Hazardous items and storage
Cited in 3 reports, with 5 deficiencies in total.
MERIDIAN MANOR
1325 MERIDIAN AVENUE, South Pasadena CA 91030
6 bedsLatest official report Mar 3, 2026Licensed
Additional info
- Telephone
- (323) 344-8700
- Licensee
- NYCZAK, EWA
- Administrator
- NYCZAK, EWA
- Contact
- NYCZAK, EWA
- License first date
- Apr 23, 1999
- License effective date
- Apr 23, 1999
- District office
- MONTEREY PARK ASC · (323) 980-4934
- Regional office
- 28
- Clients served
- 983 - RCFE / DEMENTIA
Summary
The available records show 14 Type A and 12 Type B deficiencies for this facility.
- Most recent inspection
- Mar 3, 2026
- Most recent deficiency
- Mar 3, 2026
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 14 Type A and 12 Type B deficiencies.
2 deficiencies have explicit official correction or clearance evidence in the loaded records.
- Official inspections
- 6
- Recorded deficiencies
- 26
- Type A deficiencies
- 14
- Type B deficiencies
- 12
- Substantiated complaints
- 0
- Repeated topics
- 1
More than the typical 4
1 in the last 12 months
Well above the typical 1
5 in the last 12 months
Most this size have none
4 in the last 12 months
Most this size have none
1 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
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 Disinfectants and cleaning solutions are stored in the unlocked bathroom cabinets, the unlocked storage room and the unlocked cabinet under the kitchen sink. Knives, scissors, sharp objects, and other similar items are stored in a unlocked kitchen drawer. Laundary detergine is left unattended outside the locked storage. Based on observation, the licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 03/04/2026 Plan of Correction Licensee agreed to lock disinfectants, cleaning solutions and sharp items. Provide in service training to ensure staff are following the regulation 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)(1)
- 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. (1) Disinfectants, cleaning solutions, and poisonous substances shall be stored in areas separate from food supplies as specified in Section 87555, General Food Service Requirements. This requirement is not met as evidenced by: Deficient Practice Statement Disinfectants and cleaning solutions are left unattended outside of the locked storage in the food supplies areas in the kitchen. Based on observation, the licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 03/04/2026 Plan of Correction Licensee agreed to lock disinfectants, cleaning solutions and stored separately from the food supplies. Provide in service training to ensure staff are following the regulation by POC due date.
Plan of correction recorded
Correction not verified in available records
Medication handling and storageType A
- 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 is not met as evidenced by: Deficient Practice Statement All residents' medication were centrally stored in the kitchen cabinet drawer UNLOCKED and accessible to residents. Based on observation, the licensee did not comply with the section cited abovewhich poses an immediate health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 03/04/2026 Plan of Correction LIcensee agreed to lock the residents' medication cabinet and provide in-service training to ensure staff would keep the medication drawer locked by POC due date
Plan of correction recorded
Correction not verified in available records
Medication handling and storageType A
- 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 Alll residents' medication were transferred from the original bottles to medication boxes for 7 days. Based on observation, the licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 03/04/2026 Plan of Correction LIcensee agreed to stop transferring residents' medication to other medication boxes and provide in-service training to ensure staff are trained about handling medication 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
- 87307(d)(2)
- Regulation authority
- CCR
What the official deficiency says
(2) The premises shall be maintained in a state of good repair and shall provide a safe and healthful environment. This requirement is not met as evidenced by: Deficient Practice Statement Kitchen ceiling has paint peeling at the area above the sink; Bathroom ceiling has paint peeling and mold at the shower areag; Stove burner (front, right burner) is not igniting, Audio device on the back exit door is not working, Based on observation and testing, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 03/12/2026 Plan of Correction Licensee agreed to fix the issues and provided the proof of correction with pictures and labor invoices by POC due day.
Plan of correction recorded
Correction not verified in available records
Inspection
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, the licensee did not comply with the section cited above in medication bottles were observed in kitchen drawer, and cleaning supplies were observed in cabinet without locks, kitchen is 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: 03/28/2025 Plan of Correction Administrator will certify in writing that staff will ensure to maintain medications and cleaning supplies inaccessible to the residents at all times and submit a picture of the locks that will be install in the drawers by POC due date 3/28/25.
Plan of correction recorded
Correction not verified in available records
Staffing, personnel, and trainingType B
- 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 in 1 out of 4 staff did not have a health screening and TB test clearance on file which poses/posed a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 04/03/2025 Plan of Correction Administrator will obtain a health screening and TB test clearance for staff #3(S3) and submit a copy to the department by POC due date 4/3/25.
Plan of correction recorded
Correction not verified in available records
Inspection
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, the licensee did not comply with the section cited above in cleaning solution was observed in B1 accessible to the residents which poses an immediate health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 04/06/2024 Plan of Correction Administrator will submit in writing schedule for training to be provided to the staff by POC due date 4/8/24. Training will be provided on safety of storing cleaning supplies and other harmful items per section 87309 and will create a plan to ensure staff are following guidelines to maintain harmful items inaccessible to residents will submit a copy of training, log, duration, and plan to the deparment by 4/19/24.
