BALBOA ISLAND BOARD & CARE

Official classification

Type A

Official code

87355(e)

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: This requirement is not met as evidenced by: Deficient Practice Statement Based on the review of the Department's Guardian rosters, S1 was not associated to the facility during their employment which poses an immediate Health, Safety, and/or Personal Rights risk to persons in care.

Official plan of correction

POC Due Date: 02/12/2026 Plan of Correction Licensee stated they will ensure S1 is associated to the facilty via and will send proof transfer forms submitted to CCLD by POC due date.

Official classification

Type B

Official code

87412(d)

Regulation authority

CCR

What the official deficiency says

(d) The licensee shall maintain documentation that an administrator has met the certification requirements specified in Section 87406, Administrator Certification Requirements or the recertification requirements in Section 87407, Administrator Recertification Requirements. This requirement is not met as evidenced by: Deficient Practice Statement Based on interview and record review, the licensee did not comply with the section cited above, which poses a potential health and saftety risk to persons in care. Records reviewed and interviews conducted revealed the facility does not have a current administrator as the former administrator admitted not completing CEU courses required prior to June 2022.

Official plan of correction

POC Due Date: 03/12/2026 Plan of Correction Licensee stated they will ensure all CEU course are completed and will send proof records sent to CAB via email to LPA by POC due date.

Official classification

Type B

Official code

1569.695(a)

Regulation authority

HSC

What the official deficiency says

(a)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: This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above as there were no available disaster prepeardiness plan or infection control plan available for review; which poses a potential health and safety risk to persons in care.

Official plan of correction

Administrator will aquire infection control plan and disaster preparidness plan. AD will have the plans filled out and send proof of correction via email to LPA Vanegas by P.O.C due date

Deadline recorded: Apr 29, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87411(f)

Regulation authority

CCR

What the official deficiency says

(f) All personnel, including the licensee and administrator, shall be in good health, and physically and mentally capable of performing assigned tasks. Good physical health shall be verified by a health screening, including a chest x-ray or an intradermal test, performed by a physician not more than six (6) months prior to or seven (7) days after employment or licensure. A report shall be made of each screening, signed by the examining physician. The report shall indicate whether the person is physically qualified to perform the duties to be assigned, and whether he/she has any health condition that would create a hazard to him/herself, other staff members or residents. A signed statement shall be obtained from each volunteer affirming that he/she is in good health.Personnel with evidence of physical illness or emotional instability that poses a significant threat to the well-being of residents shall be relieved of their duties. 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 one out of three staff members no having a staff file with all required documentation; which poses a potential health risk to persons in care.

Official plan of correction

POC Due Date: 03/17/2025 Plan of Correction Administrator will ensure to get required staff records and create a folder for staff member. Administrator will send proof of correction via email to LPA Vanegas by P.O.C 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 one out of three staff members not having an availiable staff file to review; which poses a potential health risk to persons in care.

Official plan of correction

POC Due Date: 03/17/2025 Plan of Correction Administrator will ensure to get required staff records and create a folder for staff member. Administrator will send proof of correction via email to LPA Vanegas by P.O.C due date

Official classification

Type B

Official code

87506(b)

Regulation authority

CCR

What the official deficiency says

(b) Each resident's record shall contain at least 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 one out of two residents not having an available resident record for review; which poses a potential health risk to persons in care.

Official plan of correction

POC Due Date: 03/17/2025 Plan of Correction Administrator will create a resident file for resident in care, and send proof of correction to LPA Vanegas via eamil by P.O.C due date.

Official classification

Type B

Official code

1569.695(a)

Regulation authority

HSC

What the official deficiency says

(a)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: This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above as there were no available disaster prepeardiness plan or infection control plan available for review; which poses/posed a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 03/17/2025 Plan of Correction Administrator will aquire infection control plan and disaster preparidness plan. AD will have the plans filled out and send proof of correction via email to LPA Vanegas by P.O.C due date.

Official classification

Type A

Official code

87705(f)(1)

Regulation authority

CCR

What the official deficiency says

This requirement is not met as evidenced by: Deficient Practice Statement 87705 :Care of Persons with Dementia (f)(1)(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 was not met as evidence by: Kitchen cabinet where knives are kept locked was unlocked. Caregiver Rose Breton indicated " It's broken, doesn't work. " This poses an immediate risk to residents in care.

Official plan of correction

POC Due Date: 04/01/2022 Plan of Correction On today's date at 11:28am, Caregiver Rose Breton removed kitchen knives from kitchen cabinet not working and placed the knives in secured cabinet where medications are securely being stored. L/AD Cynthia Barton will have kitchen cabinet door repaired and submit proof of repair to LPA Quiroz by 4/1/2022.

Official classification

Type A

Official code

87303(2)

Regulation authority

CCR

What the official deficiency says

This requirement is not met as evidenced by: Deficient Practice Statement 87303 Maintenance and Operation (2)Faucets used by residents for personal care...not less than 105 degree F (41 degree C) and not more than 120 degree F (49 degree C). This requirement was not met as evidence by: At 12:10pm, LPA Quiroz recorded water temperature to be 139.1 in resident hallway restroom. L/AD Barton indicated " I knew it was high, it's a new heater. I will call plumber and schedule him to bring water temperature down. " This poses an immediate risk to residents in care.

Official plan of correction

POC Due Date: 04/08/2022 Plan of Correction On today's date at 12:17pm, L/AD Cynthia Barton called Plumber and scheduled appointment to bring down facility water temperature down. L/AD Cynthia Barton will record water temperature for 7 consecutive days and submit proof of repair to LPA Quiroz by 4/8/2022.