AAA JERUSALEM STARS

Official classification

Type A

Official code

87202(a)

Regulation authority

CCR

What the official deficiency says

(a) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, or the State Fire Marshal. Prior to accepting or retaining any of the following types of persons, the applicant or licensee shall notify the licensing agency and obtain an appropriate fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, or the State Fire Marshal: This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above as the direct exit for Bedroom #3, which has fire clearance for bedridden, was obstructed with a metal pipe preventing it from opening. This poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/23/2025 Plan of Correction Staff removed the metal pipe during the visit. POC is cleared.

Official classification

Type A

Official code

87309(a)

Regulation authority

CCR

What the official deficiency says

(a) Except as specified in subsection (b), the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances, knives, matches, tools, sharp objects, and other similar items which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above as the lock for the knife drawer was non-functional resulting in knives being stored accessible. This poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/23/2025 Plan of Correction Administrator stated the lock on the drawer will be replaced. Administrator will submit proof to CCLD by the due date.

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

(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 requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above as the vinyl flooring in Bedroom #4 was peeling, restroom sinks were in unsanitary condition, and the toilet lid in Bedroom #4's restroom was not in good repair which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/12/2026 Plan of Correction Administrator stated that restroom sinks will be cleaned and maintained in sanitary condition, flooring will be patched so it is no longer a trip hazard, and the toilet lid will be repaired. Administrator will submit proof to CCLD by the due date.

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 as two (2) window screens for the sliding doors in the living room and Bedroom #4 were uninstalled which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/29/2025 Plan of Correction Administrator stated that the screens will be reinstalled onto their tracks. Administrator will submit proof to CCLD by the due date.

Official classification

Type B

Official code

87303(e)(5)(A)

Regulation authority

CCR

What the official deficiency says

(e) Water supplies and plumbing fixtures shall be maintained as follows: (5) Slip-resistant mats, strips, or flooring shall be used in all bathtub and shower floors. (A) All slip-resistant mats, strips, or flooring shall be in good repair and maintain slip-resistant properties. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above as the slip-resistant mat in the hallyway restroom was in disrepair which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/29/2025 Plan of Correction Administrator stated the mat will be replaced. Administrator will submit proof to CCLD by the due date.

Official classification

Type B

Official code

87303(f)(1)

Regulation authority

CCR

What the official deficiency says

(f) All waste shall be located, stored, and disposed of in a manner that will not transmit communicable diseases or odors, pose a risk to health and safety, or provide a breeding place or food source for insects or rodents. (1) All containers storing waste shall be in good repair, free of leaks, and emptied in a timely manner. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above as the trash can in Bedroom #4's restroom was in disrepair with a broken lid and no trash bag which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/29/2025 Plan of Correction Administrator stated they will replace the trash can. Administrator will submit proof to CCLD by the due date.

Official classification

Type B

Official code

87307(a)(3)(C)

Regulation authority

CCR

What the official deficiency says

(C) Clean linen, including blankets, bedspreads, top bed sheets, bottom bed sheets, pillow cases, mattress pads, bath towels, hand towels and wash cloths. The quantity shall be sufficient to permit changing at least once per week or more often when indicated to ensure that clean linen is in use by residents at all times. The linen shall be in good repair. The use of common wash cloths and towels shall be prohibited. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and interview, the licensee did not comply with the section cited above as the mattress in Bedroom #4 was in unsanitary condition and not equipped with mattress pads and appropriate sheets which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/05/2026 Plan of Correction Administrator stated they will replace the mattress and equip it with appropriate sheets. Administrator will submit proof to CCLD by the due date.

Official classification

Type B

Official code

87555(b)(27)

Regulation authority

CCR

What the official deficiency says

(b) The following food service requirements shall apply: (27) All kitchen areas shall be kept clean and free of litter, rodents, vermin and insects. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and interview, the licensee did not comply with the section cited above as the kitchen had an active fruit fly infestation in the pantry which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/12/2026 Plan of Correction Administrator installed a fruit fly trap in the pantry during the visit. Administrator stated they will service an exterminator to address the fruit flies. Administrator will submit proof to CCLD by the due date.

Official classification

Type A

Official code

87465(h)(4)

Regulation authority

CCR

What the official deficiency says

(h) The following requirements shall apply to medications which are centrally stored: (4) All centrally stored medications shall be labeled and maintained in compliance with state and federal laws. No persons other than the dispensing pharmacist shall alter a prescription label. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, the licensee did not comply with the section cited above as six (6) medication errors between start dates and logged were observed and an evening medication for R1 was being administered in the morning which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/28/2024 Plan of Correction Administrator agreed to schedule a medications training with a qualified professional and send the date of the training to LPA Barutyan by 12/28/2024.

