Admission, assessment, and eviction
Cited in 3 reports, with 6 deficiencies in total.
TIFFANY'S BOARD AND CARE IV
16955 JANINE DRIVE, Whittier CA 90603
6 bedsLatest official report Aug 19, 2026Licensed
Additional info
- Telephone
- (562) 690-9274
- Licensee
- FLORDELIZA SASADA
- Administrator
- COSTANCE EDWARDS
- Contact
- COSTANCE EDWARDS
- License first date
- Jul 11, 2007
- License effective date
- Jul 11, 2007
- District office
- MONTEREY PARK ASC · (323) 980-4934
- Regional office
- 28
- Clients served
- 935 - ELDERLY
Summary
The available records show 7 Type A and 26 Type B deficiencies for this facility.
- Most recent inspection
- Jul 24, 2026
- Most recent deficiency
- Jun 30, 2026
2 later reports, from Jul 10, 2026 through Jul 24, 2026, recorded no deficiencies, though the records do not say whether they were follow-ups.
What Type A and Type B mean
- Type A
- Violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
- Type B
- Violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care.
Both classifications are published by California CDSS and are shown as published. SeniorLivingFacts does not rename them or add a severity level of its own.
At a glance
Counts cover the five-year public record. Typical figures are the median for the 1,564 Los Angeles County facilities licensed for 6 or fewer beds.
In the available public five-year record, CCLD published 11 reports for this facility: 9 inspections, 1 complaint investigation, and 1 licensing or administrative record.
Those records contain 7 Type A and 26 Type B deficiencies.
0 deficiencies have explicit official correction or clearance evidence in the loaded records.
- Official inspections
- 9
- Recorded deficiencies
- 33
- Type A deficiencies
- 7
- Type B deficiencies
- 26
- Substantiated complaints
- 0
- Repeated topics
- 8
More than the typical 4
4 in the last 12 months
Well above the typical 1
15 in the last 12 months
Most this size have none
3 in the last 12 months
Most this size have none
12 in the last 12 months
Most this size also have none
0 in the last 12 months
Last 36 months
Repeated topics
Topics cited in more than one report during the last 36 months. A repeat may show a pattern worth asking about. Each date opens its report below.
Staffing, personnel, and training
Cited in 3 reports, with 4 deficiencies in total.
Background checks
Cited in 3 reports, with 3 deficiencies in total.
Fire safety and emergency preparedness
Cited in 2 reports, with 4 deficiencies in total.
Health conditions and treatments
Cited in 2 reports, with 4 deficiencies in total.
Records and plan of operation
Cited in 2 reports, with 3 deficiencies in total.
Facility condition and maintenance
Cited in 2 reports, with 2 deficiencies in total.
Resident rights
Cited in 2 reports, with 2 deficiencies in total.
Official report history
All preserved reports from the most recent to the oldest, sortable by report type.
Inspection
No deficiencies recorded in this report
Inspection
No deficiencies recorded in this report
Inspection
Not classified in the sourceType A
- Official classification
- Type A
- Official code
- 1569.32
- Regulation authority
- HSC
What the official deficiency says
Any duly authorized officer, employee, or agent of the department may, upon presentation of proper identification, enter and inspect any place providing personal care, supervision, and services at any time, with or without advance notice, to secure compliance with, or to prevent a violation of, this chapter. This requirement is not met as evidenced by: Deficient Practice Statement Based on interview and observation, the licensee did not comply with the section cited above in 2 out of 2 residents, because LPA did not allow LPA to enter Bedroom #1 or the Garage identified in the facility sketch which is from the facility file, which poses an immediate health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 07/01/2026 Plan of Correction Administrator is to allow the licensing agency to inspect all areas of the facility at all times. Administrator shall review the regulation and confirm this to LPA by email, and email LPA the facility's plan on how the Bedroom #1 and the garage will be excluded from the operating portion of the facility, including an updated facility sketch, to LPA by the POC due date.
