Facility condition and maintenance
Cited in 2 reports, with 3 deficiencies in total.
BENTITS RETIREMENT VILLA
1301 N BIRCHNELL AVE, San Dimas CA 91773
6 bedsLatest official report Nov 7, 2025Licensed
Additional info
- Telephone
- (626) 335-9598
- Licensee
- MARALIT RESIDENTIAL VILLA, INCORPORATED
- Administrator
- MARALIT, TERESITA
- Contact
- MARALIT, TERESITA
- License first date
- Nov 15, 2019
- License effective date
- Nov 15, 2019
- District office
- MONTEREY PARK ASC · (323) 980-4934
- Regional office
- 28
- Clients served
- 983 - RCFE / DEMENTIA
Summary
The available records show 12 Type A and 23 Type B deficiencies for this facility.
- Most recent inspection
- Nov 7, 2025
- Most recent deficiency
- Nov 7, 2025
No later report is available, so the records do not show what happened afterward.
What Type A and Type B mean
- Type A
- Violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
- Type B
- Violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care.
Both classifications are published by California CDSS and are shown as published. SeniorLivingFacts does not rename them or add a severity level of its own.
At a glance
Counts cover the five-year public record. Typical figures are the median for the 1,564 Los Angeles County facilities licensed for 6 or fewer beds.
In the available public five-year record, CCLD published 6 reports for this facility: 6 inspections, 0 complaint investigations, and 0 licensing or administrative records.
Those records contain 12 Type A and 23 Type B deficiencies.
0 deficiencies have explicit official correction or clearance evidence in the loaded records.
- Official inspections
- 6
- Recorded deficiencies
- 35
- Type A deficiencies
- 12
- Type B deficiencies
- 23
- Substantiated complaints
- 0
- Repeated topics
- 1
More than the typical 4
1 in the last 12 months
Well above the typical 1
4 in the last 12 months
Most this size have none
4 in the last 12 months
Most this size have none
0 in the last 12 months
Most this size also have none
0 in the last 12 months
Last 36 months
Repeated topics
Topics cited in more than one report during the last 36 months. A repeat may show a pattern worth asking about. Each date opens its report below.
Official report history
All preserved reports from the most recent to the oldest, sortable by report type.
Inspection
Not classified in the sourceType A
- 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 observation, the licensee did not comply with the section cited above in [1] out of [1] carbon monoxide detector located in the hallway was tested and not operable which poses an immediate health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 11/08/2025 Plan of Correction Licensee agreed to have maintance service the carbon monoxide detector. Licensee will send LPA video of the carbon monoxide detector being tested and operable by POC due date.
Plan of correction recorded
Correction not verified in available records
Hazardous items and storageType A
- Official classification
- Type A
- Official code
- 87309(a)
- Regulation authority
- CCR
What the official deficiency says
(a) Except as specified in subsection (b), the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances, knives, matches, tools, sharp objects, and other similar items which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage. 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 in that cleaning solutions were observed unsecured on a countertop in the hallway accesible 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: 11/07/2025 Plan of Correction Corrected at time of visit. Caregiver stored cleaning solution in a secured cabinet located in the laundry, making them inaccessable to clients in care.
Plan of correction recorded
Correction not verified in available records
Food serviceType A
- Official classification
- Type A
- Official code
- 87555(b)(26)
- Regulation authority
- CCR
What the official deficiency says
(b) The following food service requirements shall apply: (26) Supplies of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days shall be maintained on the premises. 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 that LPA observed not a sufficient supply of fresh fruit or bread for a minimum of two days which poses an immediate health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 11/08/2025 Plan of Correction Licensee stated they are bring groceries tomorrow. Licensee will provide LPA proof in the form of photos of the food and photos of receipt as proof of purchase by POC due date.
Plan of correction recorded
Correction not verified in available records
Food serviceType A
- Official classification
- Type A
- Official code
- 87555(b)(27)
- Regulation authority
- CCR
What the official deficiency says
(b) The following food service requirements shall apply: (27) All kitchen areas shall be kept clean and free of litter, rodents, vermin and insects. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above in that LPA observed a pest trap on the kitchen counter top full of bugs which poses an immediate health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 11/08/2025 Plan of Correction Licensee stated they have a contract with Terminx pest control services. Licensee will provide proof of contract and photos showing the countertop has been clean and full pest trap removed.
