A FAITHFUL HOME OF ANAHEIM

Official classification

Type B

Official code

87309(a)

Regulation authority

CCR

What the official deficiency says

87309(a) Except as specified in subsection (b), the licensee shall ensure that ...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 ...This requirement is not met as evidenced by: Based on observation, the licensee did not ensure knives were inaccessible to clients in care which poses a potential health, safety, or personal rights risk to persons in care. Kitchen knives were stored in a kitchen cabinet and were observed to be unlocked.

Official plan of correction

LPA observed staff lock kitchen knives in a locked kitchen cabinet. Licensee stated they will conduct an in-service training and send to LPA via email by POC due date. Civil Penalty was assessed.

Deadline recorded: Aug 4, 2026. 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

(h) The following requirements shall apply... (2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons... This requirement is not met as evidenced by: The licensee did not comply with the section cited above in LPAs observing accessible medications in the unlocked garage fridge, kitchen cabinet and a dining room drawer, this poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

LPAs observed staff lock medications that were found in the kitchen cabinet and dining room drawer. LPAs observed staff lock the garage door making the garage fridge inaccessible to residents in care. Licensee stated they will remove all cleaning supplies and place in a locked cabinet and Licensee also stated they will obtain a lock for the garage fridge. Licensee to conduct an in-service training and send to LPA by POC due date. Civil Penalty was assessed.

Deadline recorded: Jul 15, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87465(e)

Regulation authority

CCR

What the official deficiency says

87465(e)For every prescription and nonprescription PRN medication ... there shall be a signed, dated written order from a physician, on a prescription blank, maintained in the residents file, and a label on the medication ...This requirement is not met as evidenced by: Based on observation and interview, the licensee did not ensure medications were prescribed before admnistering medication which poses a potential health, safety, or personal rights risk to persons in care. Bayer, vitamin D3 and melatonin for R1 do not have a doctor's order.

Official plan of correction

Licensee to receive doctor's orders before administering over the counter medication to resident. Orders to be sent to LPA by POC due date.

Deadline recorded: Jul 8, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87309(a)

Regulation authority

CCR

What the official deficiency says

87309(a) Except as specified in subsection (b), the licensee shall ensure that disinfectants, cleaning solutions, ...and other similar items which could pose a danger to residents are in locked storage and are not left unattended ...This requirement is not met as evidenced by: Based on observation, the licensee did not ensure cleaning solutions were inaccessible to clients in care which poses a potential health, safety, or personal rights risk to persons in care. Glass cleaner and disinfectant spray were left unattanded in resident restroom.

Official plan of correction

Licensee to conduct in-service training in regards to regulation 87309(a). Licensee to send written log of staff attended and items discussed to LPA via email by POC due date.

Deadline recorded: Jul 8, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87555(b)(27)

Regulation authority

CCR

What the official deficiency says

(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 and interview, the licensee did not comply with the section cited above due to six dead small roaches in kitchen cabinets and one small live roach that ran under the fridge which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/10/2026 Plan of Correction Licensee to have kitchen and cabinets cleaned. Licensee to contact Pest Control and schedule and appoinment, Licensee to notify LPA of appointment date and send pictures of cleaned cabinet to LPA via email by POC due date. Receipt of services rendered by Pest Control to be submitted to LPA via email once appointment has concluded.

Official classification

Type A

Official code

87465(h)(2)

Regulation authority

CCR

What the official deficiency says

(h) The following requirements shall apply to medications which are centrally stored: (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. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and interview, the licensee did not comply with the section cited above due to having 29 medications in fridge accessible to residents in care which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/10/2026 Plan of Correction Licensee immediately placed medication in garage fridge. Garage can be locked an be inaccessible to residents in care. Licensee to conduct and in-service training, Licensee to send a statement of understanding to LPA by POC due date via email.

Official classification

Type A

Official code

87468.1(a)(1)

Regulation authority

CCR

What the official deficiency says

87468.1(a)(1) Personal Rights of Residents in All Facilities To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement was not met as evidence by: LPA observed a video where S1 yelled at and repeated what residents were saying in a demeaning tone. This poses an immediate health, safety and personal rights risk to residents in care.

