TNA RESIDENTIAL CARE

Official classification

Type A

Official code

87202(a)(2)

Regulation authority

CCR

What the official deficiency says

Fire Clearance: (a) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, or the State Fire Marshal. Prior to accepting or retaining any of the following types of persons, the applicant or licensee shall notify the licensing agency and obtain an appropriate fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, or the State Fire Marshal: (2) Bedridden persons. This requirement is not met as evidenced by: Deficient Practice Statement Based on interview and record review, the licensee did not comply with the section cited above by accepting a bedridden resident (R3) without having a proper fire clearance, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/26/2026 Plan of Correction Licensee must submit LIC200 along with the facility sketch by POC date. This is zero tolerance and an immediate civil penalty of $500.00 will be assessed.

Official classification

Type A

Official code

87705(f)(2)

Regulation authority

CCR

What the official deficiency says

87705(f)(2) Care of Persons 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 by leaving medications and nutritional supplements or vitamins, 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: 03/26/2026 Plan of Correction Licensee agreed to conduct an in-house training with all staff regarding the care for Dementia residents and always keep medications and locked. Proof of training will be emailed to LPA by POC date.

Official classification

Type A

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, observation, document review and inspection, the licensee did not comply with the section cited above by renovating/reconstructing or adding new construction to a facility, without notifying CCLD. This poses a potential health and safety risk to residents in care.

Official plan of correction

POC Due Date: 03/26/2026 Plan of Correction The licensee should submit to the Regional Office LIC200 and a floor plan with room dimensions and an indication of the intended use for each room.

Official classification

Type A

Official code

87202(a)(2)

Regulation authority

CCR

What the official deficiency says

Fire Clearance: (a) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department...(2) Bedridden persons... This requirement is not met as evidenced by: Based on observation during today's visit the licensee did not comply with the section cited above by failing to relocate non-ambulatory residents - R1, R2, and R3, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

The Administrator agreed to re-locate three (3) non-ambulatory residents until the fire clearance is obtained and approved. Licensee will provide re-location information via e-mail by the POC due date (03/13/26). Civil penalty will be assessed.

Deadline recorded: Mar 13, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87202(a)(2)

Regulation authority

CCR

What the official deficiency says

Fire Clearance: (a) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department...(2) Bedridden persons... This requirement is not met as evidenced by: Based on observation during today's visit the licensee did not comply with the section cited above by not re-locating a bedridden and non-ambulatory residents without having a proper fire clearance, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

Staff #3 (S3) agreed to re-locate resident with bedridden and non-ambulatory status until the fire clearance is obtained and approved. Licensee will provide re-location information via e-mail by the POC due date (11/14/2025). Civil penalty will be assessed.

Deadline recorded: Nov 14, 2025. 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(e)(2) Criminal Record Clearance. Prior to working, residing or volunteering in a licensed facility, all individuals subject to a criminal record review shall request a transfer of a criminal record clearance from another facility or Trustline. Based on interview and record review, the licensee did not comply with the section cited above by hiring S1 on 02/2025 and S2 on 11/13/25, without association and fingerprint clearance, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

S3 agreed to fingerprint cleared and associate S1 and S2 to the facility. The Licensee will submit the proof of correction to LPA by POC due date. Civil penalty assessed.

Deadline recorded: Nov 14, 2025. 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 LPAs, the licensee did not comply by failing to submit the incident report previously cited on 10/13/25. This poses a potential health and safety risk to persons in care.

Official plan of correction

S3 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. R2's incident report is provided to LPAs during today's visit and POC is cleared.

Deadline recorded: Nov 14, 2025. 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 licensee and the administrator may be one and the same person....This requirement is not met as evidenced by: Based on interviews the licensee did not comply with the section cited above by not having the Administrator avaliable during three inspection visits on 9/2, 10/13 and 11/13/2025. This poses a potential health and safety risk to the persons in care.

