COURTYARD PLAZA

Official classification

Type B

Official code

87303(e)(2)

Regulation authority

CCR

What the official deficiency says

Maintenance and Operation. 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 degree C) and not more than 120 degree F (49 degree C).. This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above, as water temperature measured in three (3) out of the five (5) resident rooms were below 105 degree F; This poses a potiential health and safety risk to residents in care. Civil Penalties were assessed for repeat violation within 12 months.

Official plan of correction

The Licensee will contact their plumbing vendor to have them diagnose the ongoing problem with the lack of hot water that should have been corrected on 7/2/26 and to conduct any additional repairs. The Licensee will also conduct daily water temperature checks in various residents rooms and maintain a log to document and ensure the water temperature is stablized and attains the required range of 105-120 degrees Fahrenheit. Provide a copy of the repairs completed by 7/22/26 and weekly logs to LPA for a month after the repairs are completed.

Deadline recorded: Jul 22, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87303(e)(2)

Regulation authority

CCR

What the official deficiency says

Maintenance and Operation. 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 degree C) and not more than 120 degree F (49 degree C).. This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above, as water temperature measured in three (3) out of the five (5) resident rooms were below 105 degree F; This poses a potiential health and safety risk to residents in care. Civil Penalties were a repeat violation within 1year.

Official plan of correction

Per the Administrator, the plumbers were here on 6/24/26 to conduct repairs to the water heaters but the water temperature issue has still not been corrected. The water temperature issue previously cited on 11/25/25 has not been corrected. Licensee will contact the plumbers to stabilize the water temperature between 105-120 degrees Fahrenheit. The facility will test the water daily in the rooms toured to ensure the required Title 22 temperature is attained or addressed. Licensee will provide evidence of correction and a copy of the 14 day temperature log by 7/9/26

Deadline recorded: Jul 9, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87211(a)(1)

Regulation authority

CCR

What the official deficiency says

Reporting Requirements: 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 requirement was not met evidenced by: The facility did not report the incidents, noted in the complaint within the required time frame or have fax confirmation of reporting until 11/25/25. Also noted, the hospital visit for Resident #1 on 10/14/25 has not been reported as of today's visit.

Official plan of correction

Licensee will read Section 87211-Reporting Requirements and submit a signed written statement that the section was reviewed and understood by 6/11/26. Licensee will also complete an incident report (LIC624) for R21's 10/14/25 hospital visit and submit by 6/5/26.

Deadline recorded: Jun 11, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(g)

Regulation authority

CCR

What the official deficiency says

Incidental Medical and Dental Care: The licensee shall immediately telephone 9-1-1 if an injury or other circumstance has resulted in an imminent threat to a resident’s health including, but not limited to, an apparent life-threatening medical crisis…This requirement was not met as evidenced by: Based on interview and record review, the licensee did not comply with the section cited when R1 was not given timely medical attention on 10/14/25. 911 was not immediately called which posed an immediate health and safety risk to residents in care.

Official plan of correction

The Licensee will review their 911 protocol and provide current staff training to ensure that all staff know exactly when 911 is to be immediately contacted during an apparent medical crisis instead of endangering the health of the resident by unnecessay delays. Licensee will provide a written statement that they have reviewed their emergency protocol by 6/5/26 and have provided immediate staff training about the emergency protocol. Licensee will submit evidence of the completion of staff training about calling 911 when there is a life threatening medical crisis by no later then 6/11/26.

Deadline recorded: Jun 5, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87303(e)

Regulation authority

CCR

What the official deficiency says

Maintenance and Operation. 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 and not more than 120 degree F. This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above, as water temperature measured in four (4) out of the eight (8) resident rooms were below 105 degree F; one out of eight rooms was above 120 degree F. This poses a potiential health and safety risk to residents in care.

Official plan of correction

The Designated Administrator and Assistant Administrator reported that they are currently working on changing pipes which will rectify the hot water issue. Administrators agreed to do the following: 1. Have the water heaters adjusted within the next 24 hours. 2. Conduct a 7 day water temperature log for ten rooms on each side spread throughout the facility. Include rooms 332, 130, 128, 126, 231 and 212. Ensure that the hot water temp. is maintained with in required range of 105-120. Submit confirmation of work completed and water temp. log by 12/2/2025.

