HEPZEBAH HOUSE

Official classification

Type B

Official code

87464(a)

Regulation authority

CCR

What the official deficiency says

Basic Services: (a) The services... shall be conducted so as to continue and promote, to the extent possible, independence and self-direction for all persons accepted for care... This requirement is not met as evidenced by: Based on the credible witnesses visit conducted on 05/03/26, the licensee did not comply with the section cited above by not changing R1's soiled incontinence brief, which posed a potential health, safety, and personal rights risk to persons in care.

Official plan of correction

The Administrator agreed to create an Incontinent Plan of Care and provide in-service training to all current and future staff members. Proof of training will be submitted to LPA by POC date.

Deadline recorded: May 19, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87465(f)(1)

Regulation authority

CCR

What the official deficiency says

Incidental Medical...: Emergency care requirements shall include the following: (1) The name, address, telephone number of each resident's physician... shall be readily available to... and facility staff. This requirement is not met as evidenced by: Based on credible witnesses visit conducted on 05/03/26, licensee did not comply with the section cited above by failing to provide R1's emergency record during 911 visit. This poses a potential health, safety, and personal rights risk to persons in care.

Official plan of correction

Administrator agreed to create an emergency card for residents that will be used/provided to first responders. Also in-service training will be conducted with all staff and copies will be submitted to LPA by POC date.

Deadline recorded: May 19, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87307(d)(6)

Regulation authority

CCR

What the official deficiency says

Personal Accommodations and Services: (d) The following space and safety provisions shall apply to all facilities: (6) All outdoor and indoor passageways and stairways shall be kept free of obstruction. This requirement is not met as evidenced by: Based on LPAs observation, licensee did not comply with the section cited above by not ensuring that the outside (front) hose is away from the ramp and properly placed/rolled on a hook. This poses a potential health, safety, and personal rights risk to persons in care.

Official plan of correction

During today's visit the Administrator removed the hose from the front lawn. The Administrator agreed to conduct in-service trainig with all staff regarding this section. Copy of training will be submitted to LPA by POC date.

Deadline recorded: May 19, 2026. 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

Requirements: (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... ... any of the events specified in (A), (B) & (D)... This requirement is not met as evidenced by: Based on interviews and record reviews conducted by LPA, the licensee did not comply with the section cited above by failing to notify CCLD regarding R1's hospitalization on 05/03/26, which poses a potential health and safety risk to persons in care.

Official plan of correction

Licensee shall ensure a written report is submitted to the licensing agency and to the person responsible for the resident within seven (7) days of the occurrence of any of the events. Incident report shall be submitted to LPA by POC date.

Deadline recorded: May 19, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87355(e)(2)

Regulation authority

CCR

What the official deficiency says

Criminal Record Clearance: (d) All individuals subject to criminal record review shall be fingerprinted and sign a Criminal Record Statement under penalty of perjury. This requirement is not met as evidenced by: Based on LPA interview and record review, licensee did not comply with the section cited above by failing to obtain S1's fingerprint clearance prior to employement. This poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

The Administrator agreed to complete S1's fingerprints and associate them with the facility prior to employement. Copy of LIC500 and proof of association will be submitted to LPA by POC date.

Deadline recorded: May 19, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

1569.605

Regulation authority

HSC

What the official deficiency says

Liability insurance; coverage requirements On and after July 1, 2015, all residential care facilities for the elderly...shall maintain liability insurance covering injury to residents and guests... This requirement is not met as evidenced by: Deficient Practice Statement Based on interview, the licensee did not comply with the section cited above by failing to obtain/maintain liability insurance as required, which poses a potential health, safety, and personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/15/2026 Plan of Correction Licensee will review the health and safety code, obtain liability insurance as required by the health and safety code. Copy of the current liability insurance certificate will be submitted to LPA by POC date.

Official classification

Type B

Official code

87506(a)

Regulation authority

CCR

What the official deficiency says

87506 Resident Records: (a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident... 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. Resident records were incomplete and or missing documents, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/30/2025 Plan of Correction Licensee agreed to complete/update five (5) out of five (5) resident files and submit to LPA by the POC due date.

Official classification

Type B

Official code

87412(a)

Regulation authority

CCR

What the official deficiency says

Personnel Records: (a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: 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. Upon LPA's request Licensee/Administrator was unable to provide S1's facility records. LPA was informed that S1 got hired on 01/15/2024 and no file was completed. This poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/30/2025 Plan of Correction Licensee agreed to have an individual file for each staff member along with the training certificate.

Official classification

Type B

Official code

87211(a)(1)

Regulation authority

CCR

What the official deficiency says

Requirements: (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... ... any of the events specified in (A), (B) & (D)... 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 two out of two incidents reports for R4 were not submitted to the department which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/30/2025 Plan of Correction LPA was provided both incident reports during the annual inspection visit. Deficiency cleared during the annual visit. Administrator will have to submit a statement of understanding about the above section and reporting requirements.