Plan of correction recorded
Correction not verified in available records
Inspection
Facility condition and maintenanceType B
- Official classification
- Type B
- Official code
- 87303(e)(3)
- Regulation authority
- CCR
What the official deficiency says
(e) Water supplies and plumbing fixtures shall be maintained as follows;(3) fawcets used by residents for personal care such as grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by the residents to attaina temperature of not less that 105 degrees F(41 degrees C) and not more than120 degrees F(49 degreesC) 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 the water temperature measuring 131.7 and 130.6 in bathroom #1 with Jack and Jill basins which poses a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 09/20/2024 Plan of Correction Administrator will adjust the water temperature within the required limits of 105 F -120 F by the due date. A temperature log will need to be completed for the following 7 days and submitted to LPA via email by 09/20/24.
Plan of correction recorded
Correction not verified in available records
Inspection
Licensing and administrationType A
- Official classification
- Type A
- Official code
- 1569.605
- Regulation authority
- HSC
What the official deficiency says
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 evidenced by: Deficient Practice Statement Based on observation, interview, record review, the licensee did not comply with the section cited above in admitting to have an expired liability insurance policy, which poses an immediate health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 11/18/2023 Plan of Correction Licensee has submitted proof of the application in process with the new insurance company. LPA has advised licensee to submit new insurance policy to LPA, via email, once obtained.
Plan of correction recorded
Correction not verified in available records
Facility condition and maintenanceType A
- Official classification
- Type A
- Official code
- 87303(e)(2)
- Regulation authority
- CCR
What the official deficiency says
(e) Water supplies and plumbing fixtures shall be maintained as follows: (2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degrees C) and not more than 120 degree F (49 degrees C). This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above in the hot water temperature measuring between 140*F-144*F, which poses an immediate health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 11/18/2023 Plan of Correction Licensee will adjust water temperaure immediately to bring to compliance. A water log will be completed for the following 5 days and submit to LPA via email, by the POC due date.
Plan of correction recorded
Correction not verified in available records
Background checksType A
- Official classification
- Type A
- Official code
- 87355(e)(3)
- Regulation authority
- CCR
What the official deficiency says
(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: (3) Request a transfer of a criminal record clearance as specified in Section 87355(c) or 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 2 of 4 staff missing proper association to the facility, which poses an immediate health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 11/18/2023 Plan of Correction Licensee will submit Request for Transfer of 2 staff, including criminal background clearance, to LPA via email, by POC due date. Staff will need to be immediately removed from the facility until documentation is provided.
Plan of correction recorded
Correction not verified in available records
Dementia careType A
- Official classification
- Type A
- Official code
- 87705(j)
- Regulation authority
- CCR
What the official deficiency says
(j) The licensee shall have an auditory device or other staff alert feature to monitor exits, if exiting presents a hazard to any resident. 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 auditory devices at all entrances/exits inoperable/missing, which poses an immediate health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 11/18/2023 Plan of Correction Licensee will repair/replace auditory devices and submit proof of purchase/pictures of installation to LPA via email, by POC due date.
Plan of correction recorded
Correction not verified in available records
Dementia careType A
- Official classification
- Type A
- Official code
- 87705(l)(2)
- Regulation authority
- CCR
What the official deficiency says
(l) The following initial and continuing requirements shall be met for the licensee to lock exterior doors or perimeter fence gates: (2) The licensee shall ensure that the fire clearance includes approval of locked exterior doors or locked perimeter fence gates. 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 in the front entrance door and resident room# 2 emergency exit door locked by key, from the inside, which poses an immediate health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 11/18/2023 Plan of Correction Licensee will submit a written plan on how the facility will comply with providing care/supervision to residents with dementia and wandering behaviors, without locking the doors to prevent residents from leaving, to LPA via email, by POC due date.
Plan of correction recorded
Correction not verified in available records
Facility condition and maintenanceType B
- Official classification
- Type B
- Official code
- 87303(a)
- Regulation authority
- CCR
What the official deficiency says
The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above in kitchen sink cabinet is broken and falling apart, visitor/staff bathroom sink leaking, bedroom# 3's wall is scuffed and paint is chipped, and the ceiling is cracked, which poses a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 12/08/2023 Plan of Correction Licensee will make reparations required and submit work receipts and pictures of the corrections to LPA, via email, by POC due date.
