Fire safety and emergency preparednessType B
- Official classification
- Type B
- 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, the licensee did not comply with the section cited above as the facility's fire extinguisher was last purchased/serviced more than 12 months prior to inspection which poses a potential safety risk to persons in care.
Official plan of correction
POC Due Date: 07/06/2026 Plan of Correction Administrator agreed to submit proof of either a completed servicing of the fire extinguisher or a newly purchased fire extinguisher to CCLD no later than POC due date.
Resident rightsType B
- Official classification
- Type B
- Official code
- 87468.2(a)(1)
- Regulation authority
- CCR
What the official deficiency says
87468.2 Additional Personal Rights of Residents in Privately Operated Facilities (a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (1) To have a reasonable level of personal privacy in accommodations, medical treatment, personal care and assistance, visits, communications, telephone conversations, use of the Internet, and meetings of resident and family groups. 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 as the facility's admission agreement stated that no video surveillance is utilized at the facility and one resident room had cameras installed without documented consent or proof of the family's ability to make decisions on the resident's behalf which poses a potential personal rights risk to persons in care.
Official plan of correction
POC Due Date: 07/06/2026 Plan of Correction Administrator agreed to either remove all interior cameras from the facility or to create an addendum to their admission agreement for each resident and obtain signatures that acknowledge the use of video surveillance at the facility, obtain consent from the identified individual's family to install cameras in the resident's room, and obtain documentation which proves that the family has legal authority to make decisions on the resident's behalf. Administrator agreed to submit proof of either option being completed to CCLD no later than POC due date.
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 as one employee's health screening was blank and was missing all required information which poses a potential health risk to persons in care.
Official plan of correction
POC Due Date: 07/06/2026 Plan of Correction Administrator agreed to submit a completed LIC 503 health screening for the identified employee including proof of a negative TB test to CCLD no later than POC due date.
Staffing, personnel, and trainingType B
- Official classification
- Type B
- Official code
- 87412(c)(2)(D)
- Regulation authority
- CCR
What the official deficiency says
(c) Licensees shall maintain in the personnel records verification of required staff training and orientation. (2) Documentation of staff training shall include: (D) Number of training hours per subject. 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 one employee's training record was missing the number of hours completed for each training subject which poses a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 07/06/2026 Plan of Correction Administrator agreed to complete a true and accurate training record for the identified employee which includes the number of training hours per subject and to send proof of the completed training log to CCLD no later than POC due date.
Resident rightsType B
- Official classification
- Type B
- Official code
- 87468(b)(1)(A)
- Regulation authority
- CCR
What the official deficiency says
(b) At the time the admission agreement is signed, a resident and the resident's representative shall be personally advised of and given a copy of: (1) The personal rights of residents specified in Sections 87468.1, Personal Rights of Residents in All Facilities and 87468.2, Additional Personal Rights of Residents in Privately Operated Facilities, as applicable to the facility. (A) The licensee shall have each resident and the resident's representative sign a copy of these rights, and the signed copy shall be included in the resident's record. 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 two resident files were observed to be missing a signed copy of the personal rights of residents which poses a potential personal rights risk to persons in care.
Official plan of correction
POC Due Date: 07/06/2026 Plan of Correction Administrator agreed to send proof of a signed copy of the personal rights of residents for the identified residents to CCLD no later than POC due date.
Admission, assessment, and evictionType B
- Official classification
- Type B
- Official code
- 87457(c)
- Regulation authority
- CCR
What the official deficiency says
(c) Prior to admission a determination of the prospective resident's suitability for admission shall be completed and shall include an appraisal of their individual service needs in comparison with the admission criteria specified in Section 87455, Acceptance and Retention Limitations. 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 two new residents did not have a completed [re-admission appraisal before being accepted into the facility which poses a potential health or safety risk to persons in care.
Official plan of correction
POC Due Date: 07/06/2026 Plan of Correction Administrator agreed to complete an appraisal for the two residents and to send proof of the completed appraisal to CCLD no later than POC due date.
Admission, assessment, and evictionType B
- Official classification
- Type B
- Official code
- 87458(c)
- Regulation authority
- CCR
What the official deficiency says
(c) The medical assessment shall include, but not be limited to: 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 one resident medical assessment was observed to be missing even numbered pages including required information (TB test results, ambulatory status, etc.) and one resident medical assessment was observed to be missing proof of a negative TB test which poses a potential health risk to persons in care.
Official plan of correction
POC Due Date: 07/06/2026 Plan of Correction Administrator agreed to submit proof of a completed medical assessment for the identified individual and proof of a negative TB test for the identified individual to CCLD no later than POC due date.
Medication handling and storageType B
- Official classification
- Type B
- Official code
- 87465(h)(6)
- Regulation authority
- CCR
What the official deficiency says
87465 Incidental Medical and Dental Care (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: 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 no medications observed were appropriately documented on their CSMDRs and were missing all required information which poses a potential health risk to persons in care.
Official plan of correction
POC Due Date: 07/06/2026 Plan of Correction Administrator agreed to complete an accurate CSMDR for all residents of the facility. Administrator agreed to complete a statement of understanding confirming that they are aware of the importance of accurately logging medications in a timely manner and that they will adhere to medication documentation requirements for all future resident medications that come into the facility. Administrator agreed to submit the CSMDRs and the statement to CCLD no later than POC due date.