Fire safety and emergency preparednessType A
- Official classification
- Type A
- Official code
- 87202(a)(2)
- 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: (2) Bedridden persons 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 one out of three residents were not in the approved room (room 1 or 2) for bedridden which poses an immediate health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 07/30/2026 Plan of Correction Resident will be moved from room #3 to Room #1
Staffing, personnel, and trainingType A
- Official classification
- Type A
- Official code
- 87412(a)(11)
- Regulation authority
- CCR
What the official deficiency says
(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: (11) A health screening as specified in Section 87411, Personnel Requirements - General. 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 out of three staff did not have a health screening, which poses an immediate health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 08/14/2026 Plan of Correction Licensee agreed to have staff get the health screening completed by the the POC date.
Staffing, personnel, and trainingType A
- Official classification
- Type A
- Official code
- 87411(d)
- Regulation authority
- CCR
What the official deficiency says
(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: 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 staff out two of which poses an immediate health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 08/10/2026 Plan of Correction Licensee agre to provide the intial 20 hour training and will email the department LPA, proof of training.
Food serviceType A
- Official classification
- Type A
- Official code
- 87555(b)(26)
- Regulation authority
- CCR
What the official deficiency says
(26) Supplies of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days shall be maintained on the premises. 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 2 day and 7 day supply of perishable and non-perishable supply of food was not avalibale at te iem of the visit. which poses an immediate health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 07/31/2026 Plan of Correction The licensee will purchase appropiate quantity of food and will submit pictures to the LPA by POC date.
Medication handling and storageType A
- Official classification
- Type A
- Official code
- 87465(c)(2)
- Regulation authority
- CCR
What the official deficiency says
(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: (2) Once ordered by the physician the medication is given according to the physician's directions. 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 three out of three bottles of medication did not the correct number of pills per the centrally stored and destruction record, which poses an immediate health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 08/10/2026 Plan of Correction The licensee agreed to provide training and email the LPA the training certification for all staff and administrative staff.
Admission, assessment, and evictionType A
- Official classification
- Type A
- Official code
- 87458(c)(1)
- Regulation authority
- CCR
What the official deficiency says
(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: 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 out of which poses an immediate health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 08/10/2026 Plan of Correction The Licensee agreed to send the LIC 602 to the LPA via email by the POC 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 in three out of three residents files were missing persnal rights, which poses/posed a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 08/10/2026 Plan of Correction licensee agreed to have all residents files complted by the POC due date.
Records and plan of operationType B
- 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 (record review)], the licensee did not comply with the section cited above in three out of three residents files which poses/posed a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 08/10/2026 Plan of Correction licensee agreed to have all residents files complted by the POC due date.
Not classified in the sourceType B
- Official classification
- Type B
- Official code
- 87508(a)
- Regulation authority
- CCR
What the official deficiency says
(a) The licensee shall ensure that a current register of all residents in the facility is maintained and contains the following updated information: 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 out of three residents physician inormation and contact information was missing which poses/posed a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 08/10/2026 Plan of Correction The licensee will update the LIC 9020 to reflect the information required.