Licensing and administrationType B
- Official classification
- Type B
- Official code
- 1569.618(b)
- Regulation authority
- HSC
What the official deficiency says
(b) At least one administrator, facility manager, or designated substitute who is at least 21 years of age and has qualifications adequate to be responsible and accountable for the management and administration of the facility pursuant to Title 22 of the California Code of Regulations shall be on the premises 24 hours per day. The designated substitute may be a direct care staff member who shall not be required to meet the educational, certification, or training requirements of an administrator. The designated substitute shall meet qualifications that include, but are not limited to, all of the following: 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 facility failed to comply and ensure certified administrator present at the facility, which poses/posed a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 12/12/2025 Plan of Correction Administrator will submit update / anticipated date to admin training completion to LPA by POC date of 12/12/2025.
Health conditions and treatmentsType B
- Official classification
- Type B
- Official code
- 87470(a)
- Regulation authority
- CCR
What the official deficiency says
(a) A licensee shall ensure that infection control practices are maintained as follows: 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 facility residents do not have updated 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: 12/12/2025 Plan of Correction Administrator will submit update Infection Control to LPA by POC date of 12/12/2025.
Records and plan of operationType B
- Official classification
- Type B
- Official code
- 87208(a)
- Regulation authority
- CCR
What the official deficiency says
(a) The licensee shall have and maintain a current, written definitive plan of operation for the facility. The licensee shall operate the facility in accordance with the terms specified in the plan of operation and may be cited for not doing so pursuant to Health and Safety Code section 1569.49. The plan and related materials shall be on file in the facility and shall be submitted to the licensing agency with the license application. Any significant changes in the plan of operation which would affect the services to residents shall be submitted to the licensing agency for approval. The plan and related materials shall contain the following: This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, the licensee did not comply with the section cited above in facility missing definitive Plan of Opearations, which poses/posed a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 12/12/2025 Plan of Correction Administrator will review and update Plan of Operations by POC date of 12/12/2025.
Hazardous items and storageType B
- Official classification
- Type B
- 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 record review, the licensee did not comply with the section cited above in facility leaving cleaning supplies/desinfectant accesible to residents with dementia diagnose, which poses/posed a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 12/12/2025 Plan of Correction Administrator will submit plan of corrections to LPA by POC date of 12/12/2025.
Licensing and administrationType B
- Official classification
- Type B
- Official code
- 1569.618(c)(3)
- Regulation authority
- HSC
What the official deficiency says
(c)The facility shall employ, and the administrator shall schedule, a sufficient number of staff members to do all of the following: (3) Ensure that at least one staff member who has cardiopulmonary resuscitation (CPR) training and first aid training is on duty and on the premises at all times. This paragraph shall not be construed to require staff to provide CPR. 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 facility staff missing staff records including current CPR and first aid certificate/ classes , which poses/posed a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 12/12/2025 Plan of Correction Administrator will ensure employee records updated by POC date of 12/12/2025.