Official plan of correction

Licensee stated they terminated S1 and will provide in service trainings for staff on topics such as yelling and mocking at residents and send proof to LPA by POC due date.

Deadline recorded: Dec 5, 2025. 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(a)(3) Personal Rights of Residents in All Facilities To be free from punishment, humiliation, intimidation, abuse or other actions of a punitive nature, such as withholding residents’ money or interfering with daily living functions such as eating sleeping, or elimination. This requirement was not met as evidence by: LPA observed a video where S1 was seen intimidating R1 with a shoe and hit R2 on the thigh. This poses an immediate health, safety and personal rights risk to residents in care.

Official plan of correction

Licensee stated they terminated S1 and will provide in service trainings for staff on topics of intimidation and physical abuse and send proof to LPA by POC due date.

Deadline recorded: Dec 5, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87458(a)

Regulation authority

CCR

What the official deficiency says

87458(a) 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 was not met as evidence by: LPA did not observe a medical assessment for R1 in their facility file. This poses a potential health and safety risk to residents in care.

Official plan of correction

Licensee stated they will obtain medical assessment with proof of TB test and send to LPA by POC due date.

Deadline recorded: Dec 5, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

1569.311

Regulation authority

HSC

What the official deficiency says

Every residential care facility for the elderly shall have one or more carbon monoxide detectors in the facility that meet the standards established in Chapter 8 (commencing with Section 13260) of Part 2 of Division 12. The department shall account for the presence of these detectors during inspections. 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 not having one carbon monoxide detector which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/31/2025 Plan of Correction Licensee stated they will obtain a working carbon monoxide detector and send proof to LPA by POC due date.

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 ensuring that toxins and chemicals are inaccessible to residents in care which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/31/2025 Plan of Correction Licensee stated that they will lock the toxins and chemicals making them inaccessible to residents and send proof of statement of understanding and staff training to LPA by POC due date.

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 2 of 2 staff present not being CPR trained which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/31/2025 Plan of Correction Licensee stated they will enroll staff in CPR by POC due date and send proof of obtained certificate to LPA.

Official classification

Type A

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 LPA observing bugs inside the kitchen cupboards which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/31/2025 Plan of Correction Licensee stated they will obtain a work order to spray for bugs by POC due date and send LPA the invoice once completed.

Official classification

Type A

Official code

87465(h)(2)

Regulation authority

CCR

What the official deficiency says

(h) The following requirements shall apply to medications which are centrally stored: (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. 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 storing medication in the fridge in the unlocked garage making them accessible to residents in care which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/31/2025 Plan of Correction Licensee stated they will lock the medication and give staff training by POC due date on medication.

Official classification

Type A

Official code

87465(c)(1)

Regulation authority

CCR

What the official deficiency says

(c) If the resident's physician has stated in writing that the resident is unable to determine his/her own need for nonprescription PRN medication, but can communicate his/her symptoms clearly, facility staff designated by the licensee shall be permitted to assist the resident with self-administration, provided all of the following requirements are met: (1) There is written direction from a physician, on a prescription blank, specifying the name of the resident, the name of the medication, all of the information specified in Section 87465(e), instructions regarding a time or circumstance (if any) when it should be discontinued, and an indication of when the physician should be contacted for a medication reevaluation. 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 6 of 6 resident PRN and over the counter medication not having prescriptions poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/31/2025 Plan of Correction Licensee stated they will send proof of obtaining prescriptions to LPA by POC due date and send prescriptions to LPA once obtained.

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 record review, the licensee did not comply with the section cited above in 2 of 2 staff not having annual training which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/20/2025 Plan of Correction Licensee stated they will train their staff and send proof of training to LPA by POC due date.

Official classification

Type B

Official code

87412(a)

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: 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 1 of 2 staff not having their file at the facility which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/20/2025 Plan of Correction Licensee stated they will obtain and send the file to LPA by POC due date.

