WHITTIER GLEN ASSISTED LIVING

Official classification

Type B

Official code

87468.1(a)(9)

Regulation authority

CCR

What the official deficiency says

Personal Rights of Residents in All Facilities (a)(9) To have communications to the licensee from their representatives answered promptly and appropriately. This requirement is not met as evidenced by: Administrator did not respond to resident#1 (R1)’s responsible party's communication and failed to follow up with resident’s Assisted Living Waiver Program (ALWP). Based on observation and record review, the licensee did not comply with the section cited above which poses a potential health and safety risk to residents in care.

Official plan of correction

Licensee agreed to provide (1) a statement according to 87468.1(a)(9) that indicate how to prevent future occurrence. (2) in-service training regarding responding to residents’ authorized presentative timely by POC due date.

Deadline recorded: Aug 14, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.1(a)(8)

Regulation authority

CCR

What the official deficiency says

To have their representatives regularly informed by the licensee of activities related to care or services,...as appropriate to their needs. This requirement is not met as evidenced by: Administrator did not assist R1 to maintain in ALWP 60-day retention requirement to meet R1's cares and service needs. Based on observation and record review, the licensee did not comply with the section cited above which poses a potential health and safety risk to residents in care.

Official plan of correction

Licensee agreed to provide (1) a statement according to 87468.1(a)(8) that indicate how to prevent future occurrence. (2) in-service training regarding responding to residents’ authorized presentative timely by POC due date.

Deadline recorded: Aug 14, 2026. 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

Additional Personal Rights of Residents in Privately Operated Facilities (a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (4) To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs. This requirement is not met as evidenced by: Based on interviews, facility staff did not conduct proper checks on R1 which resulted in R1 eloping and walking outside of the facility unassisted and without anyone noticing. Records also show that R1 fell and sustained a fracture during the time they R1 was missing from the facility.

Official plan of correction

Licensee/Administrator shall ensure to comply with Title 22 Section 87468.2 at all times. Additionally, Licensee/Administrator shall develop a written Plan of Correction to ensure compliance with California Code of Regulations Title 22, Section 87468.2(a)(4). Written POC must be submitted to CCL/LPA by POC due date. An immediate Civil Penalty of $500.00 is being issued today, due to a resident sustaining injury while in care. Refer to LIC 421IM.

Deadline recorded: Jul 24, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87457(c)(3)

Regulation authority

CCR

What the official deficiency says

Pre-Admission Appraisal (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.(3) The prospective resident, or his/her responsible person, if any, shall be involved in the development of the appraisal. This requirement is not met as evidenced by: during record review it was noted that there is no indication that Resident 1’s Preplacement Appraisal was completed appropriately because the appraisal the facility provided to the department for review is missing a signature from Resident 1 and/or authorized representative.

Official plan of correction

Licensee will ensure that this form is thoroughly completed as a part of the admissions process/intake assessment for all future residents. Licensee will email LPA confirmation that the regulation was reviewed and a plan on how appropriate monitoring for accurary and completion of residents' documents will take place by POC due date.

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

Official classification

Type A

Official code

87465(a)(4)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care(a) A plan for incidental medical and dental care shall be developed by each facility. (4) The licensee shall assist residents with self-administered medications as needed. This requirement is not met as evidenced by: Based on observation and record review, the medication for Resident #1 was not administered today which poses an immediate health and safety risk to residents in care.

Official plan of correction

The licensee shall submit a plan to ensure that all the residents' medications are present and refills are obtained. The plan is due by 5/6/26.

Deadline recorded: May 6, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87411(a)

Regulation authority

CCR

What the official deficiency says

87411 Personnel Requirements - General(a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. This requirement is not met as evidenced by: Based on interview and record review, the facility did not employ sufficient caregivers to assist residents with their needs timely which poses a potential health, safety, and personal rights risk to residents in care.

Official plan of correction

The licensee shall develop a plan to provide sufficient staffing to ensure residents' needs are met in a timely manner. The plan is due to LPA by 5/12/26.

Deadline recorded: May 12, 2026. 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

(a) In addition to (...) residents (...) shall have the following personal rights. (4) To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs. This regulation is not met as evidenced by: Based on record review and interview, the facility did not meet the above requirement in one (1) out of nine (9) residents, because R1 was unable to leave the facility unassisted and was allowed to travel on ther own by bus without a responsible adult to assist them, which posed an immediate health and safety risk to resident in care.

