SANTA ANITA ASSISTED LIVING

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

87303 Maintenance and Operation (a) 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: LPAs observed signal/auditory devices on (4) exit doors. Staff indicated that the facility recently installed the auditory devices; however, they are non-operational. LPAs observed the auditory devices to be non-operational during visit.

Official plan of correction

Licensee/Administrator will ensure that the auditory/signal system is working at all times. Licensee/Administrator will email proof of staff in-service and proof that the entire building's auditory/signal system and pendants were tested and are receiving the page within facility protocols response time by POC due date.

Deadline recorded: Sep 4, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87312

Regulation authority

CCR

What the official deficiency says

...Any vehicle used by the facility to transport residents shall be maintained in a safe operating condition. This requirement was not met as evidenced by: The facility van's sliding door is jammed and not operable. This poses a potential health and safety risk to residents in care.

Official plan of correction

Administrator agreed to repair the facility van's sliding door and submit the proof of repair to licensing by the POC due date. POC was cleared on 06/10/26.

Deadline recorded: Jul 3, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

(a) 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 observations, the licensee did not comply with the section cited above in (2) out of (10) resident rooms inspected had loose shower grab bars. Shower side grab bar in room #143 and shower grab bar above faucet in room #112 are loose. Grabs bars observed not properly bolted to the wall, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/07/2026 Plan of Correction Licensee/Director will send LPA photos of the repairs for the grab bars by POC due date.

Official classification

Type B

Official code

1569.38(a)

Regulation authority

HSC

What the official deficiency says

1569.38 Posting of licensing reports; disclosure to new residents (a) Each residential care facility for the elderly shall place in a conspicuous place copies of all licensing reports issued by the department within the preceding 12 months... This requirement is not met as evidenced by: Based on interviews and observation, the copies of licensing reports are not posted in a conspicuous place which poses a potential personal rights to residents in care.

Official plan of correction

The licensee shall have copies of licensing reports in a visible area of the facility. A statement acknowledging this regulation and the location of reports is to submitted to LPA by 6/23/26.

Deadline recorded: Jun 23, 2026. A deadline is not proof that correction was completed.

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. This requirement was not met as evidenced by: The facility van's sliding door is jammed and not operable. This poses a potential health and safety risk to residents in care.

Official plan of correction

Adminsitrator agreed to repair the facilty van's sliding door or replace the van if needed. Adminsitrator will submit the proof of repair to licensing by the POC due date

Deadline recorded: Jun 11, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(a)(4)

Regulation authority

CCR

What the official deficiency says

(a) A plan for incidental medical ... care shall be developed by each facility. The plan shall encourage routine medical care and provide assistance in obtaining such care, by compliance with the following: (4) The licensee shall assist residents with self-administered medications as needed. This requirement is not met as evidenced by: Based on observation, interviews, and record review, the licensee did not comply with the cited section, as the facility failed to ensure timely administration of morning medications as prescribed on 4/26/26. This deficiency poses an immediate risk to the health, safety, and personal rights of residents in care.

Official plan of correction

Administrator shall submit a written plan by the POC due date outlining how medication administration training will be provided to staff to ensure compliance. Administrator shall provide proof of completed training, including sign-in sheets and training curriculum, to the Department by 05/19/2026.

Deadline recorded: May 19, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(a)(4)

Regulation authority

CCR

What the official deficiency says

(4) The licensee shall assist residents with self-administered medications as needed. This requirement is not met as evidenced by: Based on observation, interviews, and record review, the licensee did not comply with the cited section, as the facility failed to ensure timely administration of morning medications as prescribed on 4/26/26. This deficiency poses an immediate risk to the health, safety, and personal rights of residents in care.

Official plan of correction

The Administrator shall submit a written plan by the POC due date outlining how medication administration training will be provided to staff to ensure compliance. Administrator shall provide proof of completed training, including sign-in sheets and training curriculum, to the Department by 05/19/2026.

