LINDA FALLS GUEST HOME 1

Official classification

Type B

Official code

1569.625(b)(1)

Regulation authority

HSC

What the official deficiency says

Staff training; legislative findings; contents1569.625(b)(1)....A staff member shall complete 20 hours...before working independently with residents. The remaining 20 hours... shall be completed within the first four weeks of employment. This requirement is not met as evidenced by: Based on record review, the licensee did not comply with the section cited above where S1's personnel file was observed missing proof of all of the required initial training which poses a potential health, safety and/or personal rights risk to persons in care.

Official plan of correction

Licensee agrees to self certify that S1 has completed all of the required training to CCL by POC dues date of 05/01/2026.

Deadline recorded: May 1, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

1569.69(b)

Regulation authority

HSC

What the official deficiency says

(b) Each employee who received training and passed the examination required in paragraph (5) of subdivision (a), and who continues to assist with the self-administration of medicines, shall also complete eight hours of in-service training on medication-related issues in each succeeding 12-month period. 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 2 out of 3 staff files reviewed which were missing proof of the required annual medication training which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/10/2025 Plan of Correction Licensee agrees to self certify that all staff have completed the required annual medication training to CCL by POC dues date of 10/10/2025.

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. This requirement is not met as evidenced by: Based on records reviewed, Licensee did not ensure R1 received a medical assessment prior to admission. This poses a potential Health, Safety or Personal rights risk to persons in care.

Official plan of correction

Licensee shall submit self certification they have read and understand Regulation 87458. Self certification shall be submitted to CCLD by 03/21/2025. Copy of regulation 87458 provided to Licensee.

Deadline recorded: Mar 21, 2025. 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: (c) Prior to admission a determination of the prospective resident's suitability for admission shall be completed and shall include an appraisal of their individual service needs in comparison with the admission criteria specified in Section 87455, Acceptance and Retention Limitations. This requirement is not met as evidenced by: Based on records reviewed, Licensee did not complete an evaluation of residents condition prior to admission and keep it in the file. This poses a potential Health, Safety or personal rights risk to persons in care.

Official plan of correction

Licensee shall submit self certification they have read and understand Regulation 87457. Self certification shall be submitted to CCLD by 03/21/2025. Copy of regulation 87457 provided to Licensee.

Deadline recorded: Mar 21, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87303

Regulation authority

CCR

What the official deficiency says

87303 Maintenance and Operation: (b)A comfortable temperature for residents shall be maintained at all times.(1)The facility shall heat rooms that residents occupy to a minimum of 68 degree F, (20 degrees C). This requirement is not met as evidenced by: Based on thermometer reading during visit, Licensee did not ensure the temperature was at least 68 degrees F. Temperature was 67 degrees. This poses a potential Health, Safety or Personal rights risk to persons in care.

Official plan of correction

Licensee shall submit self certification they have read and understand Regulation 87303. Self certification shall be submitted to CCLD by 03/21/2025. Copy of regulation 87303 provided to Licensee.

Deadline recorded: Mar 21, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87224(f)

Regulation authority

CCR

What the official deficiency says

87224 Eviction Procedures: (f) A written report of any eviction shall be sent to the licensing agency within five (5) days. This requirement is not met as evidenced by: Based on records reviewed, Licensee issued an eviction on 09/24/2024 to R1 and did not forward a copy to CCLD. This poses a potential Health, Safety or Personal rights risk to persons in care.

Official plan of correction

Licensee shall submit self certification they have read and understand Regulation 87224. Self certification shall be submitted to CCLD by 03/21/2025. Copy of regulation 87224 provided to Licensee.

Deadline recorded: Mar 21, 2025. A deadline is not proof that correction was completed.

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 Per LPA observation and record review, the licensee did not comply with the section cited above in that one non-ambulatory, R2 resident is located on the second level of the facility, however fire clearance prohibits non ambulatory residents on the second floor, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/08/2024 Plan of Correction Licensee to ensure that residents retained are within fire clearance approval. Licensee to submit to CCL updated facility sketch showing all resident rooms with their current ambulatory/non-abulatory/bedridden status and submit an LIC200 in order to obtain fire clearance approval.

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 LPA observation and record review, the licensee did not comply with the section cited above in that facility does not have a Centrally Stored Medication List on File for Residents in care, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/08/2024 Plan of Correction Facilty to submit to CCL completed Centrally Stored Medication List for all residents in care by Plan of Correction due date of 8/8/2024. Additionally, facility to conduct medication training for Centrally Stored Medication Log by no later than August 29, 2024.

