COMPLETE HARMONY BOARD AND CARE INC

Official classification

Type A

Official code

87309(a)

Regulation authority

CCR

What the official deficiency says

(a)... licensee shall ensure that disinfectants, cleaning solution...are in locked storage and are not left unattended if outside the locked storage. This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above as a under sink cabinet which contained laundry chemicals, bleach, floor cleaner and resident hygiene supplies was left unsecured which posed an immediate health and safety risk to persons in care.

Official plan of correction

Administrator agreed to conduct an in-service training with all facility staff covering the importance of securing items listed in CCR 87309(a) and the facility's policies and procedures regarding securing dangerous items. Administrator agreed to submit proof of the completed training to CCLD no later... than POC due date.

Deadline recorded: Jul 17, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

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 on 11/06/2024 which was more than 12 months from the inspection date which posed an immediate safety risk to persons in care.

Official plan of correction

POC Due Date: 01/05/2026 Plan of Correction Administrator had a new fire extinguisher purchased and installed at the time of the inspection. POC cleared.

Official classification

Type A

Official code

87309(a)

Regulation authority

CCR

What the official deficiency says

(a) Except as specified in subsection (b), the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances, knives, matches, tools, sharp objects, and other similar items which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage. 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 an unsecured saw blade and bottle of motor oil were observed in the backyard of the facility which posed an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 01/05/2026 Plan of Correction Administrator secured the items at the time of the inspection. POC cleared.

Official classification

Type A

Official code

87465(a)(4)

Regulation authority

CCR

What the official deficiency says

(4) The licensee shall assist residents with self-administered medications as needed. 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 R1's medication did not appear to be administered as prescribed based on R1's CSMDR and medication count not aligning appropriately which poses an immediate health risk to persons in care.

Official plan of correction

POC Due Date: 01/06/2026 Plan of Correction Administrator agreed to submit a statement of understanding confirming that they will log and administer medications appropriately and per doctor's orders. Administrator agreed to submit the statement no later than POC due date.

Official classification

Type B

Official code

87463(a)

Regulation authority

CCR

What the official deficiency says

(a) The pre-admission appraisal, as specified in Section 87457, Pre-Admission Appraisal, shall be updated, in writing as frequently as necessary or once every 12 months, whichever occurs first, to note significant changes in condition, as defined in Section 87101, Definitions, and to keep the appraisal accurate. For the purposes of this section, the updated pre-admission appraisal shall be referred to as the reappraisal. 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 2 of 2 residents had incomplete appraisal needs and services plans that were missing most information included and signatures from the residents/ resident's responsible parties which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/19/2026 Plan of Correction Administrator agreed to submit completed appraisal needs and services plans for both residents to CCLD no later than POC due date.

Official classification

Type B

Official code

87507(a)(1)(A)

Regulation authority

CCR

What the official deficiency says

(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. (1) The text of the admission agreement, including any attachments and modifications, shall be: (A) Printed in black type of not less than 12-point type size, on plain white paper. The print shall appear on one side of the paper only. 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 both resident admission agreements were printed on both sides of the paper which poses a potential personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/19/2026 Plan of Correction Administrator agreed to copy the admission agreements to appear on one side of the page only and Administrator agreed to submit a statement of understanding confirming that they will only print admission agreements on one side of the paper for all future admissions to the facility.

Official classification

Type B

Official code

87608(a)(5)(B)

Regulation authority

CCR

What the official deficiency says

(B) Bed rails that extend the entire length of the bed are prohibited except for residents who are currently receiving hospice care and have a hospice care plan that specifies the need for full bed rails. 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 R1's bed contained full bed rails and R1 was not receiving hospice services which posed a potential personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/05/2026 Plan of Correction Administrator removed the full rails from R1's bed at the time of the visit. POC cleared.

Official classification

Type B

Official code

87211(a)(1)

Regulation authority

CCR

What the official deficiency says

(1) 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 report shall include the resident's name, age, sex and date of admission; date and nature of event; attending physician's name, findings, and treatment, if any; and disposition of the case. This requirement is not met as evidenced by: Deficient Practice Statement Based on interview and record review, the licensee did not comply with the section cited above as two resident death reports were submitted to CCLD outside of the seven day required timeframe which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/15/2025 Plan of Correction Licensee submitted the death reports at the time of the visit. The Administrator verbally confirmed that all incident reports and death reports will be submitted to CCLD within the seven day due date window.

