SWANER GUEST HOME

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's observed cleaning solutions including bleach inside residents bedroom, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/23/2025 Plan of Correction Licensee will conduct training on ensuring chemicals, and cleaning solutions are not accessible to residents and submit to LPA by POC date of 11/23/2025.

Official classification

Type A

Official code

87465(a)(4)

Regulation authority

CCR

What the official deficiency says

(4) The licensee shall assist residents with self-administered medications as needed. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation. and record review, the licensee did not comply with the section cited above in Resident 1 has not been given several doses of prescribed medication, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/23/2025 Plan of Correction Licensee will submit proof of refills of all Resident 1's prescribed medications, and submit proof to LPA by POC date of 11/23/2025. LPA will return to facility to confirm deficiency is cleared.

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 in LPA's observed facility backyard with old furniture and junk to be removed, animal feces in side area of backyard, hallway to the right of entrance smells of animal urine, facility bathroom vent is dirty, and hanging off the ceiling, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/06/2025 Plan of Correction Licensee will clean the facility inside and outside and submit proof to LPA by POC date of 12/06/2025.

Official classification

Type B

Official code

87307(a)(3)(B)

Regulation authority

CCR

What the official deficiency says

(B) Bedroom furniture, which shall include, for each resident, a chair, night stand, a lamp, or lights sufficient for reading, and a chest of drawers. 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's observed facility resident bedroom dressers are not in good repair, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/06/2025 Plan of Correction Licensee will repair or purchase new resident bedroom furniture and submit proof to LPA by POC date of 12/06/2025.

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, the licensee did not comply with the section cited above in resident female bedroom pink sheets are ripped and not in good repair, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/06/2025 Plan of Correction Licensee will change sheets and submit proof to LPA by POC date of 12/06/2025.

Official classification

Type B

Official code

87405(d)

Regulation authority

CCR

What the official deficiency says

(d) The administrator shall have the qualifications specified in Sections 87405(d)(1) through (7). If the licensee is also the administrator, all requirements for an administrator shall apply. 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's observed multiple citings and the facility is out of compliance with licensing regulations, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/06/2025 Plan of Correction Licensee / Administrator will submit a written plan on how the facility will come into compliance with all Title 22 Regulations and submit to LPA by POC date of 12/06/2025.

Official classification

Type B

Official code

87411(d)

Regulation authority

CCR

What the official deficiency says

(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 [(observation) (interview) (record review)], the licensee did not comply with the section cited above in Licensee did not have staff training for all staff to meet training requirements, 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 Licensee agrees to submit copies of staff training for all staff to meet all RCFE training regulations by POC due date 12/12/25.

Official classification

Type B

Official code

87555(b)(8)

Regulation authority

CCR

What the official deficiency says

(b) The following food service requirements shall apply: (8) All food shall be of good quality. Commercial foods shall be approved by appropriate federal, state and local authorities. Food in damaged containers shall not be accepted, used or retained. 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's observed food items in refrigerator without labels and crab and meats inside damaged packages,which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/06/2025 Plan of Correction Licensee will immediately dispose of all food items in damaged or open containers, and expired foods.Licensee wll retrain staff on safe fod handling practices including packaging integrity upon delivery and during weekly inspections and submit proof to LPA's by POC date of 12/06/2025.

Official classification

Type B

Official code

87555(b)(23)

Regulation authority

CCR

What the official deficiency says

(b) The following food service requirements shall apply: (23) All readily perishable foods or beverages capable of supporting rapid and progressive growth of micro-organisms which can cause food infections or food intoxications shall be stored in covered containers at appropriate temperatures. 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's observed spaghetti and other perishable foods on kitchen counter at room temperature, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/06/2025 Plan of Correction Licensee will re train staff on proper storage of perishable foods including maintaining appropriate temperatures and submit proof to LPA's by POC date of 12/06/2025.