Official classification

Type B

Official code

1569.605

Regulation authority

HSC

What the official deficiency says

Liability insurance; coverage requirements On and after July 1, 2015, all residential care facilities for the elderly...shall maintain liability insurance covering injury to residents and guests... This requirement is not met as evidenced by: Deficient Practice Statement Based on interview, the licensee did not comply with the section cited above by failing to obtain/maintain liability insurance as required which poses a potential health, safety, and personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/30/2025 Plan of Correction Licensee will review the health and safety code, obtain liability insurance as required by the health and safety code. Copy of the current liability insurance certificate will need to be submitted as POC by the due date to LPA.

Official classification

Type A

Official code

87405(d)

Regulation authority

CCR

What the official deficiency says

Administrator Qualifications - 87405 (d) The administrator shall have the qualifications specified in Sections 87405(d)(1) through (7). If the licensee is also the administrator... (1) Knowledge of the requirements... This requirement is not met as evidenced by: Deficient Practice Statement Based on interviews, the licensee failed to ensure that the administrator had knowledge of licensing rules and regulations which poses an immediate health and safety risk to the residents in care.

Official plan of correction

POC Due Date: 01/27/2025 Plan of Correction The Administrator agrees to follow proper guidelines for Administrator Qualifications. LPA discussed with the Administrators’ section 87405. The Administrator agrees to submit a written letter to CCL indicating that they have read the regulations, have full understanding

Official classification

Type A

Official code

87465(h)(6)(F)

Regulation authority

CCR

What the official deficiency says

Incidental Medical and Dental Care (h)(6) … (6) The licensee shall be responsible for assuring that a record of centrally stored prescriptions.., which includes (F) Instructions, if any, regarding control and custody of the medication. 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 to ensure that CSMDR were properly documented for accountability. R1’s medication was not documented properly. This poses an immediate health and safety risk to residents in care.

Official plan of correction

POC Due Date: 01/27/2025 Plan of Correction Administrator agreed to schedule vendorized training for all staff and submit to CCL the vendor information and scheduled date of training. Training certifications to be submitted to CCL upon completion

Official classification

Type B

Official code

87506(a)

Regulation authority

CCR

What the official deficiency says

87506 Resident Records: (a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident... This requirement is not met as evidenced by: Based on record review, the licensee did not comply with the section cited above. Resident records were incomplete and or missing documents, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Licensee agreed to complete five (5) out of five (5) resident files.

Deadline recorded: Oct 19, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87412(a)

Regulation authority

CCR

What the official deficiency says

87412 Personnel Records: (a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: This requirement is not met as evidenced by: Based on record review, the licensee did not comply with the section cited above. Upon LPA's request Licensee/Administrator was unable to provide S1's facility records. LPA was informed that S1 got hired in Fabruary 2023 and no file was completed. This poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Licensee agreed to have a individual file for each staff member along with the training certificate.

Deadline recorded: Oct 19, 2023. 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

87457 Pre-Admission Appraisal - General (c) Prior to admission a determination of the prospective resident's suitability for admission shall be completed and shall include an appraisal of his/her individual service needs This requirement was not met as evidenced by: Based on record review and interviews, the licensee did not comply with the section ctied above in 1 out of 5 residents which poses a potential Health, Safety, or Personal Rights risk to persons in care.

Official plan of correction

Licensee will submit a written statement regarding the cited section.

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

Official classification

Type B

Official code

87506(a)

Regulation authority

CCR

What the official deficiency says

87506 Resident Records (a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff. This requirement was not met as evidenced by: Based on record review and interviews, the licensee did not comply with the section ctied above in at least 1 resident which poses a potential Health, Safety, or Personal Rights risk to persons in care.

Official plan of correction

Licensee will ensure complete and current records are maintained at the facility for all residents in care by the POC due date.

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

Official classification

Type B

Official code

87463(c)

Regulation authority

CCR

What the official deficiency says

87463 Reappraisals (c) The licensee shall arrange a meeting with the resident... when there is significant change in the resident’s condition, or once every 12 months, whichever occurs first. This requirement is not met as evidenced by: Based on records review, R1, R2, and R3 did not have reappraisails in their facility files. This poses a potential health and safety risk to residents in care.

Official plan of correction

Licensee will conduct reappraisals for R1, R2, and R3 by the POC date and fax to LPA for verification.

Deadline recorded: Mar 14, 2022. 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

87458 Medical Assessment (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. This requirement is not met as evidence by: Based on records review, R1, R2, and R3 did not have Physician Reports or medical assesments in their facility files. This poses a potential health and safety risk to residents in care.

Official plan of correction

Licensee will obtain medical assessments for R1, R2, and R3 from residents' primary care physicians by the POC date and fax to LPA for verification.

Deadline recorded: Mar 14, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87355(a)

Regulation authority

CCR

What the official deficiency says

87355 Criminal Record Clearance (a) The Department shall conduct a criminal record review of all individuals... and shall have the authority to approve or deny a facility license, or employment, residence, or presence in the facility, based upon the results of such review. This requirement is not met as evidence by: Based on LPA observations and interviews, the individual providing supervision to residents in care did not submit a criminal background clearance to the department. This poses an immediate health and safety risk to residents in care.

Official plan of correction

Licensee will prohibit the individual from the premises. Licensee will ensure associated staff are present before leaving the facility. Licensee will provide a statement of these changes to LPA by the POC date to maintain on record.

Deadline recorded: Feb 12, 2022. A deadline is not proof that correction was completed.