Deadline recorded: Dec 2, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87355(e)(4)

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 and be approved for a transfer of a criminal record exemption, as specified in Section 87356(r), unless, upon request for a transfer, the Department permits the individual to be employed, reside or be present at the facility. Gregory LaRue(DOH 11/12/25) requested an criminal record exemption but has not received approval to be present at the facility. $500 Civil Penalties were assessed.

Official plan of correction

The Licensee will ensure that all staff have requested and been approved of a criminal record exemption prior to being present at the facility. The Licensee will review Title 22, Section 87355-Criminal Record Clearance and submit a written statement that the section was read and understood and how the licensee shall ensure compliance by 11/19/25. The Licensee will also immediately remove the employee from the premises until the facility has received an approved criminal record exemption.

Deadline recorded: Nov 19, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87355(e)(2)

Regulation authority

CCR

What the official deficiency says

87355 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: 2)Obtain a California clearance or a criminal record exemption Walter Perez, worked at the facility on 10/28/25 for one day. Rosa Garcia(DOH 2/9/17) & Consuelo Rodriguez(DOH 3/18/17). No criminal record clearance or transfer were obtained for all 3 staff prior to being present at the facility. $1100 -Civil Penatlies were assessed.

Official plan of correction

The Licensee will ensure that all staff have requested and been approved of a criminal record exemption prior to being present at the facility. The Licensee will review Title 22, Section 87355-Criminal Record Clearance and submit a written statement that the section was read and understood and how the licensee shall ensure compliance at all times by 11/19/25. Rosa Garcia and Consuelo Rodriguez were associated to the facility today 11-18-25, during this visit and Walter Perez was not retained.

Deadline recorded: Nov 19, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87355(e)(3)

Regulation authority

CCR

What the official deficiency says

87355(e)(3) All individuals subject to a criminal record review... shall prior to working, ...(3) Request a transfer of a criminal record clearance as specified in Section 87355(c) or This requirement is not met as evidenced by: Based on interviews, the licensee did not comply with the section cited above as the Administrator had fingerprint clearance but was not associated to the facility which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

Administrator submitted the required documentation to LPA and was associated at the time of the visit. POC Cleared on site.

Deadline recorded: Sep 5, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

87303 Maintenance and Operation: (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 per tour of the resident rooms - bedrooms #111, 126, 220, 221, 226 the horizontal blinds on the window and doors were observed missing slates or were broken which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/27/2023 Plan of Correction Licensee will conduct an inspection of the windows and doors in all resident bedrooms and replace all missing slates on the windows and doors by POC date - 12-27-23

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

87303 Maintenance and Operation: (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 per tour of the facility, the flooring of the balcony located by the second floor library was observed to be warped, bubbling and un-glued, causing an uneven walking surface which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/27/2023 Plan of Correction Licensee will conduct an inspection of all common areas accessible for residents use to ensure that the flooring is in good condition or conduct repairs to the floor to ensure that the flooring does not pose a tripping hazard by the POC date - 12/27/23

Official classification

Type B

Official code

87307(a)(3)(E)

Regulation authority

CCR

What the official deficiency says

87307 Personal Accommodations and Services: (a) Living accommodations and grounds shall be related to the facility's function. The facility shall be large enough to provide comfortable living accommodations and privacy for the residents, staff, and others who may reside in the facility. The following provisions shall apply: (3) Equipment and supplies necessary for personal care and maintenance of adequate hygiene practice shall be readily available to each resident. The resident may provide the following items; however, if the resident is unable or chooses not to provide them, the licensee shall assure provision of: (E) Portable or permanent closets and drawer space in the bedrooms for clothing and personal belongings. A minimum of eight (8) cubic feet (.743 cubic meters) of drawer space per resident shall be provided. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above per the rooms inspected, bedrooms #231 and bedrooms #236 contained only one dresser each. The other residents were using their desk drawers as dressers whiich poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/27/2023 Plan of Correction Licensee will ensure that the residents are provided with the minimum required Title 22 furniture including a dresser. Licensee will conduct an inspection of all resident rooms to ensure that the residents who do not bring in their own furniture are provided with a dresser that meets Title 22 requirements by 12/27/27