Official plan of correction

Licensee/Administrator is to ensure that all residents are provided care and supervision to meet their individual need at all times. Administrator shall submit the facility's plan on how all residents care plans will be adhered to by the POC due date.

Deadline recorded: May 2, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(a)(4)

Regulation authority

CCR

What the official deficiency says

(a) A plan for the indicental medical and dental care shall be developed (...) by compliance with the following: (4) The licensee shall assist residents with self-administered medications as needed. This regulation is not met as evidenced by: Based on interview and record review, the facility did not meet the above requirement in four (4) out of nine (9) residents, because R1 required insulin based on available documentation and no evidence was provided that they were provided it, along with corroborations from R2 - R4. Which poses/posed an immediate health and safety risk for residents in care.

Official plan of correction

Licensee/Administrator is to ensure that all residents are assisted with self-administered medications as needed at all times. Administrator shall submit a plan to ensure that all the residents' are assisted with their self-administered medications and injections to LPA by the POC due date.

Deadline recorded: May 2, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87211(a)(1)(D)

Regulation authority

CCR

What the official deficiency says

(a) Each licensee shall furnish to the licensing agency such reports (...) including (...) the following. (1) A written report (...) within seven days of the occurrence (...) and disposition of the case. (D) Any incident which threatens the welfare, safety (...) or unexplained absence of the resident. This regulation is not met as evidenced by: Based on interview and record review, the facility did not meet the above requirement in 1 out of 9 residents. Because an incident report was not submitted following R1's absence and death, which posed a potential health and safety risk to residents in care.

Official plan of correction

Licensee/Administrator is to ensure that all incident and death reports are to be submitted to the licensing agency within the appropriate timeframe at all times. Administrator shall submit a plan on how the facility will ensure all incident reports are reported timely to LPA by the POC due date.

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

Official classification

Type A

Official code

87468.1(a)(1)

Regulation authority

CCR

What the official deficiency says

(a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (1) To be accorded dignity in their personal relationships with staff, residents, and other persons. This regulation is not met as evidenced by: Based on resident interviews and a observation, LPA determined that 5 out of 10 residents had either been handled roughly or pushed by staff while being assisted with transfers or care, which poses a potential health and safety threat to clients in care.

Official plan of correction

Administrator is to ensure residents are assisted with care needs and bed transfers without being handled in a rough manner or leading to injury. Administrator to provide a staff training on proper procedures for bed transfers and to submit proof of training including the (...) sign-in sheet with staff signatures, date of training, duration of training and curriculum used for training to LPA by POC due date.

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

Official classification

Type B

Official code

87411(a)

Regulation authority

CCR

What the official deficiency says

(a) Facility personnel shall at all times be sufficient in numbers (...) to provide the services necessary to meet resident needs. In facilities licensed for sixteen or more, sufficient support staff shall be employed (...) for the provision of adequate services. This regulation is not met as evidenced by: Based on interviews, LPA determined that several residents have experienced delays in received care when requesting assistance through their call button, which poses a potential health and safety concern at the facility.

Official plan of correction

Licensee/Administrator is to ensure that all residents are assisted in a timely manner by staff at all times. Administrator will email LPA a plan on how the facility will ensure that there is sufficient staff to assist residents in a timely manner by the POC due date.

Deadline recorded: Dec 26, 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 standard was not met as evidence by: Per Interviews with 4 staff and 8 residents each confirmed the above allegation stating that the elevator was in disrepair for weeks during the month of October 2025. Invoices for repairs were also provided.

Official plan of correction

Durining visit LPA tested the elevator and it was in operating condition. LPA reviewed Invoices for the repairs made and due to facility already addressing the issue and making needed repairs there is no POC needed and POC will be cleared and emailed to Administrator by end of day tomorrow 11/18/25.

Deadline recorded: Nov 18, 2025. A deadline is not proof that correction was completed.

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 and keep on file, documentation of a medical assessment, signed by a physician, made within the last year. The licensee shall be permitted to use the form LIC 602 (Rev. 9/89), Physician's Report, to obtain the medical assessment. This requirement is not met as evidenced by: Based on record reviewed, R1 LIC602A dated 08/29/2025 did not clearly indicate if resident can administer injections and test glucose levels as it was marked N/A on page 8 , #6 under Medication Management b. and c.

