PRIME RESIDENTIAL SENIOR CARE

Official classification

Type B

Official code

87303(e)(2)

Regulation authority

CCR

What the official deficiency says

87303 Maintenance & Operation (e) Water supplies…shall be maintained…(2) Faucets used by residents…shall deliver hot water…to attain a temperature of not less than 105 degree F…and not more than 120 degree F… 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. The water temperature was 126.1 Degrees F which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/04/2026 Plan of Correction Licensee shall immediately adjust hot water temperature and maintain a 5 day log to ensure hot water temperature measure within Title 22 guidelines and provide a copy of the log to the department.

Official classification

Type B

Official code

87463(a)

Regulation authority

CCR

What the official deficiency says

Reappraisals (a)The pre-admission appraisal shall be updated, in writing as frequently as necessary to note significant changes and to keep the appraisal accurate. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review and interview, the licensee did not comply with the section cited above by not having R2’s appraisals on file and not updating on R3 & R5 appraisal, which poses/posed a potential health and safety risk to residents in care.

Official plan of correction

POC Due Date: 05/04/2026 Plan of Correction The Licensee agreed to develop a plan to address reappraisals of residents as frequently as necessary and provide in-service training to all staff regarding the Section 87463. Proof of training and updated appraisals should be submitted to CCLD by POC date.

Official classification

Type A

Official code

87608(a)(5)(B)

Regulation authority

CCR

What the official deficiency says

Postural Supports. Bed rails that extend the entire length of the bed are prohibited except for residents who are currently receiving hospice care and have a hospice care plan that specifies the need for full bed rails. 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 by not obtaining a full bedrail doctor's order for R5 (who is not currently on hospice), which poses an immediate health and safety risk to residents in care.

Official plan of correction

POC Due Date: 04/28/2026 Plan of Correction Administrator removed full bed rails on bed's of Resident#5 (R5). The deficiency is cleared at this time.

Official classification

Type A

Official code

87465(h)(6)(F)

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: (6) The licensee shall be responsible for assuring that a record of centrally stored prescriptions... (A)...(F)... This requirement is not met as evidenced by: Deficient Practice Statement Based on record reviews and interviews, licensee did not comply with the section above, as facility staff handling medications were not properly documenting prescribed medications on CSMDR, which poses an immediate health and safety risk to residents in care.

Official plan of correction

POC Due Date: 04/29/2026 Plan of Correction Administrator agreed to schedule vendorized training for all staff by 04/29/26 and submit to CCL the vendor information and scheduled date of training. Training certifications to be submitted to CCL upon completion.

Official classification

Type B

Official code

87305(b)

Regulation authority

CCR

What the official deficiency says

Alterations to Existing Building or New Facilities: (b) The licensing agency may require the facility to acquire a local building inspection where the agency determines that a suspected hazard to health and safety exists. This requirement is not met as evidenced by: Deficient Practice Statement Based on interviews and e-mail notification from credible witness on 04/15/26, the licensee did not comply with the section cited above by changing/construction of the facility roof without notifying CCLD. This poses a potential health and safety risk to residents in care.

Official plan of correction

POC Due Date: 05/04/2026 Plan of Correction The Licensee agrees to notify and obtain approval from the licensing agency prior to any future structural modifications, alterations, or construction projects. Facility will create an internal procedure requiring administrative review and Licensing notification before initiating any physical plant changes and will submit to LPA by the POC due date.

Official classification

Type A

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 interview , the licensee did not comply with the section cited above by going over capacity and there are seven (7) residents living at the facility which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/05/2025 Plan of Correction The Administrator agreed to relocate of the resident to a different location and submit the proof to LPA by POC due date.

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: Deficient Practice Statement Based on observation, interview, and record review, the licensee did not comply with the section cited above in not submitting an incident and death report for R5 which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/10/2025 Plan of Correction Administrator agreed to submit an incident report and a death report for R5. Administrator will have to submit a statement of understanding about the above section and reporting requirements.

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... 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. Resident records were incomplete and or missing signatures, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/10/2025 Plan of Correction icensee agreed to complete/update six (6) out of six (6) resident files and submit to LPA by the 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 not locking all the laundry and other toxins locked and was observed accessible to residents in care which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/05/2025 Plan of Correction Administrator agreed to train the staff and submit the proof to LPA by due date.

