ANGELS HANDS SENIOR LIVING

Official classification

Type A

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 the wooden walkay outside of exit door in room #2 that is uneven with visible gaps creating a tripping hazard which poses an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 05/14/2026 Plan of Correction Administrator agreed to submit plan on how they will fix the walkway anbd submit plan by 05/14/26.

Official classification

Type A

Official code

87303(f)(2)

Regulation authority

CCR

What the official deficiency says

(f) All waste shall be located, stored, and disposed of in a manner that will not transmit communicable diseases or odors, pose a risk to health and safety, or provide a breeding place or food source for insects or rodents. (2) Syringes and needles are disposed of in accordance with the California Code of Regulations, Title 8, Section 5193 concerning bloodborne pathogens. 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 one insulin pen needle that was thrown in the kitchen trash which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/15/2026 Plan of Correction The administrator agreed that they will conduct a mandatory, comprehensive in-service training session for all direct care staff regarding regulation 87303(f)(2) and will buy a sharps container to dispose of the needles safely and submit proof of purchase and training by POC Due date.

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 observation, the licensee did not comply with the section cited above in one resident's bed that was observed with a 3/4 bed rial and resident did not have a doctors order for bed rail which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/14/2026 Plan of Correction Bed rail was taken off during the visit. POC Cleared.

Official classification

Type B

Official code

87468.1(a)(2)

Regulation authority

CCR

What the official deficiency says

87468.1 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 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 two food cabinets that were observed with locks, and staff admitted they lock them at night which posed a potential health and safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/13/2026 Plan of Correction POC Cleared, locks were removed.

Official classification

Type A

Official code

87203

Regulation authority

CCR

What the official deficiency says

87203 Fire Safety. All facilities shall be maintained in conformity with the regulations adopted by the State Fire Marshal for the protection of life and property against fire and panic. 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 two exit doors (main entrance and door in room #2) that were observed with door lock latches and fire extinghishers that have not been serviced in over a year which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/20/2026 Plan of Correction Door locks were removed during visit, and visit to get fire extingher serviced was scheduled for 5/20/26. Administrator will submit proof of services to the fire extinghisers.

Official classification

Type A

Official code

87465(a)(1)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following (1) The licensee shall arrange, or assist in arranging, for medical and dental care appropriate to the conditions and needs of residents. 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 one medication that was physically present but not being administered, staff stated medication was discontinued but no discontinued order was on file 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 Administrator agreed to obtain discontinued order or claification if the resident should be taking the medication from residents physician and document the medication, will submit dc order or clarification to LPA by POC due date.

Official classification

Type B

Official code

87465(h)(6)(C)(E)(F)

Regulation authority

CCR

What the official deficiency says

87465 (h)The following requirements shall apply to medications which are centrally stored: (6) The licensee shall be responsible for assuring that a record of centrally stored prescription medications for each resident is maintained for at least one year and includes: (C) The drug name, strength and quantity.(E) The prescription number and the name of the issuing pharmacy. (F)Instructions, if any, regarding control and custody of the medication. 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 two medications that were not documented and three or more medications what were documented incorrect which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/27/2026 Plan of Correction Administrator fixed all errors during the visit and initial the Centrally Stored Medication and Destruction Record and agreed to obtain medication training for all staff including themselves by a third party.

Official classification

Type A

Official code

87465(b)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care: (b) If the resident's physician has stated in writing that the resident is able to determine and communicate his/her need for a prescription or nonprescription PRN medication, facility staff shall be permitted to assist the resident with self-administration of his/her PRN medication. 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 3 out of 3 residents who receive PRN medications, the facility does not have completed PRN Authorization letters completed by the prescribing doctor on file to indicate whether the residents are able to determine and commuinicate his/her need for a prescription or non-prescription PRN medication which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/04/2025 Plan of Correction The Licensee will contact the prescribing doctor for all PRN medications and obtain a completed PRN Authoriization Letter that determines whether the residents are/are not able to determine and communicate their need for a PRN medication and maintain in the residents files and a copy is to be faxed to CCLD by 6/4/25.