Plan of correction recorded
Correction not verified in available records
Background checksType A
- Official classification
- Type A
- Official code
- 87355(e)(3)
- Regulation authority
- CCR
What the official deficiency says
(e) 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: (3) Request a transfer of a criminal record clearance as specified in Section 87355(c) or 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 2 out of 2 staff members, because S2 and S3 do have criminal background clearances, however their association has not been transferred to this facility, which poses an immediate health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 07/01/2026 Plan of Correction Administrator is to ensure staff are associated to the facility prior to working at all times. Administrator shall submit the facility's plan to associate S2 and S3 to Guardian to LPA by the POC due date. Administrator shall follow up with LPA once the association of the two staff members is completed.
Plan of correction recorded
Correction not verified in available records
Health conditions and treatmentsType A
- Official classification
- Type A
- 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 in 1 out of 2 residents, because R2 has full-length bedrails however they are not on hospice, which poses an immediate health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 07/01/2026 Plan of Correction Administrator is to ensure only residents on hospice have full-length bedrails on their beds at all times. Administrator shall email LPA the facility's plan to either remove the full rails, or install half-rails for the resident and obtain a physician's order for R2 by the POC due date.
Plan of correction recorded
Correction not verified in available records
Health conditions and treatmentsType B
- Official classification
- Type B
- Official code
- 87470(c)
- Regulation authority
- CCR
What the official deficiency says
(c) An Infection Control Plan shall be developed by the licensee and shall be included in the Plan of Operation required by Section 87208. 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 2 out of 2 residents, because the facility did not have an infection control plan LIC9282 on file during the visit, which poses/posed a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 07/17/2026 Plan of Correction Administrator is to ensure that an infection control plan remains on file at all times.
Plan of correction recorded
Correction not verified in available records
Records and plan of operationType B
- Official classification
- Type B
- Official code
- 87208(a)
- Regulation authority
- CCR
What the official deficiency says
(a) The licensee shall have and maintain a current, written definitive plan of operation for the facility. The licensee shall operate the facility in accordance with the terms specified in the plan of operation and may be cited for not doing so pursuant to Health and Safety Code section 1569.49. The plan and related materials shall be on file in the facility and shall be submitted to the licensing agency with the license application. Any significant changes in the plan of operation which would affect the services to residents shall be submitted to the licensing agency for approval. The plan and related materials shall contain the following: This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview, and record review, the licensee did not comply with the section cited above in 2 out of 2 residents, because the current facility sketch that the licensing agency has on file includes a Bedroom #1 which is now where the administrator of the facility lives, which poses a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 07/17/2026 Plan of Correction Administrator is to ensure that the facility sketch is updated with the licensing agency at all times. Administrator shall email LPA the facility's updated and current facility sketch and to LPA by the POC due date.
Plan of correction recorded
Correction not verified in available records
Incident reportingType B
- 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 in 1 out of 3 residents, because R3 passed away on 6/23/2026, however no death report was submitted to the licensing agency which poses/posed a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 07/17/2026 Plan of Correction Administrator is to ensure that death reports are emailed to the licensing agency within the appropriate time frames at all times. Administrator is to submit the death certificate to the licensing agency by the POC due date.
Plan of correction recorded
Correction not verified in available records
Facility condition and maintenanceType B
- Official classification
- Type B
- Official code
- 87303(c)
- Regulation authority
- CCR
What the official deficiency says
(c) All window screens shall be clean and maintained in good repair. 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 1 out of 2 residents, because the bathroom in R1's room is missing a window screen, which poses a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 07/17/2026 Plan of Correction Administrator is to ensure that window screens are maintained on all windows that open in the facility at all times. Administrator shall install a window screen in R1's restroom and email photographic proof to LPA by the POC due date.
Plan of correction recorded
Correction not verified in available records
Resident rightsType B
- Official classification
- Type B
- Official code
- 87468(c)(2)(A)
- Regulation authority
- CCR
What the official deficiency says
(c) Licensees shall prominently post personal rights, nondiscrimination notice, and complaint information in areas accessible to residents, representatives, and the public. (2) Information on the appropriate reporting agency in case of a complaint or emergency, including procedures for filing confidential complaints, shall be posted as follows: (A) Licensees may use the Residential Care Facility for the Elderly (RCFE) Complaint Poster (PUB 475) or may develop their own poster as provided in this section. A poster developed by the licensee shall contain the same content as the PUB 475. The poster that is posted shall be 20” x 26” in size and be posted in the main entryway of the facility. PUB 475 may be accessed, downloaded, and printed from the www.ccld.ca.gov website. 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 2 out of 2 residents, because the PUB 475 See something Say Something poster is not posted in the facility, which poses a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 07/17/2026 Plan of Correction Administrator shall ensure that the PUB 475 poster is posted within the facility at the appropriate dimensions at all times. Administrator shall post the poster in the facility and email LPA proof it has been submitted by the POC due date.