Deadline recorded: May 6, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87465(j)

Regulation authority

CCR

What the official deficiency says

Incidental Medical and Dental Care. In all facilities licensed for sixteen (16) persons or more, one or more employees shall be designated as having primary responsibility for assuring that each resident receives needed first aid and needed emergency medical services and for assisting residents as needed with self-administration of medications......This requirement was not met evidenced by: Based on interviews, the findings indicate that on Sunday, April 26, 2026, residents (R1 & R2) had a physical fight that resulted in minor injuries with bleeding that required 1st Aid, but since there were no med-tech working the morning shift they did not receive care. This poses a potential health, safety, and personal rights risk.

Official plan of correction

Assistant Administrator agreed to submit: 1. A written plan of correction that addresses personnel shortages, staff schedules, and staff responsibilities. 2. In-service training

Deadline recorded: May 21, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87208(a)(5)

Regulation authority

CCR

What the official deficiency says

Plan of Operation 87208 (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…(5) Staffing plan, qualifications and duties. This requirement was not met as evidenced by: based on interviews and record review, the facility has staffing shortages which have delayed wellness checks, bathing and incontinent care for residents which poses a potential risk for persons in care.

Official plan of correction

Licensee/Administrator will send LPA a plan regarding how to keep staffing consistent. Administrator will also send LPA, an updated copy of the updated staff roster.

Deadline recorded: Apr 6, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87555(b)(27)

Regulation authority

CCR

What the official deficiency says

General Food Service Requirements (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: Based on observation on 7/17/25, the licensee did not comply with the section cited above in that several live cockroaches were observed in the dishwashing area of the kitchen during visit, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Licensee will contract services for pest control to alleviate the presence of cockroaches. Licensee shall closely monitor the cockroach issue and have the pest control company treat the facility. Licensee will send LPA, invoice of pest control services by POC due date. POC is cleared.

Deadline recorded: Jul 25, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87507(g)(3)(G)

Regulation authority

CCR

What the official deficiency says

Admission Agreements (g) Admission agreements shall specify the following: (3) Payment provisions, including the following: (G) A comprehensive description of billing and payment procedures. This requirement is not met as evidenced by: Based on record review, Resident 1's admission agreement does not indicate rent payment provisions for payment procedures and proper notification to resident for outstanding balances if it applies, which poses a potential personal rights risk to residents in care.

Official plan of correction

The licensee shall ensure the admission agreement specifies rent payment provisions, including description of billing and payment procedures. Licensee will also ensure that procedures for notification to residents for payments made or balances due (continues below) are also included in residents' admission agreement. The licensee shall review all the residents' admission agreements to ensure that regulation policies are included accurately. Licensee will submit a statement indicating the resident records have been reviewed and a statement acknowledging the regulation have been read by POC due date.

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

Official classification

Type B

Official code

87303(a)(1)

Regulation authority

CCR

What the official deficiency says

87303(a)(1) Maintenance and Operation (a)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. (1) Floor surfaces in bath, laundry and kitchen areas shall be maintained in a clean, sanitary, and odorless condition. This requirement was not met as evidenced by: during inspection of (2) resident dining rooms, missing floor tiles/panels were observed in the main dining room by kitchen door under table and between doorway to secondary resident dining room. Both affected areas have lifted edges and grime accumulated on the surface creating a trip hazard, which poses a potential health and safety risk for persons in care.

Official plan of correction

Licensee will replace missing floor tiles/panels in both areas of the dining rooms and will send LPA photos of the repairs/corrections by POC due date.

Deadline recorded: Mar 3, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

87303(a) Maintenance and Operation (a) 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 was not met as evidenced by: inspection and observation of the two dining rooms during and after meal services revealed that several walls and baseboards have splattered stains from drinks and other food particles. Also observed dirt and grime stains around the corners of the floor by the grand piano and doorways in both dining rooms.

Official plan of correction

Licensee will be paiting walls and baseboards and will do a deep clean on the floors to remove the grime througt the floors of both dining rooms. Licensee will send photos of the corrections by POC due date.