Official plan of correction

Administrator shall attend 1 hour of training regarding Administrator Qualifications and Duties with a Qualified Consultant copy of training shall be submitted to LPA. Administrator shall also submit a document indicating they understand licensing regulations regarding Administrator Qualifications and Duties. (Please note this is 1 hour of training)

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

Official classification

Type A

Official code

87202(a)(2)

Regulation authority

CCR

What the official deficiency says

Fire Clearance: (a) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department...(2) Bedridden persons... This requirement is not met as evidenced by: Based on interview and record review, the licensee did not comply with the section cited above by accepting a bedridden and non-ambulatory residents without having a proper fire clearance, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

Licensee agreed to re-locate resident with bedridden and non-ambulatory status until the fire clearance is obtained and approved. Licensee will provide re-location information via e-mail by the POC due date (10/14/2025). Civil penalty will be assessed.

Deadline recorded: Oct 14, 2025. 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

7355(e)(2) Criminal Record Clearance. Prior to working, residing or volunteering in a licensed facility, all individuals subject to a criminal record review shall request a transfer of a criminal record clearance from another facility or Trustline. Based on interview and record review, the licensee did not comply with the section cited above by hiring S2 on 10/12/2025 without association, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

Licensee agreed to associate S2 to the facility. The Licensee will submit the proof of correction to LPA by POC due date. Civil penalty assessed.

Deadline recorded: Oct 14, 2025. 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 LPAs, the licensee did not comply with the section cited above by failing to notify CCLD regarding the staff restraining R2 in June, 2025, which caused discomfort and pain to R2. This 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. R2's incident report shall be submitted to LPA by POC date.

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

Official classification

Type A

Official code

87202(a)(2)

Regulation authority

CCR

What the official deficiency says

Fire Clearance: (a) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, or the State Fire Marshal. Prior to accepting or retaining any of the following types of persons, the applicant or licensee shall notify the licensing agency and obtain an appropriate fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, or the State Fire Marshal: (2) Bedridden persons. This requirement is not met as evidenced by: Deficient Practice Statement Based on interview and record review, the licensee did not comply with the section cited above by accepting two bedridden residents (R1 & R2) without having a proper fire clearance, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/20/2025 Plan of Correction Licensee must submit LIC200 along with the facility sketch by POC date. Immediate civil penalty will be assessed.

Official classification

Type A

Official code

87705(f)(2)

Regulation authority

CCR

What the official deficiency says

Care of Persons 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, R2's injection medication was placed in a refrigerator 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: 03/20/2025 Plan of Correction Licensee agreed to conduct an in-house training with all staff regarding the care for Dementia residents and always keep medications and locked. Proof of training will be emailed to LPA by POC date.

Official classification

Type B

Official code

87608(a)(3)

Regulation authority

CCR

What the official deficiency says

Postural Supports: Based on the individual pre-admission appraisal and subsequent changes to that appraisal the facility shall provide assistance and care for the resident in those activities of daily living which the resident is unable to do for him/herself. Postural support may be used under the following condition: 3) A written order from the Physician indication 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: 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. Two (2) out of five (5) residents have a half bed rail without a doctor's order, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/25/2025 Plan of Correction Licensee agreed to obtain a doctor order for ttwo (2) half bed rails. Copy of proof will be submit it to LPA

Official classification

Type B

Official code

87406(g)

Regulation authority

CCR

What the official deficiency says

Administrator Certification Requirements: (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. Faciity's Administrator certificate had been expired since August 2020, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/25/2025 Plan of Correction Licensee agreed to renew the Administrator certificate and submit proof of enrolled classe to LPA by POC date.

Official classification

Type A

Official code

87355(e)(1)

Regulation authority

CCR

What the official deficiency says

Criminal record clearance: (e) All individuals subject to a criminal record review... (1) Obtain a California clearance or a criminal record exemption as required by the Department. This requirement is not met as evidenced by: Deficient Practice Statement Based on interview and record review, the licensee did not comply with the section cited above by hiring one (1) staff member S1 on March 14th, 2025 without fingerprint clearance, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/20/2025 Plan of Correction Licensee agreed to complete S1's fingerprints and associate the staff to the facility. Copy of proof will be submitted to LPA by POC date. Civil penalty assessed.

Official classification

Type A

Official code

87608(a)(5)(B)

Regulation authority

CCR

What the official deficiency says

Postural Supports (B) 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 interview and record review, the licensee did not comply with the section cited above by admitting a non-hospice resident (R3) and providing a full bed rail, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/25/2024 Plan of Correction Licensee agreed to remove R3's bed rail immediately.

