GOLDEN CITY HOME CARE

Official classification

Type B

Official code

87625(b)(8)

Regulation authority

CCR

What the official deficiency says

87625 Managed Incontinence (b) In addition to Section 87611, General Requirements for Allowable Health Conditions, the licensee shall be responsible for the following: (8) Privacy shall be afforded when care is provided. This requirement was not met as evidence by: Based on interview, Resident #1 (R1) was not provided privacy during changes which posed a potential personal rights risk to resident in care. Administrator immediately redirected the visitors because they were unaware that R1 was being changed.

Official plan of correction

The Licensee will ensure that visitors do not enter residents' room while they are being changed. Licensee will provide evidence of a plan of correction to regina.cloyd@dss.ca.gov by the POC due date.

Deadline recorded: Apr 8, 2025. 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

(27) All kitchen areas shall be kept clean and free of litter, rodents, vermin and insects. This requirement was not met as evidenced by: Based on observation and interview, the licensee did not comply with the section cited above which poses a potential health and safety risk to residents in care. LPA observed vermin on the kitchen counters and on the kitchen floor.

Official plan of correction

The Administrator immediately emailed the bi-monthly pest control service agreement processed on 05/30/24 to LPA Cloyd. The Administrator will provide evidence of service rendered between 06/04/24 and 06/11/24 to regina.cloyd@dss.ca.gov

Deadline recorded: Jun 11, 2024. 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: Based on observation and interview, the licensee did not comply with the section cited above which poses a potential safety risk to residents in care. LPA observed that staff could not receive incoming calls nor make outgoing calls due to powerless phone bases.

Official plan of correction

The licensee will install new batteries/telephones inside of the facility and ensure that staff can receive incoming and make outgoing calls. The Administrator will provide evidence of correction to regina.cloyd@dss.ca.gov by the POC due date.

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

Official classification

Type B

Official code

87307(d)(6)

Regulation authority

CCR

What the official deficiency says

Physical Plant/Environmental Safety - Row46 Section 87307(d)(6) - Domain Focused (6) All outdoor and indoor passageways and stairways shall be kept free of obstruction. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and interview, the licensee did not comply with the section cited above in room three (3). During today's, LPA observed bed B obstructing the doorway leading to the outdoors, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/21/2023 Plan of Correction Administrator agreed to make adjustments to ensure that bed B in room 3 will not obstruct the doorway. Proof of corrections will be emailed to regina.cloyd@dss.ca.gov

Official classification

Type B

Official code

87470(c)

Regulation authority

CCR

What the official deficiency says

(c) An Infection Control Plan shall be developed by the licensee and shall be included in the Plan of Operation required by Section 87208. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview, record review, the licensee did not comply with the section cited above, LPA did not observe an infection control plan, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/21/2023 Plan of Correction The administrator agreed to submit an Infection Control Plan for approval. Proof of correction will be submitted to CCL via email to regina.cloyd@dss.ca.gov

Official classification

Type B

Official code

87355(e)(4)

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: (4) Request and be approved for a transfer of a criminal record exemption, as specified in Section 87356(r), unless, upon request for a transfer, the Department permits the individual to be employed, reside or be present at the facility. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview, record review, the licensee did not comply with the section cited above. During today's visit, LPA observed staff Marisol Bade (S1) present 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: 09/08/2023 Plan of Correction The administrator agreed to submit a criminal record transfer request to CCL. Proof of correction will be submitted to CCL via email to regina.cloyd@dss.ca.gov

Official classification

Type B

Official code

1569.695(a)

Regulation authority

HSC

What the official deficiency says

(a) In addition to any other requirement of this chapter, a residential care facility for the elderly shall have an emergency and disaster plan that shall include, but not be limited to, all of the following: 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. During today's visit, LPA observed that the facility did not have an updated LIC 610E, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/21/2023 Plan of Correction The administrator agreed to submit an updated Emergency Disaster Plan (LIC 610E) for approval. Proof of correction will be submitted to CCL via email to regina.cloyd@dss.ca.gov

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. On 10/24/2022, LPA Montoya observed the kitchen cabinets and countertop are greasy. The garage is cluttered. This poses a potential health, safety and/or personal rights risk to residents in care.

Official plan of correction

Administrator shall degrease and clean the kitchen cabinets and counter top and organize the garage. Administrator shall submit a proof of correction to CCLD via email to lourdes.montoya@dss.ca.gov by the POC due date 11/15/2022. This report is amended to change the citation 87303(a) of Title 22 and to change the POC due date to 11/15/2022.