Official classification

Type B

Official code

87411(d)(4)

Regulation authority

CCR

What the official deficiency says

87411 Personnel Requirements – General: All RCFE staff who assist residents with personal activities of daily living shall receive initial and annual training as specified in Health and Safety Code sections 1569.625 and 1569.69. d) All personnel shall be given on the job training or have related experience in the job assigned to them. This training and/or related experience shall provide knowledge of and skill in the following, as appropriate for the job assigned and as evidenced by safe and effective job performance: (4) Knowledge required to safely assist with prescribed medications which are self-administered. 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 as the MAR logs for dispensed medications are not being accurately documented and initial training was provided by the Administrator and later by an RN and yet the documentation indicates that the residents are being provided PRN medications and cycle medications multiple times a day in excess of what is prescribed, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/04/2025 Plan of Correction The Licensee will obtain the services of a pharmacist or a medical professional to obtain re-training for the Administrator and all staff responsible for assisting residents with their medications with the proper process of dispensing medications and documenting the MAR log and completing notes for the PRN medications dispensed with the date, time, dosage, reactions and the outcome or any instructions obtained from contact with the prescribing doctor by 6/4/25

Official classification

Type B

Official code

87458(c)(1)(A-D)

Regulation authority

CCR

What the official deficiency says

87458 Medical Assessment: (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. (B) Infectious diseases. (C)Contagious diseases. (D) Other medical conditions. 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 1 out 3 files reviewed that Resident #2 did not have a Physician's Report with the results of a TB test which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/04/2025 Plan of Correction The Licensee will contact Resident #2's physician or schedule a visit to obtain a TB test and the results of the test and maintain in Resident #2's file and a copy of this report will be be faxed to CCLD by 6/4/25

Official classification

Type B

Official code

87507(a)

Regulation authority

CCR

What the official deficiency says

87507 Admission Agreements: (a) The licensee shall complete an individual written admission agreement, as defined in Section 87101(a), with each resident or the resident's representative, if any. 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 1 of 3 files reviewed, Resident #3 does not have a completed Admission Agreement on file which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/04/2025 Plan of Correction Licensee will contact Resident #3's responsible party to complete an Admission Agreement and provide a copy to the responsible party and the resident and retain the original in the resident's file by 6/4/25. A copy will also be provided to CCLD by 6/4/25. ***********a copy of Admission Agreement observed on visit conducted on 5/28/25*******

Official classification

Type B

Official code

1569.695(c)

Regulation authority

HSC

What the official deficiency says

§1569.695 Emergency Plans: (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 record review, the licensee did not comply with the section cited above as there was no evidence that quarterly drills were conducted at all in 2024 and one was conducted in January 2025. No other drills have been conducted since then which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/04/2025 Plan of Correction Licensee will ensure that a drill is conducted by 6/4/25 for each shift and every quarter thereafter. Each drill will be documented with the date and time it was conducted, the names of the staff and residents who participated and the event that was simulated. A copy of the current drill conducted will be provided to CCLD by 6/4/25.

Official classification

Type A

Official code

87355(e)(2)

Regulation authority

CCR

What the official deficiency says

Criminal Record Clearance: 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: Request a transfer of a criminal record clearance as specified in Section 87355(c) or This requirement was not met as evidenced by: Staff Armine Safaryan and Gervog Gevshenyan are not associated to the home. $1000 CIVIL PENALTIES WERE ASSESSED.

Official plan of correction

Licensee will ensure that all staff, volunteers or individuals who require to be associated to the facility are associated prior to being present at the facility. LIcensee will associate the 2 staff to the facility via Guardian or submit a completed LIC9182 with a legible copy of their driver license to the Regional office by 2/26/25.

Deadline recorded: Feb 26, 2025. A deadline is not proof that correction was completed.