GUARDIAN ANGEL HOME CARE II

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 in LPA observed cleaning solutions accessible to residents, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/29/2026 Plan of Correction Licensee will conduct training with staff on safely storing chemicals and send proof to LPA by POC date of 01/29/2026.

Official classification

Type B

Official code

87706(a)

Regulation authority

CCR

What the official deficiency says

(a) In addition to the requirements in Section 87705, Care of Persons with Dementia, licensees who advertise, promote, or otherwise hold themselves out as providing special care, programming, and/or environments for residents with dementia or related disorders shall meet the following requirements: This requirement is not met as evidenced by: Deficient Practice Statement Based on records reviewed the licensee did not comply with the section cited above in facility does not have required narrative with additional dementia information in plan of operation as required, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/12/2026 Plan of Correction Licensee will submit dementia narrative that will be included in facilities plan of operation to LPA by POC date of 02/12/2026.

Official classification

Type B

Official code

1569.618(a)

Regulation authority

HSC

What the official deficiency says

(a) The administrator designated by the licensee pursuant to paragraph (11) of subdivision (a) of Section 1569.15 shall be present at the facility during normal working hours. A facility manager designated by the licensee with notice to the department, shall be responsible for the operation of the facility when the administrator is temporarily absent from the facility. 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 the administrator of this facility is not present during normal working hours, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/12/2026 Plan of Correction Licensee will submit a plan to have an administrator or manager present during normal working hours and submit to LPA by POC date of 02/12/2026.

Official classification

Type B

Official code

87219(a)

Regulation authority

CCR

What the official deficiency says

(a) Residents shall be encouraged to maintain and develop their quality of life through participation in a variety of planned activities. The activities made available shall include: 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 the facility does not have planned activities for residents, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/12/2026 Plan of Correction Licensee will submit calendar of planned activities to LPA by POC date of 02/12/2026.

Official classification

Type B

Official code

87465(h)

Regulation authority

CCR

What the official deficiency says

(h) The following requirements shall apply to medications which are centrally stored: 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 Resident 2's medications are not logged into Centrally stored medication record, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/12/2026 Plan of Correction Licensee will conduct training on documenting resident medications into the centrally stored records and submit to LPA by POC date of 02/12/2026.

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 Resident 1 does not have annually updated Needs and services plan, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/12/2026 Plan of Correction Licensee will audit and updated all facility residents needs and services plan and submit to LPA by POC date of 02/12/2026.

Official classification

Type B

Official code

87307(a)

Regulation authority

CCR

What the official deficiency says

87307 Personal Accommodations and Services (a)Living accommodations and grounds shall be related to the facility's function. The facility shall be large enough to provide comfortable living accommodations and privacy for the residents, staff, and others who may reside in the facility. The following provisions shall apply:(1) There shall be common rooms such as living rooms, dining rooms, dens or other recreation/activity rooms. They shall be of sufficient space and/or separation to promote and facilitate the program of activities and to prevent such activities from interfering with other functions. 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 LPA observed a large bed inside the facility common area, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/12/2026 Plan of Correction Licensee will remove the bed and send proof to LPA by POC date of 02/12/2026.

Official classification

Type B

Official code

87411(d)

Regulation authority

CCR

What the official deficiency says

87411 Personnel Requirements - General (d) All personnel shall be given on the job training or have related experience in the job assigned to them. This training and/or related experience shall provide knowledge of and skill in the following, as appropriate for the job assigned and as evidenced by safe and effective job performance: 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 staff 1 does not have required training, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/11/2026 Plan of Correction Licensee will submit proof staff 1 has required training and submit to LPA by POC date of 02/11/2026.

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 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. The following requirement has not been met as evidenced by: Resident 1 was admitted to the facility 12/2024, and medical assessment is dated 09/2020, which poses a potential, health, safety, or personal rights risk to residents in care.

Official plan of correction

Licensee will submit resident 1's current medical assesment to LPA by POC date of 12/22/2025.

Deadline recorded: Dec 22, 2025. 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. The licensee and the administrator may be one and the same person. The administrator shall have sufficient freedom from other responsibilities and shall be on the premises a sufficient number of hours to permit adequate attention to the management and administration of the facility as specified in this section. When the administrator is not in the facility, there shall be coverage by a designated substitute who shall have qualifications adequate to be responsible and accountable for management and administration of the facility as specified in this section. The Department may require that the administrator devote additional hours in the facility to fulfill his/her responsibilities when the need for such additional hours is substantiated by written documentation. The following requirement has not been met as evidenced by: Based on interview with staff and LPA observation the facilities Administrator is not present at facility sufficient number of hours to manage the facility, which poses a potential, health, safety or personal rights risk to residents in care. v

Official plan of correction

Licensee will submit the LIC500 to LPA by POC date of 12/22/2025.

Deadline recorded: Dec 22, 2025. 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, 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. The following requirement has not been met as evidenced by: Resident 2's appraisal has not been updated since 09/2020, which poses a potential, health, safety, or personal rights risk to residents in care.

Official plan of correction

Administrator will submit current updated appraisal for resident 2 by POC date of 12/22/2025.

Deadline recorded: Dec 22, 2025. A deadline is not proof that correction was completed.

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 the facility does not have an Infection Control Plan, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/29/2025 Plan of Correction Licensee will submit Infection Control Plan to LPA by 01/29/2025 POC date.

Official classification

Type B

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 record review, the licensee did not comply with the section cited above in Resident 1's medication was not logged on centrally stored medication log correctly which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/31/2023 Plan of Correction Administrator shall conduct Medication logging training with facility staff and submit proof to LPA by 03/31/2023 POC date.

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 requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above in th facility hallway bathroom door does not properly close, and the facility master bathroom toilet does not work correctly which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/31/2023 Plan of Correction Administrator shall repair both bathrooms and submit proof to Licensing by 03/31/2023 POC date.

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 when 2 bottoles of Clorox wipes were found to be accessible to 5 out of 5 clients which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/26/2022 Plan of Correction Caregiver removed the Clorox wipes and locked them in a secure cabinet. POC CLEARED during inspection.

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 when 2 window screens were observed not in good reparit and multiple holes in the walls of the facility, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/28/2022 Plan of Correction Licensee agrees to have the window screens in the facility replaced and to fill/patch all the holes in the walls of the bathroom and resident rooms.

Official classification

Type B

Official code

87632(d)(2)

Regulation authority

CCR

What the official deficiency says

d) If the Department grants a hospice care waiver it shall stipulate terms and conditions of the waiver… which shall include, but not be limited to, the following requirements: (2) The licensee shall notify the Department in writing within five working days of the initiation of hospice care services for any terminally ill resident in the facility or within five working days of admitting a resident already receiving hospice care services. 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 when Licensee did not notify the Department of the initiation of hospice care for 1 resident which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/28/2022 Plan of Correction Licensee agreed to submit a written statement detailing the steps the facility will take to ensure the requirements of section 87632 Hospice Care Waiver are met.