ANZA HOME CARE

Official classification

Type A

Official code

87355(e)(3)

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: (3) Request a transfer of a criminal record clearance as specified in Section 87355(c) or This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview, and record review, the licensee did not comply with the section cited above in Staff 1 (S1) not being associated to the facility (S1's hire date is 4/14/2025) which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/18/2026 Plan of Correction The Licensee will associate S1 to the facility. The Licensee will create a plan to ensure that before hire date staff are associated to the facility. The Licensee will email proof of correction to Socorro.Leandro@dss.ca.gov

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 observation, the licensee did not comply with the section cited above in room 1's outside exit door not being able to open, great room's sliding door not being to open completely, the garage is overcrowded with items, facility refrigerators/freezers are not clean, outside grounds were not cleared of hazards which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/01/2026 Plan of Correction The Licensee will fix room 1's outside exit door and the great room's sliding door. The Licensee will declutter the garage and the outside grounds. The Licensee will clean and organize the reiterators/freezers. The Licensee will email pictures and videos to Socorro.Leandro@dss.ca.gov The Licensee will create a plan to maintain the facility in good repair, clean, safe, and sanitary at all times and email plan to Socorro.Leandro@dss.ca.gov

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 Staff 1 (S1) not having a health screening report and Staff 2 (S2) not having a tuberculosis test result which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/01/2026 Plan of Correction The Licensee will email S1’s health screening report and S2’s tuberculosis test result. The Licensee will create a plan to stay in compliance. Email proof of correction to Socorro.Leandro@dss.ca.gov

Official classification

Type B

Official code

1569.319(a)

Regulation authority

HSC

What the official deficiency says

(a) A licensee of a facility that has internet service shall provide at least one internet access device, such as a computer, smart phone, tablet, or other device, that can support real-time interactive applications, is equipped with videoconferencing technology, including microphone and camera functions, and is dedicated for resident use. 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 having internet but not having a videoconferencing device available to residents which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/01/2026 Plan of Correction The Licensee will place a videoconferencing device in the facility dedicated to residents in care. The Licensee will create a plan to ensure that residents always have a videoconferencing device available to them. Email proof of correction to: Socorro.Leandro@dss.ca.gov

Official classification

Type B

Official code

87555(b)(8)

Regulation authority

CCR

What the official deficiency says

(8) All food shall be of good quality. Commercial foods shall be approved by appropriate federal, state and local authorities. Food in damaged containers shall not be accepted, used or retained. 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 having foods in the refrigerator and pantry whose " best by date " had passed (e.g. Best By JAN0925) and spoiled vegetables (which looked moldy with green and black colors) which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/01/2026 Plan of Correction The Licensee will clean and organize the refrigerators/freezers, pantries/cabinets, food storage areas and dispose of any foods that are not of good quality. The Licensee will create a plan to maintain food in good quality. Email proof of correction to Socorro.Leandro@dss.ca.gov

Official classification

Type B

Official code

87506(a)

Regulation authority

CCR

What the official deficiency says

(a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff. 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 not having complete records for Residents 1 (R1) to Resident 4 (R4) (missing/incomplete records ranging from Admission Agreements, doctors’ orders full to half bed rails, home health records) which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/01/2026 Plan of Correction The Licensee will email Socorro.Leandro@dss.ca.gov complete records for R1 to R4. The Licensee will create a plan to ensure that resident records are complete and current and are available to staff in the facility. Email proof of correction to Socorro.Leandro@dss.ca.gov

Official classification

Type B

Official code

87608(a)(5)(A)

Regulation authority

CCR

What the official deficiency says

(A) A bed rail that extends from the head half the length of the bed and used only for assistance with mobility shall be allowed. 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 in [count] out of [total count] [(objects) (persons)] [identifiers] which poses/posed a potential health, safety or personal rights risk to persons in care. Resident # 2 has full bedrails on bed and is not on hospice

Official plan of correction

POC Due Date: 05/02/2024 Plan of Correction Administrator agree to remove full bedrails or provide physicial prescription for rails by POC date. Administrator will send documentation to Sparkle.day@dss.ca.gov

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 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 in [count] out of [total count] [(objects) (persons)] [identifiers] which poses/posed a potential health, safety or personal rights risk to persons in care. LPA Day toured the outside of the facility and found the ramp surrounding the rear of the home needs replacement and/ or repair due to old wood that has weak spots to walk on .