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

87303 Maintenance and Operation: (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 per tour of room #120, the front wooden panel of the bedroom door was observed to be warped and separating from the frame which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/27/2023 Plan of Correction Licensee will conduct an inspection of all bedroom doors to ensure that all the doors are well maintained or conduct repairs to the doors in addtion to the door on bedroom #120 by 12/27/23

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

87303 Maintenance and Operation: (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 per tour conducted of bedroom #201, the stucco and paint on the ceiling of the room were chipping and cracking which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/27/2023 Plan of Correction Licensee will conduct tours of all the resident rooms to ensure that the ceilings are in good repair or conduct repairs, including repairs to the ceiling in bedroom #201 by 12/27/23.

Official classification

Type B

Official code

87303(f)(3)

Regulation authority

CCR

What the official deficiency says

87303 Maintenance and Operation: (f) Solid waste shall be stored and disposed of as follows: (3) All containers, except movable bins, used for storage of solid wastes shall have tight-fitting covers on the containers; shall be in good repair; shall have external handles; and shall be leakproof and rodent-proof. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above per tour of the back parking lot, all the facility dumpsters stored in the back parking lot containing discarded items, including food items were left wide open which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/27/2023 Plan of Correction Licensee will ensure that all containers used to store solid waste are kept tightly sealed at all times. Submit POC by 12/27/23. *****************Dumpsters were observed tightly sealed on today's visit**************

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

87303 Maintenance and Operation: (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 per tour of the outside areas, all the outside areas need general cleaning. Discarded items stored along the backside of the kitchen and the large rolls of artificial grass stored in the center of the courtyard needs to be stored away which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/27/2023 Plan of Correction Licensee will ensure that the outside areas are cleaned and maintained for resident use at all times. Licensee will perform general cleaning and store/discard all items stored in the outside areas to ensure that the residents are safe and healthy by POC dated - 12/27/23.

Official classification

Type A

Official code

87303(e)(2)

Regulation authority

CCR

What the official deficiency says

87303Maintenance and Operation (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 degree C) and not more than 120 degree F (49 degree 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 per water temperature tested in bedroom #i201 read 121.8, bedroom # 206 read 121.4 and bedroom #236 read 93.2 degrees Fahrenheit which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/08/2023 Plan of Correction Licensee will adjust the thermostat so that the hot water controls shall be maintained automatically to regulate the temperature of the hot water used by the residents to attain a temperature of not less than 105 degree Fahrenheit and not more than 120 degree Fahrenheit by 12/8/23.

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, as painting supplies were accessible in an unlocked storage closet and in the hallway, which poses an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 11/30/2022 Plan of Correction The Administrator agreed to do the following: 1. The items were secured during the visit. Plan of Correction met at this time.

Official classification

Type A

Official code

87303(e)(2)

Regulation authority

CCR

What the official deficiency says

87303(e)(2) Water supplies and plumbing fixtures shall be maintained as follows: (2) Faucets.. shall deliver.. hot water.. not less than 105 degree F (41 degree C) and not more than 120 degree F (49 degree C). This requirement is not met as evidenced by: Based on LPAs observation, the licensee failed to ensure hot water temperature measured within 105 to 120 degrees F in resident rooms which poses an immediate health, and safety risk to residents in care.

Official plan of correction

The Licensee has agreed to do the following: 1. Submit proof by photos of tempurature adjustment. 2. Submit a hot water temperature log for five (5) days to maintain water temperature between 105 - 120 degrees F.