Deadline recorded: Feb 20, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87208(a)

Regulation authority

CCR

What the official deficiency says

87208(a) Plan of Operation (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... This requirement was not met as evidenced by: R1's Care Plan indicates safety checks to be conducted 4 times per shift; however, staff indicated that staff conduct safety checks 2 to 3 times per 7.5 hour shift

Official plan of correction

Licensee will conduct an in-service training regarding following resident care plans to meet their needs and provide LPA proof of training via sign-in log and training topics and agenda.

Deadline recorded: Feb 6, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87303(e)(3)

Regulation authority

CCR

What the official deficiency says

Maintenance and Operation (e) Water supplies and plumbing fixtures shall be maintained as follows: (3) Taps delivering water at 125 degree F (52 degrees C) or above shall be prominently identified by warning signs. This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above by not having the warning sign posted by the kitchen dishwashing sink for water delivered at 125 degrees F. during inspection which poses a potential safety risk for kitchen staff/empoyees.

Official plan of correction

Licensee will post the warning sign above or by the kitchen dishwashing sink by POC due date and send LPA a photo as proof.

Deadline recorded: Feb 2, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87555(b)(29)

Regulation authority

CCR

What the official deficiency says

General Food Service Requirements b) The following food service requirements shall apply: (29) All equipment, fixed or mobile, and dishes, shall be kept clean and maintained in good repair and free of breaks, open seams, cracks or chips. This requirement is not met as evidenced by: Based on observation the licensee did not comply with the section cited above in that two dry food containers for rice and oatmeal had broken lids and content was exposed during time of visit, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

Licensee will replace broken dry food containers to ensure lids are tight-fitting by the POC due date. Licensee will send a copy of purchased containers and photo of the replaced containers along with their lids.

Deadline recorded: Feb 2, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87625(b)(3)

Regulation authority

CCR

What the official deficiency says

(b) In addition to Section 87611, General Requirements for Allowable Health Conditions, the licensee shall be responsible for the following: (3) Ensuring that incontinent residents are kept clean and dry and that the facility remains free of odors from incontinence. This requirement was not met as evidenced by: Based on observation, interview, and record review, the licensee did not comply with the section cited above as on 12/12/2025, there was two (2) caregivers on duty in the AM shift to provide incontinence care for 40 to 48 residents out of the facility census of 147 residents. Resident #1 (R1’s) incontinence needs was not met as incontinence service was provided by staff at 9:15am which was two hours and fifteen minutes passed the scheduled time of 7am. LPA also observed a strong urine odor in Resident #14 (R14’s) room. This poses a potential health and safety risk to persons in care.

Official plan of correction

Facility will submit a written plan on what to do when multiple caregiver staff call out and to ensure that residents’ incontinence needs are met and provided in a timely manner.

Deadline recorded: Jan 16, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.1(a)(3)

Regulation authority

CCR

What the official deficiency says

Personal Rights of Residents in All Facilities (a) Residents...shall have all of the following personal rights: (3) To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature... This requirement was not met as evidenced by: Interviews conducted with staff and resident indicate that staff member acknowledged raising their voice at resident and making inappropriate statement to resident in care.

Official plan of correction

Administrator provided proof of disciplinary written notice for violations of professional conduct and resident care standards. POC cleared at the time of visit.

Deadline recorded: Dec 18, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.2(a)(25)

Regulation authority

CCR

What the official deficiency says

(a) In addition to the rights listed in Section 87468.1, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (25) To protection of their property from theft or loss according to Health and Safety Code sections 1569.152, 1569.153, and 1569.154. This requirement was not met as evidenced by: 6 out of 10 residents did not have property protected from theft or loss. This poses a potential risk to the health, safety, or personal rights of persons in care.

Official plan of correction

*POC CLEARED ON 10/21/25 & 11/03/25. NO FUTHER ACTION REQUIRED* Administrator will submit plan as to when all staff retraining will be conducted. Plan must be received by 10/22/25 via email. All staff will receive retraining on Health and Safety Code sections 1569.152, 1569.153, and 1569.154. Proof of staff retraining is required by 11/4/2025.

Deadline recorded: Dec 5, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87468.2(a)(25)

Regulation authority

CCR

What the official deficiency says

(a) In addition to the rights listed in Section 87468.1, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (25) To protection of their property from theft or loss according to Health and Safety Code sections 1569.152, 1569.153, and 1569.154. This requirement was not met as evidenced by: 6 out of 10 residents did not have property protected from theft or loss. This poses an immediate risk to the health, safety, or personal rights of persons in care.