Official plan of correction

POC Due Date: 05/23/2024 Plan of Correction Administrator agrees to have ramp repaired and or replaced in all the weak wood and unsafe areas by POC date. LPA will make a visit to ensure ramp is safe by POC date.

Official classification

Type B

Official code

87705(5)

Regulation authority

CCR

What the official deficiency says

Faciltiy residents with dementia shall have annual medical assessments 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 in [count] out of [total count] [(objects) (persons)] [identifiers] which poses/posed a potential health, safety or personal rights risk to persons in care. Residents #2 and #3 did not have current medical assessment on file at time of visit.

Official plan of correction

POC Due Date: 05/10/2024 Plan of Correction Administrator agrees to have annual medical assessments for all residents with dementia. Medical Assessment will be sent to Sparkle.day@dss.ca.gov by POC date.

Official classification

Type A

Official code

87303(e)(2)

Regulation authority

CCR

What the official deficiency says

(e) Water supplies and plumbing fixtures shall be maintained as follows: (2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degrees C) and not more than 120 degree F (49 degrees C). This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA's measurement, the licensee did not comply with the section cited above in showing water temperature at 128.3 F which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/15/2023 Plan of Correction Administrator Shalani Ramos (A1) will lower the water temperature, to be within Title 22 regulations as listed above. A1 will submit media evidence (video) of the water temperature within Title 22 regulations , via email at Mario.Leon@dss.ca.gov, on or prior to the POC due date as 5/15/23.

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 LPA's observation, the licensee did not comply with the section cited above, on 5/01/23, in having two knives left in the drying rack area which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/01/2023 Plan of Correction LPA observed staff relocating the knives from accessible area to the locked drawer, inaccessible to clients while LPA was on-site.

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 LPA observation, the licensee did not comply with the section cited above in missing the above mentioned poster available on 5/01/23 and on 5/12/23 was replaced with 8.5 " x12 " sheet which is not the requested size which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/15/2023 Plan of Correction LPA and A1 have agreed that the proper size poster will be displayed in the main entryway of the facility (either above the ombudsman poster, or near the facility sketch posted near the front entance of the facility. A1 will submit media evidence (photo) of the properly sized poster via email at Mario.Leon@dss.ca.gov on, or prior to, the POC due date listed above.

Official classification

Type B

Official code

1569.695(c)

Regulation authority

HSC

What the official deficiency says

(c) A facility shall conduct a drill at least quarterly for each shift. The type of emergency covered in a drill shall vary from quarter to quarter, taking into account different emergency scenarios. An actual evacuation of residents is not required during a drill. While a facility may provide an opportunity for residents to participate in a drill, it shall not require any resident participation. Documentation of the drills shall include the date, the type of emergency covered by the drill, and the names of staff participating in the drill. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA's record review, the licensee did not comply with the section cited above in not having any previous drills having been logged which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/19/2023 Plan of Correction LPA has assesed this deficiency as a repeated violation. There will be an immediate $250 fine. A1 will submit media evidence (scanned documents), via email at Mario.Leon@dss.ca.gov, of the latest drill to make sure the facility will remain in compliance. Moving forward, future drills will be conducted each quarter and will be kept on file for future record review.

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 LPA's record review the licensee did not comply with the section cited above in the lack of physician's orders for resident(s) using postural supports (bed rails) which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/26/2023 Plan of Correction LPA and A1 have agreed that A1 will seek physician's orders for clients who require postural supports (bed rails). If A1 is unable to acquire the proper physician's orders, A1 will remove the bed rails. A1 will submit media evidence (photos AND scanned documents), via email at Mario.Leon@dss.ca.gov, to follow state licensing regulation in order to remain in state compliance.