Official classification

Type B

Official code

87555(b)(26)

Regulation authority

CCR

What the official deficiency says

(b) The following food service requirements shall apply: (26) Supplies of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days shall be maintained on the premises. 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 facility does not have required one week perishable food supply,which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/06/2025 Plan of Correction Licensee will purchase required minimum one week perishable food supply and submit to LPA by POC date of 12/06/2025.

Official classification

Type B

Official code

87555(b)(28)

Regulation authority

CCR

What the official deficiency says

(b) The following food service requirements shall apply: (28) All food shall be protected against contamination. Contaminated food shall be discarded immediately upon discovery. 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's observed spaghetti and other foods out on facility counter at room temperature, crab and other meat products open and exposed inside facility freezer, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/06/2025 Plan of Correction Licensee will submit written statement of understanding on how to properly store foods and submit to LPA's by POC date of 12/06/2025.

Official classification

Type B

Official code

87506(b)(15)

Regulation authority

CCR

What the official deficiency says

(b) Each resident's record shall contain at least the following information: (15) The admission agreement and pre-admission appraisal, specified in Sections 87507, Admission Agreements and 87457, Pre-admission Appraisal. 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 required pre admission appraisal, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/06/2025 Plan of Correction Licensee will submit Pre admission assesment for resident 1 to LPA's by POC date of 12/06/2025.

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 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. 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 a completed medical assesment, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/06/2025 Plan of Correction Licensee will submit Resident 1's Physician Report to LPA's for review by poc date of 12/06/2025.

Official classification

Type A

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 Staff 1 does not have required CPR/first aid training, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/09/2024 Plan of Correction Administrator Mathew Magsambol will send proof Staff 1 has required CPR/First aid training to LPA by POC date of 11/09/2024.

Official classification

Type A

Official code

87412(a)(11)

Regulation authority

CCR

What the official deficiency says

(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: (11) A health screening as specified in Section 87411, Personnel Requirements - General. 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 LIC503 Health Screening report, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/09/2024 Plan of Correction Administrator Mathew Magsambol will send proof to LPA of Staff 1's Health Screening report by POC date of 11/09/2024.

Official classification

Type A

Official code

87555(b)(8)

Regulation authority

CCR

What the official deficiency says

(b) The following food service requirements shall apply: (8) All food shall be of good quality. Commercial foods shall be approved by appropriate federal, state and local authorities. Food in damaged containers shall not be accepted, used or retained. 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 which LPA observed food inside refrigerator stored with no container or coverings, poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/09/2024 Plan of Correction Administrator will attend food service/storage training and submit proof to LPA by POC date of 11/09/2024.

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

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 LPA observed webs throughout facility, and also resident back bedroom vents to be extremely dirty, large hole under back bedroom bathroom toilet, sink fixture in the back bedroom bathroom not working correctly, vents not on the wall correctly, and sink in hallway bathroom clogged, which poses/posed a potential health, safety or personal rigthts risk to persons in care.

Official plan of correction

POC Due Date: 11/22/2024 Plan of Correction Administrator will clean all vents, sink faucets, sinks, hole under toilet, and ensure all vent covers are on correctly, and submit proof to LPA by POC date of 11/22/2024.

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 in LPA observed the side sliding glass door screen to be in disrepair and off track, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/22/2024 Plan of Correction Adminsitrator will fix window screen, and submit proof to LPA by POC date of 11/22/2024.

Official classification

Type B

Official code

87303(f)(3)

Regulation authority

CCR

What the official deficiency says

(f) Solid waste shall be stored and disposed of as follows: (3) All containers, except movable bins, used for storage of solid wastes shall have tight-fitting covers on the containers; shall be in good repair; shall have external handles; and shall be leakproof and rodent-proof. 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 bathroom trash with no lid,which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/22/2024 Plan of Correction Administator will ensure all facility trash bins have covers, and submit proof to LPA by POC date of 11/22/2024.

Official classification

Type B

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 in LPA observed disinfectant under hallway bathroom sink accessible to residents, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/22/2024 Plan of Correction Adminstrator will conduct training on safely handling and storing disinfectant, and send proof to LPA by POC date of 11/22/2024.