Official plan of correction

Administrator will obtained up to date LIC602A from RI Physician and sent it to LPA as proof by POC date which is 11/21/2025

Deadline recorded: Nov 25, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(a)(4)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care(a) A plan for incidental medical and dental care shall be developed by each facility. (4) The licensee shall assist residents with self-administered medications as needed. This requirement is not met as evidenced by: Based on observation and record review, the medication for Resident #3 was not administered as prescribed by the physician which poses an immediate health and safety risks to residents in care.

Official plan of correction

The licensee shall submit a plan to ensure that all the residents' medications are present, obtaining refills, and staff training. The plan is due by 8/6/25.

Deadline recorded: Aug 6, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87411(a)

Regulation authority

CCR

What the official deficiency says

87411 Personnel Requirements - General(a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. This requirement is not met as evidenced by: Based on interview and record review, the facility did not employ sufficient caregivers to assist residents with their needs which poses a potential health, safety, and personal rights risk to residents in care.

Official plan of correction

The licensee shall develop a plan to provide sufficient staffing to ensure residents are assisted in a timely manner and that their needs are met. Plan due to LPA by 8/12/25.

Deadline recorded: Aug 12, 2025. A deadline is not proof that correction was completed.

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 regulation is not met as evidence by: Based on record review, it was determined that there was no available pre-admission appraisal or recent appraisal available for C1, which poses a potential health and safety risk to residents in care.

Official plan of correction

Administrator is to ensure that appraisals for all residents are available at all times. Administrator is to create a plan explaining how the facility will ensure that appraisal are conducted, documented, and available at all times in the facility and submit this plan to the LPA by the POC due date.

Deadline recorded: Feb 14, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.2(a)(4)

Regulation authority

CCR

What the official deficiency says

(a) In addition to the rights listed in Section 87468.1 (...) residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (4) To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs. This regulation is not met as evidenced by: Based on observation, record review, and interview, LPA determined that at least one resident had been drinking heavily in a common area in the facility, which poses a potential health and safety risk to clients in care.

Official plan of correction

Administrator is to ensure that the house rules are enforced by the facility staff at all times to ensure proper supervision. Administrator is to submit a written plan to LPA explaining how the facility will ensure that they will ensure the house rules related to drinking alcohol will be enforced by the POC due date.

Deadline recorded: Jan 10, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87224(a)

Regulation authority

CCR

What the official deficiency says

87224 Eviction Procedures (a)The licensee may evict a resident for one or more of the reasons listed in Section 87224(a)(1) through (5). Thirty (30) days written notice to the resident is required except as otherwise specified in paragraph... This requirement is not met as evidenced by: Based on LPA interviews and record review, Facility / administrator refusal to accept R1 back to the facility upon discharge from hospital and not providing R1 with the 30 day eviction notice which poses a potential health, safety or personal rights risk to the residents in care.

Official plan of correction

Administrator will review Title 22 Regulations, Section 87224 on Eviction Procedures, and submit a written statement to CCL ensuring that he/she understands and will comply with Title 22 Regulations pursuant to this section by the POC due date.

Deadline recorded: May 30, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87628(a)(b)(2)

Regulation authority

CCR

What the official deficiency says

(a) The licensee shall be permitted to accept or retain a resident who has diabetes if the resident is able to perform his/her own glucose testing with blood or urine specimens, and is able to administer his/her own medication including medication administered orally or through injection, or has it administered by an appropriately skilled professional. (b) In addition to Section 87611, General Requirements for Allowable Health Conditions, the licensee shall be responsible for the following: (2) Ensuring that sufficient amounts of medicines, testing equipment, syringes, needles and other supplies are maintained and stored in the facility as specified in Section 87465(c). This requirement was not met as evidence by: Medication records were reviewed for R1. R1 was admitted to facility on 04/19/2024 and facility did not received the resident's insulin and glucose meter until 05/14/2024. R1 went 25 days without glucose testing and insulin which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Licensee will send a written plan to LPA on how facility will avoid residents from going without medication and send it to LPA by POC date which is 05/21/2024

Deadline recorded: May 21, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87211(a)(1)(D)

Regulation authority

CCR

What the official deficiency says

87211(a)(1) 87211 Reporting Requirements: (a) Each licensee shall furnish..: (1)A written report shall be submitted to the licensing agency... within seven days of the occurrence...(D)Any incident which threatens the welfare, safety or health of any resident.. This requirement is not met as evidence by: LPA observed facility reports dated 6/1/23 and 12/6/22 met the above requirement but were not reported to licensing which poses a potential health and safety risk to the persons in care.