Deadline recorded: Nov 15, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.1(a)(2)

Regulation authority

CCR

What the official deficiency says

87468.1(a)(2) Personal Rights of Residents in all facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights. (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. Based on LPA's observations, interviews and record reviews, Direct care providers (S2 and S3) failed to wear a mask while providing care to residents. This poses a potential health, safety and/or personal rights risk to residents in care .

Official plan of correction

Adminstrator shall conduct in-service training to staff on PPE usage. Administrator shall submit a proof of correction to CCLD via email to lourdes.montoya@dss.ca.gov by the POC due date 10/31/2022.

Deadline recorded: Oct 31, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87307(d)(6)

Regulation authority

CCR

What the official deficiency says

(6) All outdoor and indoor passageways and stairways shall be kept free of obstruction. This requirement is not met as evidenced by: Deficient Practice Statement Based on (observation), the licensee did not comply with the section cited above. LPA identified a twin size mattress obstructing exit passage way inside room #4. This violation which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/22/2022 Plan of Correction The licensee will adhere to Title 22 Section 87307. The licensee will perform knowledge of and conform to applicable laws, rules, and regulations and remove any object obstructing emergency passage exits. Plan of correction will be submitted by POC due date: 08/22/22.

Official classification

Type B

Official code

1569.618(c)(4)

Regulation authority

HSC

What the official deficiency says

(c) The facility shall employ, and the administrator shall schedule, a sufficient number of staff members to do all of the following: (4) Ensure that the facility is clean, safe, sanitary, and in good repair at all times. This requirement is not met as evidenced by: Deficient Practice Statement Based on (observation), the licensee did not comply with the section cited above. LPA observed the garage cluttered with furnishings with evidence of rodent droppings and ants. This violation which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/21/2022 Plan of Correction The licensee will adhere to HSC 1569.18. The licensee will perform knowledge of and conform to applicable laws, rules, and regulations. The licensee will hire a pest control company to spray the inside of the garage and the perimter of the external home. The licensee will organize the garage and dispose any furnishings no longer needed. Plan of correction will be submitted by POC due date: 09/21/22. A receipt from Pest Control Company is required.

Official classification

Type B

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. LPA identified the kitchen stove and overhead microwave oven fille with build up grease and food particles. This violation which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/06/2022 Plan of Correction The licensee will adhere to Title 22 Section 87555. The licensee will perform knowledge of and conform to applicable laws, rules, and regulations. Plan of correction to do a deep cleaning of the kitchen and appliances. Correction will be submitted by POC due date: 09/06/22.

Official classification

Type B

Official code

87411(c)(1)

Regulation authority

CCR

What the official deficiency says

Personnel Requirements - General -Staff providing care shall receive appropriate training in first aid from persons qualified by such agencies as the American Red Cross. This requirement is not met as evidenced by: Deficient Practice Statement Based on (record review), the licensee did not comply with the section cited above. LPA identified staff #2 had an expired CPR/First Aid dated 02/13/22. This violation which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/06/2022 Plan of Correction Licensee will ensure that staff complete CPR training and submit copies of certificates to CCL by POC due date via fax 323-981-1781 attn: LPA Ernand Dabuet.

Official classification

Type B

Official code

1569.605

Regulation authority

HSC

What the official deficiency says

Liability Insurance; coverage requirements- On and after July 1, 2015, all residential care facilities for the elderly, except those facilities that are an integral part of a continuing care retirement community, shall maintain liability insurance covering injury to residents and guests in the amount of at least one million dollars ($1,000,000) per occurrence and hree million dollars ($3,000,000) in the total annual aggregate, caused by the negligent acts or omissions to act of, or neglect by, the licensee or its employees. The requirement is not met as evidenced by: On 08/22/19 & 09/20/19 CCLD requested proof of Liability Insurance. As of today's visit, CCLD has not receive proof of Liability Insurance. This requirement is not met as evidenced by: Deficient Practice Statement Based on (interview), the licensee did not comply with the section cited above. Licensee informed LPA no liability insurance on file. The coverage has expired and did not have a current insurance for coverage. This violation which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/06/2022 Plan of Correction The licensee will ensure all residential care facilities for the elderly shall maintain liability insurance covering injury to residents and guests in the amount of at least one million dollars per occurrence and three million dollars in the total annual aggregate. The administrator will send the copy of the liability insurance to LPA Dabuet by 09/06/22