Official classification

Type B

Official code

87457(c)

Regulation authority

CCR

What the official deficiency says

87457 Pre-Admission Appraisal (c) Prior to admission a determination of the prospective resident's suitability for admission shall be completed... This requirement is not met as evidenced by: Based on interview the licensee did not comply with the section cited above as the Administrator admitted that a pre-admission appraisal was not completed for R1 which poses a potential health, safety, or personal rights risk to clients in care.

Official plan of correction

Licensee will submit a statement confirming that they understand the importance of conducting pre-admission appraisals and stating that they will not admit future residents without conducting a pre-admission appraisal. Licensee will submit proof of corrections no later than POC due date.

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

Official classification

Type B

Official code

87705(d)

Regulation authority

CCR

What the official deficiency says

87705 Care of Persons with Dementia (d) The licensee shall ensure that the facility has an auditory device or other staff alert feature to monitor exits on exterior doors and perimeter fence gates... This requirement is not met as evidenced by: Based on observation and interview the licensee did not comply with the section cited above as the front door auditory alarm was turned off and not activated during inspection and on 03/01/2025 which poses a potential safety risk to clients in care.

Official plan of correction

Licensee will submit their plan on how they will ensure auditory alarms remain on and active at all times. Licensee will install an auditory alarm on the exterior gate to the facility. Licensee will submit proof of corrections to CCLD no later than POC due date.

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

Official classification

Type B

Official code

87464(f)(1)

Regulation authority

CCR

What the official deficiency says

87464 Basic Services (f) Basic services shall at a minimum include: (1) Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). This requirement is not met as evidenced by: Based on interview the licensee did not comply with the section cited above as R1 eloped from the facility without staff's knowledge which poses a potential safety rick to clients in care.

Official plan of correction

Licensee will submit their plan on how they will ensure adequate staff supervision of clients to CCLD no later than POC due date.

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

Official classification

Type B

Official code

87468.2(a)(5)

Regulation authority

CCR

What the official deficiency says

87468.2 Additional Personal Rights... (a) ...residents shall have all of the following personal rights: (5) To be served food...necessary to meet their nutritional needs. This requirement is not met as evidenced by: Based on interview the licensee did not comply with the section cited above as one resident stated that they have been fed food which they are allergic to which poses a potential health risk to clients in care

Official plan of correction

Licensee will submit their plan on how they will meet the identified resident's dietary needs and a statement of understanding confirming that they understand the importance of following resident's dietary restrictions to CCLD no later than POC due date.

Deadline recorded: Mar 21, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.2(a)(7)

Regulation authority

CCR

What the official deficiency says

87468.2 Additional Personal Rights... (a) In addition...shall have..the... rights: (7) ...The licensee shall provide necessary information and support to ensure that residents direct the planning of their care... This requirement is not met as evidenced by: Based on interview the licensee did not comply with the section cited above as one resident stated that they were not provided with access to their MAR to know what medications they were taking which poses a potential personal rights risk to clients in care

Official plan of correction

The licensee will submit a statement of understanding confirming that they understand the importance of including residents in the planning of their care needs and providing residents the nessicary information to plan their care needs to CCLD no later than POC due date.

Deadline recorded: Mar 21, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87465(a)(6)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental... (a) ... by compliance with the following: (6) ... a record of dosages of medications which are centrally stored shall be maintained by the facility. This requirement is not met as evidenced by: Based on record review the licensee did not comply with the section cited above as one resident's MAR was observed to not be filled out and missing administrations of medications which poses a potential health risk to clients in care

Official plan of correction

Licensee will submit their plan on how they will ensure resident's MARs are complete and accurately filled out to CCLD no later than POC due date.

Deadline recorded: Mar 21, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87506(a)

Regulation authority

CCR

What the official deficiency says

87506 Resident Records (a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility... This requirement is not met as evidenced by: Based on record review the licensee did not comply with the section cited above as two resident's file was observed to be missing from the facility which poses a potential personal rights risk to clients in care

Official plan of correction

Licensee will submit a completed resident files for R1 and R3 no later than POC due date.

Deadline recorded: Mar 21, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87219(a)

Regulation authority

CCR

What the official deficiency says

87219 Planned Activities (a) Residents shall be encouraged to maintain and develop their quality of life through participation in a variety of planned activities.... This requirement is not met as evidenced by: Based on interview the licensee did not comply with the section cited above as residents stated that activities are not offered at the facility which poses a potential personal rights risk to clients in care

Official plan of correction

The licensee will submit their plan on how they will incorporate activities residents are interested in to CCLD no later than POC due date.

Deadline recorded: Mar 21, 2025. A deadline is not proof that correction was completed.