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 interview and record review, the licensee did not comply with the section cited above as drills are not conducted quarterly which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/03/2025 Plan of Correction Administrator agreed to conduct a drill for the current quarter and submit a statement of understanding of the section cited to CCL by 01/03/2025.

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 and medication review, the licensee did not comply with the section cited above as medications were stored in pill boxes for one week in advance and not their containers which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/03/2025 Plan of Correction Administrator stated they will conduct medication training with all staff and only prepare medications for one day in advance. Administrator will submit proof of training to CCL by 01/03/2025.

Official classification

Type A

Official code

87464(f)(1)(c)

Regulation authority

CCR

What the official deficiency says

87464 Basic services (f)(1)(c) " Care and supervision " means the facility assumes responsibility for...ongoing assistance with activities of daily living without which the resident’s physical health, mental health, safety, or welfare would be endangered. This requirement is not met as evidenced by: Based on interview and record review, the facility did not comply with the above cited section as R1 was able to leave the facility unassisted which posed an immediate risk to residents' safety.

Official plan of correction

Administrator agreed to conduct an in-service training with staff to review section cited. In addition Licensee agreed to submit a letter of understanding to LPA via email by 09/18/2024 EOD.

Deadline recorded: Sep 18, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87705(c)(5)

Regulation authority

CCR

What the official deficiency says

Care of Persons with Dementia (c) Licensees who accept and retain residents with dementia shall be... ensuring the following:(5)Each resident with dementia shall have an annual medical assessment...and a reappraisal... This requirement is not met as evidenced by: Based on record review, the facility did not comply with the section cited above as R1 has dementia and does not have an updated medical assessment and reappraisal which poses a potential health, safety, and personal rights risk to resident in care.

Official plan of correction

Administrator agreed to obtain an updated medical assessment and perform a reappraisal of resident's needs and services. Administrator agreed to submit proof to CCL by 09/24/2024.

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

Official classification

Type B

Official code

87705(j)

Regulation authority

CCR

What the official deficiency says

87705 Care of Persons with Dementia (j) The licensee shall have an auditory device or other staff alert feature to monitor exits, if exiting presents a hazard to any resident. This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above in that two (2) auditory exit alarms were observed off and one (1) exit door did not have an auditory device installed which poses a potential health and safety risk to persons in care.

Official plan of correction

Administrator will ensure that auditory devices remain on at all times. Administrator agreed to install an auditory device to the sliding exit door in the living room and will submit proof to CCL by 09/24/2024.

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

Official classification

Type A

Official code

87309(a)

Regulation authority

CCR

What the official deficiency says

(a) Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation the licensee did not comply with the section cited above as chemicals and cleaning solutions were accessible to residents, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/28/2023 Plan of Correction Licensee promptly removed all items that posed a danger to residents in care.

Official classification

Type A

Official code

87555(b)(27)

Regulation authority

CCR

What the official deficiency says

(b) The following food service requirements shall apply: (27) All kitchen areas shall be kept clean and free of litter, rodents, vermin and insects. 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 five dead cockroaches were observed in kitchen cupboard below the oven, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/31/2024 Plan of Correction Licensee agreed to hired new pesticide compnay to fumigate affected areas in the kitchen, and will email invoice for the fumigation service to LPA via email.

Official classification

Type A

Official code

87465(a)(6)

Regulation authority

CCR

What the official deficiency says

(6) When requested by the prescribing physician or the Department, a record of dosages of medications which are centrally stored shall be maintained by the facility. 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 three out of three medications were not listed in the centrally stored and distruction record, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/08/2024 Plan of Correction Livensee agreed to have medication training for all staff who assist with medication. Training shall be conducted a medical professional and the licensee will email the LPA the training agenda, hours of training, certification of professional providing the training, and sign in sheet of all staff attending the training.

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, the licensee did not comply with the section cited above in seven shaving razors were observed on the bathroom sink top, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/28/2023 Plan of Correction Licensee quickly removed all the razors fro the bathroom.

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 two out of two staff didnot have the required training, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/19/2024 Plan of Correction Licensee agreed to provide to direct services staff/caregivers training in the required topics for the 20 hour annual training.