Official classification

Type A

Official code

87705(f)(1)

Regulation authority

CCR

What the official deficiency says

Care of Persons with Dementia: (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 by leaving the kitched drawer, with knives and sharp objects, 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: 04/25/2024 Plan of Correction Licensee agreed to have an in-house training with all staff regarding the care for Dementia residents and keep the sharp objects locked at all times. Proof of training will be emailed to LPA by POC date.

Official classification

Type A

Official code

1569.69(a)(2)

Regulation authority

HSC

What the official deficiency says

1569.69(a)(2) Other Provisions: (a) Each residential care facility for the elderly licensed under this chapter shall ensure that each employee of the facility who assists residents with the self-administration of medications meets all of the following training requirements: (2) In facilities licensed to provide care for 15 or fewer persons, the employee shall complete 10 hours of initial training. This training shall consist of 6 hours of hands-on shadowing training, which shall be completed prior to assisting with the self-administration of medications, and 4 hours of other training or instruction, as described in subdivision (f), which shall be completed within the first two weeks of employment. 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 by not having a proper training for the staff (former Administrator) prior to their employment, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/25/2024 Plan of Correction Licensee agreed to hire a licensed vendor and provide training to all current and future staff. Proof of training/certificate will be submitted to LPA by POC date.

Official classification

Type A

Official code

87705(f)(2)

Regulation authority

CCR

What the official deficiency says

Care of Persons 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 by leaving medications and nutritional supplements or vitamins, 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: 04/25/2024 Plan of Correction Licensee agreed to conduct an in-house training with all staff regarding the care for Dementia residents and always keep medications and locked. Proof of training will be emailed to LPA by POC date.

Official classification

Type A

Official code

1569.625(b)(1)

Regulation authority

HSC

What the official deficiency says

Other Provisions (1) The department shall adopt regulations to require staff members of residential care facilities for the elderly who assist residents with personal activities of daily living to receive appropriate training. This training shall consist of 40 hours of training. A staff member shall complete 20 hours, including six hours specific to dementia care, as required by subdivision (a) of Section 1569.626 and four hours specific to postural supports, restricted health conditions, and hospice care, as required by subdivision (a) of Section 1569.696, before working independently with residents. The remaining 20 hours shall include six hours specific to dementia care and shall be completed within the first four weeks of employment. The training coursework may utilize various methods of instruction, including, but not limited to, lectures, instructional videos, and interactive online courses. The additional 16 hours shall be hands-on training. This requirement is not met as evidenced by: Deficient Practice Statement Based on interview and record review, the licensee did not comply with the section cited above by not providing all required training for Mrs. Akmakchyan , (training is important due to the level of care for the clients) which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/25/2024 Plan of Correction Licensee agreed to hire a licensed vendor and provide training to all staff members. Copy of proof will be submitted to LPA by POC date.

Official classification

Type A

Official code

87202(a)(2)

Regulation authority

CCR

What the official deficiency says

Fire Clearance: (a) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, or the State Fire Marshal. Prior to accepting or retaining any of the following types of persons, the applicant or licensee shall notify the licensing agency and obtain an appropriate fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, or the State Fire Marshal: (2) Bedridden persons. This requirement is not met as evidenced by: Deficient Practice Statement Based on interview and record review, the licensee did not comply with the section cited above by accepting a bedridden resident (R3) without having a proper fire clearance, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/25/2024 Plan of Correction Licensee must submit LIC200 along with the facility sketch by POC date. Immediate civil penalty will be assessed.

Official classification

Type B

Official code

87608(a)(3)

Regulation authority

CCR

What the official deficiency says

Postural Supports: Based on the individual pre-admission appraisal and subsequent changes to that appraisal the facility shall provide assistance and care for the resident in those activities of daily living which the resident is unable to do for him/herself. Postural support may be used under the following condition: 3) A written order from the Physician indication 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: Deficient Practice Statement Based on observation and record review, the licensee did not comply with the section cited above. Three (3) out of six (6) residents have a half bed rail without a doctor's order, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/30/2024 Plan of Correction Licensee agreed to obtain a doctor order for three (3) half bed rails. Copy of proof will be submit it to LPA

Official classification

Type B

Official code

87406(g)

Regulation authority

CCR

What the official deficiency says

Administrator Certification Requirements: (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. Faciity's Administrator certificate had been expired since August 2020, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/30/2024 Plan of Correction Licensee agreed to renew the Administrator certificate and submit proof of enrolled classe to LPA by POC date.

