CROWN COVE

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 observations the licensee did not comply with the cited above as the laundry room in Memory Care was unlocked the toxins in the room were also unsecured. This poses an immediate health and safety to persons in care.

Official plan of correction

POC Due Date: 11/21/2025 Plan of Correction Corrected during visit.

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 observations and records reviewed the licensee did not comply with the cited above in 2 out of 6 staff members files reviewed. This poses an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 12/05/2025 Plan of Correction Administrator stated will provide proof of training by POC due date.

Official classification

Type A

Official code

87411(a)

Regulation authority

CCR

What the official deficiency says

(a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. In facilities licensed for sixteen or more, sufficient support staff shall be employed to ensure provision of personal assistance and care as required in Section 87608, Postural Supports. Additional staff shall be employed as necessary to perform office work, cooking, house cleaning, laundering, and maintenance of buildings, equipment and grounds. The licensing agency may require any facility to provide additional staff whenever it determines through documentation that the needs of the particular residents, the extent of services provided, or the physical arrangements of the facility require such additional staff for the provision of adequate services. This requirement is not met as evidenced by: Deficient Practice Statement Based on records reviewed and observations the licensee did not comply with the cited above, per Non Compliance Conference held on 09/05/2025, Licensee agreed to maintain a staffing ratio of 1 caregiver to 7 residents, per review there are 18 residents in Memory Care and only 2 caregivers. This poses an immediate health and safety risks to persons in care.

Official plan of correction

POC Due Date: 11/22/2025 Plan of Correction Administrator agreed to schedule 3 caregivers per shift and 2 med-techs for Memory Care and provide schedule to LPA by POC due date.

Official classification

Type A

Official code

87463(h)

Regulation authority

CCR

What the official deficiency says

(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 records reviewed the licensee did not comply with the cited above in 3 out of 9 residents as their LIC 602 Physician's Report for Resident 3, Resident 6 and Resident 7 listed on LIC 858-C over a year old. This poses an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 12/05/2025 Plan of Correction Administrator agreed to have Resident 3, Resident 6 and Resident 7 have updated LIC 602s and provide proof to LPA by POC due date.

Official classification

Type A

Official code

87606(c)

Regulation authority

CCR

What the official deficiency says

(c) To accept or retain a person who is bedridden, other than for a temporary illness or recovery from surgery, a licensee shall obtain and maintain an appropriate fire clearance as specified in Section 87202, Fire Clearance. This requirement is not met as evidenced by: Deficient Practice Statement Based on observations and records reviewed the licensee did not comply with the cited above as Resident 3 listed on LIC 858. Resident 3 is noted as bedridden, the faciltiy is not licensed to accept bedridden residents. This poses an immediate health and safety risks.

Official plan of correction

POC Due Date: 11/22/2025 Plan of Correction Administrator stated will obtain a new LIC 602 physician report with an updated ambulatory status.

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 records reviewed the licensee did not comply with the cited above in 6 out of 6 staff did not have the required 4 hours of training on the following : postural support, restricted health conditions and hospice care. This poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 12/05/2025 Plan of Correction Administrator agreed to conduct training in the following areas: postural support, restricted health conditions and hospice care and provide proof to LPA by POC due date.

Official classification

Type B

Official code

87468(c)(2)(A)

Regulation authority

CCR

What the official deficiency says

(c) Licensees shall prominently post personal rights, nondiscrimination notice, and complaint information in areas accessible to residents, representatives, and the public. (2) Information on the appropriate reporting agency in case of a complaint or emergency, including procedures for filing confidential complaints, shall be posted as follows: (A) Licensees may use the Residential Care Facility for the Elderly (RCFE) Complaint Poster (PUB 475) or may develop their own poster as provided in this section. A poster developed by the licensee shall contain the same content as the PUB 475. The poster that is posted shall be 20” x 26” in size and be posted in the main entryway of the facility. PUB 475 may be accessed, downloaded, and printed from the www.ccld.ca.gov website. This requirement is not met as evidenced by: Deficient Practice Statement Based on observations the licensee did not comply with the cited above as there was no PUB poster in the faciltiy. This poses a potential personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/28/2025 Plan of Correction Administrator to purchase PUB 475 and provide proof to LPA by POC due date.

Official classification

Type B

Official code

1569.695(a)(2)

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: (2) Plans for the facility to be self-reliant for a period of not less than 72 hours immediately following any emergency or disaster, including, but not limited to, a short-term or long-term power failure. If the facility plans to shelter in place and one or more utilities, including water, sewer, gas, or electricity, is not available, the facility shall have a plan and supplies available to provide alternative resources during an outage. This requirement is not met as evidenced by: Deficient Practice Statement Based on observations made licensee did not comply with the cited above. LPA Mendivil and LPA Lyman observed 3 cases of water for the entire building. This poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 11/28/2025 Plan of Correction Administrator agreed to purchase more cases of water and provide proof to LPA by POC due date.

Official classification

Type B

Official code

1569.695(d)

Regulation authority

HSC

What the official deficiency says

(d) A facility shall review the plan annually and make updates as necessary, including changes in floor plans and the population served. The licensee or administrator shall sign and date documentation to indicate that the plan has been reviewed and updated as necessary. This requirement is not met as evidenced by: Deficient Practice Statement Based on records reviewed and observation the licensee did not comply with the cited above as the last signature for review was in 2022 from previous executive director. This poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 11/28/2025 Plan of Correction Admininstrator stated will review plan and provide proof to LPA by POC due date.