Official classification

Type B

Official code

87303(e)(2)

Regulation authority

CCR

What the official deficiency says

(e) Water supplies and plumbing fixtures shall be maintained as follows: (2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degrees C) and not more than 120 degree F (49 degrees C). 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 that water temperature in sinks accessible to residents in care measured at 101.8, 103.6, 138.2 degrees F, which is not within the allowable range of 105 to 120 degrees F. which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/21/2024 Plan of Correction Facility to submit to CCL two week log of water temperature within regulation. Licensee to submit photos of thermometer readings along with temperature log. Picture of thermometer reading to include specific faucets being read.

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 observation and record review, the licensee did not comply with the section cited above in that S1, S2, S3 had no required annual training on file, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/28/2024 Plan of Correction Facility to submit to CCL completed training certificates and/or training log for S1, S2, S3. Training log to include name of course, name of trainer, name of attendees, and course duration to CCL by POC due date.

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 that LPA observed the kitchen pantry cabinet to have multiple food items to be expired. (Kikkoman sweet cooking seasoning exp 12/4/2023, Organic coconut aminos sauce exp 7/6/2021, Worcestershire sauce exp 2/20/2021, Bulls Eye bbq sauce exp 10/11/2020, Sugarman Maple syrup exp 1/17/2020, Sweet chili sauce exp 4/9/2021, chili beans exp 4/21/23, Kraft Parmesan cheese exp 4/23/23 and 9/12/21). Refrigerated food was not found to be stored in a safe manner with open items not labeled with opened date which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/28/2024 Plan of Correction Facility to submit an LIC9098, self certifying that all perishable items in kitchen pantry are not past the best by due date and to label food items with date when opened.

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, the licensee did not comply with the section cited above in that LPA observed kitchen pantry cabinet where food was stored to have multiple rodent droppings on every shelf, underneath the kitchen sink and where the potatoes were stored which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/28/2024 Plan of Correction Facility to submit to CCL service work order from Pest Control company for vermin and rodent service. Facility to submit paid invoice along with work order. Service work order and paid invoice must be on Pest Control company professional letterhead. Facility to submit photos of pantry without all the rodent droppings by POC due date.

Official classification

Type B

Official code

87463(c)

Regulation authority

CCR

What the official deficiency says

(c) The licensee shall arrange a meeting with the resident, the resident's representative, if any, appropriate facility staff, and a representative of the resident's home health agency, if any, when there is significant change in the resident's condition, or once every 12 months, whichever occurs first, as specified in Section 87467, Resident Participation in Decision Making. 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 that R2, R4, R5, R6 do not have a current Appraisal Needs and Services Plan on file, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/21/2024 Plan of Correction Facility to submit to CCL current Appraisal Needs and Services plan for R2, R4, R5, and R6 by POC due date.

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 observation and record review, the licensee did not comply with the section cited above in R1 does not have a current LIC602 and Appraisal 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: 08/28/2024 Plan of Correction Facility to submit to CCL current Appraisal Needs and Services Plan and LIC602 by POC due date.

Official classification

Type A

Official code

87465(h)(2)

Regulation authority

CCR

What the official deficiency says

87465(h)(2) Incidental Medical and Dental Care-Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. This requirement was not met, as evidenced by: LPA observed a large container of several prescribed medications, as well as over the counter medications, of R1, out in the open, not locked up, This is an immediate health and safety risk to residents in care.

Official plan of correction

Administrator to ensure all medications are centrally stored and inaccessible to residents in care. Administrator to hold an in-service regarding facility's medication policy and procedures regarding storage of medications. Follow-up proof of training to be submitted by 11/14/23. POC due 11/8/23.

Deadline recorded: Nov 8, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87307(d)(4)

Regulation authority

CCR

What the official deficiency says

87307 Personal Accommodations and Services (d)(4)-The following space and safety provisions shall apply to all facilities: Stairways, inclines, ramps and open porches and areas of potential hazard to residents with poor balance or eyesight shall be made inaccessible to residents.This requirement was not met, as evidenced by: LPA observed there are three (3) residents on the upper level, two (2) residents have/use walkers, and one (1) resident is wheelchair bound. LPA observed the inside upper-level stairs has no barrier, and the upper-level outside balcony stairs has no barrier, this is a health and safety risk to residents in care

Official plan of correction

Licensee has agreed to install barrier gates, one at the top of the facility upper level inside stairs, and at the top of the stairs off the upper level outside balcony. Plan on getting the barrier gates installed for residents' safety inside and outside of the facility common areas. Submit completion notification to the Department of installed gates no later than 11/20/23. Submit plan of correction by 11/8/23.

