HMS HOME

Official classification

Type A

Official code

87303(e)(2)

Regulation authority

CCR

What the official deficiency says

Maintenance and Operations: 87303(e)(2) 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 in the water temperature tested in the back bathroom, by Bedroom #3, the water temperature was tested and read 123.7 degreens Fahrenheit which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/19/2025 Plan of Correction The Licensee will adjust the thermostat to ensure that the water temperature for the water used by the residents is within Title 22 requirements of 105 to 120 degrees Fahrenheits. Licensee will provide evidence that the facility has corrected the deficiency or will self ceritify that the water temperature is within Title 22 requirements by 12/19/25.

Official classification

Type B

Official code

1569.605

Regulation authority

HSC

What the official deficiency says

On and after July 1, 2015, all residential care facilities for the elderly, except those facilities that are an integral part of a continuing care retirement community, shall maintain liability insurance covering injury to residents and guests in the amount of at least one million dollars ($1,000,000) per occurrence and three million dollars ($3,000,000) in the total annual aggregate, caused by the negligent acts or omissions to act of, or neglect by, the licensee or its employees. 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 per review of facility files, the licensee does not have liability insurance with the required limits of $1million per incident and $3 million annual aggregate. Per licensee, she has liability insurance but the limits are shared by the 2 sister facilities which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/07/2023 Plan of Correction Licensee will ensure that Liability insurance is purchased for all 3 facilities that she owns with its own limits of $1 million per incident and a total annual aggregate of $3million by the POC date. Licensee will provide the Department with evidence that the appropriate coverage has been obtained for all facilities she owns.

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 physical plant, it was observed that the screen doors for the sliding glass door located in the living room had holes by the door handle which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/07/2023 Plan of Correction Licensee will ensure that all screen doors are maintained in good repair. Licensee agreed to repair the screen door and submit photograph(PDF) once the repair is completed by 12/7/23.

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. (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 tour of the physical plant, all the residents have not been provided with the required sized dressers which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/12/2023 Plan of Correction Licensee will purchase the regulation sized dresser for all the residents' rooms and submit evidence that the required dressers have been provided for resident use by 12/7/23

Official classification

Type B

Official code

87216(a)

Regulation authority

CCR

What the official deficiency says

87216 Bonding (a) Each licensee, other than a county, who is entrusted to safeguard resident cash resources, shall file or have on file with the licensing agency a copy of a bond issued by a surety company to the State of California as principal. (1) The amount of the bond shall be in accordance with the following schedule: Total Safeguarded Per Month Bond Required: $750 or less -$1,000, $751 to $1,500.- $2,000, $1,501 to $2,500 - $3,000 Every further increment of $1,000 or fraction thereof shall require an additional $1,000 on the bond. 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 per review of facility records, the Licensee is the payee for Resident #6 and has not obtained a surety bond in the appropriate limits which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/07/2023 Plan of Correction Licensee will ensure that a surety bond is obtained in the appropriate amount to ensure that the residents cash resources and valuables handled by the LIcensee are protected. Provide the Department with evidence that a surety bond in the appropriate amounts have been obtained by 12/7/23

Official classification

Type B

Official code

87303(e)(4)

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. e) Water supplies and plumbing fixtures shall be maintained as follows: (4) Grab bars shall be maintained for each toilet; bathtub and shower used by residents. 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 physical plant the bathroom located by Bedroom #4 does not have grab bars in the shower stall which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/07/2023 Plan of Correction Licensee will ensure that all bathrooms in the facility is equipped with the required grab bars. Licensee will provide evidence that grab bars have been installed in the bathroom located by Bedroom #4 by 12/7/23

Official classification

Type B

Official code

87303(a)(1)

Regulation authority

CCR

What the official deficiency says

87303 Maintenance and Operation (a)(1)…Floor surfaces in bath, laundry and kitchen areas shall be maintained in a clean, sanitary, and odorless condition. This requirement is not met as evidenced by: Based on interviews, the licensee did not comply with the section cited above, as staff admitted that the floor was soiled due to an incontinent accident, which poses a potential health and safety risk to residents in care.

Official plan of correction

The Administrator agreed to do the following: Submit a plan of action of how staff manage resident incontinence problems to CCL no later than 2/25/22.

Deadline recorded: Feb 25, 2022. A deadline is not proof that correction was completed.

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: Based on interviews, the licensee did not comply with the section cited above, as staff admitted to not wearing a mask during prior a incident, which poses a potential health and safety risk to residents in care.

Official plan of correction

The Administrator agreed to do the following: 1. Submit staff retraining log on Infection Control PIN 21-38-ASC regarding masks wearing in the facility to CCL by 2/25/22.

Deadline recorded: Feb 25, 2022. A deadline is not proof that correction was completed.