Plan of correction recorded
Correction not verified in available records
Staffing, personnel, and trainingType B
- Official classification
- Type B
- Official code
- 1569.625(b)(1)
- Regulation authority
- HSC
What the official deficiency says
(1) The department shall adopt regulations to require staff members of residential care facilities for the elderly who assist residents with personal activities of daily living to receive appropriate training. This training shall consist of 40 hours of training. A staff member shall complete 20 hours, including six hours specific to dementia care, as required by subdivision (a) of Section 1569.626 and four hours specific to postural supports, restricted health conditions, and hospice care, as required by subdivision (a) of Section 1569.696, before working independently with residents. The remaining 20 hours shall include six hours specific to dementia care and shall be completed within the first four weeks of employment. The training coursework may utilize various methods of instruction, including, but not limited to, lectures, instructional videos, and interactive online courses. The additional 16 hours shall be hands-on training. 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 2 out of 2 staff members, because there was no documented training on topics related to dementia care, hospice care, postural supports, or restricted health conditions, which poses a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 07/24/2026 Plan of Correction Administrator shall ensure that all staff members receive training pertaining to dementia care at all times. Administrator shall conduct the required training amongst S2 and S3, and email the doucmented training to LPA by the POC due date.
Plan of correction recorded
Correction not verified in available records
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 in 1 out of 2 residents, because R2 did not have a pre-admission appraisal in their file, which poses a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 07/17/2026 Plan of Correction Administrator is to ensure that pre-admission appraisals are conducted for residents at all times. Administrator shall conduct an appraisal for R2 and email the appraisal to LPA by the POC due date.
Plan of correction recorded
Correction not verified in available records
Admission, assessment, and evictionType B
- Official classification
- Type B
- Official code
- 87458(c)(1)(D)
- 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: (D) Other medical conditions. 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 1 out of 2 residents, because R1 does not have an updated LIC602A (4/25) physician's report, they instead have the older LIC602A (8/11) which is incomplete, which poses/posed a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 07/24/2026 Plan of Correction Administrator shall ensure that residents have the current LIC602A form in their file at all times. Administrator shall obtain and updated physician's report for R1 and submit it to LPA by the POC due date.
Plan of correction recorded
Correction not verified in available records
Admission, assessment, and evictionType B
- 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 in 1 out of 2 residents, because R1 did not have a reappraisal conducted within the past 12 months, which poses a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 07/24/2026 Plan of Correction Administrator is to ensure that reappraisals are conducted at least every 12 months at all times. Administrator is to conduct a reappraisal for R1 and email it to LPA by the POC due date.
Plan of correction recorded
Correction not verified in available records
Fire safety and emergency preparednessType B
- Official classification
- Type B
- Official code
- 1569.695(c)
- Regulation authority
- HSC
What the official deficiency says
(c) A facility shall conduct a drill at least quarterly for each shift. The type of emergency covered in a drill shall vary from quarter to quarter, taking into account different emergency scenarios. An actual evacuation of residents is not required during a drill. While a facility may provide an opportunity for residents to participate in a drill, it shall not require any resident participation. Documentation of the drills shall include the date, the type of emergency covered by the drill, and the names of staff participating in the drill. 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 2 out of 2 residents, becuase there was no documented disaster drill conducted within the past 3 months, which poses a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 07/17/2026 Plan of Correction Administrator is to ensure that disaster drills are conducted and documented at least every 3 months. Administrator shall conduct a disaster drill, document the drill and the type of disaster it covered, and email the drill to LPA by the POC due date.
