FAMILY HOME LLC

Official classification

Type A

Official code

87309(a)

Regulation authority

CCR

What the official deficiency says

87309Storage Space and Access ...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: LPA observed a bottle of isopropyl alcohol on the countertop in the hallway and two (2) 1-gallon cans of paint under the bathroom sink in an unlocked cabinet accessible to to residents, which poses an immediate health, safety and personal rights risk to residents in care.

Official plan of correction

Corrected at the time of visit. Staff removed the items and secured them making them inaccessible to residents in care.

Deadline recorded: Jul 8, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87355(a)(3)

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: (3)Request a transfer of a criminal record clearance… This requirement is not met as evidenced by: Based on interview and record review, 1 staff was not associated to the facility on Guardian prior to working at the facility which poses an immediate health, safety and personal rights risks to residents in care.

Official plan of correction

Administrator is to ensure that all staff are associated to the facility prior to working at all times. Administrator is to submit a written plan explaining how the facility will ensure all staff are associated to the facility prior to beginning work and submit the proof staff has been associated to the licensing agency for review by the POC due date.

Deadline recorded: Jul 8, 2026. A deadline is not proof that correction was completed.

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, the licensee did not comply with the section cited above in that bleach and other cleaning solutions located in an unlocked hall closet,were not secured and accessible to resdients which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/27/2026 Plan of Correction Staff removed bleach and cleaning solutions at time of visit.

Official classification

Type B

Official code

87458(c)(5)

Regulation authority

CCR

What the official deficiency says

(c) The medical assessment shall include, but not be limited to: (5) The determination whether the person is ambulatory or nonambulatory as defined in Section 87101, Definitions, or bedridden as defined in Health and Safety Code section 1569.72. The assessment shall indicate whether nonambulatory status is based upon the resident's physical condition, mental condition, or both. 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 out of 5 residents medical assessments for R1, R3 and R5 reflect diagnosis of dementia but indicated ambulatory instead of non-ambulatory due to the mental condition status which posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/20/2026 Plan of Correction Staff agreed to submit updated medical assessments for R1, R3, R5 to LPA via email by POC due date.

Official classification

Type A

Official code

87465(h)(2)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care (h) The following requirements shall apply to medications which are centrally stored:(2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. This requirement was not met as evidenced by: LPA observed medication in an unlocked drawer in attached garage accessible to residents. This poses an immediate risk to the health, safety, or personal rights of persons in care.

Official plan of correction

Facility will conduct training with all staff on section 87465(h)(2) and submit to LPA by POC due date.

Deadline recorded: Dec 12, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(h)(5)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care(h) The following requirements shall apply to medications which are centrally stored:(5) Each resident's medication shall be stored in its originally received container. No medications shall be transferred between containers. This requirement was not met as evidenced by: LPA observed medication in prefilled pill boxes in an unlocked drawer in attached garage. This poses an immediate risk to the health, safety, or personal rights of persons in care.

Official plan of correction

Facility will conduct training on section 87465(h)(5) with staff and submit to LPA by POC due date.

Deadline recorded: Dec 12, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87465(h)(5)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care (h) The following requirements shall apply to medications which are centrally stored: (5) Each resident's medication shall be stored in its originally received container. No medications shall be transferred between containers. This requirement was not met as evidenced by: Four residents’ medication were not stored in original container. S2 pre- filled medication for month and hid pill boxes in garage drawer because LPA made an unannounced visit and S2 knew they shouldn’t have had resident’s pills in boxes.

Official plan of correction

Facility will conduct training to all staff on section 87465(h)(5) and send completed log to LPA by POC due date.

Deadline recorded: Nov 10, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87355(e)(1)(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: (1) Submit a valid mailing address at which the individual shall receive communications from the Department. (3) Request a transfer of a criminal record clearance as specified in Section 87355(c). This requirement was not met as evidenced by: S1 and S2 did not have record of criminal clearance transfer. This poses an immediate risk to the health, safety, or personal rights of persons in care.

Official plan of correction

Licensee will develop a plan on when S1 and S2's criminal clearance transfer will be completed and how the facility will comply with this regulation until this is completed.

Deadline recorded: Oct 27, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(h)(2)

Regulation authority

CCR

What the official deficiency says

(h) The following requirements shall apply to medications which are centrally stored: (2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. This requirement was not met as evidenced by: R1's refrigerated medication was not in a locked place and was accessible to other persons besides staff. This poses an immediate risk to the health, safety, or personal rights of persons in care.

Official plan of correction

Licensee will draft plan on how the facility will comply with regulation.

Deadline recorded: Oct 27, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87355(e)(1)

Regulation authority

CCR

What the official deficiency says

Criminal Record Clearance Prior to working ... in a licensed facility, all individuals subject to a criminal record review shall obtain a clearance or criminal record exemption. This requirement is not met as evidence by: S1 and S4 are employed by facility for at least 5 days and have not been cleared and/or associated to facility which poses a health a safety risk to persons in care.

Official plan of correction

Administrator will make sure staff are finger printed and associated to facility prior to working at facility, Due to supervision of resident's concerns, LPA did not ask Administrator to remove the staff from premises immediately. Administrator will associated and clear staff by POC date which 01/08/2025

Deadline recorded: Jan 8, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87464(f)(1)

Regulation authority

CCR

What the official deficiency says

(f) Basic services shall at a minimum include: (1) Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(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 which poses a potential health, safety or personal rights risk to persons in care. Routine symptom screening has been initiated at entry for all staff, residents, and visitors. This practice has a health and safety impact that includes, but is not limited to personal rights, health-related services, responsibility for providing care and supervision, and personnel requirements. LPA was not screened at the time of the visit.

Official plan of correction

POC Due Date: 02/17/2022 Plan of Correction Facility will provide training for staff and remind staff to conduct symptom screening for all visitors including LPAs.

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, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care. A sign-in policy has been enacted with all visitors to ensure compliance with central entry point for symptom screening and to record contact information (for reporting requirements to public health officer and contact tracing). This practice has a health and safety impact that includes, but is not limited to personal rights, and reporting requirements. LPA was not required to sign in at the time of the visit.

Official plan of correction

POC Due Date: 02/17/2022 Plan of Correction Facility will provide additional training for staff and will submit proof of training by 2/17/22.

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 observation, the licensee did not comply with the section cited above in 3 out of 3 persons which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/17/2022 Plan of Correction Facility will submit all 3 health screenings by 2/17/22.

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, the licensee did not comply with the section cited above in 3 out of 4 persons which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/17/2022 Plan of Correction Facility will obtain physician's orders for all 3 residents' bed rails. Physician's orders will be submitted by 2/17/22.