Official classification

Type B

Official code

87465(a)(4)

Regulation authority

CCR

What the official deficiency says

Incidental Medical and Dental Care: (a) A plan for incidental medical and dental care shall be developed by each facility... (4) The licensee shall assist residents with self-administered medications as needed. This requirement is not met as evidence by: based on documents and interviews, the staff did not ensure R1 received their medication as prescribed on multiple days and times. R1 missed multiple doses for 9 medications from September 1, 2022 to November 30, 2022. This poses an immediate health and safety risk to persons in care

Official plan of correction

Executive director stated they will provide in-house medication training with all staff on cited regulation and addressing importance of giving the residents their medication as prescribed. The proof of training will be submitted to the LPA via email POC date.

Deadline recorded: Oct 21, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87464(f)(1)

Regulation authority

CCR

What the official deficiency says

Basic Services. Basic services shall at a minimum include: Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). This requirement was not met as evidence by Licensee did not ensure R1... was assisted with food services resulting in R1 reporting they spilled coffee or hot liquids on themselves. As a result, R1 sustained blisters on their chest. This poses an immediate health and safety risks to persons in care.

Official plan of correction

Executive Director to conduct in services about residents needs in dining and potential use of adaptive utensils/cups. Immediate Civil Penalty issued * Manual 421IM form used due to technical difficulties

Deadline recorded: Jun 2, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87506(e)

Regulation authority

CCR

What the official deficiency says

(e) Original records or photographic reproductions shall be retained for a minimum of three (3) years following termination of service to the resident. This requirement was not met as evidence by facility did not obtain Medication Administration Records from 2023.

Official plan of correction

Executive Director agreed to file all records in one central location and will conduct in services. Executive Director will provide proof by POC due date.

Deadline recorded: Feb 2, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.1(a)(2)

Regulation authority

CCR

What the official deficiency says

87468.1 Personal Rights of Residents in All Facilities (a) … (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This requirement was not met as evidenced by: Based on interviews and documents, the licensee did not ensure R1 had safe, healthful, and comfortable accommodations by permanently closing their window, which poses a potential personal rights risk to persons in care.

Official plan of correction

Licensee stated they understand that windows cannot be permanently closed. Licensee stated they have created a protocol for resident requests for maintenance and will submit recent maintenance records to LPA by POC due date.

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

Official classification

Type A

Official code

87465(a)(1)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care. (a) … (1) The licensee shall arrange, or assist in arranging, for medical and dental care appropriate to the conditions and needs of residents… This requirement was not met as evidenced by Based on documents and interviews, the licensee did not ensure R1, who had known skin issues, received proper assistance and medical care resulting in R1 developing an unstageable wound, which poses an immediate health risk to persons in care.

Official plan of correction

The licensee stated they have created a protocol for preventing pressure injuries in residents with skin issues and mobility issues and that staff have been trained on this protocol. Licensee stated they will submit the protocol and training records to LPA by POC due date.

Deadline recorded: Jul 16, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87466

Regulation authority

CCR

What the official deficiency says

Observation of the Resident. ... When changes … are observed, the licensee shall ensure that such changes are documented and brought to the attention of … the resident's responsible person, if any. This requirement was not met as evidenced by: Based on documents and interviews, the licensee did not ensure R1’s worsening skin condition was noted and brought to the attention of their responsible party, which poses a potential health risk to persons in care.

Official plan of correction

The licensee stated they have created a protocol for documenting skin issues and other changes of condition with residents and notifying their families and doctors and that staff are trained on these protocols. Licensee stated they will submit the protocol and training records to LPA by POC due date.

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

Official classification

Type A

Official code

87468.1(a)(6)

Regulation authority

CCR

What the official deficiency says

87468.1 Personal Rights of Residents in All Facilities. (a) … (6) To leave or depart the facility at any time... This requirement was not met as evidenced by: Based on documents and interviews, the licensee did not licensee did not ensure that R1 was free to leave or depart from the facility without being forced to quarantine in their room upon return, which poses an immediate personal rights risk to persons in care.

Official plan of correction

The licensee previously submitted a plan of correction on 06/12/20 that included a letter to residents and family with an updated policy that does not mandate forced quarantine and has already conducted in-service training to all staff as well. Licensee stated they will submit their current infection control protocols regarding isolation to LPA by POC due date.

Deadline recorded: Jul 16, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(a)(4)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care. (a) … (4) The licensee shall assist residents with self-administered medications as needed. This requirement was not met as evidenced by Based on documents and interviews, the licensee did not ensure R1 received multiple medications as prescribed, which poses an immediate health risk to persons in care.

Official plan of correction

The licensee stated they created a protocol for auditing medications, ordering medications timely, and ensuring residents receive their medications as prescribed and that staff are trained on this protocol. Licensee stated they will submit this protocol and training records to LPA by POC due date.

Deadline recorded: Jul 16, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87464(f)(1)

Regulation authority

CCR

What the official deficiency says

87464 Basic Services (f) Basic services shall at a minimum include: (1) Care and supervision... This requirement was not met as evidenced by: Based on interview and documents, the licensee did not provide adequate supervision to R1 when R1 left the facility without assistance, which posed an immediate safety risk to persons in care.

Official plan of correction

Licensee added motion alarms to the front entryway, created an updated list of residents unable to leave unassisted, and conducted training for staff. LPA confirmed these items during the inspection. POC CLEARED.

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

Official classification

Type B

Official code

87412(c)

Regulation authority

CCR

What the official deficiency says

Licensees shall maintain in the personnel records verification of required staff training and orientation. This requirement is not being met as evidenced by: Based on record review and interviews conducted, Licensee failed to ensure staff training verification is maintained in personnel records. This poses a potential health and safety risk to residents in care.

Official plan of correction

Licensee to conduct training for all staff on schedule and forward proof to LPA by POC due date.

Deadline recorded: Nov 1, 2023. A deadline is not proof that correction was completed.