Plan of correction recorded
Correction not verified in available records
Fire safety and emergency preparednessType B
- Official classification
- Type B
- Official code
- 1569.695(d)
- Regulation authority
- HSC
What the official deficiency says
(d) A facility shall review the plan annually and make updates as necessary, including changes in floor plans and the population served. The licensee or administrator shall sign and date documentation to indicate that the plan has been reviewed and updated as necessary. 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 2 out of 2 residents, because there was not an updated 9-page LIC610E (12/25) disaster plan on file, only the single-page older LIC610E (10/03), which poses a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 07/24/2026 Plan of Correction Administrator is to ensure that an updated LIC610E is documented and kept on file at all times, and reviewed yearly which shall be documented. Administrator shall complete the current 9-page LIC610E and email it to LPA by the POC due date.
Plan of correction recorded
Correction not verified in available records
Health conditions and treatmentsType B
- Official classification
- Type B
- Official code
- 87608(a)(5)(A)
- Regulation authority
- CCR
What the official deficiency says
(A) A bed rail that extends from the head half the length of the bed and used only for assistance with mobility shall be allowed. 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 1 out of 2 residents, because R1 has half-bed rails but does not have a physician order for the rails, which poses a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 07/17/2026 Plan of Correction Administrator is to ensure that all residents half physician orders for residents that have half-bed rails at all times. Administrator is to either obtain a physician's order for the rails or remove the rails for the resident by the POC due date.
Plan of correction recorded
Correction not verified in available records
Inspection
No deficiencies recorded in this report
Inspection
Facility condition and maintenanceType A
- Official classification
- Type A
- Official code
- 87303(e)(2)
- Regulation authority
- CCR
What the official deficiency says
(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 degrees C) and not more than 120 degree F (49 degrees 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 5 out of 5 clients, as both resident restrooms of the facility measured over 120 degress fahrenheit, which poses an immediate health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 08/22/2025 Plan of Correction Administrator is to ensure that the hot water temperature remains within the required range at all times. Administrator is to adjust the hot water temperature for the facility and submit a water temperature log showing the water temperature is within the required range to LPA by the POC due date.
Plan of correction recorded
Correction not verified in available records
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 in 5 out of 5 residents, as 3 staff members did not have health screenings with TB clearances available to review, which poses a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 09/18/2025 Plan of Correction Administrator is to ensure that health screenings for all staff members are available at all times. Administrator is to email LPA the health screenings for the identified staff members by the POC due date.
Plan of correction recorded
Correction not verified in available records
Staffing, personnel, and trainingType B
- Official classification
- Type B
- Official code
- 1569.625(b)(2)
- Regulation authority
- HSC
What the official deficiency says
(2) In addition to paragraph (1), training requirements shall also include an additional 20 hours annually, eight hours of which shall be dementia care training, as required by subdivision (a) of Section 1569.626, and four hours of which shall be specific to postural supports, restricted health conditions, and hospice care, as required by subdivision (a) of Section 1569.696. This training shall be administered on the job, or in a classroom setting, or both, and may include online training. 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 5 out of 5 residents, because the annual in-service training was not available to review, which poses a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 09/18/2025 Plan of Correction Administrator is to ensure that the required annual training is avilable for LPA to review at all times. Administrator is to conduct the annual in-service training related to the identified topics and email the list of trainings to LPA by the POC due date.
Plan of correction recorded
Correction not verified in available records
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 5 out of 5 residents, because during the initial annual visit on 8/14/2025, the residents MARs was not initialled for passes on 8/13/2025 and 8/14/2025, which poses/posed a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 09/18/2025 Plan of Correction Administrator is to ensure that the MARs for all clients are completed fully and accurately at all times. Administrator is to email LPA the facility's plan for how the facility will ensure the MARs is fully completed and initialled to LPA by the POC due date.
Plan of correction recorded
Correction not verified in available records
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 in 3 out of 5 residents, as 3 residents did not have a pre-placement appraisal on file, which poses a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 09/18/2025 Plan of Correction Administrator is to ensure that pre-admission appraisals are conducted and documented for all residents at all times. Administrator is to email the pre-placement appraisals for all the residents to LPA by the POC due date.
Plan of correction recorded
Correction not verified in available records
Admission, assessment, and evictionType B
- Official classification
- Type B
- Official code
- 87458(a)
- Regulation authority
- CCR
What the official deficiency says
(a) Prior to a person's acceptance as a resident, the licensee shall obtain documentation of a medical assessment, signed by a licensed medical professional acting within the scope of their practice and made within the last year, to be kept 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 1 out of 5 residents, as one resident did not have a physician's report on record, which poses a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 09/18/2025 Plan of Correction Administrator is to ensure that all resident physician's reports are kept on file and available for review at all times. Administrator is to email the LPA the physician's report for the identified resident to LPA by the POC due date.