Official classification

Type A

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). Based on observation, the licensee did not comply with the section cited above due to hot water in resident bathrooms measuring over 120 F degrees.

Official plan of correction

House Manager stated the facility will create a water log to measure the hot water in all resident bathrooms and adjust hot water to be within 105 and 120 degrees by the assigned POC due date of 7/31/2024.

Deadline recorded: Jul 31, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

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 due to hot water in resident bathrooms measuring over 120 F degrees which poses an immediate safety risk to persons in care.

Official plan of correction

POC Due Date: 07/11/2024 Plan of Correction House Manager stated the facility will maintain a water log to measure the hot water in all resident bathrooms. House Manager stated they will email the water log to LPA by the assigned POC due date of 7/11/2024.

Official classification

Type A

Official code

87224(a)

Regulation authority

CCR

What the official deficiency says

Eviction Procedures- The licensee may evict a resident for one or more of the reasons listed in Section 87224(a)(1) through (5). Thirty days written notice to the resident is required...This requirement was not met as evidenced by: Based on interviews and file review, the licensee admitted to not accepting R1 back to the facility from the hospital. The licensee did not serve R1 with a 30 day notice to evict the resident. This poses a potential risk to the health & safety of residents in care.

Official plan of correction

Licensee agrees to review regulation 87224 Eviction Procedures and provide proof of understanding that a 30 day notice should be issued before a resident is evicted by POC due date of 08/31/2023.

Deadline recorded: Aug 31, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87411(g)(2)

Regulation authority

CCR

What the official deficiency says

(g) Prior to employment or initial presence in the facility, all employees and volunteers subject to a criminal record review shall; (2) request a transfer of a criminal record clearance as specified in Section 87355(c) or... This requirement is not met as evidenced by: LPA observed through record review and the use of the Guardian website that Staff 1 and Staff 2 are not associated to the facility. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation in Guardian and interview with Administrator Kholoma, the facility did not comply with the section cited above in that 2 of 2 staff members were not associated to the facility. This poses an immediate health, safety or personal rights risk to persons in care. Civil Penalty to be Assessed

Official plan of correction

POC Due Date: 05/02/2022 Plan of Correction Administrator states the 2 staff members will be associated to the facility and all future staff will be associated to the facility prior to starting employment. LPA will review Guardian to verify the staff have been associated. Administrator to review section cited and self certify understanding and submit proof to LPA by 05/05/2022.

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. This requirement is not met as evidenced by: This requirement is not met as evidenced by: Deficient Practice Statement Based on observation the facility did not comply with the section cited above. LPA observed over-the-counter medication (Melatonin, Extra Strength Acetaminphen, Anit-Diarrheal) and a pre poured pill box with one day medication in unlocked cabinet in dining room, prescription medication was also observed in 2 of 3 unlocked cabinets in hallway; only one cabinet was locked of the 3; two bottles of medication (Lorazapam Intensol Oral Concentrate, Mapap 500) were observed in the main refrigerator which poses an immediate health, safety risk to persons in care. (photos taken)

Official plan of correction

POC Due Date: 05/02/2022 Plan of Correction Medication was secured away, cabinets were all locked during today's visit. Licensee to conduct in-service training to staff on section cited and submit proof to LPA Martinez by close of business day of 5/5/2022

Official classification

Type A

Official code

87608(a)(5)(B)

Regulation authority

CCR

What the official deficiency says

(5) Under no circumstances shall postural supports include tying, depriving, or limiting the use of a resident's hands or feet. (B) Bed rails that extend the entire length of the bed are prohibited except for residents who are currently receiving hospice care and have a hospice care plan that specifies the need for full bed rails. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview and record review the licensee did not comply with the section cited above in that Resident 1 has (two) 2 half bed rails on one side of the bed essentially creating a full bed rail. which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/02/2022 Plan of Correction Staff removed the two (2) half bed rails that made-up the full bed rail during today's visit. A physician order for half-bed rail, must be obtain prior to putting the half bed rail back.