Deadline recorded: Nov 8, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

1569.695(a)(d)(1)

Regulation authority

HSC

What the official deficiency says

Emergency Plans 1569.695 (a)(d) (1)In addition to any other requirement of this chapter, a residential care facility for the elderly shall have an emergency and disaster plan that shall include, but not be limited to, all of the following: d) A facility shall review the plan annually and make updates as necessary, including changes in floor plans and the population served. The licensee or administrator shall sign and date documentation to indicate that the plan has been reviewed and updated as necessary. An evacuation chair at each stairwell. This requirement was not met as evidenced by: LPA observed three non-ambulatory residents on the upper level. LPA observed the facility does not have fire/emergency exits per LPA's inspection, the facility only has stairs inside on the upper floor and outside stairs from the balcony, this is a health and safety risk to residents in care.

Official plan of correction

Licensee to ensure that the facility has evacuation chairs to assist in evacuating residents in the vent of an emergency at either the stairs inside the facility on the upper level, and/or the stairs off the balcony on the upper level. Both the stair areas, inside and outside, are the only ways out of the facility's second floor. Licensee to submit copy of receipt of purchase of evacuation chairs, and pictures of the evacuation chairs for the facility. POC due 11/10/23. Reminder-Post up the evacuation chair use instructions where the evac chairs are kept. by stair areas.

Deadline recorded: Nov 10, 2023. A deadline is not proof that correction was completed.

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 Per file review and observations by the LPA, facility is fire cleared for four ambulatory, and two(2) non-ambulatory only. Licensee has a two additional non-ambulatory residents, and a bedridden resident admitted into the facility, which is out of compliance with the approved fire clearance, the licensee did not comply with the section cited above in [3] out of 3] admitted residents] which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/19/2023 Plan of Correction Licensee tto ensure that admitted residents and residents retained are within the fireclearance approval; Licensee to submit updated facility sketch shwoing all resident rooms and current ambulatory/nonambulatory/bedridden status, submit an LIC200 if wanting to try and get a new fire clearance approval. If not able to obtain and/or you don't want to try to obtain a new fire clearance, please submit plan of how you will bring the facility into compliance. POC due 9/19/23.

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 Per record review, three out of four staff/caregivers lack current First Aid; Three out of four staff lack current CPR certification the licensee did not comply with the section cited above in [3] out of (4] which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/19/2023 Plan of Correction Licensee to ensure that all caregivers have first aid certification, and that staff obtain CPR certification, so on every shift the facility has at a minimum one staff that has CPR and their first aid. Copies od certifications by 9/23. Plan of correction due by 9/19/23.

Official classification

Type B

Official code

87625(b)(3)

Regulation authority

CCR

What the official deficiency says

(b) In addition to Section 87611, General Requirements for Allowable Health Conditions, the licensee shall be responsible for the following: (3) Ensuring that incontinent residents are kept clean and dry and that the facility remains free of odors from incontinence. This requirement is not met as evidenced by: Deficient Practice Statement LPA observed a resident room to have a strong urine odor as soon as the resident's door was opened, the licensee did not comply with the section cited above in [1] out of [3] resident rooms] which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/29/2023 Plan of Correction Licensee to ensure that resident's room, R6, is cleaned and that the room is free from urine odors. Submit plan of correction by 9/29/23. Include how the correction was made and how facility plans on maintaing a clean urine free room for the resident. POC due 9/29/23.

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

Maintenance and Operation 87303(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 LPA observed that two resident rooms with very dirty carpet, one room is on the upstairs level, and the other is on the downstairs level, the licensee did not comply with the section cited above in [count] out of [total count] [(objects) (persons)] [identifiers] which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/29/2023 Plan of Correction Licensee to ensure that the resident room rugs are cleaned as needed. Submit photo of both the resident rooms rugs having been cleaned, and include how the facility will maintain the facility rug to be clean moving forward. POC due 9/29/23.

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 Per record reviews, Three out of Four staff lack required annual training, the licensee did not comply with the section cited above in [3] out of [4] staff] which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/29/2023 Plan of Correction Licensee to ensure all staff obtain the annual required 20 hours of training. Submit copies of staff S2, S3, and S4's training having been completed by 10/29/23. POC due 10/29/23.