NS CARE

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, which poses an immediate risk to the health and safety of persons in care. LPA did not observe any carbon monoxide detectors installed/operational during the visit.

Official plan of correction

POC Due Date: 12/05/2025 Plan of Correction Licensee stated they will purchase and install carbon monoxide detector and submit proof to CCLD 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, which poses an immediate health and safety risk to persons in care. LPA observed toxins and sharps unsecured throughout the facility.

Official plan of correction

POC Due Date: 12/05/2025 Plan of Correction Licensee secured all hazardous items, stated they will conduct a training for staff and submit proof to CCLD 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 observation and record review, the licensee did not comply with the section cited above, which poses an immediate health and safety risk to persons in care. LPA did not observe any record of First Aid and CPR training for staff.

Official plan of correction

POC Due Date: 12/05/2025 Plan of Correction Licensee stated they will ensure staff complete first aid and CPR and submit proof to CCLD by POC due date.

Official classification

Type A

Official code

87413(a)(1)

Regulation authority

CCR

What the official deficiency says

(1) When regular staff members are absent, there shall be coverage by personnel with qualifications adequate to perform the assigned tasks. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and record review, the licensee did not comply with the section cited above, which poses an immediate health and safety risk to persons in care. Licensee stated S2 works M-F and S1 covers all other shifts. There are currently three non-ambulatory residents in care.

Official plan of correction

POC Due Date: 12/05/2025 Plan of Correction Licensee stated they hire addition staff to care for three residents in care and submit proof to CCLD by POC due date.

Official classification

Type A

Official code

87412(f)

Regulation authority

CCR

What the official deficiency says

(f) All personnel records shall be available to the licensing agency to inspect, audit, and copy upon demand during normal business hours. Records may be removed if necessary for copying. Removal of records shall be subject to the following requirements: This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and record review, the licensee did not comply with the section cited above, which poses an immediate health and safety risk to persons in care. The licensee provided 1 out of 4 staff files during inspection. No additional records were available.

Official plan of correction

POC Due Date: 12/05/2025 Plan of Correction Licensee stated they complete all staff files and submit proof to CCLD by POC due date.

Official classification

Type A

Official code

87412(a)(13)

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: (13) For employees that are required to be fingerprinted pursuant to Section 87355, Criminal Record Clearance: 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. LPA reviewed Guardian roster and did not observe a background clearance or association for S3 and S4. The two indiviuals are not associated with the facility. This poses an immediate health, safety, and personal rights risk to persons in care. CIVIL PENALTIES ASSESSED.

Official plan of correction

POC Due Date: 12/05/2025 Plan of Correction The Licensee stated they will request background clearance and associate S3 and S4 to the facility. Licensee will submit proof to CCLD via email by POC due date.

Official classification

Type A

Official code

87555(b)(28)

Regulation authority

CCR

What the official deficiency says

(b) The following food service requirements shall apply: (28) All food shall be protected against contamination. Contaminated food shall be discarded immediately upon discovery. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above, which poses an immediate health and safety risk to persons in care. LPA observed expired perishable and non-perishable items.

Official plan of correction

POC Due Date: 12/05/2025 Plan of Correction LPA observed Licensee dispose of expired perishable and non-perishable items. Licensee stated they will grocery shop this evening and check food items weekly. Licensee stated they will conduct training for all staff and submit proof to CCLD by POC due date.

Official classification

Type A

Official code

87465(a)(6)

Regulation authority

CCR

What the official deficiency says

(6) When requested by the prescribing physician or the Department, a record of dosages of medications which are centrally stored shall be maintained by the facility. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and record review, the licensee did not comply with the section cited above, which poses an immediate health and safety risk to persons in care. LPA observed the facility does not keep a record of centrally stored medication for three out of three residents in care.

Official plan of correction

POC Due Date: 12/05/2025 Plan of Correction Licensee stated they will review the Title 22 regulations and conduct training for all staff. Licensee will submit proof to CCLD by POC due date.

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 record review, the licensee did not comply with the section cited above, which poses an immediate health and safety risk to persons in care. LPA observed medications for current and former residents, unsecured throughout the facility.

Official plan of correction

POC Due Date: 12/05/2025 Plan of Correction Licensee stated they will remove and secure all medication, properly dispose of all former resident medication and discontinued medication for current residents, and conduct a training for staff. Licensee stated they will submit proof to CCLD by POC due date.