Official plan of correction

Facility will conduct in-service training for staff and create incident reports to file from the previous mentioned dates. Administrator will provide a copy of in-service training along with names of participants to the department by POC due date provided.

Deadline recorded: May 14, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87463(a)

Regulation authority

CCR

What the official deficiency says

87463 Reappraisals (a) The pre-admission appraisal shall be updated, in writing as frequently as necessary to note significant changes and to keep the appraisal accurate. The reappraisals shall document changes in the resident's physical, medical, mental, and social condition. This requirement was not met as evidenced by: Baased on records review, Licensee failed to update R1's appraisal/plan of care to implement fall interventions due to R1's fall history that led to R1 sustaining a head laceration, which poses a potential Health, Safety, or Personal Rights risk to persons in care.

Official plan of correction

Licensee will submit a written plan indicating how facility will ensure to document and update resident's plan of care any time a change in condition is observed. POC to be emailed to LPA by POC due date.

Deadline recorded: Apr 24, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87625(b)(3)

Regulation authority

CCR

What the official deficiency says

87625.Managed Incontinence(b)In addition to Section 87611... the licensee shall be responsible for the following:(3)Ensuring that incontinent residents are kept clean and dry and that the facility remains free of odors from incontinence. This was not met as evidenced by: R1 was left unchanged for prolonged times resulting in rashes. This poses a potential health and safety risk to residents in care.

Official plan of correction

Facility to provide in service training to staff in regarding information on providing residents assistance with toileting needs. Letter of completion signed by staff attending to be provided to Licensing by POC due date.

Deadline recorded: Mar 7, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87219(f)

Regulation authority

CCR

What the official deficiency says

87219. Planned Activities(f) In facilities licensed for fifty (50) persons or more, one staff member shall have full-time responsibility to organize, conduct and evaluate planned activities... This was not met as evidenced by Facility went about 4 months without a full time activity coordinator for the residents, which poses a potential health and safety risk to residents in care.

Official plan of correction

Facility currently has a qualified full time activity coordinator. Deficiency cleared at the time of this visit.

Deadline recorded: Jan 12, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87633(b)

Regulation authority

CCR

What the official deficiency says

(b) A current and complete hospice care plan shall be maintained in the facility for each hospice resident and include the following: 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 a Resident #1-#3's hospice care plans were incomplete by not showing licensee/staff involvement in residents hospice care plan which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/14/2023 Plan of Correction Facility to provide LPA with updated Hospice Care Plan's for residents #1-#3 showing facility involvement in residents care. Hospice Care Plans due by POC date provided.

Official classification

Type B

Official code

87555(b)(29)

Regulation authority

CCR

What the official deficiency says

(b) The following food service requirements shall apply: (29) All equipment, fixed or mobile, and dishes, shall be kept clean and maintained in good repair and free of breaks, open seams, cracks or chips. This requirement is not met as evidenced by: LPA observed 3 ovens and over head vent in the kitchen not operable which poses a health and stafety risk to residents in care.

Official plan of correction

Executive Director will repair or replace the 3 ovens and over head vent by POC date and send proof to LPA by POC date.

Deadline recorded: Oct 30, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87625(b)

Regulation authority

CCR

What the official deficiency says

Managed Incontinence. Ensuring that incontinent residents are kept clean and dry and that the facility remains free of odors from incontinence. This requirement is not met as evidence by: 5 of 6 staff and 8 of 9 residents collaborated the allegation that there is a odor of urine in the common dining area and kitchen area on most days.

