ACACIA GUEST HOME-ANAHEIM

Official classification

Type A

Official code

87303(e)(6)

Regulation authority

CCR

What the official deficiency says

(e) Water supplies and plumbing fixtures shall be maintained as follows: (6) Toilet, handwashing and bathing facilities shall be maintained in operating condition. Additional equipment shall be provided in facilities accommodating physically handicapped and/or nonambulatory residents, based on the residents' needs. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation the licensee did not comply with the section cited above ; Restroom (1)non-operational due to a leaking showerhead from the main pipe and a clogged bathtub drain which poses an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 10/20/2025 Plan of Correction AD to fix restrrom leaking showerhead and clogged bathtub by POC due date

Official classification

Type A

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 ; facility does not have supplies of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days which poses an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 10/20/2025 Plan of Correction AD to buy food ASAP and send proof to LPA by POC due date

Official classification

Type B

Official code

87303(e)(5)

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. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation the licensee did not comply with the section cited above by not having a slip-resistant mat in restrrom (1) which poses a potential health, safety risk to persons in care.

Official plan of correction

POC Due Date: 10/24/2025 Plan of Correction AD to buy slip-resistant mats and provide proof to LPA by POC due 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 with leaving cleaning supplies in resident's room which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/06/2024 Plan of Correction AD removed items and will provide training to staff and e mail LPA by POC due date

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 by leaving scissors in resident' romm which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/06/2024 Plan of Correction AD secured the scissors and will provide training to staff and e mail LPA by poc due date

Official classification

Type A

Official code

87705(f)(2)

Regulation authority

CCR

What the official deficiency says

(f) The following shall be stored inaccessible to residents with dementia: (2) Over-the-counter medication, nutritional supplements or vitamins, alcohol, cigarettes, and toxic substances such as certain plants, gardening supplies, cleaning supplies and disinfectants. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above by leaving cleaning supplies in backyard and over the counter med in resident's room which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/06/2024 Plan of Correction Items were secured and AD will provide training and e mail LPA by POC due date

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 by leaving grease and oil on oven and unsafe kitchen drawers not intact and falls if open which poses an potintail health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/02/2025 Plan of Correction AD will fix and clean kitchen drawers and grease and send profe via e mail to LPA by POC due date

Official classification

Type B

Official code

87303(a)(1)

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. (1) Floor surfaces in bath, laundry and kitchen areas shall be maintained in a clean, sanitary, and odorless condition. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above by having mold in restroom and mildew all around the glass shower door which poses an potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/02/2025 Plan of Correction AD will clean and paint restroom and e mail profe to LPA via e mail by POC 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, the licensee did not comply with the section cited above by having grease and broken kitchen drawers which poses an potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/02/2025 Plan of Correction AD will fix and e mail LPA 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, the licensee did not comply with the section cited above by not having annual physician report for 2/3 dementia residents which poses an potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/02/2025 Plan of Correction AD will obtain Phsician report and e mail LPA by POC due date

Official classification

Type B

Official code

81019(e)(3)

Regulation authority

CCR

What the official deficiency says

(e) All individuals subject to a criminal record review pursuant to Health and Safety Code section 1522 shall prior to working, residing or volunteering in a licensed facility: (3) Request a transfer of a criminal record clearance as specified in Section 81019(f); This requirement is not met as evidenced by Based on a record review, the licensee did not comply with the section cited above as one out of two staff members present at the facility were not associated to the facility. This poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Administrator stated they will associate all facility staff to the facility by the assigned POC due date.

Deadline recorded: Nov 4, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87307(d)(6)

Regulation authority

CCR

What the official deficiency says

(6) All outdoor and indoor passageways and stairways shall be kept free of obstruction. This requirement is not met as evidenced by: Based on observations, two doors leading from resident rooms to outside the facility were observed to be obstructed by a bed frame and box spring in one room. The other room's door was blocked by a small dresser.

Official plan of correction

Facility staff stated they will unobstruct both doors by the assigned POC due date.

Deadline recorded: Nov 4, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(h)(2)

Regulation authority

CCR

What the official deficiency says

(2) 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. Based on observations, the Licensee did not comply with the section cited above due to medication being stored in the refrigerator without being locked.

Official plan of correction

Administrator stated they will move medication to another refrigerator in a room with a lock or that they would purchase a lock box in order to safely store medication. AD stated they will notify LPA upon completion of plan.

Deadline recorded: Oct 29, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87555(b)(23)

Regulation authority

CCR

What the official deficiency says

87555(b)(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. Based on observations, the licensee did not comply with the section cited above due to uncovered breakfast sausage and vegetables being observed in

Official plan of correction

Administrator stated they will conduct an in-service training pertaining to food storage/handling/preparation. AD stated they will document topics covered, staff in attendance and date/time of training and send the documentation to the LPA via email by the POC due date.

Deadline recorded: Nov 11, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

81019(e)(3)

Regulation authority

CCR

What the official deficiency says

(e) All individuals subject to a criminal record review pursuant to Health and Safety Code section 1522 shall prior to working, residing or volunteering in a licensed facility: (3) Request a transfer of a criminal record clearance as specified in Section 81019(f); This requirement is not met as evidenced by Based on a record review, the licensee did not comply with the section cited above as two out of two staff members present at the facility were not associated to the facility. This poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Administrator stated they will associate all facility staff to the facility by the assigned POC due date.

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