Facility condition and maintenanceType B
- 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 that the kitchen door connects to garage does not open & there are missing pavers on the side of the home that pose a tripping hazard, which poses a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 08/03/2026 Plan of Correction Administrator agreed to submit picture proof that repairs to the kitchen/garage door and side yard paver have been fixed.
Staffing, personnel, and trainingType B
- Official classification
- Type B
- Official code
- 87411(f)
- Regulation authority
- CCR
What the official deficiency says
(f) All personnel, including the licensee and administrator, shall be in good health, and physically and mentally capable of performing assigned tasks. Good physical health shall be verified by a health screening, including a chest x-ray or an intradermal test, performed by a physician not more than six (6) months prior to or seven (7) days after employment or licensure. A report shall be made of each screening, signed by the examining physician. The report shall indicate whether the person is physically qualified to perform the duties to be assigned, and whether he/she has any health condition that would create a hazard to him/herself, other staff members or residents. A signed statement shall be obtained from each volunteer affirming that he/she is in good health.Personnel with evidence of physical illness or emotional instability that poses a significant threat to the well-being of residents shall be relieved of their duties. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, the licensee did not comply with the section cited above in that S1's file is missing their health screening and S3's health screening does not have TB exam results, which poses/a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 08/03/2026 Plan of Correction Administrator agreed to submit a copy of S1's health screening and proof of S3's TB test results.
Staffing, personnel, and trainingType B
- Official classification
- Type B
- Official code
- 87412(a)
- Regulation authority
- CCR
What the official deficiency says
(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: 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 because other facility names were listed on staff documents, documents had incomplete information, and they were not on site until the end of the visit, which poses a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 08/03/2026 Plan of Correction Administrator agreed to submit a written plan of correction addressing how the citation was corrected. A copy of Records to Be Maintained at the RCFE was provided.
Staffing, personnel, and trainingType B
- Official classification
- Type B
- Official code
- 87411(c)(1)
- Regulation authority
- CCR
What the official deficiency says
(1) 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 in that S2, S4 and S5 do not have proof of 1st Aid/CPR training on file and/or it is expired, which poses a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 08/03/2026 Plan of Correction Administrator agreed to submit proof of S2, S4 and S5's completed 1st Aid/CPR training.
Admission, assessment, and evictionType B
- Official classification
- Type B
- Official code
- 87458(c)(1)(A)
- Regulation authority
- CCR
What the official deficiency says
(c) The medical assessment shall include, but not be limited to: (1) A physical examination of the resident indicating the licensed medical professional's diagnosis or diagnoses and results of an examination for all of the following: (A) Communicable tuberculosis. 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 that R6's Medical Assessment dated 6/16/26 does not have proof of TB test/results, which poses a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 08/03/2026 Plan of Correction Administrator agreed to submit proof of resident (R6's) updated Medical Assessment /TB results.
Health conditions and treatmentsType B
- 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, the licensee did not comply with the section cited above in because R1 & R5's beds have 2 half rails (split rails) on each side of the bed, neither resident is enrolled in hospice, which poses/posed a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 07/15/2026 Plan of Correction Administrator agreed to submit picture evidence that the lower bed rail has been removed from R1 and R5's bed.