Plan of correction recorded
Correction not verified in available records
Staffing, personnel, and trainingType B
- Official classification
- Type B
- Official code
- 87411(a)
- Regulation authority
- CCR
What the official deficiency says
(a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. In facilities licensed for sixteen or more, sufficient support staff shall be employed to ensure provision of personal assistance and care as required in Section 87608, Postural Supports. Additional staff shall be employed as necessary to perform office work, cooking, house cleaning, laundering, and maintenance of buildings, equipment and grounds. The licensing agency may require any facility to provide additional staff whenever it determines through documentation that the needs of the particular residents, the extent of services provided, or the physical arrangements of the facility require such additional staff for the provision of adequate services. 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 havng insufficient staff to provide services/care needed to meet resident needs, which poses a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 12/08/2023 Plan of Correction Licensee will submit written plan indicating how they will ensure there is sufficient staff at all times to meet the needs of residents in care, to LPA via email, by POC due date.
Plan of correction recorded
Correction not verified in available records
Staffing, personnel, and trainingType B
- Official classification
- Type B
- Official code
- 87412(f)
- Regulation authority
- CCR
What the official deficiency says
(f) All personnel records shall be available to the licensing agency to inspect, audit, and copy upon demand during normal business hours. Records may be removed if necessary for copying. Removal of records shall be subject to the following 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 in 3 of 4 staff files unavailable for licensing to audit, which poses a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 12/08/2023 Plan of Correction Licensee will submit written plan to LPA via email, on how they will comply with maintaining personnel records for all staff/volunteers at the facility at all times.
Plan of correction recorded
Correction not verified in available records
Records and plan of operationType B
- Official classification
- Type B
- Official code
- 87506(b)(16)
- Regulation authority
- CCR
What the official deficiency says
(b) Each resident's record shall contain at least the following information: (16) Records of resident's cash resources as specified in Section 87217, Safeguards for Resident Cash, Personal Property, and Valuables. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, the licensee did not comply with the section cited above in R2 and R3's files were missing records of resident's cash resources/personal property/valuables, which poses a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 12/08/2023 Plan of Correction Licensee will submit records of resident's cash resources/personal property/valuables for R2 and R3, to LPA via email, by POC due date.
Plan of correction recorded
Correction not verified in available records
Records and plan of operationType B
- Official classification
- Type B
- Official code
- 87506(b)(17)(A)
- Regulation authority
- CCR
What the official deficiency says
(b) Each resident's record shall contain at least the following information: (17) Documents and information requried by the following: (A) Section 87457, Pre-Admission Appraisal; 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 3 of 3 residents missing Pre-Admissions Appraisal in their file, which poses a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 12/08/2023 Plan of Correction Licensee will provide a copy of Pre-Admission's Appraisal for 3 residents in care, to LPA via email, by POC due date.
Plan of correction recorded
Correction not verified in available records
Records and plan of operationType B
- Official classification
- Type B
- Official code
- 87506(b)(17)(B)
- Regulation authority
- CCR
What the official deficiency says
(b) Each resident's record shall contain at least the following information: (17) Documents and information requried by the following: (B) Section 87459, Functional Capabilities; 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 of 3 residents missing the Functional Capabilities Assessment in their file, which poses a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 12/08/2023 Plan of Correction Licensee will submit a copy of R2 and R3's Functional Capabilties Assessment, to LPA via email, by POC due date.
Plan of correction recorded
Correction not verified in available records
Records and plan of operationType B
- Official classification
- Type B
- Official code
- 87506(b)(17)(D)
- Regulation authority
- CCR
What the official deficiency says
(b) Each resident's record shall contain at least the following information: (17) Documents and information requried by the following: (D) Section 87462, Social Factors; 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 3 of 3 residents missing Needs and Services Plan on file, which poses a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 12/08/2023 Plan of Correction Licensee to submit a Needs and Services Plan for 3 residents in care, to LPA via email, by POC due date.
Plan of correction recorded
Correction not verified in available records
Health conditions and treatmentsType B
- Official classification
- Type B
- Official code
- 87608(a)(3)
- Regulation authority
- CCR
What the official deficiency says
(a) Based on the individual's preadmission 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 himself/herself. Postural supports may be used under the following conditions: (3) A written order from a physician indicating the need for the postural support shall be maintained in the resident's record. The licensing agency shall be authorized to require other additional documentation if needed to verify the order. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and record review, the licensee did not comply with the section cited above in R1 having full bed rails without proper physician's orders indicating the need for them, which poses a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 12/08/2023 Plan of Correction Licensee will obtain written physician's orders for R1, indicating the need for full bed rails. Orders will be emailed to LPA by the POC due date.