Official classification

Type B

Official code

87506(a)

Regulation authority

CCR

What the official deficiency says

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 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 documents, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/30/2024 Plan of Correction Licensee agreed to complete six (6) out of six (6) resident files.

Official classification

Type B

Official code

87412(a)

Regulation authority

CCR

What the official deficiency says

Personnel Records: (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: 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. Upon LPA's request Licensee/Administrator was unable to provide own facility records. This poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/30/2024 Plan of Correction Licensee agreed to have a individual file for each staff member along with the training certificate.

Official classification

Type B

Official code

87156(a)

Regulation authority

CCR

What the official deficiency says

(a) An applicant or licensee shall be charged fees as specified in Health and Safety Code section 1569.185. 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 by failiy and renew her licensing fees that were due in March 2023, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/30/2024 Plan of Correction Licensee agreed to make a full payment immediately. Proof of payment/confirmation will be emailed to LPA by POC date.

Official classification

Type A

Official code

87355(e)(1)

Regulation authority

CCR

What the official deficiency says

Criminal record clearance: (e) All individuals subject to a criminal record review... (1) Obtain a California clearance or a criminal record exemption as required by the Department. This requirement is not met as evidenced by: Based on interview and record review, the licensee did not comply with the section cited above by hiring one (1) staff member S2 on January 8th, 2024 without fingerprint clearance, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

Licensee agreed to complete S2's fingerprints and associate the staff to the facility. Copy of proof will be submitted to LPA by POC date. Civil penalty assessed.

Deadline recorded: Jan 24, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87202(a)(2)

Regulation authority

CCR

What the official deficiency says

Fire Clearance: (a) All facilities shall maintain a fire clearance approved... Prior to accepting or retaining any of the following types of persons... (2) Bedridden persons This requirement is not met as evidenced by: Based on interview and record review, the licensee did not comply with the section cited above by accepting two (2) bedridden residents (R2 and R3) without having a proper fire clearance, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

Licensee agreed to complete and submit LIC200 along with the facility sketch to Fire Department for a Bedridden and non-ambulatory approval by POC date. Bedridden plan of operation and proof will be submitted to LPA Civil penalty issued

Deadline recorded: Jan 24, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87406(g)

Regulation authority

CCR

What the official deficiency says

Administrator Certification Requirements: (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: Based on record review, the licensee did not comply with the section cited above. Faciity's Administrator certificate had been expired since August 2020, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Licensee agreed to renew the Administrator certificate and submit proof of enrolled classe to LPA by POC date.

Deadline recorded: Jan 30, 2024. 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. Three (3) 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

Licensee agreed to complete three (3) out of five (5) resident files.

Deadline recorded: Jan 30, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87608(a)(3)

Regulation authority

CCR

What the official deficiency says

Postural Supports: Based on the individual pre-admission apprasial... Postural support maybe used udner the following condition: 3) A written order from the Physician indication... licensing agency shall be authorized to require... This requirement is not met as evidenced by: Based on interview and record review, the licensee did not comply with the section cited above having two (2) full bed rail beds and two (2) half bed rail without a doctors approval, which poses an potential health, safety or personal rights risk to persons in care.

Official plan of correction

Licensee agreed to obtain a doctor order for two (2) half bed rails and two (2) hospice full rails. Copy of proof will be submitted to LPA

Deadline recorded: Jan 24, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87632(a)(1)

Regulation authority

CCR

What the official deficiency says

87632 Hospice Care Waiver: (a) In order accept or retain terminally ill residents... To obtain this waiver the licensee shall submit a written request for a waiver to the Department... This requirement is not met as evidenced by: Based on record review the licensee did not comply with the section cited above by addmiting two (2) hospice residents, when theh facility is only approved for one (1). This poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Licensee agreed to submit a hospice exception for one (1) resident. Proof of the exception letter will be emailed to LPA by POC date.

Deadline recorded: Jan 30, 2024. 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 two (2) incidents that occured with R6, 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 two (2) incidents, shall be submitted to LPA by POC date.