Official classification

Type B

Official code

87633(f)(1)

Regulation authority

CCR

What the official deficiency says

(1) The record of each training session shall specify the names and credentials of the trainer, the persons in attendance, the subject matter covered, and the date and duration of the training session. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA's record review, the licensee did not comply with the section cited above in not having any documentations / histories related to hospice training sessions which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/26/2023 Plan of Correction LPA and A1 have agreed that to remain in state compliance, A1 will submit media evidence (scanned documents) via email at Mario.Leon@dss.ca.gov, in order to remain in compliance. A1 has agreed to move forward with having all training documentation on file for future review.

Official classification

Type B

Official code

87405(a)

Regulation authority

CCR

What the official deficiency says

87405 Administrator - Qualifications and Duties(a) All facilities shall have a qualified and currently certified administrator...The administrator shall have ... other responsibilities and shall be on the premises a sufficient number of hours to permit adequate attention to the management and administration of the facility as specified in this section... This requirement was not met as evidenced by: Based on observation and interview, the licensee did not have an authorized administrator file with CCLD. This citation poses a potential health and safety risk to residents in care.

Official plan of correction

The licensee will adhere to Title 22 Section 87405. The licensee will perform knowledge of and conform to applicable laws, rules, and regulations. Plan of correction will be submitted by POC due date: 07/22/22 with documentation for authorized facility administrator.

Deadline recorded: Jul 22, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87705(5)

Regulation authority

CCR

What the official deficiency says

87705 (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 was not met as evidenced by: Based on observation and interview, the licensee did not have up to date medical assessments and reappraisal for (R1-R4). This citation poses a potential health and safety risk to residents in care.

Official plan of correction

The licensee will adhere to Title 22 Section 87705. The licensee will perform knowledge of and conform to applicable laws, rules, and regulations. The licensee will ensure to obtain medical assessments/reappraisals for all residents in care. Plan of correction will be submitted by POC due date: 08/08/22.

Deadline recorded: Aug 8, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

1569.311

Regulation authority

HSC

What the official deficiency says

Every residential care facility for the elderly shall have one or more carbon monoxide detectors in the facility that meet the standards established in Chapter 8 (commencing with Section 13260) of Part 2 of Division 12. The department shall account for the presence of these detectors during inspections. 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 (1) carbon monoxide was not in working condition. This violation poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/09/2022 Plan of Correction The licensee will ensure that all emergency equipments are in working condition. The licensee will submit correction by POC date 07/09/22. *This violation was cleared during visit.*

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 and other toxic materials under the kitchen and bathroom sinks accessible to resident in care. This violation poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/09/2022 Plan of Correction The licensee will ensure to adhere to Title 22 Regulation 87309 and ensure all hazadous materials are in stored in locked storage and inaccessble to residents in care. The licensee will submit correction by POC date 07/09/22. *This violation was corrected during visit. *

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. 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 [(observation) the licensee did not comply with the section cited above with unsantary and uclean bathroom and kitchen areas. This violation poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/22/2022 Plan of Correction The licensee will adhere to Title 22 regulations 87303. The licensee will ensure the facility is clean and sanitized at all times. The licensee will submit correction by POC date 07/22/22.

Official classification

Type B

Official code

87465(a)(7)

Regulation authority

CCR

What the official deficiency says

(7) When requested by the prescribing physician or the Department, a record of dosages of medications which are centrally stored shall be maintained by the facility. 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. The facility was issuing PRN without a record of dosages of medications for resident #4. This violation which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/22/2022 Plan of Correction The licensee will adhere to Title 22 Reg 87465 and ensure to maintain medication administration records for all residents. The licensee will submit correction by POC date 07/22/22.

Official classification

Type B

Official code

1569.695(c)

Regulation authority

HSC

What the official deficiency says

(c) A facility shall conduct a drill at least quarterly for each shift. The type of emergency covered in a drill shall vary from quarter to quarter, taking into account different emergency scenarios. An actual evacuation of residents is not required during a drill. While a facility may provide an opportunity for residents to participate in a drill, it shall not require any resident participation. Documentation of the drills shall include the date, the type of emergency covered by the drill, and the names of staff participating in the drill. This requirement is not met as evidenced by: Deficient Practice Statement Based on [(observation) and (record review), the licensee has not conducted quartlery fire drills. This violation poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/22/2022 Plan of Correction The licensee will adhere to HSC 1569.695 and perform quarterly emergency drills. The licensee will submit correction by POC date 07/22/22.