Plan of correction recorded
Correction not verified in available records
Inspection
Facility condition and maintenanceType A
- Official classification
- Type A
- Official code
- 87303(e)(2)
- Regulation authority
- CCR
What the official deficiency says
(e) Water supplies and plumbing fixtures shall be maintained as follows: (e) Water supplies and plumbing fixtures shall be maintained as follows: (2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degrees C) and not more than 120 degree F (49 degrees C). This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview, record review, the licensee did not comply with the section cited above in the water temperature measuring at 131.5*F in bathroom# 1 and no hot water running in bathroom# 2, which poses an immediate health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 11/19/2022 Plan of Correction Licensee will turn on the hot water in bathroom# 2 and adjust the water temperature to measure within the required limits of 105*F-120*F by the POC due date. A temperature log will need to be completed for the following 7 days and submitted to LPA via email by 11/25/22.
Plan of correction recorded
Correction not verified in available records
Hazardous items and storageType A
- 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, interview, and record review, the licensee did not comply with the section cited above in cleaning supplies and toxins were stored in the laundry room, unlocked and accessible, which poses an immediate health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 11/19/2022 Plan of Correction Licensee will remove all cleaning supplies and toxins from the closet and place them somewhere inaccessible to residents in care, or a lock will be placed and kept on the cabinet at all times. Licensee will send LPA a picture of the properly stored items via email by the POC due date.
Plan of correction recorded
Correction not verified in available records
Facility condition and maintenanceType B
- Official classification
- Type B
- Official code
- 87303(a)
- Regulation authority
- CCR
What the official deficiency says
The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview, record review, the licensee did not comply with the section cited above in the cabint underneath the kitchen sink was broken and leaking, the vent in the dining room has accumulated dust, and there is not running hot water in bathroom# 2, which poses a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 12/02/2022 Plan of Correction Licensee will have cabinet under the kitchen sink fixed and plumbing fixed to stop the leak, and will turn on the hot water tap in bathroom# 2. Licensee will send a picture of the corrections and of the recipts for the work completed to LPA via email by the POC due date.
Plan of correction recorded
Correction not verified in available records
Staffing, personnel, and trainingType B
- Official classification
- Type B
- Official code
- 87412(f)
- Regulation authority
- CCR
What the official deficiency says
(f) All personnel records shall be available to the licensing agency to inspect, audit, and copy upon demand during normal business hours. Records may be removed if necessary for copying. Removal of records shall be subject to the following requirements: 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 1 of 2 staff files were not available to inspect at the time of the visit, which poses a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 12/02/2022 Plan of Correction Licensee will complete a file for staff Jonathan and will send copies of the completed file to LPA via email by the POC due date.
Plan of correction recorded
Correction not verified in available records
Staffing, personnel, and trainingType B
- Official classification
- Type B
- Official code
- 87411(d)
- Regulation authority
- CCR
What the official deficiency says
(d) All personnel shall be given on the job training or have related experience in the job assigned to them. This training and/or related 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: 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 2 staff not having proof of current required annual training which poses a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 12/02/2022 Plan of Correction Licensee will provide LPA proof of required annual training to LPA via email by the POC due date.
Plan of correction recorded
Correction not verified in available records
Staffing, personnel, and trainingType B
- Official classification
- Type B
- Official code
- 1569.625(b)(2)
- Regulation authority
- HSC
What the official deficiency says
(2) In addition to paragraph (1), training requirements shall also include an additional 20 hours annually, eight hours of which shall be dementia care training, as required by subdivision (a) of Section 1569.626, and four hours of which shall be specific to postural supports, restricted health conditions, and hospice care, as required by subdivision (a) of Section 1569.696. This training shall be administered on the job, or in a classroom setting, or both, and may include online training. 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 2 staff not having proof of current required annual training which poses a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 12/02/2022 Plan of Correction Licensee will provide LPA proof of required annual training to LPA via email by the POC due date.