Deadline recorded: Jul 14, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87463(c)

Regulation authority

CCR

What the official deficiency says

87463(c) Reappraisals(c):The licensee shall arrange a meeting with… a representative of the resident’s home health agency, if any, when there is significant change in the resident’s condition… This requirement is not met as evidenced by: Based on records review and interviews, the licensee did not comply with the section cited above. Facility failed to have a level of care meeting to discuss R1’s change of condition when R1’s pressure injuries were worsening, and R1 was not compliant with Home Health care plan, which posed a potential health and safety risk to residents in care.

Official plan of correction

Licensee will submit a plan on how you will ensure level of care meetings are conducted in a timely manner when there is a change in resident condition. Submit to CCL by 05/31/22.

Deadline recorded: May 31, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87463(a)(3)

Regulation authority

CCR

What the official deficiency says

Reappraisals(a)The pre-admission appraisal shall be updated...as frequently as necessary to note significant changes…(3) Any illness, injury…or change in the health care needs... specified in Sections 87455(c) or 87615, Prohibited Health Conditions. This requirement is not met as evidenced by: Based on records review and interviews, the licensee did not comply with the section cited above. Facility failed to update R1’s appraisal with change of condition when R1’s pressure injuries worsened, and R1 was not compliant with Home Health care plan, which posed a potential health and safety risk to residents in care.

Official plan of correction

Licensee will submit a plan on how you will ensure level of care meetings are conducted in a timely manner when there is a change in resident condition. Submit to CCL by 05/31/22.

Deadline recorded: May 31, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

1569.312(a)

Regulation authority

HSC

What the official deficiency says

1569.312(a) Basic services requirements: Every facility required to be licensed under this chapter shall provide at least the following basic services: (a) Care and supervision as defined in Section 1569.2 This requirement is not met as evidenced by: Based on interviews and records review, the licensee did not comply with the section cited above, Licensee failed to coordinate care when R1’s pressure injuries worsened and R1 was not compliant with treatment, resulting in stage 3 pressure injuries, which posed an immediate health and safety risk to residents in care.

Official plan of correction

The Licensee will submit plan to provide proper level of care and supervision to ensure resident needs are met to CCL by 05/27/22. An immediate civil penalty of $500 is warranted in accordance with California Health and Safety Code Section 1548(c)(1).

Deadline recorded: May 27, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87466

Regulation authority

CCR

What the official deficiency says

Observation of the Resident: The licensee shall ensure that residents are regularly observed for changes… and that appropriate assistance is provided when such observation reveals unmet needs…the licensee shall ensure…changes are documented and brought to the attention of the resident's physician… This requirement is not met as evidenced by: Based on interviews and records review, the licensee did not comply with the section cited above. The facility failed to communicate R1’s worsening pressure injuries/wounds with R1’s physician which attributed to R1’s stage 3 pressure injuries while in care, which posed an immediate health and safety risk to residents in care.

Official plan of correction

The Licensee will submit plan to provide proper level of care and supervision to ensure resident needs are met to CCL by 05/27/22.

Deadline recorded: May 27, 2022. A deadline is not proof that correction was completed.

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: Based on observation, the licensee did not comply with the section cited above, as the exit/ back door leading to the parking lot contained a double action door latch, which poses an immediate health and safety risk to residents in care.

Official plan of correction

During visit, the double action door latch was replaced with a single action door latch. POC met. This is a zero tolerance violation, resulting in a civil penalty in the amount of $500.

Deadline recorded: May 17, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87468.2(a)(4)

Regulation authority

CCR

What the official deficiency says

87468.2(a)(4)...In addition to the rights listed… residential care facilities for the elderly shall have all of the following personal rights: To care, supervision, and services that meet their individual needs... This requirement is not met as evidenced by: Based on staff interviews, file review, and incident report review the licensee did not comply with the cited section by not providing proper care and supervision which resulted in R1 sustaining a hip fracture which posed an immediate health and safety and personal rights risk to R1.

Official plan of correction

licensee/Administrator will obtain vendorized training for staff on regulation 87468.2(a)(4). Verification of scheduled training with the credentials of the trainer will need to be submitted within 24 hours. Licensee/Administrator will submit verification of the the completed training by 2/4/2021

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