SOUTH BAY RESIDENTIAL CARE HOME

Official classification

Type B

Official code

87405(d)(2)

Regulation authority

CCR

What the official deficiency says

(d) The administrator shall have the qualifications specified in Sections 87405(d)(1) through (7). If the licensee is also the administrator, all requirements for an administrator shall apply. (2) Knowledge of and ability to conform to the applicable laws, rules and regulations. This requirement was not met as evidence by: the Administrator allowed residents to use a bedroom without obtaining a fire clearancel. This poses a potential safety risk to residents in care.

Official plan of correction

The Administrator will review the regulations on 87305 Alterations to Existing Building or New Facilities and 87202 Fire Clearance and send evidence of correction to regina.cloyd@dss.ca.gov.

Deadline recorded: Sep 2, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87202(a)

Regulation authority

CCR

What the official deficiency says

(a) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, or the State Fire Marshal. Prior to accepting or retaining any of the following types of persons, the applicant or licensee shall notify the licensing agency and obtain an appropriate fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, or the State Fire Marshal: 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 for one resident which poses an immediate safety risk to persons in care. During facility tour, LPA observed Resident #4 in bedroom #5. The fire inspection report and facility sketch on file with Community Care Licensing does not reflect a fifth bedroom.

Official plan of correction

POC Due Date: 08/08/2025 Plan of Correction The Licensee will submit evidence of correction to regina.cloyd@dss.ca.gov by the POC due date.

Official classification

Type B

Official code

87463(h)

Regulation authority

CCR

What the official deficiency says

(h) The licensee shall request that all residents receive an annual routine visit with a licensed medical professional once every twelve months, either in person or by video appointment. 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 for two out of four residents which poses a potential health risk to persons in care. LPA did not observe an annual assessment for or decline of statement for an assessment from Resident #1 and Resident #3.

Official plan of correction

POC Due Date: 08/25/2025 Plan of Correction The Administrator will provide plans of correction to regina.cloyd@dss.ca.gov by the POC due date.

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 on record review, the licensee did not comply with the section cited above for four out of four staff members (S2, S3, S4, S5) which poses a potential safety risk to persons in care. LPA Cloyd did not observe 20 hours of annual training for staff.

Official plan of correction

POC Due Date: 08/13/2024 Plan of Correction The Administrator will email 20 hours of annual training for S2, S3, S4, and S5 to regina.cloyd@dss.ca.gov. The Administrator will ensure that staff stay current on annual training requirements.