Plan of correction recorded
Correction not verified in available records
Staffing, personnel, and trainingType B
- Official classification
- Type B
- Official code
- 87411(c)(1)
- Regulation authority
- CCR
What the official deficiency says
(1) Staff providing care shall receive appropriate training in first aid from persons qualified by such agencies as the American Red Cross. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview, record review, the licensee did not comply with the section cited above in 1 staff had expired first aid/CPR training and 1 staff did not have proof of certification, which poses a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 12/02/2022 Plan of Correction Licensee will provide proof of certification for 2 staff to LPA via email by the POC due date.
Plan of correction recorded
Correction not verified in available records
Medical and dental careType B
- Official classification
- Type B
- Official code
- 87465(a)(9)
- Regulation authority
- CCR
What the official deficiency says
(9) If a facility has no medical unit on the grounds, a complete first aid kit shall be maintained and be readily available in a specific location in the facility. The kit shall be a general type approved by the American Red Cross, or shall contain at least the following: 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 the first aid kit not being complete and missing required bandages, scissors, and thermometer, which poses a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 12/02/2022 Plan of Correction Licensee will obtained required items and send a picture of the purchase receipt for items and a picture of the items to LPA via email by the POC due date.
Plan of correction recorded
Correction not verified in available records
Medical and dental careType B
- Official classification
- Type B
- Official code
- 87465(a)(9)(A)
- Regulation authority
- CCR
What the official deficiency says
(9) If a facility has no medical unit on the grounds, a complete first aid kit shall be maintained and be readily available in a specific location in the facility. The kit shall be a general type approved by the American Red Cross, or shall contain at least the following: (9) If a facility has no medical unit on the grounds, a complete first aid kit shall be maintained and be readily available in a specific location in the facility. The kit shall be a general type approved by the American Red Cross, or shall contain at least the following: (A) A current edition of a first aid manual approved by the American Red Cross, the American Medical Association or a state or federal health agency. 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 a first aid manual was not available at the facility at the time of the visit, which poses a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 11/19/2022 Plan of Correction Licensee will print or purchase a first aid manual and provide a picture of the purchase receipt and book or a picture of the printed manual to LPA via email by the POC due date.
Plan of correction recorded
Correction not verified in available records
Dementia careType B
- Official classification
- Type B
- Official code
- 87705(c)(5)
- Regulation authority
- CCR
What the official deficiency says
(c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following: (c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following: (5) Each resident with dementia shall have an annual medical assessment as specified in Section 87458, Medical Assessment, and a reappraisal done at least annually, both of which shall include a reassessment of the resident's dementia care needs. 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 2 of 3 residents with dementia did not have an updated medical assessment or reapparaisal, which poses a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 12/02/2022 Plan of Correction Licensee will obtain a new medical assessment and reappraisal for 2 residents with dementia and email copies of the documents to the LPA by the POC due date.
Plan of correction recorded
Correction not verified in available records
Inspection
No deficiencies recorded in this report
Inspection
Staffing, personnel, and trainingType A
- Official classification
- Type A
- Official code
- 87412(a)(13)(B)
- Regulation authority
- CCR
What the official deficiency says
(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: (13) For employees that are required to be fingerprinted pursuant to Section 87355, Criminal Record Clearance: (B) Documentation of either a criminal record clearance or a criminal record exemption as required by Section 87355(e). This requirement is not met as evidenced by: Deficient Practice Statement Based on records reviewed, the licensee did not comply with the section cited above in 1 out of 2 staff members which poses an immediate health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 11/20/2021 Plan of Correction Administrator will not allow S1 to work without proof of fingerprint clearance. Administrator will certify that all staff working will have fingerprint clearances and will certify that S1 will not continue to work until a criminal record clearance is obtained. Certification is due by 11/20/21. This will result in a civil penalty.
Plan of correction recorded
Correction not verified in available records
Resident rightsType B
- Official classification
- Type B
- Official code
- 87468.1(a)(2)
- Regulation authority
- CCR
What the official deficiency says
(a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA's observation, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care. Per COVID-19 procedures and facility Mitigation Plan, staff are required to conduct routine symptom screening (+/- temperature and symptom check) for all staff, residents, and visitors. LPA was not screened during the visit. Also 2 visitors were observed entering the facility and they were also not screened.
Official plan of correction
POC Due Date: 12/03/2021 Plan of Correction Administrator will submit proof of training for all staff regarding screening of all visitors. Proof of training will be submitted by 12/3/21.