Official classification

Type A

Official code

87465(h)(4)

Regulation authority

CCR

What the official deficiency says

(h) The following requirements shall apply to medications which are centrally stored: (4) All centrally stored medications shall be labeled and maintained in compliance with state and federal laws. No persons other than the dispensing pharmacist shall alter a prescription label. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and record review, the licensee did not comply with the section cited above, which poses an immediate health and safety risk to persons in care. LPA observed three or more medication bottle and pills without label and out of compliance with state and federal laws.

Official plan of correction

POC Due Date: 12/05/2025 Plan of Correction Licensee stated they will properly dispose of medications without labels and conduct a training for staff. Licensee stated they will submit proof to CCLD by POC due date.

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

(a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include 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: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above in one out of five stove burners that were non operational, which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 12/12/2025 Plan of Correction Licensee stated they will have burner repaired or purchase new stove and submit proof to CCLD via email by POC due date.

Official classification

Type B

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, which poses a potential health and safety risk to persons in care. LPA observed a large amount of clutter in garage with no available walkways. LPA observed 4 or more areas of dog feces in backyard, dog hair in several areas throughout the facility, and unsanitary conditions in the kitchen used for residents in care. LPA also observed several knats in kitchen.

Official plan of correction

POC Due Date: 12/12/2025 Plan of Correction Licensee stated they will de-clutter and deep clean all areas, inside and outside the physical plant and schedule a bulk trash pick up by POC. Licensee also stated they will hire a professional pest control company to treat all areas of the facility and purchase items to prevent future pest. Licensee stated they will submit proof to CCLD via email by POC due date.

Official classification

Type B

Official code

87463(a)

Regulation authority

CCR

What the official deficiency says

(a) The pre-admission appraisal, as specified in Section 87457, Pre-Admission Appraisal, shall be updated, in writing as frequently as necessary or once every 12 months, whichever occurs first, to note significant changes in condition, as defined in Section 87101, Definitions, and to keep the appraisal accurate. For the purposes of this section, the updated pre-admission appraisal shall be referred to as the reappraisal. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and record review, the licensee did not comply with the section cited above, which poses an potential health and safety risk to persons in care. LPA observed incomplete records for three out of three residents in care. LPA observed missing Needs and Service Plans, Consent Forms, ID & Emergency Contacts Forms, and Personal Rights.

Official plan of correction

POC Due Date: 12/12/2025 Plan of Correction Licensee stated they will work with residents and families to complete all requires licensing forms and submit proof to CCLD by POC due date.

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 interview and record review, the licensee did not comply with the section cited above. LPA reviewed Guardian Roster and confirmed I1’s is not background cleared and associated with the facility. This poses an immediate health, safety, and personal rights risk to persons in care.

Official plan of correction

The Licensee stated they do not wish to employee I1 and will ensure the individual will no longer have contact with residents in care.

Deadline recorded: Oct 21, 2025. 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. LPA reviewed S1’s record that they are not associated with the facility. This poses an immediate health, safety, and personal rights risk to persons in care.

Official plan of correction

The Licensee stated they will associate S1 to the facility and submit proof to CCLD via email by POC due date.

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

Official classification

Type B

Official code

87465(a)(1)

Regulation authority

CCR

What the official deficiency says

87465(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 is not met as evidenced by: Based on interview and record review, the licensee did not comply with the section cited above. LPA reviewed R1’s record that medical appointments for labratory and OBGYN were not scheduled by facility. This poses a potential health, safety, and personal rights risk to persons in care.

Official plan of correction

The Licensee stated they will ensure appointments are schduled for R1 by the facility, and submit proof to CCLD via email by POC due date.

Deadline recorded: Oct 27, 2025. A deadline is not proof that correction was completed.

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 LPAs file review and interviews, the licensee did not comply with the section cited above in four of four staff which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/19/2024 Plan of Correction Administrator (AD) will have four of four staff do online CPR/ First Aid training within 24 hours and email LPA Ruppert with course completion certificates.

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 LPAs file review and interview the licensee did not comply with the section cited above in four of four staff which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/25/2024 Plan of Correction Administrator (AD) will complete LIC 503 Health Screening and show documentation that four of four staff are TB cleared. AD will email LIC 503s by POC date.