Official plan of correction

The Executive Director will submit a written plan on how the facility will address the issue of keeping the clients clean and dry and the facility free of odors from incontinence and send it to LPA by POC dat

Deadline recorded: Oct 9, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87555(a)

Regulation authority

CCR

What the official deficiency says

General Food Service Requirements: The total daily diet shall be of the quality and in the quantity necessary to meet the needs of the residents and shall meet the Recommended Dietary Allowances of the Food and Nutrition Board of the National Research Council. All food shall be served in a safe and healthful manner. This requirement was not met as evidence by, 8 of 9 of the residents state, there was occasions when the meals were served to them cold; meaning, it was served to them in a way that was not in a healthful manner. 4 of six staff stated the they place the food while hot on the plates but the cold plates absorb the heat and the food arrives cold.

Official plan of correction

The Executive Director shall provide a written meal service plan detailing how all meals will be served to the residents hot in a healthful manner. The required plan shall be submitted to CCL by the POC Date.

Deadline recorded: Oct 9, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87625(b)(3)

Regulation authority

CCR

What the official deficiency says

Managed Incontinence. Ensuring that incontinent residents are kept clean and dry and that the facility remains free of odors from incontinence. This requirement is not met as evidence by: 5 of 6 staff and 8 of 9 residents collaborated the allegation that there is a odor of urine in the common dining area and kitchen area on most days.

Official plan of correction

The Executive Director will submit a written plan on how the facility will address the issue of keeping the clients clean and dry and the facility free of odors from incontinence and send it to LPA by POC date.

Deadline recorded: Oct 9, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

97555(a)

Regulation authority

CCR

What the official deficiency says

General Food Service Requirements: The total daily diet shall be of the quality and in the quantity necessary to meet the needs of the residents and shall meet the Recommended Dietary Allowances of the Food and Nutrition Board of the National Research Council. All food shall be served in a safe and healthful manner. This requirement was not met as evidence by, 8 of 9 of the residents state, there was occasions when the meals were served to them cold; meaning, it was served to them in a way that was not in a healthful manner. 4 of six staff stated the they place the food while hot on the plates but the cold plates absorb the heat and the food arrives cold.

Official plan of correction

The Executive Director shall provide a written meal service plan detailing how all meals will be served to the residents hot in a healthful manner. The required plan shall be submitted to CCL by the POC Date.

Deadline recorded: Oct 9, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87468.1(a)(1)

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: (1) To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement is not met as evidenced by; Based on observation, interviews conducted and file review it was revealed that the facility did not ensure Resident #2 had the capacity to establish consent for a sexual relationship when they were notified, which poses an immediate health, safety, or personal rights risk to persons in care.

Official plan of correction

The administrator will ensure the personal right of residents in all facilities The administrator will retrain staff regarding the personal right and how to handle residents personal relationships. The facility will send the staff training log to LPA by POC due date

Deadline recorded: Aug 25, 2023. 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

87211(a)(1) 87211 Reporting Requirements: (a) Each licensee shall furnish...: (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... This requirement is not met as evidence by: Based on document review licensee failed to report incidents occurred on 7/14/22 to CCLD and resident's responsible party which poses a potential personal right, health, or safety risk to the persons in care.

Official plan of correction

Administrator will request in-service training for self and wellness director from corporate and will provide a written notice to responsible party and R1 of any incidents. Administrator will provide a copy of in-service to the department by POC due date 7/21/23. Deficiency cleared as of 7/19/23.

Deadline recorded: Aug 11, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.1(a)(1)(3)

Regulation authority

CCR

What the official deficiency says

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:(1) To be accorded dignity in their personal relationships with staff, residents, and other persons.(3) To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature, such as withholding residents’ money or interfering with daily living functions such as eating, sleeping, or elimination. This requirement was not met evidenced by: Based on interview with Executive Director Michael Forsgren it was stated that R11 showed the voice recording proving the alleged verbal abuse from S1 and termination of S1 was due to this incident.

Official plan of correction

A training regarding personal rights for residents will be provided to all staff prior to POC Due date. Executive Director Michael Forsgren will also provide training materials, agenda, and a log with staff signatures/initials proving they attened the training by POC due date.

Deadline recorded: Aug 4, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87217(b)

Regulation authority

CCR

What the official deficiency says

Safeguards for Resident Cash, Personal Property, and Valuables. Every facility shall take appropriate measures to safeguard residents' cash resources, personal property and valuables which have been entrusted to the licensee or facility staff. The licensee shall give the residents receipts for all such articles or cash resources. This requirement was not met evidenced by: Based on interviews conducted, R1 has had at least one incidence in which their clothing, towels, and washcloths were not returned after being laundered; which poses a potential health and safety risk to persons in care.