Official plan of correction

Administrator will submit plan as to when all staff retraining will be conducted. Plan must be received by 10/22/25 via email. All staff will receive retraining on Health and Safety Code sections 1569.152, 1569.153, and 1569.154. Proof of staff retraining is required by 11/4/2025.

Deadline recorded: Oct 22, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87207

Regulation authority

CCR

What the official deficiency says

False Claims. No licensee, officer or employee of a licensee shall make or disseminate any false or misleading statement regarding the facility or any of the services provided by the facility. This requirement was not met evidenced by: Based on record review of Medication Release form dated 12/24/24 and multiple other forms on different dates it was observed that form dated 12/24/24's signature is different and inconsistent with the majority of signatures on record. Therefore, there is a signature mismatch. This poses a potential health, safety, and personal rights risk to residents in care.

Official plan of correction

Executive Director agreed to: 1. Provide proof of med-tech in-service training on Medication Release form, and protocols regarding obtaining resident signatures of residents that are unable to sign on their own. 2. Submit a written plan with facility procedures and training materials.

Deadline recorded: Oct 28, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

Maintenance and Operation. 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 was not met evidenced by: Based on observation, there is one (1) indoor surveillance camera located in the hallway by the lobby, and multiple cameras in the exterior of the building. The main office camera monitors only show 3 operable cameras. The indoor camera is not operable. This poses a potential health, safety, and personal rights risk to residents in care.

Official plan of correction

Executive Director agreed to submit a written plan that addresses surveillance use, policy, and repairs. If cameras are to be used indoors, the facility plan of operation, sketch, and admission agreement must be updated and submitted to Community Care Licensing.

Deadline recorded: Nov 11, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87468.2(a)(4)

Regulation authority

CCR

What the official deficiency says

87468.2 (a)(4) Additional Personal Rights of Residents in Privately Operated Facilities (a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (4)To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs. This requirement is not met as evidence by: Based on interviews conducted and documents reviewed, licensee did not ensure that R1 received their medication at the correct times and thus, received excessive medication within a six-hour period. Medication was administered too soon between doses which poses an immediate risk to the health, safety, or personal rights to residents in care.

Official plan of correction

Administrator will provide medication training to med-tech staff which will include shadowing and will submit a copy of training log, topic, description of training, and duration of training by POC due date.

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

Official classification

Type A

Official code

87303(i)(1)(A)(B)(C)

Regulation authority

CCR

What the official deficiency says

Maintenance and Operation Facilities shall have signal systems which shall meet the following criteria: (1) All facilities licensed for 16 or more and all residential facilities having separate floors or buildings shall have a signal system which shall: (A) Operate from each resident's living unit. (B) Transmit a visual and/or auditory signal to a central staffed location or produce an auditory signal at the living unit loud enough to summon staff. (C) Identify the specific resident living unit. This requirement is not met as evidenced by: Facility failed to have a signal system operable in R7 and R9's room which poses an immediate health and safety risk to residents in care.

Official plan of correction

Facility to submit by POC due date verification of a scheduled appointment with a company to repair call buttons. Also to submit receipts when the work is completed.

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

Official classification

Type B

Official code

87465(c)(3)

Regulation authority

CCR

What the official deficiency says

Incidental Medical and Dental Care 87465(c)(3): (c) If the resident's physician has stated in writing that the resident is unable to determine his/her own need for nonprescription PRN medication but can communicate his/her symptoms clearly, facility staff designated by the licensee shall be permitted to assist the resident with self-administration, provided all of the following requirements are met: (3) A record of each dose is maintained in the resident's record. The record shall include the date and time the PRN medication was taken, the dosage taken, and the resident's response. This requirement was not met as evidenced by: at the time of visit on 8/11/25, the facility was unable to provide a record of each dose including date and time the PRN medication was taken, the dosage taken, and teh resident's response for May 2, 4 and 5, 2025 for R1.

