staff has been trained on certain wound care issues. Need to obtain complete hospice care plan outling the stage of the wound. The resident reappraisal and needs and service needs to reflect the resident wounds and how staff can assist.

Deadline recorded: Aug 3, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87631(a)(3)(B)

Regulation authority

CCR

What the official deficiency says

Except as specified in Section 87611(a), the licensee shall be permitted to accept or retain a resident who has a healing wound..(3)... pressure injury must have the condition diagnosed by a physician or an appropriately skilled professional. (B) All aspects of care performed by the medical professional and facility staff shall be documented in the resident's file. This requirement is not met as evidence by: Based on interviews and file review the facility is not documenting all aspects of care for R1 This poses a potential risk to residents in care.

Official plan of correction

Administrator has agreed to have hospice document that staff has been trained on certain wound care issues. Need to obtain complete hospice care plan outling the stage of the wound. The resident reappraisal and needs and service needs to reflect the resident wounds and how staff can assist.

Deadline recorded: Aug 3, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

1569.605

Regulation authority

HSC

What the official deficiency says

§1569.605 Liability insurance; coverage requirements On and after July 1, 2015, all residential care facilities for the elderly, except those facilities that are an integral part of a continuing care retirement community, shall maintain liability insurance covering injury to residents and guests in the amount of at least one million dollars ($1,000,000) per occurrence and three million dollars ($3,000,000) in the total annual aggregate, caused by the negligent acts or omissions to act of, or neglect by, the licensee or its employees. This requirement is not met as evidence by: Based on records reviewed, facility does not have current liability insurance coverage.

Official plan of correction

Licensee will review the health and safety code, obtain liability insurance as required by the health and safety code. Copy of the current liability insurance certificate will need to be submitted as POC.

Deadline recorded: Jul 7, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87411(d)(3)

Regulation authority

CCR

What the official deficiency says

Personnel Requirements - General 87411(d)(3).. experience shall provide knowledge of and skill in the following, as appropriate for the job assigned and as evidenced by safe and effective job performance.. Skill and knowledge required to provide necessary resident care and supervision,... This requirement is not met as evidenced by: Based on LPA interview with staff, the administrator did not have staff available to communicate with residents and emergency personnel effectively which poses a potential risk to the residents in care.

Official plan of correction

Administrator/Licensee agrees to put in writing their plan for hiring or ensuring English Speaking staff are always on shift and submit the plan by the POC date. Additionally, Administrator shall submit updated LIC500 to reflect all staff.

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

Official classification

Type B

Official code

87411(d)(3)

Regulation authority

CCR

What the official deficiency says

87411 Personnel Requirements - General (d) All personnel shall... have related experience in the job assigned to them. (3) Skill and knowledge required to provide necessary resident care... including the ability to communicate with residents. This requirement is not met as evidenced by: Based on observations and interviews, the licensee did not comply with the section cited above in 2 out of 2 employees which poses a potential Health, Safety, or Personal Rights risk to persons in care.

Official plan of correction

Licensee has hired staff who can adequately communicate with residents. Deficiency is cleared as of 01/12/2023.

Deadline recorded: Feb 10, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87464(f)(3)

Regulation authority

CCR

What the official deficiency says

87464 Basic Services (f) Basic services shall at a minimum include: (3) Three nutritionally well-balanced meals and snacks made available daily, including low salt or other modified diets This requirement was not met as evidenced by: Based on observations and interviews, the licensee did not comply with the section cited above in 3 out of 5 residents which poses a potential Health, Safety, or Personal Rights risk to persons in care.

Official plan of correction

Licensee will conduct a training with all staff on food service requirements and submit to LPA by POC due date.

Deadline recorded: Feb 10, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87506(c)(1)

Regulation authority

CCR

What the official deficiency says

87506 Resident Records (c) All information and records obtained from or regarding residents shall be confidential. (1) The licensee and all employees shall reveal or make available confidential information only upon the resident's written consent. This requirement is not met as evidenced by: Based on observations and interviews, the licensee did not comply with the section cited above in 1 out of 5 residents which poses a potential Health, Safety, or Personal Rights risk to persons in care.

Official plan of correction

Administrator showed LPA resident files which are ready for emergency responders. Staff have been trained. Licensee to submit written statement confirming that staff are capable of accessing emergency files for emergency personnel.

Deadline recorded: Feb 10, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87411(c)

Regulation authority

CCR

What the official deficiency says

87411 Personnel Requirements - General (c) All RCFE staff who assist residents with personal activities of daily living shall receive initial and annual training This requirement was not met as evidenced by: Based on interviews and record review, the licensee did not comply with the section cited above in 2 out of 2 employees which posed a potential risk to the Health, Safety, or Personal Rights to persons in care.

Official plan of correction

Licensee has hired 2 additional staff with sufficient qualifications. Deficiency cleared during visit.