Plan of correction recorded
Correction not verified in available records
Hazardous items and storageType A
- Official classification
- Type A
- Official code
- 87309(b)
- Regulation authority
- CCR
What the official deficiency says
(b) Medicines shall be stored as specified in Section 87465(c) and separately from other items specified in (a) above. 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 resident's prepared medication was observed in kitchen's counter top, hospice medication was observed in freezer's door, and a liquid medication was observed in the refrigerator's door accessible to the residents which poses an immediate health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 04/06/2024 Plan of Correction Administrator will certify in writing that medication will be stored properly, will schedule training for staff by pharmacist by POC due date 4/6/24. Administrator will provide training on medication storage per section 87465 and will provide copies of training description, log, duration of training, create a plan to ensure staff are following training guidelines, and will submit to the department by 4/19/24.
Plan of correction recorded
Correction not verified in available records
Admission, assessment, and evictionType B
- Official classification
- Type B
- Official code
- 87204(a)
- Regulation authority
- CCR
What the official deficiency says
(a) A licensee shall not operate a facility beyond the conditions and limitations specified on the license, including specification of the maximum number of persons who may receive services at any one time. An exception may be made in the case of catastrophic emergency when the licensing agency may make temporary exceptions to the approved capacity. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and record review, the licensee did not comply with the section cited above in facility is currently providing care to (4) residents in hospice and has a current hospice waiver for (3) which poses/posed a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 04/17/2024 Plan of Correction Administrator will submit either a hospice waiver increase or submit an exception hospice waiver letter request with required documents for (1) out of the (4) residents at the facility to the department by POC due date 4/19/24.
Plan of correction recorded
Correction not verified in available records
Resident rightsType B
- Official classification
- Type B
- Official code
- 87468(c)(2)(A)
- Regulation authority
- CCR
What the official deficiency says
(c) Licensees shall prominently post personal rights, nondiscrimination notice, and complaint information in areas accessible to residents, representatives, and the public. (2) Information on the appropriate reporting agency in case of a complaint or emergency, including procedures for filing confidential complaints, shall be posted as follows: (A) Licensees may use the Residential Care Facility for the Elderly (RCFE) Complaint Poster (PUB 475) or may develop their own poster as provided in this section. A poster developed by the licensee shall contain the same content as the PUB 475. The poster that is posted shall be 20” x 26” in size and be posted in the main entryway of the facility. PUB 475 may be accessed, downloaded, and printed from the www.ccld.ca.gov website. 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 PUB 475 was not observed posted at the facility which poses/posed a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 04/17/2024 Plan of Correction Administrator will obtain a copy of PUB 475 and post it at the facility, will submit a picture of PUB 475 posted to the department by POC due date 4/17/24.
Plan of correction recorded
Correction not verified in available records
Admission, assessment, and evictionType B
- Official classification
- Type B
- Official code
- 87458(a)
- Regulation authority
- CCR
What the official deficiency says
(a) Prior to a person's acceptance as a resident, the licensee shall obtain and keep on file, documentation of a medical assessment, signed by a physician, made within the last year. The licensee shall be permitted to use the form LIC 602 (Rev. 9/89), Physician's Report, to obtain the medical assessment. 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 4 residents, R3 does not have a physician's report on file which poses/posed a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 04/17/2024 Plan of Correction Administrator will obtain a copy of physician's report for R3 and submitted to the department by POC due date 4/17/24.
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 1 out of 4 residents, R2 has full bed rails and no physician's request was found on file or hospice file which poses/posed a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 04/17/2024 Plan of Correction Administrator will provide a copy of physician's order for full bed rails to the department by POC due date 4/17/24.
Plan of correction recorded
Correction not verified in available records
Inspection
Hazardous items and storageType A
- Official classification
- Type A
- Official code
- 87309(a)(1)
- 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. (1) Storage areas for poisons, and firearms and other dangerous weapons shall be locked. 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 cleaning solutions in kitchen cabinet were not locked during the visit which poses an immediate health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 03/10/2023 Plan of Correction Licensee will certify via LIC 9098 and will schedule training for staff on regulation 87309 by 3/10/23 and submit training and sign in sheet by 3/17/23.
Plan of correction recorded
Correction not verified in available records
Hazardous items and storageType A
- Official classification
- Type A
- Official code
- 87309(b)
- Regulation authority
- CCR
What the official deficiency says
(b) Medicines shall be stored as specified in Section 87465(c) and separately from other items specified in (a) above. 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 refrigerated medication was observed in the butter cupboard of refrigerator, prescribed medication was observed in counter between refrigerator and kitchen counter which poses an immediate health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 03/10/2023 Plan of Correction Licensee will ceritfy via LIC 9098 and will schedule training for staff on 87309 by 3/10/23 and submit trainig and sign in sheet by 3/17/23.