Official plan of correction

Administrator agreed to: 1. Develop a written Plan of Correction (POC) to ensure compliance with California Code of Regulations Title 22, 87217. 2. Conduct/submit proof of staff training 3. Submit R1's Inventory list of personal belongings

Deadline recorded: Jul 28, 2023. 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

87211 Reporting Requirements: (a) Each licensee shall furnish...: (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... This requirement is not met as evidence by: Based on document review licensee failed to report incidents occured on 7/14/22 to CCLD and resident's responsible party which poses a potential personal right, health, or safety risk to the persons in care.

Official plan of correction

Administrator will request in-service training for self and wellness director from corporate and will provide a written notice to responsible party and R1 of any incident. Administrator will provided a copy of in-service to the department by POC due date 7/21/23.

Deadline recorded: Jul 21, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87405(a)

Regulation authority

CCR

What the official deficiency says

87405 Administrator - Qualifications and Duties (a) All facilities shall have a qualified and currently certified administrator.... This was not met as evidenced by: Adminstrator Mona Tirado left the facility on 2/12/21 and was not replaced by a full time Administrator until 5/2/21. This poses a potential health and safety risk to residents in care and supervision.

Official plan of correction

Facility Administrator to review Title 22 Regulations regarding 87405 Administrator - Qualifications and Duties and submit letter to LPA signed and dated by POC due date.

Deadline recorded: Jun 2, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87213

Regulation authority

CCR

What the official deficiency says

87213.Finances.The licensee shall have a financial plan that conforms to the requirements of Section 87155, Application for License, and that...; shall maintain adequate financial records. This was not met as evidenced by: LPA reviewed R1 facility ledger statements and observed charges on R1's account that the facility was unable to provide a reason for. This poses a potential health and safety risk to residents in care and supervision.

Official plan of correction

Facility to provide in service training on proper documentation of charges or credits provided to residents in care by POC due date.

Deadline recorded: Mar 31, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87303(a)(1)

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...(1) Floor surfaces in bath, laundry and kitchen areas shall be maintained in a clean, sanitary, and odorless condition. This requirement was not met as evidenced by: Based on observation and interview, licensee failed to maintain (2) of (5) resident restrooms inspected, clean and odorless, and (1) of (5) resident room carpets clean, which poses a potential Health, Safety, or Personal Rights risk to persons in care.

Official plan of correction

Administrator will have the carpet cleaned in R2's room, and the restrooms cleaned in R1, R4 and R5's rooms. Pictures of the cleaned toilets and bathtubs will be emailed to LPA by the POC due date.

Deadline recorded: Mar 31, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

80088(f)(1)

Regulation authority

CCR

What the official deficiency says

80088 Furniture, Fixtures, Equipment, and Supplies(f) Solid waste shall be stored...in a manner that will not transmit...odors...(1)All containers...used for...solid wastes shall have tight-fitting covers kept on the containers... This requirement was not met as evidenced by: Based on observation and interview, the licensee failed to maintain trash bins with a lid to dispose of soiled adult briefs in R4's room, which poses a potential Health, Safety, or Personal Rights risk to persons in care.

Official plan of correction

Administrator will obtain a trash bin with a tight fitting lids in R4's room to dispose of soild waste appropriately. A picture of the bin will be sent to LPA via email by the POC due date.

Deadline recorded: Mar 21, 2023. 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...shall have...the following personal rights:(2)To be accorded safe, healthful and comfortable accommodations...and equipment. This requirement was not met as evidenced by: Based on observation and interview, the licensee failed to allow safe access to the signal system in R5's room, as there is furniture placed in front of it making it inaccessible, which poses a potential Health, Safety, or Personal Rights risk to persons in care.

Official plan of correction

Administrator will rearrange R4's room furniture to give easy and safe access to the signal system. A picture of the rearranged furniture will be sent to LPA via email by the POC due date.

