SOLIVEN CARE HOME

Official classification

Type B

Official code

87211(1)(D)

Regulation authority

CCR

What the official deficiency says

87211 Reporting Requirements (1) A written report shall be submitted... within seven days of the occurrence of any of the events specified... below. This report shall include the resident's name, age, sex and date of admission; date and nature of event; attending physician's name, findings, and treatment, if any; and disposition of the case. (D) Any incident which threatens the welfare, safety or health of any resident, such as psychological abuse of a resident by staff or other residents, or unexplained absence of any resident. This requirement is not being met as evidenced by: The admission by Licensee Soliven, that the responsible party was not notified regarding R1’s change in condition and there was no incident report sent to the department regarding R1’s hospitalization.

Official plan of correction

Licensee Soliven agrees to review the reporting requirements and email LPA Haley a signed statement of acknowledgement and understanding of the reporting requirements. Licensee Soliven will also inform LPA who will be the primary person responsible for reporting incidents to the department and the back up person responsible, in case the primary person is unavailable. POC is due by 4:00pm on the POC due date.

Deadline recorded: Oct 31, 2025. 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 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 confirmation, the licensee did not comply with the section cited above, as Resident 1 (R1) unsecured medication was observed in a pill container sitting on a night stand in the residents room which poses an immediate health and safety risk to persons in care. Medications were removed immediately.

Official plan of correction

POC Due Date: 10/29/2025 Plan of Correction Licensee agrees to conduct an in-service training on medications administration and medication storage. Licensee Soliven will email LPA Haley a sign in sheet for all staff in attendance of the medication training, as well as an outline of the topics covered and the duration of the in-service training. POC will be emailed to LPA Haley by 4:00pm on the POC due date.

Official classification

Type A

Official code

87303(f)

Regulation authority

CCR

What the official deficiency says

Maintenance and Operation (f) All waste shall be located, stored and disposed of in a manner that will not transmit communicable diseases or odord, pose a risk to health and safety, or provide a breeding place or food source for insects or rodents. 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 as fallen fruit and dog feces was observed on the ground in the backyard. The fallen fruit was in various stages of decomposition and the dog feces was left behind was also mixed in variety, with some of the feces fresher than other feces that was observed, which poses an immediate health, safety and personal rights risk to persons in care. Photos were taken.

Official plan of correction

POC Due Date: 10/29/2025 Plan of Correction Licensee Soliven agrees to clean the backyard and remove all the fallen fruit and dog feces and email LPA Haley a photo of the clean backyard. Licensee will also include a schedule of the ongoing cleaning that will be conducted in the backyard with a list of who will be responsible for the cleaning on the scheduled cleaning days. POC will be emailed to LPA Haley by 4:00pm on the POC due date.

Official classification

Type B

Official code

87463(h)

Regulation authority

CCR

What the official deficiency says

Reappraisals (h) The licensee shall request that all residents receive an annual routine visit with a licensed medical professional once every twelve months, either in person or by video appointment. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and interview confirmation, the licensee did not comply with the section cited above, as 2 of 5 residents had a physicians report older than one year old which poses a potential health and safety risk to residents in care.

Official plan of correction

POC Due Date: 10/31/2025 Plan of Correction Licensee Soliven will schedule a routine visit for the two residents by the poc due date and email LPA Haley the scheduled appointment information. Once the visits are completed, the updated physicians report will be emailed to LPA Haley.

Official classification

Type B

Official code

87303

Regulation authority

CCR

What the official deficiency says

Maintenance and Operation (2) The facility shall be clean, safe, sanitary, and in good repair at all times... 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 as old furniture items no longer being used were observed in the backyard under the shaded patio area which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/31/2025 Plan of Correction Licensee Soliven will have all the items removed from the backyard and a photo will be emailed to LPA Haley once completed. The correction is due by 4:00pm on the POC due date.

Official classification

Type A

Official code

87355(e)(1)

Regulation authority

CCR

What the official deficiency says

87355 Criminal Record Clearance (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: (1) Obtain a California clearance or a criminal record exemption as required by the Department. This requirement is not met as evidence by: Per LIS Facility Personnel Report Summary S1 is not associated and/or cleared to work, reside or volunteer at the facility.

Official plan of correction

Administrator agrees to obtain a background clearance for S1 to work at the facility. Licensee agress to sent S1 to go get background clearance today. Licensee to provide proof of POC via email by POC due date.

Deadline recorded: Aug 2, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.1(a)(11)

Regulation authority

CCR

What the official deficiency says

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: (11)To have their visitors...permitted to visit privately during reasonable hours and without prior notice, provided that the rights of other residents are not infringed upon. This requirement is not met as evidenced by: During the course of the interviews the AD reported that he told R1's friend that he needed to contact the Power of Attorney (POA) before visiting R1.

Official plan of correction

Licensee/Administrator agrees to read regulation and sign a statement of understanding and forward proof to LPA by POC due date.

Deadline recorded: Aug 5, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include the 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: During the inspection LPA Haley observed a broken bedroom window, a missing door knob, and a missing knob on the stove. Administrator Soliven was present and acknowledged the presence of the broken window, missing door knob and missing knob on the stove. Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above which poses potential safety risk to persons in care.

Official plan of correction

POC Due Date: 11/04/2022 Plan of Correction Administrator Soliven will order a new knob for the stove, replace the door knob on the exit door in the kitchen, and have the broken window in his room replaced.