Deadline recorded: Jan 30, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87405(d)

Regulation authority

CCR

What the official deficiency says

Administrator Qualifications - 87405 (d) The administrator shall have the qualifications specified in Sections 87405(d)(1) through (7). If the licensee is also the administrator... (1) Knowledge of the requirements... This requirement is not met as evidenced by: Based on interviews, the licensee failed to insure that the administrator had knowledge of licensing rules and regulations which poses an immediate health and safety risk to the residents in care.

Official plan of correction

Licensee agrees to follow proper guidelines for Administrator Qualifications. LPA discussed with the administrators section 87405. Licensee agrees to submit a written letter to CCL indicating that they have read the regulations, have full understanding

Deadline recorded: Jan 30, 2024. 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

87211 Reporting 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, the licensee did not comply with the section cited above by failing to notify CCLD regarding R1s multiple visits to an Emergency Room/Hospital between 08/02/22 -05/05/23, which poses a potential health and safety risk to persons in care.

Official plan of correction

Licensee shall ensure a written reports are submitted to the licensing agency within seven (7) days of the occurrence of any of the events. An in-service training to all staff will be provided to address this section of the Regulation, and copy of the training certificates will be submitted to LPA.

Deadline recorded: Jul 8, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87202(a)(2)

Regulation authority

CCR

What the official deficiency says

(a) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, or the State Fire Marshal. Prior to accepting or retaining any of the following types of persons, the applicant or licensee shall notify the licensing agency and obtain an appropriate fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, or the State Fire Marshal: (2) Bedridden persons This requirement is not met as evidenced by: Deficient Practice Statement Based on interview and record review, the licensee did not comply with the section cited above by accepting a bedridden resident (R3) without having a proper fire clearance] which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/25/2023 Plan of Correction Licensee agreed to complete and submit LIC200 along with the facility sketch to Fire Department for a Bedridden and non-ambulatory approval by POC date. Bedridden plan of operation and proof will be submitted to LPA Civil penalty issued

Official classification

Type A

Official code

1569.311

Regulation authority

HSC

What the official deficiency says

Every residential care facility for the elderly shall have one or more carbon monoxide detectors in the facility that meet the standards established in Chapter 8 (commencing with Section 13260) of Part 2 of Division 12. The department shall account for the presence of these detectors during inspections. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA team observation, the licensee did not comply with the section cited above to assure that the facility Carbon monoxide is operational, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/25/2023 Plan of Correction Licensee agreed to purchase and replace a carbon monoxide by POC date. Copy of the receipt will be submitted to LPA

Official classification

Type A

Official code

1569.625(b)(1)

Regulation authority

HSC

What the official deficiency says

(1) The department shall adopt regulations to require staff members of residential care facilities for the elderly who assist residents with personal activities of daily living to receive appropriate training. This training shall consist of 40 hours of training. A staff member shall complete 20 hours, including six hours specific to dementia care, as required by subdivision (a) of Section 1569.626 and four hours specific to postural supports, restricted health conditions, and hospice care, as required by subdivision (a) of Section 1569.696, before working independently with residents. The remaining 20 hours shall include six hours specific to dementia care and shall be completed within the first four weeks of employment. The training coursework may utilize various methods of instruction, including, but not limited to, lectures, instructional videos, and interactive online courses. The additional 16 hours shall be hands-on training. This requirement is not met as evidenced by: Deficient Practice Statement Based on interview and record review, the licensee did not comply with the section cited above in hiring two (2) staff members in April 2023 and not providing required training, (training is important due to the level of care for the clients) which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/25/2023 Plan of Correction Licensee agreed to hire a licensed vendor and provide training to all staff members. Copy of proof will be submitted to LPA by POC date.

Official classification

Type A

Official code

1569.69(a)(2)

Regulation authority

HSC

What the official deficiency says

(a) Each residential care facility for the elderly licensed under this chapter shall ensure that each employee of the facility who assists residents with the self-administration of medications meets all of the following training requirements: (2) In facilities licensed to provide care for 15 or fewer persons, the employee shall complete 10 hours of initial training. This training shall consist of 6 hours of hands-on shadowing training, which shall be completed prior to assisting with the self-administration of medications, and 4 hours of other training or instruction, as described in subdivision (f), which shall be completed within the first two weeks of employment. 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 by not providing a proper training to two staff members prior to their employment, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/25/2023 Plan of Correction Licensee agreed to hire a licensed vendor and provide training to all current and furture staff. Proof of training/certificate will be submitted to LPA by POC date.