Deadline recorded: Mar 21, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87307(3)(C)

Regulation authority

CCR

What the official deficiency says

87307 Personal Accommodations and Services (3)Equipment and supplies necessary for...maintenance of adequate hygiene...shall be...available to... resident...if...unable...the licensee shall assure provision of:(C)Clean linen, including blankets... This requirement was not met as evidenced by: Based on observation and interview, the licensee failed to ensure R4 had clean blankets on their bed, which poses a potential Health, Safety, or Personal Rights risk to persons in care.

Official plan of correction

Administrator will ensure R4 receives laundry services as needed. A picture of clean bed linens on the bed will be sent to LPA via email by POC due date.

Deadline recorded: Mar 21, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87208(a)(5)

Regulation authority

CCR

What the official deficiency says

87208.Plan of Operation.(a) Each facility shall have and maintain a current, written definitive plan of operation...The plan and related materials shall contain the following:(5) Staffing plan, qualifications and duties. This was not met as evidenced by: S1 borrowed money from R1 and did not return their money. This is against the facilites staff handbook which is part of the plan of operation, and poses a potential health and safety risk to residents in care and supervision.

Official plan of correction

Facility to provide inservice training on the plan of operation policies to staff and create a plan to address borrowed money incident between R1 and S1, by POC due date.

Deadline recorded: Mar 23, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87211(a)(2)

Regulation authority

CCR

What the official deficiency says

(a) Each licensee shall furnish to the licensing agency such reports... (2)Occurrences, such as epidemic outbreaks, ... which threaten the welfare, safety or health of residents, personnel or visitors, shall be reported... to the licensing agency and to the local health officer when appropriate. This was evidence by: LPAs review showed (3) staff and (1) resident who were covid positive on 12/8/22 were not reported until 12/20/22, this poses a potential health and safetey risk to residents in care and supervision.

Official plan of correction

Facility to provide licensing report of covid positives for 12/8-12/9/22 to Licensing as well as provide documentation in letter that staff who creates incident reports has read and understands Title 22 Reporting Requirements by POC Due Date Citation cleared at the time of visit

Deadline recorded: Mar 17, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87468.2(a)(2)

Regulation authority

CCR

What the official deficiency says

87468.2 Additional Personal Rights of Residents in Privately Operated Facilities: (a) ...residential care facilities for the elderly shall have... personal rights: (2) To have their records and personal information remain confidential and to approve their release, except as authorized by law. This requirement is not met as evidence by: Based on documents reviewed Licensee did not ensure medical diagnosis/directives were maintain confidential for residents in care which poses an immediate health, safety, or personal rights violation for the residents in care.

Official plan of correction

Administrator will ensure staff is properly train on section 87468.2 Personal Rights - maintaining personal information confidential for Residents in care and will submit a plan for training by POC due date 2/3/23 and a copy of training and signing logs by 2/9/23.

Deadline recorded: Feb 3, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87456(a)(2)

Regulation authority

CCR

What the official deficiency says

87456 Evaluation of Suitability for Admission (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 evidence by: Based on interviews and records reviewed the licensee did not comply with the section cited above which poses a potential risk to the health, safety, or personal rights of the persons in care. R1's pre-appraisal and appraisal/needs and services plan was not completed prior to being admitted.

Official plan of correction

Facility is to ensure that Title 22 Section 87456 regulations are met at all times. Additionally, a statement indicating facility understands and will comply with Title 22 Section 87456 will be submitted to CCLD by 01/27/2023.

Deadline recorded: Jan 27, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87406(a)

Regulation authority

CCR

What the official deficiency says

87406 Administrator Certification Requirements (a) All individuals shall be residential care facility for the elderly certificate holders prior to being employed as an administrator. This requirement is not met as evidence by: Based on interviews and records reviewed the licensee did not comply with the section cited above which poses a potential risk to the health, safety, or personal rights of the persons in care. The Operations Manager did not have an administrator certificate prior to being employed.

Official plan of correction

Facility is to ensure that Title 22 Section 87406 regulations are met at all times. Additionally, a plan to comply with Title 22 Section 87406 will be submitted to CCLD by 01/27/2023. The Operations Manager has already completed the administrator courses and submitted the administrator application to Community Care Licensing Division Administrator Certification Section on 12/27/2022.