Official plan of correction

Licensee will ensure med-techs receive additional training regarding proper documentation of medication administration, documenting and reporting documentation errors and notifying physicians of errors by POC due date. Licensee will send training sign-in log and an agenda stating the topics discussed with staff.

Deadline recorded: Aug 18, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87303(i)(A)

Regulation authority

CCR

What the official deficiency says

87303 (i)(A) Maintenance and Operation (i) Facilities shall have signal systems which shall meet the following criteria: (A) Operate from each resident’s living unit. This requirement is not met as evidence by: During inspection, (4) out of (24) call buttons were inoperable. Four (4) buttons located in (2) resident rooms, did not trigger an alert to front desk staff.

Official plan of correction

Licensee will conduct checks to ensure call buttons are working properly in resident rooms. Licensee will log call button inspections for the next five days and provide LPA a copy of the log by POC due date.

Deadline recorded: Aug 29, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87411(a)

Regulation authority

CCR

What the official deficiency says

87411 Personnel Requirements - General (a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. This requirement is not met as evidenced by: Based on interview, Staff could not find R1's PRN medication which poses an immediate health and safety risk to residents in care.

Official plan of correction

The licensee shall submit a written plan explaining how PRN medications are stored and documented when given. The plan is due to LPA by 8/16/25.

Deadline recorded: Aug 16, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87465(b)(3)

Regulation authority

CCR

What the official deficiency says

Incidental Medical and Dental Care (b) If resident's physician has stated in writing that the resident is able to determine and communicate his/her need for a prescription or nonprescription PRN medication, facility staff shall be permitted to assist the resident with self-administration of his/her PRN medication. (3) A record of each dose is maintained in the resident's record. The record shall include the date and time the PRN medication was taken, the dosage taken, and the resident's response. This requirement was not met as evidenced by: QuickMAR has multiple medication errors regarding a medication dose for pain relief for May 2, 4 and 5, 2025 for R1.

Official plan of correction

Licensee will ensure med-techs receive additional training regarding proper documentation of medication administration, documenting and reporting documentation errors and notifying physicians of errors by POC due date. Licensee will send training sign-in log and an agenda stating the topics discussed with staff.

Deadline recorded: Aug 18, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87411(d)(4)

Regulation authority

CCR

What the official deficiency says

87411(d)(4) Personnel Requirements - General (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: (4) Knowledge required to safely assist with prescribed medications which are self-administered. This requirement was not met as evidenced by: based on observation, staff and resident interviews and record review, licensee did not ensure that caregiving staff who are not qualified to administer medication to residents refrain from administering medication to a resident.

Official plan of correction

Licensee will conduct training with caregiving and medical technician staff regarding medication administration policies and precedures. Licensee will submit proof of training by POC due date in a form of sign-in log of staff in attendance and topics discussed via an agenda of training.

Deadline recorded: Jul 29, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(a)(4)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility. (4) The licensee shall assist residents with self-administered medications as needed. This requirement is not met as evidenced by: Based on record review, Resident #3 did not take the medication Alendronate Sodium 70 MG once a week in June which poses an immediate health and safety risk to resident in care.

Official plan of correction

The licensee shall ensure medications are refilled timely and that residents do not miss any dosage. An in-service training for medication staff shall be conducted and the log to be submitted to LPA by 7/19/25.

Deadline recorded: Jul 19, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

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) Taps delivering water at 125 degree F (52 degrees C) or above shall be prominently identified by warning signs. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above by not having the warning sign posted by the kitchen dishwashing sink for water delivered at 125 degrees F. during inspection, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/18/2025 Plan of Correction Licensee will post the warning sign above or by the kitchen dishwashing sink by POC due date and send LPA a photo as proof.

Official classification

Type A

Official code

87303(e)(4)

Regulation authority

CCR

What the official deficiency says

(e) Water supplies and plumbing fixtures shall be maintained as follows: (4) Grab bars shall be maintained for each toilet, bathtub and shower used by residents. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above in that grab bar in shower breaking off the wall in resident bathroom, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/18/2025 Plan of Correction Licensee will repair broken grab bar in resident bedroom by POC due date and send LPA a photo of the repair.