Official classification

Type A

Official code

87465(h)(5)

Regulation authority

CCR

What the official deficiency says

(h) The following requirements shall apply to medications which are centrally stored: (5) Each resident's medication shall be stored in its originally received container. No medications shall be transferred between containers. 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 by leaving various medications in a pre-pored box and not in their original container, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/25/2023 Plan of Correction Licensee agreed to hire a licensed vendor and provide a centrally stored medication training to all staff. Proof of training will be emailed to LPA by POC date.

Official classification

Type A

Official code

87608(a)(5)(B)

Regulation authority

CCR

What the official deficiency says

(B) 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 interview and record review, the licensee did not comply with the section cited above by admitting a non-hospice resident (R4) and providing a full bed rail without a doctors approval, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/25/2023 Plan of Correction Licensee agreed to remove R4's bed rail immediately, and proof of picture will be submitted to LPA by POC 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 by leaving the kitched drawer, with knives and sharp objects, 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: 05/25/2023 Plan of Correction Licensee agreed to have an in-house training with all staff regarding the care for Dementia residents and keep the sharp objects locked at all times. Proof of training will be emailed to LPA by POC 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: (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 by leaving medications and nutritional supplements or vitamins, 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: 05/25/2023 Plan of Correction Licensee agreed to conduct an in-house training with all staff regarding the care for Dementia residents and always keep medications and locked. Proof of training will be emailed to LPA by POC 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 record review, the licensee did not comply with the section cited above. No staff records on file, no health screening/TB, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/30/2023 Plan of Correction Licensee agreed to have all staff members shedule an appointment with their primary physician, complete health screening, including chest x-ray. Proof of health screening for two (2) staff members will be submitted to LPA

Official classification

Type A

Official code

87355(e)(1)

Regulation authority

CCR

What the official deficiency says

Criminal record clearance: (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: (1) Obtain a California clearance or a criminal record exemption as required by the Department or This requirement is not met as evidenced by: Deficient Practice Statement Based on interview and record review, the licensee did not comply with the section cited above by hiring two (2) staff members (S1 and S2) in April 2023 without fingerprint clearance, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/25/2023 Plan of Correction Licensee agreed to complete S1's and S2's fingerprints and associate both staff members to the facility. Copy of proof will be submitted to LPA by POC date. Civil penalty assessed.

Official classification

Type B

Official code

87113

Regulation authority

CCR

What the official deficiency says

Posting requirements: The license shall be posted in a prominent location in the licensed facility accessible to public view 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 did not observe license issued by the Department of Social Services being posted by the main entry door, which poses a potential health, safety risk to persons in care.

Official plan of correction

POC Due Date: 05/30/2023 Plan of Correction Licensee agreed to post the facility license issued by the Department of Social Services by the entryway and proof of picture will be submitted to LPA by POC date.

Official classification

Type B

Official code

87156(a)

Regulation authority

CCR

What the official deficiency says

(a) An applicant or licensee shall be charged fees as specified in Health and Safety Code section 1569.185. 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 by failiy and renew her licensing fees that were due in March 2023, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/30/2023 Plan of Correction Licensee agreed to make a full payment immediately. Proof of payment/confirmation will be emailed to LPA by POC date.

Official classification

Type B

Official code

87468(c)

Regulation authority

CCR

What the official deficiency says

Personal Rights: (c) Licensees shall prominently post personal rights, nondiscrimination notice, and complaint information in areas accessible to residents, representatives, and the public. 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 did not observe Personal Rights being posted in the facility, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/30/2023 Plan of Correction Licensee agreet to post all required personal rights and nondiscrimination notice in a public area by the entrance.

Official classification

Type B

Official code

87406(g)

Regulation authority

CCR

What the official deficiency says

Administrator Certification Requirements: (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. Faciity's Administrator certificate had been expired since August 2020, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/30/2023 Plan of Correction Licensee agreed to renew the Administrator certificate and submit proof of enrolled classe to LPA by POC date.