Plan of correction recorded
Correction not verified in available records
Records and plan of operationType B
- Official classification
- Type B
- Official code
- 87208(a)(7)(A)
- Regulation authority
- CCR
What the official deficiency says
(a) The licnensee shall have and maintain a current, written, definitive plan of oepration for the facility. (...) (7) Sketches, showing dimensions, of the following: (A) Building(s) to be occupied, including a floor plan that describes the capacities of the building for the uses intended and a designation of the rooms to be used for nonambulatory residents and for bedridden residents, other than for a temporary illness or recovery from surgery as specified in Section 87606(d) and (e) 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 1 out of 5 residents, since one resident's bedroom is the " multipurpose room " rather than a listed bedroom, which poses a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 09/18/2025 Plan of Correction Administrator is to ensure resident bedrooms are to be consisted with the bedrooms identified on the facility sketch at all times. Administrator is to update the facility sketch with identified rooms for residents and submit it to LPA by the POC due date.
Plan of correction recorded
Correction not verified in available records
Licensing and administrationType A
- Official classification
- Type A
- Official code
- 87755(a)
- Regulation authority
- CCR
What the official deficiency says
(a) Any duly authorized officer, employeee or agent of the licensing agency may, upon proper identification and upon stating the purpose of his/her visit, enter and inspect the entire premise of any place providing services at any time, with or without advance notice. This requirement is not met as evidenced by: Deficient Practice Statement Based on interview, the licensee did not comply with the section cited above in 5 out of 5 residents, as administrator did not allow LPA to tour bedroom #1 of the facility, which poses an immediate health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 08/22/2025 Plan of Correction Administrator is to ensure that all staff of CCLD are available to tour the entire area of the facility at all times. Administrator is to submit a written statement indicating that she has read regulations under 87755 and will comply with them moving forward.
Plan of correction recorded
Correction not verified in available records
Background checksType A
- Official classification
- Type A
- Official code
- 87355(e)(2)
- Regulation authority
- CCR
What the official deficiency says
(e) 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 as required by the Department. 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 5 out of 5 residents, as 1 staff member is not associated to the facility, which poses an immediate health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 08/22/2025 Plan of Correction Administrator is to ensure that all staff are associated to the facility before beginning work at the facility at all times. Administrator is to associate the identified Staff #1 to the facility by the POC due date.
Plan of correction recorded
Correction not verified in available records
Inspection
No deficiencies recorded in this report
Inspection
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, LPA reviewed Staff#1 does not have health screen and TB test result in the personnel file, which poses/posed a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 06/20/2024 Plan of Correction The administrator will send the Staff#1 health screening and TB test result to LPA By POC due date.
Plan of correction recorded
Correction not verified in available records
Background checksType B
- Official classification
- Type B
- Official code
- 87355(e)
- Regulation authority
- CCR
What the official deficiency says
(e) 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: This requirement is not met as evidenced by: Deficient Practice Statement Based on the record review, LPA was not able to observe Staff#1 background check paper work and the staff was not associated witht the facility which poses/posed a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 06/20/2024 Plan of Correction The administrator will send Staff#1 background check clearance paper work and the association to the LPA by POC due date.
