BRIGHTWATER GUEST HOME 3

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 and record review, the licensee did not comply with the section cited above in having a leaky shower faucet in bathroom 1; the garage has several items which makes it difficult to maneuver around or grab items; room 1 has a non-ambulatory resident who uses a wheelchair and their room has several items on the floor which makes it difficult to maneuver around, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/25/2026 Plan of Correction The Administrator has agreed to fix bathroom 1's shower faucet; declutter the garage; declutter Room 1 and make it a safe and comfortable place for the resident. The Administrator will email pictures to Socorro.Leandro@dss.ca.gov

Official classification

Type B

Official code

87303(e)(2)

Regulation authority

CCR

What the official deficiency says

(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 observation, the licensee did not comply with the section cited above in the hot water temperature measuring 129.02 Fahrenheit.

Official plan of correction

POC Due Date: 05/17/2026 Plan of Correction The Administrator will fix hot water temperature to measure 105 to 120 degrees Fahrenheit. The Administrator has agreed to create a plan to maintain hot water temperatures at 105 to 120 degrees Fahrenheit. Email proof of correction to: Socorro.Leandro@dss.ca.gov

Official classification

Type B

Official code

87305(a)

Regulation authority

CCR

What the official deficiency says

(a) Prior to construction or alterations, all facilities shall obtain a building permit. 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 their facility layout not matching their facility sketch (there is a staff room that was not on the facility sketch), which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/25/2026 Plan of Correction The Administrator agreed to update the facility sketch and email it 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 updated records for Resident 2 (does not have an updated Medical Assessment & does not have their Home Health Folder), Resident 4 (does not have doctors order for half bed rail), and Resident 5 (does not have an updated Medical Assessment), 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 Administrator has agreed to update Resident 2, Resident 4 and Resident 5's file and email records to Socorro.Leandro@dss.ca.gov The licensee has agreed to create a plan to maintain complete and current records in the facility for each resident and email plan 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 was not met as evidenced by: Based on observation and record review the licensee did not comply with the section cited above. In R1's to R5's records were incomplete. R1 did not have: a Home Health Care Plan; a Doctor’s Order for Hoyer Lift & Half Bedrails. R2 and R3 did not have a Doctor’s Order for Half Bedrail. R4 did not have a Doctor’s Order for Half Bedrail & Hoyer Lift. R5 did not have a Doctor’s Order for Full Bedrail & Oxygen Machine.

Official plan of correction

The Administrator Irene Formentera has agreed to email the pending records for Resident 1 (R1) to Resident 5 (R5) to Socorro.Leandro@dss.ca.gov.

Deadline recorded: Oct 7, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(c)(1)

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: (1) There is written direction from a physician, on a prescription blank, specifying the name of the resident, the name of the medication, all of the information in Section 87465(e), instructions regarding a time or circumstance (if any) when it should be discontinued, and an indication when the physician should be contacted for a medication reevaluation. This was requirement was not met as evidenced by: Based on interviews conducted, three staff (S3, S4, and S5) and two witnesses (W1-W2) stated R1 was given a treatment when R1’s sustained a skin tear on the forearm on 4/29/2023. The topical medications applied to R1’s injured arm are called Calmoseptine and A & D. Based on record review, R1 has no prescription of Calmoseptine and A & D from a physician. This poses an immediate health, safety and/or personal rights risk to residents in care.

Official plan of correction

Administrator shall review Section 87465 of Title 22 and shall self-certify understanding and compliance to this regulation. Administrator shall conduct an in-service training to staff involved in dispensing medications. Administrator shall submit a POC to CCLD via email to lourdes.montoya@dss.ca.gov. by the POC due date (5/20/2023).

Deadline recorded: May 20, 2023. 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 Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: (1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below. This report shall include the resident's name, age, sex and date of admission; date and nature of event; attending physician's name, findings, and treatment, if any; and disposition of the case. (D) Any incident which threatens the welfare, safety or health of any resident, such as psychological abuse of a resident by staff or other residents, or unexplained absence of any resident. This requirement was not met as evidenced by: Based on records review and interviews, the Resident’s authorized representative was not notified in writing of R1’s injury. A copy of the “Unusual Incident/injury Report” (LIC 624) was not provided to R1’s authorized representative. This poses a potential health, safety and/or personal rights risk to residents in care.

Official plan of correction

Administrator shall review Section 87211 of Title 22 and shall self-certify understanding and compliance to this regulation. Administrator shall submit a POC to CCLD via email to lourdes.montoya@dss.ca.gov. by the POC due date.

Deadline recorded: Jun 2, 2023. A deadline is not proof that correction was completed.