Official classification

Type B

Official code

1569.695(e)(3)

Regulation authority

HSC

What the official deficiency says

(e) A facility shall have all of the following information readily available to facility staff during an emergency: (3) A resident medication list for residents with centrally stored medications. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPAs record review, observations and interview, the licensee did not comply with the section cited above in six of six residents which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/25/2024 Plan of Correction Administrator (AD) will create and update Medication Administration Records (MAR) for six of six residents and submit to LPA Ruppert via email by POC due date.

Official classification

Type A

Official code

87355(a)

Regulation authority

CCR

What the official deficiency says

87355(a) Criminal Record Clearance. (a) The Department shall conduct a criminal record review of all individuals... and shall have the authority to approve or deny... presence in the facility, based upon the results of such review. This requirement was not met as evidenced by: CONT CONT...Based on file review and interview, the Facility did no secure criminal background clearance for CG1. CG1 was allowed to work at the facility and have direct contact with the residents without criminal background clearance since 6/6/24 at 8am. CONTINUE...

Official plan of correction

LPA Quiroz requested for CG1 to leave premises immediately. L/AD Sofrani indicated he will work and relieve CG1. Immediate risks reduced. Immediate civil penalty was assessed. This poses immediate threat to safety of the residents in care. (see LIC 421BG)

Deadline recorded: Jun 6, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87307(d)(6)

Regulation authority

CCR

What the official deficiency says

87307(d)(6) Personal Accommodations and Services: (d)The following space and safety provisions shall apply to all facilities:(6)All outdoor and indoor passageways and stairways shall be kept free of obstruction...At 4:25pm, while conducting tour of CONTINUED CONT..facility premises, LPA Quiroz observed 3 vehicles parked on facility driveway and 2 vehicles on side walk/street of which 3 of 5 have expired tags and 1 of 5 is not operable. (L/AD) Sofroni indicated " Yeah they still have expired tags, and the 69 Chevy...CONTINUE...

Official plan of correction

L/AD Sofrani will remove 3 of 5 vehicles with expired tags from facility driveway by POC due date of 6/10/2024. CONT... Nova has bad battery. Three of the cars are not permitted to be operated on the public road until tags are renewed. " This poses a potential risk to residents in care.

Deadline recorded: Jun 6, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87203

Regulation authority

CCR

What the official deficiency says

87203: Fire Safety-All facilities shall be maintained in conformity with the regulations adopted by the State Fire Marshal for the protection of life and property against fire and panic. This requirement is not being met as evidenced by: At 4:30pm while CONT...conducting tour in the garage area, LPA Quiroz observed clutter and not able to walk through the garage area. This was verified with (L/AD) Sofroni who indicated " Yeah, it's still bad. I know need to clean it. " This poses a potential risk to residents in care

Official plan of correction

(L/AD) Sofroni agreed to have garage cleaned by POC due date of 6/13/2024 and submit proof of correction via pictures email to CCL by POC due date.

Deadline recorded: Jun 6, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87203

Regulation authority

CCR

What the official deficiency says

87203: Fire Safety-All facilities shall be maintained in conformity with the regulations adopted by the State Fire Marshal for the protection of life and property against fire and panic. This requirement is not being met as evidenced by: At 1:02pm while CONT... CONT...conducting tour in the garage area, LPA Quiroz observed clutter and not able to walk through the garage area. This was verified with (L/AD) Sofroni who indicated " Yeah, it's bad. I know need to clean it. " This poses a potential risk to residents in care

Official plan of correction

(L/AD) Sofroni agreed to have garage cleaned by POC due date of 3/19/2024 and submit proof of correction via pictures email to CCL by POC due date.

Deadline recorded: Mar 19, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87307(d)(6)

Regulation authority

CCR

What the official deficiency says

87307(d)(6) Personal Accommodations and Services: (d)The following space and safety provisions shall apply to all facilities:(6)All outdoor and indoor passageways and stairways shall be kept free of obstruction. At 12:33pm, while conducting tour of outdoor premises, LPA Quiroz observed CONT...

Official plan of correction

4 vehicles parked on facility driveway, of which 3 of 4 have expired tags. " Yeah they have expired tags and not permitted to be operated on the public road until tags are renewed. " (L/AD) Sofroni agreed to have all current registrations for all vehicles on facility driveway and to operable by POC due date of 3/21/2024.

Deadline recorded: Mar 21, 2024. A deadline is not proof that correction was completed.