Plan of correction recorded
Correction not verified in available records
Dementia careType A
- Official classification
- Type A
- Official code
- 87705(f)(1)
- Regulation authority
- CCR
What the official deficiency says
(f) The following shall be stored inaccessible to residents with dementia: (1) Knives, matches, firearms, tools and other items that could constitute a danger to the resident(s). This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above in drawer with knives and sharps located to the left of the kitchen sink was observed unlock which poses an immediate health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 03/10/2023 Plan of Correction Licensee will certify by LIC 9098 and will schedule training on 87705 for staff by 3/10/23. Administrator will submit training and sign in sheet by 3/17/23.
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 record review, the licensee did not comply with the section cited above in 4 out of 5 staff files review did not have yearly training for 2022 which poses/posed a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 03/23/2023 Plan of Correction Licensee will provide proper training to staff and submit copies of a total of 20 hours in the required subjects for each staff to the department by POC due date 3/23/23.
Plan of correction recorded
Correction not verified in available records
Admission, assessment, and evictionType B
- Official classification
- Type B
- Official code
- 87458(a)
- Regulation authority
- CCR
What the official deficiency says
(a) Prior to a person's acceptance as a resident, the licensee shall obtain and keep on file, documentation of a medical assessment, signed by a physician, made within the last year. The licensee shall be permitted to use the form LIC 602 (Rev. 9/89), Physician's Report, to obtain the medical assessment. 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 5 resident files reviewed did not have a physician's report in their files which poses/posed a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 03/23/2023 Plan of Correction Licensee will obtain physician's report for resident #5 and will submit a copy to the department by POC due date 3/23/23.
Plan of correction recorded
Correction not verified in available records
Dementia careType B
- Official classification
- Type B
- 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 exit door/main entrance and kitchen exit door have an auditory device but it was not working at the time of the visit which poses/posed a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 03/23/2023 Plan of Correction Administrator will ensure auditory devices are in working condition and staff maintain them on at all times in LIC 9098 by POC due date 3/23/23. Deficiency cleared during visit as of 3/23/23.
Official record says corrected or clearedRecorded in report dated Mar 9, 2023
Plan of correction recorded
Inspection
No deficiencies recorded in this report
Inspection
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, the licensee did not comply with the section cited above in cleaning solutions were observed under kitchen sink, cabinet and under B2 sink unlock, and next to toilet in B1 which poses an immediate health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 04/14/2022 Plan of Correction Administrator requested staff to remove cleaning solutions from each area and placed them under lock during this visit. Deficiency clear during visit.
Plan of correction recorded
Correction not verified in available records
Medication handling and storageType A
- 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 is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above in resident's medication was stored refrigerator's door compartment, drawer and on top of counter unlock which poses an immediate health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 04/14/2022 Plan of Correction Administrator requested staff to place medication in a container and place it in refrigerator in garage wich is not accessible to the residents and remove medication from drawer and on top of counter and placed them in medication cabinet under lock. Deficiency cleared during this visit.
Official record says corrected or clearedRecorded in report dated Apr 14, 2022
Plan of correction recorded
Medication handling and storageType A
- Official classification
- Type A
- Official code
- 87465(h)(4)
- Regulation authority
- CCR
What the official deficiency says
(h) The following requirements shall apply to medications which are centrally stored: (4) All centrally stored medications shall be labeled and maintained in compliance with state and federal laws. No persons other than the dispensing pharmacist shall alter a prescription label. 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 2 out of 4 residents, R2 and R4 prescribed medication did not have label which poses an immediate health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 04/15/2022 Plan of Correction Administrator will request medication or label from pharmacy to replace medication that does not have labels and submit a picture of the medication by 4/15/22.
Plan of correction recorded
Correction not verified in available records
Health conditions and treatmentsType A
- Official classification
- Type A
- 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 residents have bed rails and do not have physician's orders on file for R2,R3,R4 which poses an immediate health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 04/15/2022 Plan of Correction Administrator will request physician's orders for R2,R3,R4 and submit a copy to the department by 4/15/22.
Plan of correction recorded
Correction not verified in available records
Facility condition and maintenanceType B
- Official classification
- Type B
- Official code
- 87307(d)(2)
- Regulation authority
- CCR
What the official deficiency says
(2) The premises shall be maintained in a state of good repair and shall provide a safe and healthful environment. 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 water patches from repaired leaks have popcorn ceiling peeling which poses/posed a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 04/28/2022 Plan of Correction Administrator will have ceiling repair and submit pictures to the deparment by 4/28/22.
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: (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 and documents review, the licensee did not comply with the section cited above in 1 out of 4 resident files reviewed, for R1 physician's report is not current which poses/posed a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 04/21/2022 Plan of Correction Administrator will obtain a current physician report for R1 and submit a copy to the department by 4/21/22.
Plan of correction recorded
Correction not verified in available records
Dementia careType B
- Official classification
- Type B
- 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 3 out of 3 exits/entry to the facility auditory system is not in working condition for main entrance and exit door to the back yard or activated for exit door in the kitchen which poses/posed a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 04/21/2022 Plan of Correction Administrator will ensure auditory devices are in working condition at all times. Administrator replaced auditory devices in main entrance, activated auditory device in exit door in the kitchen, will replaced auditory device system in exit door to the backyard and submit a picture to the department by 4/21/22.
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.
Read the data methodology