Plan of correction recorded
Correction not verified in available records
Staffing, personnel, and trainingType B
- Official classification
- Type B
- Official code
- 87411(a)
- Regulation authority
- CCR
What the official deficiency says
(a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. In facilities licensed for sixteen or more, sufficient support staff shall be employed to ensure provision of personal assistance and care as required in Section 87608, Postural Supports. Additional staff shall be employed as necessary to perform office work, cooking, house cleaning, laundering, and maintenance of buildings, equipment and grounds. The licensing agency may require any facility to provide additional staff whenever it determines through documentation that the needs of the particular residents, the extent of services provided, or the physical arrangements of the facility require such additional staff for the provision of adequate services. 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 which poses a potential health, safety or personal rights risk to persons in care. Facility is required to have a sign-in policy per COVID-19 procedures and as indicated in the approved Mitigation Plan. LPA was not asked or required to sign-in at the time of entry. Also 2 visitors were observed entering the facility and they were also not asked to sign-in.
Official plan of correction
POC Due Date: 12/03/2021 Plan of Correction Administrator will submit proof that staff have been trained on sign-in procedures. Proof of training will be submitted by 12/3/21.
Plan of correction recorded
Correction not verified in available records
Staffing, personnel, and trainingType B
- Official classification
- Type B
- Official code
- 87412(a)
- Regulation authority
- CCR
What the official deficiency says
(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA's observation and interviews conducted, the licensee did not comply with the section cited above in 1 out of 2 staff members which poses a potential health, safety or personal rights risk to persons in care. Staff #1 (S1) did not have a personnel file at the facility. According to Staff #2 (S2) S1 is only a reliver and does not have a personnel file.
Official plan of correction
POC Due Date: 12/03/2021 Plan of Correction Administrator will submit S1's personnel file to the department for review. Administrator will provide the file by 12/3/21.
Plan of correction recorded
Correction not verified in available records
Admission, assessment, and evictionType B
- Official classification
- Type B
- Official code
- 87456(a)(2)
- Regulation authority
- CCR
What the official deficiency says
(a) Prior to accepting a resident for care and in order to evaluate his/her suitability, the facility shall, as specified in this article 8: (2) Perform a pre-admission appraisal. This requirement is not met as evidenced by: Deficient Practice Statement Based on records reviewed, the licensee did not comply with the section cited above in 1 out of 4 resident files which poses a potential health, safety or personal rights risk to persons in care. Resident #1 (R1) did not have a pre-admission appraisal on file.
Official plan of correction
POC Due Date: 12/03/2021 Plan of Correction Administrator will complete a pre-admission appraisal for R1. Appraisal will be submitted by 12/3/21 for review.
Plan of correction recorded
Correction not verified in available records
Admission, assessment, and evictionType B
- 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 records reviewed, the licensee did not comply with the section cited above in 1 out of 4 resident records which poses a potential health, safety or personal rights risk to persons in care. Resident #1 (R1) did not have proof of TB test on file.
Official plan of correction
POC Due Date: 12/03/2021 Plan of Correction Administrator will obtain proof of TB clearance for R1. TB test results will be submitted to the department for review by 12/3/21.
Plan of correction recorded
Correction not verified in available records
Admission, assessment, and evictionType B
- Official classification
- Type B
- Official code
- 87507(a)
- Regulation authority
- CCR
What the official deficiency says
(a) The licensee shall complete an individual written admission agreement, as defined in Section 87101(a), with each resident or the resident's representative, if any. This requirement is not met as evidenced by: Deficient Practice Statement Based on records reviewed, the licensee did not comply with the section cited above in 2 out of 4 resident files which poses a potential health, safety or personal rights risk to persons in care. Resident #1 (R1) did not have an admission agreement on file. Resident #2 (R2) had the wrong admission agreement on file. R2's agreement lists the previous owner's facility name. This agreement must be corrected to list the new owner's information.
Official plan of correction
POC Due Date: 12/03/2021 Plan of Correction Administrator will submit complete admission agreements for both residents. Admission agreements will be submitted by 12/3/21 for review.
Plan of correction recorded
Correction not verified in available records
Source and limits
California Department of Social Services, Community Care Licensing Division. Public facility history is described by the source as a five-year window. Older records and previous-licensee history may require a regional-office request. Type 741 RCFE-CCRCs, nursing homes, and other care settings are excluded from this page.
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