Official classification

Type A

Official code

87705(f)(1)

Regulation authority

CCR

What the official deficiency says

(f) The following shall be stored inaccessible to residents with dementia: (1) Knives, matches, firearms, tools and other items that could constitute a danger to the resident(s). 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 scissors in the bathroom and gardening tools in the backyard unlocked and accessible to residents in care which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/05/2025 Plan of Correction Administrator also agreed to provide training to their staff and provide LPA with a proof by the due date.

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 is not met as evidenced by: Deficient Practice Statement Based on record review, the licensee did not comply with the section cited above in two out of two staff not completed their annual required training which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/10/2025 Plan of Correction Administrator agreed to provide all required training to their staff and submit the proof to LPA by the due date.

Official classification

Type A

Official code

87465(h)(6)(F)

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: (6) The licensee shall be responsible for assuring that a record of centrally stored prescriptions... (A)...(F)... This requirement is not met as evidenced by: Deficient Practice Statement Based on record reviews and interviews, licensee did not comply with the section above, as facility staff handling medications were not properly documenting prescribed medications on CSMDR, which poses an immediate health and safety risk to residents in care.

Official plan of correction

POC Due Date: 02/05/2025 Plan of Correction Administrator agreed to schedule vendorized training for all staff by 02/05/23 and submit to CCL the vendor information and scheduled date of training. Training certifications to be submitted to CCL upon completion.

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 two out of two toxins (Comet & Laundry detergent) accessible to residents in care which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/01/2024 Plan of Correction Toxins were immediately locked away. Administrator agreed to train the staff and submit the proof to LPA by due date.

Official classification

Type A

Official code

87705(f)(1)

Regulation authority

CCR

What the official deficiency says

(f) The following shall be stored inaccessible to residents with dementia: (1) Knives, matches, firearms, tools and other items that could constitute a danger to the resident(s). 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 one out of one knife and three out of three scissors in the kitchen as well as in residents rooms which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/01/2024 Plan of Correction Administrator immediately removed and locked away the sharps. Administrator also agreed to provide training to their staff and provide LPA with a proof by the due date.

Official classification

Type A

Official code

87705(f)(2)

Regulation authority

CCR

What the official deficiency says

(f) The following shall be stored inaccessible to residents with dementia: (f) The following shall be stored inaccessible to residents with dementia: (f) The following shall be stored inaccessible to residents with dementia: (2) Over-the-counter medication, nutritional supplements or vitamins, alcohol, cigarettes, and toxic substances such as certain plants, gardening supplies, cleaning supplies and disinfectants. 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 two out of two medication storage, medication for diabetes unlocked in the fridge & over the counter medication of stomach relife unlocked and accessible to residents in care which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/01/2024 Plan of Correction Administrator locked medication and removed from the fridge and put it in the fridge in garage for now. Administrator will buy a separate small fridge for diabetes medication and submit the receipt to LPA including the training for staff.

Official classification

Type B

Official code

87208(a)(7)(A)

Regulation authority

CCR

What the official deficiency says

...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:(7) Sketches, showing dimensions, of the following: Building(s) to be occupied, including a floor plan that describes the capacities of the buildings... This requirement is not met as evidenced by: Based on LPA's observation on 06/30/2023 there was an additional room created by the Licensee which was not reflected on the facility sketch during the application process, which posed a potential health and safety issue for residents in care.

Official plan of correction

Licensee aggress to submit and LIC200 and updated facility sketch indicating a change in facility floor plan by or before POC due date.

Deadline recorded: Jul 28, 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

Personal Rights of Residents in All facilities-To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This requirement was not met as evidenced by: Bases on observations facility staff did not ensure the personal rights of persons in care to a safe, healthy, and comfortable home and engaged in conduct inimical to the health, welfare, and safety of persons in care, in that facility staff did not wear a mask, and did not follow COVID-19 guidelines by screening visitors.

Official plan of correction

Administrator shall have an in-service with all staff on Covid Protocols by POC due date. Copy of sign in sheet shall be sent to LPA by email or fax by POC due date.

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