Deadline recorded: Jan 27, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87455(c)(3)(A)

Regulation authority

CCR

What the official deficiency says

87455 Acceptance and Retention Limitations c) No resident shall be accepted or retained if any of the following apply: (3) The resident's primary need for care and supervision results from either:(A)An ongoing behavior, caused by a mental disorder, that would upset the general resident group; This what not met as evidenced by: R1's primary diagnoses led to an ongoing behavior of shouting at yelling at staff and residents that upsets the general resident group. This poses a potential health and safety risk to residents in care and supervision.

Official plan of correction

Administrator to reach out to Department of Mental health (DMH) for assistance regarding R1. Faciltiy to reassess R1 to review proper placement. Administrator will send letter to LPA of contacts made to DMH and reassessment by POC Due Date.

Deadline recorded: Sep 9, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87507(e)

Regulation authority

CCR

What the official deficiency says

87507.Admission Agreements.(e)The licensee shall provide a copy of the signed and dated current admission agreement, and all subsequent signed and dated modifications, to the resident or the resident's representative...The licensee shall provide additional copies to the resident or resident’s representative upon request. This was not met as evidenced by: R1's family requested a copy of the admissions agreement as of 9/28/21 after R1 stated to staff to provide it and facility did not provide it. This poses a potential health and safety risk to clients in care.

Official plan of correction

Administrator to provide licensing with a letter stating that they have reviewed title 22 section 87507 by POC due date.

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

Official classification

Type B

Official code

87507(g)(3)(A)

Regulation authority

CCR

What the official deficiency says

87507 Admission Agreements (g) Admission agreements shall specify the following:(3) Payment provisions, including the following: (A) Rate for all basic services... Basic services rate(s), including: 1. A comprehensive description of any items and services provided.. This was not met as evidence by: R1's admissions agreement did not have a break down of how R1s rate was calculated and staff interviewed were not able to explain. This poses a potential health and safety risk to residents in care and supervision.

Official plan of correction

Administrator to provide licensing with a letter stating that they have reviewed title 22 section 87507 by POC due date.

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

Official classification

Type A

Official code

87465(c)(2)

Regulation authority

CCR

What the official deficiency says

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 ...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 was not met as evidence by: Facility failed to provide Acetaminophen 325 mg, 500mg and 650 mg R1 as prescribed. Facility failed to provide Loratadine 10mg R2 as prescribed. This poses an immediate Health and Safety risk to clients in care

Official plan of correction

The Licensee shall conduct staff training on medication documentation to ensure that they are providing medication to residents as prescribed.

Deadline recorded: Mar 24, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87303(e)(2)

Regulation authority

CCR

What the official deficiency says

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 being met as evidenced by: LPA Rea observed that the water temperature measured at 130.6 * F in staff restroom, 127.4 * F in kitchen/coffee bar area, 129 *F in common bathroom on 2nd floor, and 125.6 * F in Room #201. This poses a health and safety risk to residents in care.

Official plan of correction

The Administrator will ensure that hot water provided for the use of residents shall be maintained between 105 and 120 degrees F at all times. Administrator will adjust the thermostat on the water heater to ensure water provided is within the required range. Administrator shall provide evidence that the deficiency has been corrected by 3/22/2022.

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

Official classification

Type B

Official code

87211(a)(1)(D)

Regulation authority

CCR

What the official deficiency says

(a) Each licensee shall furnish to the licensing agency such reports... (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... (D) Any incident which threatens the welfare, safety or health of any resident.... This was evidence by: LPA interviews and file review show that Resident fell on 3/1/22 and it was not reported until 3/10/22 when LPA visited the facility, this poses a potential health and safetey risk to residents in care and supervision.

Official plan of correction

Adminstrator was able to provide LPA with the Incident Report at time of visit. POC cleared during the visit.

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

Official classification

Type B

Official code

87468.1(a)(3)

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:(3)To be free from punishment, humiliation, intimidation, abuse, or other actions... This deficiency was evidenced by the following: Resident #1 (R1) had been financial abused by Staff #1 (S1) leading to non-authourized purchases made to R1's bank account. This poses a potential health and safety risk to residents under care and supervision.

Official plan of correction

Administrator had notified ombudsman via SOC 341 but will need to porivide a copy to Licensing. S1 was also removed as staff. Administrator conduct training for staff on Resident Personal Rights and provide LPA with proof by POC due date.

Deadline recorded: Jan 21, 2022. A deadline is not proof that correction was completed.