Plan of correction recorded
Correction not verified in available records
Fire safety and emergency preparednessType B
- Official classification
- Type B
- Official code
- 1569.69(a)(2)
- Regulation authority
- HSC
What the official deficiency says
(a) Each residential care facility for the elderly licensed under this chapter shall ensure that each employee of the facility who assists residents with the self-administration of medications meets all of the following training requirements: (2) In facilities licensed to provide care for 15 or fewer persons, the employee shall complete 10 hours of initial training. This training shall consist of 6 hours of hands-on shadowing training, which shall be completed prior to assisting with the self-administration of medications, and 4 hours of other training or instruction, as described in subdivision (f), which shall be completed within the first two weeks of employment. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, LPA reviewed the house manager and staff#1 do not have any required training hours or in service training paper work hich poses/posed a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 06/20/2024 Plan of Correction The administrator will send the required staff in service training hours for house manger and Staff#1 to LPA by POC due date
Plan of correction recorded
Correction not verified in available records
Resident rightsType B
- Official classification
- Type B
- Official code
- 87468(d)
- Regulation authority
- CCR
What the official deficiency says
(d) Licensees shall post the personal rights, nondiscrimination notice, and complaint information specified above in English, and, in any other language in which at least five (5) percent of the residents can only read that other language. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, LPA did not observe any resident personal right poster in the facility which poses/posed a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 06/20/2024 Plan of Correction The administrator will send the picture of the personal right poster which has to be posted on the wall to LPA by POC due date
Plan of correction recorded
Correction not verified in available records
Admission, assessment, and evictionType B
- Official classification
- Type B
- Official code
- 87456(a)(2)
- Regulation authority
- CCR
What the official deficiency says
(a) Prior to accepting a resident for care and in order to evaluate his/her suitability, the facility shall, as specified in this article 8: (2) Perform a pre-admission appraisal. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, LPA reviewed Resident#1 does not have pre-admission appraisal in file which poses/posed a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 06/20/2024 Plan of Correction The administrator will send the residnet#1 pre-admission appraisal to LPA by POC due date
Plan of correction recorded
Correction not verified in available records
Fire safety and emergency preparednessType B
- Official classification
- Type B
- Official code
- 1569.695(c)
- Regulation authority
- HSC
What the official deficiency says
(c) A facility shall conduct a drill at least quarterly for each shift. The type of emergency covered in a drill shall vary from quarter to quarter, taking into account different emergency scenarios. An actual evacuation of residents is not required during a drill. While a facility may provide an opportunity for residents to participate in a drill, it shall not require any resident participation. Documentation of the drills shall include the date, the type of emergency covered by the drill, and the names of staff participating in the drill. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, LPAs did not observe the fire /disaster drill log in the facility which poses/posed a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 06/20/2024 Plan of Correction The administrator will conduct the fire /disaster drill and send the log to LPA by POC due date.
Plan of correction recorded
Correction not verified in available records
Health conditions and treatmentsType B
- Official classification
- Type B
- Official code
- 87608(a)(5)(A)
- Regulation authority
- CCR
What the official deficiency says
(A) A bed rail that extends from the head half the length of the bed and used only for assistance with mobility shall be allowed. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, LPAs reviewed that two residents who have the half bed rail beds but does not have any physican order in file, which poses/posed a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 06/20/2024 Plan of Correction The administrator will send the two residents' half bed rail physican order to LPA by POC due date.
Plan of correction recorded
Correction not verified in available records
Inspection
Dementia careType A
- Official classification
- Type A
- Official code
- 87705(f)(1)
- Regulation authority
- CCR
What the official deficiency says
(f) The following shall be stored inaccessible to residents with dementia: (1) Knives, matches, firearms, tools and other items that could constitute a danger to the resident(s). This requirement is not met as evidenced by: Deficient Practice Statement Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above as (3) separate sharp gardining tools were observed in the backyard which poses an immediate health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 08/15/2023 Plan of Correction Deficiency Corrected at the time of Visit. Staff removed the gardening tools and stored in locked area.
Plan of correction recorded
Correction not verified in available records
Medication handling and storageType B
- Official classification
- Type B
- Official code
- 87465(h)(5)
- Regulation authority
- CCR
What the official deficiency says
(h) The following requirements shall apply to medications which are centrally stored: (5) Each resident's medication shall be stored in its originally received container. No medications shall be transferred between containers. This requirement is not met as evidenced by: Deficient Practice Statement Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above medications for resident #1 were popped from their original packs for the rest of the week and placed in a small medicine container which poses/posed a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 08/28/2023 Plan of Correction Facility will stop using weekly medicine containers and conduct in service training on medication management by POC due date. Proof of training to be submitted to licensing.
Plan of correction recorded
Correction not verified in available records
Inspection
No deficiencies recorded in this report
Source and limits
California Department of Social Services, Community Care Licensing Division. Public facility history is described by the source as a five-year window. Older records and previous-licensee history may require a regional-office request. Type 741 RCFE-CCRCs, nursing homes, and other care settings are excluded from this page.
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