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 several live cockroaches were observed in the dishwashing area of the kitchen during visit, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/18/2025 Plan of Correction Licensee will contract services for pest control to alleviate the presence of cockroaches. Licensee shall closely monitor the cockroach issue and have the pest control company treat the facility. Licensee will send LPA, invoice of pest control services by POC due date.

Official classification

Type A

Official code

87555(b)(29)

Regulation authority

CCR

What the official deficiency says

(b) The following food service requirements shall apply: (29) All equipment, fixed or mobile, and dishes, shall be kept clean and maintained in good repair and free of breaks, open seams, cracks or chips. 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 two dry food containers for rice and oatmeal had broken lids and content was exposed during time of visit, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/18/2025 Plan of Correction Licensee will replace broken dry food containers to ensure lids are tight-fitting by the POC due date. Licensee will send a copy of purchased containers and photo of the replaced containers along with their lids.

Official classification

Type A

Official code

87465(a)(4)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following: (4) The licensee shall assist residents with self-administered medications as needed. 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 that LPA observed a medication present in the bubble pack and not given to a resident which should have been administered on 7/8/25 to R1 (Famotidine 20 mg). Staff interview indicated, they forgot to give the resident (R1) the medication at the time it was due for administration. Also, an evening medication was administered too early on 7/17/25 to R4. LPA observed missing medication in the evening slot for 7/17/25 (Quetiapine Fumarate 25 mg), which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/31/2026 Plan of Correction Licensee will contact the primary physician to notify them of the missed medication. Licensee will also document plan to prevent medication errors. Plan is due by POC due date. Medication training for staff will be conducted and is due by: 7/31/25. LIcense will send training log with personnel in attendance by day of training.

Official classification

Type A

Official code

87465(e)

Regulation authority

CCR

What the official deficiency says

Incidental Medical and Dental Care. For every prescription and nonprescription PRN medication for which the licensee provides assistance there shall be a signed, dated written order from a physician, on a prescription blank, maintained in the residents file, and a label on the medication. Both the physician's order and the label shall contain at least all of the following information. This requirement was not met evidenced by: Based on record review and interviews conducted, on June 14m, 2025 R1 ran out of 2 medications [ Furosemide 20 mg or Hydrochlorothiazide 25 mg]. Facility does not have a current physician order for the medications and they have not been filled as of today. This poses an immediate health and safety risk.

Official plan of correction

Executive Director agreed to submit 1. A written statement on medication administration protocols, and a plan that addresses the medications errors. 2. All med-tech staff shall obtain medication training from a medical professional 3. Physician orders for medications Furosemide 20 mg or Hydrochlorothiazide 25 mg.

Deadline recorded: Jun 18, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87211(a)(1)(D)

Regulation authority

CCR

What the official deficiency says

87211(a)(1) 87211 Reporting Requirements: (a) Each licensee shall furnish..: (1)A written report shall be submitted to the licensing agency... within seven days of the occurrence...(D)Any incident which threatens the welfare, safety or health of any resident.... This requirement is not met as evidence by: LPA observed that the facility did not submit an incident report for Resident #1 (R1) who fell on 04/25/2025 and sustained an injury which poses a potential health and safety risk to the residents in care.

Official plan of correction

Administrator agreed to conduct in-service training for staff and create the incident report for R1 and submit it to CCL/LPA by POC due date.

Deadline recorded: May 30, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(c)(2)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care.(c)If the resident's physician has stated in writing that the resident is unable to determine his/her own need for nonprescription PRN medication but can communicate his/her symptoms clearly, facility staff designated by the licensee shall be permitted to assist the resident with self-administration, provided all of the following requirements are met: (2) Once ordered by the physician the medication is given according to the physician's directions. Title 22, Division 6 Chapter 8 This requirement was not met as evidenced by: On 08/08/24, staff #21 gave R#20 the afternoon blood pressure medication, a dosage of 10 mg in the morning.

Official plan of correction

Administrator will provide staff with medication administering training by 12/13/24.

