LOS TIEMPOS SENIOR LIVING #3

Official classification

Type A

Official code

87202(a)

Regulation authority

CCR

What the official deficiency says

87202 Fire Clearance (a) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department, or district providing fire protection services, or the State Fire Marshal. This requirement was not met as evidenced by: Based on observations and interviews, an office was built in the garage not approved by the current fire clearance, which poses an immediate Health, Safety, or Personal Rights risk to persons in care.

Official plan of correction

Licensee stated that they will request a new fire clearance inspection in writing, submit a LIC200, and provide a copy of the current and new facility sketch to the Department by POC due date.

Deadline recorded: Apr 30, 2026. 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

87355 (e)(3) All individuals subject to a criminal record review... shall prior to working, residing or volunteering in a licensed facility: (3)Request a transfer of a criminal record clearance... This requirement is not met as evidenced by Based on observation, interview, and record review, the licensee did not comply with the section cited above. LPAs reviewed S1’s record and found that they are not associated with the facility. This poses an immediate health, and safety, risk to persons in care.

Official plan of correction

The Licensee stated they will associate S1 to the facility and submit a written statement of acknowledgement and understanding to CCLD via email by POC due date.

Deadline recorded: Mar 6, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87355(e)(2)

Regulation authority

CCR

What the official deficiency says

All individuals subject a criminal record review pursuant to H & S code section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (2) obtain a california clearance or criminal record exemption as required by the department This requirement is not met as evidenced by: Staff 1 is not associated to facility Los Tiempos Senior Living #3- 306004791 Deficient Practice Statement Based on record review, the licensee did not comply with the section cited above in two out of five persons which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/03/2025 Plan of Correction Licensee to associate staff 1 and 2 to facility #306004791 by Plan of Correction (POC) due date September 3, 2025 and email proof to Department.

Official classification

Type B

Official code

87506(b)(17)(E)(F)

Regulation authority

CCR

What the official deficiency says

Each resident's record shall contain at least the following information: (17) Documents and info required by the following (E) section 87463 reappraisals and (F) section 87505 documentation and support. This requirement is not met as evidenced by: Four of six residents (R1,R2,R4 & R5) are missing reappraisal Deficient Practice Statement Based on record review the licensee did not comply with the section cited above in four out of six persons which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/09/2025 Plan of Correction Licensee to update Appraisals for R1, R2, R4 & R5 and submit proof to department by Plan of correction due date 9/9/2025.

Official classification

Type B

Official code

1569.69(a)

Regulation authority

HSC

What the official deficiency says

Each residential care facility for the elderly licensed under this chapter shall that each employee of the facility who assists residents with the self administration of medications meets all the following training requirements. This requirement is not met as evidenced by: three of five staff (S1, S2 & S3) are missing required medication training. Deficient Practice Statement Based on record review, the licensee did not comply with the section cited above in three out of five persons which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/09/2025 Plan of Correction Licensee to provide proof of medication training to department by plan of correction due date 9/9/2025.

Official classification

Type B

Official code

87307(d)(7)

Regulation authority

CCR

What the official deficiency says

(7) Fireplaces and open-faced heaters shall be adequately screened. 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 2 out of 2 fireplaces, LPAs observed the fireplace in the dining room and the fireplace in the living room are not screened which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 09/25/2024 Plan of Correction Licensee agrees to have install fireplace screens for both fireplaces. LIcensee to forward proof to LPA by POC due date.

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 3 out of 3 members which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/10/2024 Plan of Correction Licensee agrees to have all 3 staff members trained to meet the regulatory requirements. Licensee to forward proof to LPA by POC due date.

Official classification

Type B

Official code

87465(h)(5)

Regulation authority

CCR

What the official deficiency says

(h) The following requirements shall apply to medications which are centrally stored: (5) Each resident's medication shall be stored in its originally received container. No medications shall be transferred between containers. 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 6 out of 6 residents' medication which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/17/2024 Plan of Correction Licensee agrees to keep residents medication in its original container until administered. Licensee to provide a signed stated certifying they have read and understand regulation 87465.

Official classification

Type B

Official code

87458(a)

Regulation authority

CCR

What the official deficiency says

(a) Prior to a person's acceptance as a resident, the licensee shall obtain and keep on file, documentation of a medical assessment, signed by a physician, made within the last year. The licensee shall be permitted to use the form LIC 602 (Rev. 9/89), Physician's Report, to obtain the medical assessment. 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 out of 6 resident files, R3 did not have a current medication assessment, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/25/2024 Plan of Correction Licensee agrees to get a new updated medical assessment for R3 and to submit proof to LPA by the POC due date.

Official classification

Type B

Official code

1569.695(c)

Regulation authority

HSC

What the official deficiency says

(c) A facility shall conduct a drill at least quarterly for each shift. The type of emergency covered in a drill shall vary from quarter to quarter, taking into account different emergency scenarios. An actual evacuation of residents is not required during a drill. While a facility may provide an opportunity for residents to participate in a drill, it shall not require any resident participation. Documentation of the drills shall include the date, the type of emergency covered by the drill, and the names of staff participating in the drill. 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, there is no documentation that the facility conducted an emergency drill in 2024, which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 09/25/2024 Plan of Correction Licensee agrees to conduct an emergency disaster drill and to document it before the POC due date. Licensee agree to conduct emergency drills every quarter in compliance with the regulation above.

Official classification

Type B

Official code

87705(f)(1)

Regulation authority

CCR

What the official deficiency says

(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 is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above, LPA observed the drawer which stores the knives did not have a working lock which poses a potential health and safety or personal risk to persons in care.

Official plan of correction

POC Due Date: 09/17/2024 Plan of Correction