Official classification

Type B

Official code

87555(b)(23)

Regulation authority

CCR

What the official deficiency says

(b) The following food service requirements shall apply: (23) All readily perishable foods or beverages capable of supporting rapid and progressive growth of micro-organisms which can cause food infections or food intoxications shall be stored in covered containers at appropriate temperatures. 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 several meat items in refrigerator not covered properly, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/22/2024 Plan of Correction Administrator will provide proof of food storage training to LPA by POC date of 11/22/2024.

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 record review, the licensee did not comply with the section cited above in Administrator could not provide proof required quarterly disater drills, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/22/2024 Plan of Correction Administrator will conduct quarterly disaster drills and send proof to LPA by POC date of 11/22/2024.

Official classification

Type B

Official code

87705(c)(5)

Regulation authority

CCR

What the official deficiency says

(c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following: (5) Each resident with dementia shall have an annual medical assessment as specified in Section 87458, Medical Assessment, and a reappraisal done at least annually, both of which shall include a reassessment of the resident's dementia care needs. 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 required annual medical assessment, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/22/2024 Plan of Correction Administrator will provide updated LIC602 Physicians report for Resident 1 to LPA by POC date 11/22/2024.

Official classification

Type A

Official code

87555(b)

Regulation authority

CCR

What the official deficiency says

GENERAL FOOD SERVICE REQUIREMENTS. 87555(b)All food shall be of good quality. Commercial foods shall be approved by appropriate federal, state and local authorities. The following requirement has not been met as evidenced by: LPA's observed expired perishable food items in the facility refrigerator which poses an immediate. health, safety or personal rights risk to residents in care.

Official plan of correction

Administrator Mathew Magsambol will audit facility food supply to ensure there is no expired food inside facility refrigerator and send proof to LPA by POC date of 12/07/2023.

Deadline recorded: Dec 7, 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: The following requirement has not been met as evidenced by: Staff 1 does not have Health Screeing Report LIC 503, or Criminal Records Statement LIC 508 in facility file which poses a potential health, safety, or personal rights risk to residents in care.

Official plan of correction

Administrator Mathew Magsambol will send S1's file to LPA by 12/20/2023 POC date.

Deadline recorded: Dec 20, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87555(b)

Regulation authority

CCR

What the official deficiency says

GENERAL FOOD SERVICE REQUIREMENTS. 87555(b)All food shall be of good quality. Commercial foods shall be approved by appropriate federal, state and local authorities. The following requirement has not been met as evidenced by: LPA Hurt observed large container of expired potato salad in the fridge marked 08/23/2023 which contains a potential health, safety, or personal rights risk to residents in care.

Official plan of correction

Administrator agrees to conduct staff training on food safety and contamination and submit proof to LPA by 10/17/2023.

Deadline recorded: Oct 17, 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: The following requirement has not been met as evidenced by: Staff 1 has been working at the facility and is fingerprint cleared, but does not have a Personnel record which poses a potential, health, safety, or personal rights risk to residents in care.

Official plan of correction

Administrator will provide Personnel records for Staff 1 to LPA Hurt by 10/17/2023.

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

Official classification

Type B

Official code

Not listed

Regulation authority

Not listed

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. The following requirement has not been met as evidenced by: LPA Hurt observed three of the six facility rooms to be very cluttered, and not suitable for residents, resident bathrooms including showers were not clean which poses an immediate, health, safety or personal rights risk to residents in care.

Deadline recorded: Dec 29, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

Not listed

Regulation authority

Not listed

What the official deficiency says

GENERAL FOOD SERVICE REQUIREMENTS. All food shall be of good quality. Commercial foods shall be approved by appropriate federal, state and local authorities. The following requirement has not been met as evidenced by: During today's inspection LPA observed several food containers with no date, or label which poses a potential health, safety, or personal rights risk to residents in care.

Deadline recorded: Dec 29, 2022. A deadline is not proof that correction was completed.