Deadline recorded: Dec 13, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87507(5)(c)

Regulation authority

CCR

What the official deficiency says

Admission Agreements 87507(5) Refund conditions.(c) A refund of any fees paid in advance covering the time after the resident’s personal property has been removed from the facility... the deceased resident paid the fees, to the resident’s estate, within 15 days after the personal property is removed. This requirement not met as evidence by: Based on interviews and record review, licensee failed to refund monies with 15 days after R1's belonging were removed and after R1's death. California Code of Regulations, (Title 22, Division 6 & Chapter 8), are being cited.

Official plan of correction

Administrator produced the proof of refunded monies to R1's responsible party on 07/29/24. Proof of correction has been satisfied.

Deadline recorded: Aug 1, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87224(a)

Regulation authority

CCR

What the official deficiency says

87224 Eviction Procedures...(a) The licensee may evict a resident.. Thirty (30) days written notice to the resident is required.... This requirement is not met as evidenced by: The facility did not comply with regulation of evictions procedures. R1 is ready to be discharged from the hospital however facility does not have room available for R1, facility gave away room to other resident. R1 did not given 30 day notice to facility about leaving.

Official plan of correction

Within 24-48 hours facility will send nurse to hospital and perform an assesment and then R1 will continue residing at the facility until more skilled nursing home is found for the resident.

Deadline recorded: Jul 25, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468(a)(3)

Regulation authority

CCR

What the official deficiency says

87468.2 Additional Personal Rights of Residents in Privately Operated Facilities- (a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (3) To be encouraged and assisted in exercising their rights as citizens and as residents of the facility. Residents shall be free from interference, coercion, discrimination, and retaliation in exercising their rights.

Official plan of correction

This requirement was not met as evidence by: R1 was asked to sign a document violating thier right to leave the facility freely, interfere and retaliate against R1 for exercising their rights. Licensee will retrain staff on this regulation and send proof of re-training by 6/28/24. Licensee will recind this notice by 6/17/24 and send proof to LPA Ramirez via email.

Deadline recorded: Jun 28, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87224(d)

Regulation authority

CCR

What the official deficiency says

(d) The licensee shall set forth in the notice to quit the reasons relied upon for the eviction with specific facts to permit determination of the date, place, witnesses, and circumstances concerning those reasons. This requirement was not met as evidence by: Licensee did not provide R1 in the notice to quit the reasons relied upon for the eviction with specific facts to permit determination of the date, place, witnesses, and circumstances concerning those reasons.

Official plan of correction

Licensee will rescind eviction. Licensee could not provide factual evidence that resident failed to comply with state or local law and received written notice of the alleged violation.

Deadline recorded: Oct 25, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87506(b)(13)

Regulation authority

CCR

What the official deficiency says

87506 Resident Records (b) Each resident’s record shall contain at least the following information: (13) Continuing record of any illness, injury, or medical or dental care, when it impacts the resident's ability to function or needed services. This requirement is not met as evidence by: R1 physican ordered R1 have blood sugar monitored and recorded 3x a day, R8 physican ordered R8 have blood pressure monitored and recorded. Staff only recorded 1 day of R1's blood sugar and no proof of monitoring or logging of R8 blood pressure.

Official plan of correction

Licensee will certify plan to re-train staff on providing assistance in meeting medical needs of residents and following the physicans orders in regards to medical needs. Licensee will provide proof of staff training attendance sheet by 7/25/23. *No further action required*

Deadline recorded: Sep 28, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87468.1(a)(16)

Regulation authority

CCR

What the official deficiency says

87468.1 (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (16) To receive or reject medical care or other services. This requirement is not met evidenced by: Based on interviews, LPA determined that facility staff noticed R1's health was declining on 7/26/2022, however medical care was not obtained until 7/31/2022 after R1's family called for an ambulance, which poses an immediate health and safety risk.

Official plan of correction

Administrator shall ensure that all residents are afforded timely medical care. Administrator is to submit a written plan indicating how the facility will meet regulation 87468.1(a)(16) in a timely manner for all residents moving forward.

