Records and plan of operationType B
- Official classification
- Type B
- Official code
- 87208(a)
- Regulation authority
- CCR
What the official deficiency says
(a) The licensee shall have and maintain a current, written definitive plan of operation for the facility. The licensee shall operate the facility in accordance with the terms specified in the plan of operation and may be cited for not doing so pursuant to Health and Safety Code section 1569.49. The plan and related materials shall be on file in the facility and shall be submitted to the licensing agency with the license application. Any significant changes in the plan of operation which would affect the services to residents shall be submitted to the licensing agency for approval. The plan and related materials shall contain the following: This requirement is not met as evidenced by: Deficient Practice Statement Based on (observation), LPA observed a queen size bed and personal items, such as clothing for staff # 2. The facility is not operating according to it's plan of operation. The licensee did not comply with the section cited above, which poses/ a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 07/08/2025 Plan of Correction Administrator has agreed to remove the bed and replace with a couch for a staff lounge area. Pictures need to be submitted to LPA that bed has been removed by June 27, 2025. Couch will be ordered and receipt needs to be submitted to LPA by POC 07/08/2025.
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 [1] out of [2] resident records was missing safeguard of personal property documents. Which poses a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 07/01/2025 Plan of Correction Administrator will submit document to LPA for resident # 2, who is missing safeguard/personal property document.
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 required 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 [1] out of [2] record review, resident # 2 is missing the pre-admission appraisal document. Which poses a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 07/08/2025 Plan of Correction Administrator will submit the pre-admission document to LPA by POC date for resident # 2.
Admission, assessment, and evictionType B
- Official classification
- Type B
- Official code
- 87457(c)
- Regulation authority
- CCR
What the official deficiency says
(c) Prior to admission a determination of the prospective resident's suitability for admission shall be completed and shall include an appraisal of their individual service needs in comparison with the admission criteria specified in Section 87455, Acceptance and Retention Limitations. This requirement is not met as evidenced by: Deficient Practice Statement Based on (record review)], the licensee did not comply with the section cited above in [2] out of [2] record review for residents, both residents were missing needs and service plans. Which poses a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 07/08/2025 Plan of Correction Administrator will submit the needs and service plan for both resident # 1 and # 2 by POC date.
Facility condition and maintenanceType B
- Official classification
- Type B
- Official code
- 87307(a)
- Regulation authority
- CCR
What the official deficiency says
Personal Accodamations & Services: 87307 (a) Living accommodations and grounds shall be related to the facility's function. The facility shall be large enough to provide comfortable living accommodations and privacy for the residents, staff, and others who may reside in the facility. The following provisions shall apply: This requirement is not met as evidenced by: Deficient Practice Statement Based on today's physical plant inspection, LPA observed a queen side bed and personal items and clothing in the garage that belongs to staff # 2. This poses as a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 07/08/2025 Plan of Correction Administrator has agreed to remove the bed and replace with a couch for a staff lounge area. Pictures need to be submitted to LPA that bed has been removed by June 27, 2025. Couch will be ordered and receipt needs to be submitted to LPA by POC 07/08/2025.