Official classification

Type B

Official code

87608(a)(3)

Regulation authority

CCR

What the official deficiency says

Postural Supports: Based on the individual pre-admission apprasial and subsequent changes to that appaisal the facility shall provide assistance and care for the residnet in those activities of daily living which the residnet is unable to do for him/herself. Postural support mayby used udner the following condition: 3) A written order from the Physician indication the need for the postural support shall be maintained in the residents record. The licensing agency shall be authorized to require othe additional documentation if needed to verify the order. 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. Three (3) out of four (4) residents have a half bed rail without a doctor's odrer, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/30/2023 Plan of Correction Licensee agreed to obtain a doctor order for three (3) half bed rails. Copy of proof will be submitted to LPA

Official classification

Type B

Official code

87632(a)(1)

Regulation authority

CCR

What the official deficiency says

87632 Hospice Care Waiver: (a) In order accept or retain terminally ill residents and permit them to receive care from a hospice agency, the licensee shall have obtained a facility hospice care waiver from the Department. To obtain this waiver the licensee shall submit a written request for a waiver to the Department on behalf of any residents who may request retention, and any future residents who may request acceptance, along with the provision of hospice services in the facility. The request shall include, but not be limited to the following: (1) Specification of the maximum number of terminally ill residents which the facility wants to have at any one time. 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 by addmiting two (2) hospice residents, when theh facility is only approved for one (1). This poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/30/2023 Plan of Correction Licensee agreed to submit a hospice exception for one (1) resident. Proof of the exception letter will be emailed to LPA by POC date.

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 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 documents, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/30/2023 Plan of Correction Licensee agreed to complete four (4) out of four (4) resident files.

Official classification

Type B

Official code

87412(a)

Regulation authority

CCR

What the official deficiency says

87412 Personnel Records: (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: 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. Upon LPA's request Licensee/Administrator was unable to provide S1's and S2's facility records. LPA was informed that both staff members were hired in April 2023 and no file was completed. This poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/30/2023 Plan of Correction Licensee agreed to have a individual file for each staff member along with the training certificate.

Official classification

Type B

Official code

87303(e)(6)

Regulation authority

CCR

What the official deficiency says

87303 Maintenance and Operation (e) Water supplies and plumbing fixtures shall be maintained as follows: (6) Toilet, handwashing and bathing facilities shall be maintained in operating condition. This requirement was not met as evidenced by: Based on observation, the Licensee did not maintain the knob to the faucet in operating condition in 1 out of 2 bathrooms. This posed a potential health and safety risk to residents in care.

Official plan of correction

Licensee will fix the knob to deliver hot and cold water. LPA will return to verify the faucet delivers water within the specified temperature range.

Deadline recorded: Mar 24, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87303(e)(4)

Regulation authority

CCR

What the official deficiency says

87303 Maintenance and Operation (e) Water supplies and plumbing fixtures shall be maintained as follows: (4) Grab bars shall be maintained for each toilet; bathtub and shower used by residents. This requirement was not met as evidenced by: Based on observation, the Licensee did not provide grab bars for 1 out of 2 toilets. This posed a potential health and safety risk to residents in care.

Official plan of correction

Licensee will ensure grab bars are installed in all bathrooms. LPA will return to verify grab bars are installed.

Deadline recorded: Mar 24, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87204(b)

Regulation authority

CCR

What the official deficiency says

87204 Limitations - Capacity and Ambulatory Status (b) Resident rooms approved for 24-hour care of ambulatory residents only shall not accommodate nonambulatory residents. This requirement was not met as evidenced by: Based on observation and interview, it was determined a non-ambulatory resident stayed in a room designated for ambulatory residents. This posed an immediate health and safety risk for residents in care.

Official plan of correction

Licensee will obtain a new fire clearance for a non-ambulatory resident.

Deadline recorded: Feb 23, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87303(e)(2)

Regulation authority

CCR

What the official deficiency says

87303 Maintenance and Operation (e) Water supplies and plumbing fixtures shall be maintained as follows: (2) ... a temperature of not less than 105 degree F (41 degree C) and not more than 120 degree F (49 degree C). This requirement was not met as evidenced by: Based on observation, the water temperature in 2 out of 2 bathrooms was not maintained within the required range. This posed an immediate health and safety risk to residents in care.

Official plan of correction

Licensee will adjust the water heater and LPA will return to verify the water temperature is within the required range.

Deadline recorded: Feb 23, 2022. A deadline is not proof that correction was completed.