POLLY'S PLACE

Official classification

Type A

Official code

87468.1(a)(1)

Regulation authority

CCR

What the official deficiency says

87468.1 Personal Rights of Residents in All Facilities: (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (1) To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement was not evidenced by: Based on evidence gathered, the Licensee did not ensure Resident #8 was treated with dignity. LPA observed a video recording in which the Licensee spoke to R8 in an inappropriate manner. This poses an immediate health, safety, and personal rights risk to persons in care.

Official plan of correction

The Licensee stated that she will complete a statement and conduct an in service training with all staff regarding this regulation. The Licensee agreed to provide LPA the statement and proof of training via email or fax by POC date.

Deadline recorded: Mar 3, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87468.1(a)(3)

Regulation authority

CCR

What the official deficiency says

87468.1 Personal Rights of Residents in All Facilities: (a) Residents in all residential care facilities for the elderly shall ...:(3) ...be free from punishment, humiliation, intimidation, abuse... This requirement was not evidenced by: Based on evidence gathered, the Licensee did not ensure Resident #8 was free from intimidation and abuse. LPA observed a video recording in which the Licensee handled R8 in a rough manner. This poses an immediate health, safety, and personal rights risk to persons in care.

Official plan of correction

The Licensee stated that she will complete a statement and conduct an in service training with all staff regarding this regulation. The Licensee agreed to provide LPA the statement and proof of training via email or fax by POC date.

Deadline recorded: Mar 3, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87408(a)(6)

Regulation authority

CCR

What the official deficiency says

87408 Denial or Revocation of a Certificate: (a) The Department may deny or revoke any administrator certificate ... (6) The certificate holder engaged in conduct which is inimical to the health, morals, welfare, or safety of ... an individual ... This requirement was not evidenced by: Based on evidence gathered, the Licensee engaged in conduct inimical to the health and safety of a resident in care. The Licensee also provide false statements on two occasions to the Department. This poses an immediate health, safety, and personal rights risk to persons in care.

Official plan of correction

The Licensee stated that she will complete a statement of understanding regarding this regulation. The Licensee agreed to provide the statement to LPA via email or fax by POC date.

Deadline recorded: Mar 9, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87211(a)(1)

Regulation authority

CCR

What the official deficiency says

A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below...This requirement was not met as evidenced by The facility verified R1 suffered a fall in September 2023 but did not report it to the Department, this poses a potential health and safety risk to residents in care.

Official plan of correction

Licensee agrees to sign a statement of understanding for CCR 87211 and to train staff on CCR 87211. Licensee to submit proof to LPA by the POC due date.

Deadline recorded: Dec 26, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87355(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 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (3) Request a transfer of a criminal record clearance as specified in Section 87355(c) or This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and interview and record review, the licensee did not comply with the section cited above 2 out of 3 staff present on 11/23/2024 visit did not transfer their criminal record clearance to Polly's Place prior to working which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/26/2024 Plan of Correction Licensee will associate staff to faciliy by POC date. POC will be submitted to LPA Calderon by email.

Official classification

Type A

Official code

87203

Regulation authority

CCR

What the official deficiency says

All facilities shall be maintained in conformity with the regulations adopted by the State Fire Marshal for the protection of life and property against fire and panic. This requirement is not being met as evidenced by: LPA observed the smoke detectors in the kitchen and TV room have been removed. This poses an immediate health and safety risk to residents in care. CIVIL PENALTY ASSESSED.

Official plan of correction

Licensee agrees to install smoke detectors in the kitchen and TV room next to the kitchen and to forward proof to LPA by POC due date.

Deadline recorded: Apr 25, 2024. A deadline is not proof that correction was completed.