Deadline recorded: Sep 23, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

87303 Maintenance and Operation (a) 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 evidence by: Resident accommodation carpet is disrepair and not clean. Room 129 bathroom tub and floor was observed to be dirty.

Official plan of correction

Licensee will replace carpet or remove stains. Licensee will send picture proof of replaced carpet or invoice of professional carpet cleaning services for room 129. Licensee had staff clean bathroom during visit. No further action required for bathroom correction.

Deadline recorded: Sep 5, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.2(a)(8)

Regulation authority

CCR

What the official deficiency says

87468.2 Additional Personal Rights of Residents in Privately Operated Facilities a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights:(8)To be free from neglect, financial exploitation, involuntary seclusion, punishment, humiliation, intimidation, and verbal, mental, physical, or sexual abuse. The requirement was not met as evidenced by interviews conducted and records reviewed which indicated the facility failed to obtain additional medical care for R1 as required which resulted in the advancement of her scabies diagnosis which posed a potential risk tor resident in care.

Official plan of correction

Administrator to submit written Plan of Correction to ensure the facility is meeting Title 22 Regulation. Licensee to submit a faxed or mailed copy of POC by due date

Deadline recorded: Aug 4, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(a)(1)(2)

Regulation authority

CCR

What the official deficiency says

87465(a)(1) Incidental Medical and Dental Care: (a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following: (1) The licensee shall arrange, or assist in arranging, for medical and dental care appropriate to the conditions and needs of residents. (2)The licensee shall provide assistance in meeting necessary medical and dental needs. This includes transportation which may be limited to the nearest available medical or dental facility which will meet the resident's need. In providing transportation the licensee shall do so directly or make arrangements for this service. This requirement is not met as evidence by: R1 physican ordered R1 have blood sugar monitored and recorded 3x a day, R8 physican ordered R8 have blood pressure monitored and recorded. Facility staff only recorded 1 day of R1's blood sugar and no proof of monitoring or logging of R8 blood pressure.

Official plan of correction

Licensee will certify plan to re-train staff on providing assistance in meeting medical needs of residents and following the physicans orders in regards to medical needs. Licensee will provide proof of staff training attendance sheet by 7/25/23.

Deadline recorded: Jul 18, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

87303 Maintenance and Operation (a) 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 evidence by: Seven out of the seven residents interviewed do not have keys to lock their rooms. 3 out of the seven residents are have been at the facility less than 60 days and never received a key to their room.

Official plan of correction

Licensee will develop a plan to address how facility will record lost keys and replacements, how facility will record new residents receiving keys to room. Facility staff provided majority of residents replacement keys to their rooms after report was drafted. Licensee will send list of all residents awaiting replacement keys 7/31/23.

Deadline recorded: Jul 31, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87466

Regulation authority

CCR

What the official deficiency says

87466 Observation of the Resident The licensee shall ensure that residents are regularly observed for changes in physical, mental, emotional and social functioning and that appropriate assistance is provided when such observation reveals unmet needs. The requirement was not met as evidenced by LPA contacted the medical professional and confirmed the faciltiy had scabies infection two to three months ago. And faciltiy had about 7 residents infected which pose an potenial risk to residents in care.

Official plan of correction

Administrator to submit written Plan of Correction to ensure the facility is meeting Title 22 Regulation. Administrator to submit a faxed or mailed copy of POC by due date.

Deadline recorded: Nov 28, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87224(a)(4)

Regulation authority

CCR

What the official deficiency says

87224 Eviction Procedures...(a) The licensee may evict a resident.. Thirty (30) days written notice to the resident is required....(4)If, after admission, has a need and a reappraisal has been conducted ... the licensee and the person who performs the reappraisal....not appropriate for the resident. This requirement is not met as evidenced by: The Administrator did not issue/provide the required thirty (30) days eviction written notice to the family or the resident's responsible party and CCLD.

Official plan of correction

The Administrator will submit a copy of the written eviction notice and a signed statement that she read, reviewed and understood Title 22 Regulations Division 6 Chapter 8 Article 04 Section 87224 Eviction Procedures to LPA on or before the POC due date.

Deadline recorded: Nov 21, 2022. A deadline is not proof that correction was completed.