Deadline recorded: Feb 10, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87555(b)(5)

Regulation authority

CCR

What the official deficiency says

87555 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... backgrounds and food habits of residents. This requirement was not met as evidenced by: Based on interviews, the licensee did not comply with the section cited above in 3 out of 5 residents which posed a potential risk to the Health, Safety, or Personal Rights to persons in care.

Official plan of correction

Licensee will conduct a food requirement training for all staff and submit by POC due date.

Deadline recorded: Feb 10, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87307(a)(3)(A)

Regulation authority

CCR

What the official deficiency says

87307 Personal Accommodations and Services (a)...The following provisions shall apply: (3) ...the licensee shall assure: (A) A bed... shall be equipped with good springs, a clean and comfortable mattress, available pillow(s) and lightweight warm bedding. This requirement is not met as evidenced by: Based on interviews and observations, the licensee did not comply with the section cited above in 3 out of 5 residents which posed a potential risk to the Health, Safety, or Personal Rights to persons in care.

Official plan of correction

Licensee will inspect all resident beds and ensure that resident are comfortable with their sleeping arrangements. Confirmation will be provided to LPA by POC due date.

Deadline recorded: Feb 10, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87355(e)(2)

Regulation authority

CCR

What the official deficiency says

87355 Criminal Record Clearance (e) All individuals subject to a criminal record review... shall prior to working, residing or volunteering in a licensed facility: (2) Request a transfer of a criminal record clearance as specified in Section 87355(c) This requirement is not met as evidenced by: Based on file review, the licensee did not comply with the section cited above in 2 out of 3 employees which poses an immediate Health, Safety, or Personal Rights risk to persons in care.

Official plan of correction

Licensee will request for a criminal background clearance transfer to the facility and provide LIC 508, LIC 9182, and identification of all staff needing a transfer.

Deadline recorded: Dec 8, 2022. 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

87411 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. This requirement is not met as evidenced by: Based on interviews and observations, the licensee did not comply with the section cited above in 1 out of 2 employees which posed a potential Health, Safety, or Personal Rights risk to persons in care.

Official plan of correction

Licensee will hire and retain at least one staff who is able to communicate effectively to residents. Licensee to submit LIC 500 with staff work hours and schedule.

Deadline recorded: Dec 9, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87465(h)(5)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care (h) The following requirements shall apply to medications which are centrally stored: (5) ...medication shall be stored in its originally received container. No medications shall be transferred between containers. This requirement is not met as evidenced by: Based on observations, the licensee did not comply with the section cited above in 1 out of 3 residents which posed a potential Health, Safety, or Personal Rights risk to persons in care.

Official plan of correction

Licensee will conduct an in-service training on the cited section for all staff handling medication and submit proof by the POC due date.

Deadline recorded: Dec 9, 2022. 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

87405 Administrator - Qualifications and Duties (a) All facilities shall have a qualified and currently certified administrator...The administrator shall be on the premises a sufficient number of hours to permit adequate attention to the management ... of the facility. This requirement is not met as evidenced by: Based on observations the licensee did not comply with the section cited above in 1 administrator which poses a potential Health, Safety, or Personal Rights risk to persons in care.

Official plan of correction

Licensee will provide the LIC 500 with the administrator and their hours by the POC due date. The Administrator will be available during the scheduled hours to ensure the facility is managed properly.

Deadline recorded: Nov 25, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87412(g)

Regulation authority

CCR

What the official deficiency says

87412 Personnel Records (g) All personnel records shall be maintained at the facility and shall be available to the licensing agency for review. This requirement is not met as evidenced by: Based on observations the licensee did not comply with the section cited above for 2 out of 8 employees which poses a potential Health, Safety, or Personal Rights risk to persons in care.

Official plan of correction

Licensee will ensure all personnel files are maintained at the facility and available for audit by the POC due date.

Deadline recorded: Nov 25, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87355(e)(2)

Regulation authority

CCR

What the official deficiency says

87355 Criminal Record Clearance (e) All individuals subject to a criminal record review... shall prior to working, residing or volunteering in a licensed facility: (2) Request a transfer of a criminal record clearance as specified in Section 87355(c) This requirement is not met as evidenced by: Based on file review, the licensee did not comply with the section cited above in 1 out of 1 employees which poses an immediate Health, Safety, or Personal Rights risk to persons in care.

Official plan of correction

Licensee will request for a criminal background clearance transfer to the facility and provide LIC 508, LIC 9182, and identification of all staff needing a transfer.

Deadline recorded: Oct 6, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87506(a)

Regulation authority

CCR

What the official deficiency says

87506 Resident Records (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 was not met as evidenced by: Based on interview and record review, the licensee did not comply with the section cited above in 2 out of 2 residents which poses a potential Health, Safety, or Personal Rights risk to persons in care.

Official plan of correction

Licensee will provide a key for staff and designees to access the files. Licensee will also submit copies of resident records for all current residents by the POC due date.

Deadline recorded: Oct 28, 2022. A deadline is not proof that correction was completed.