SHASTA RESIDENTIAL CARE

Official classification

Type A

Official code

87224(a)

Regulation authority

CCR

What the official deficiency says

87224 (a)Eviction Procedures - The licensee may evict a resident for one or more of the reasons listed in Section 87224(a)(1) through (5). Thirty days written notice to the resident is required...This requirement was not met as evidenced by: Based on interview confirmation, Resident 1 (R1) was not allowed to come back to the facility after a visit to the hospital on May 5, 2026. R1 was discharged from the hospital May 5, 2026 and Licensee/Administrator stated to LPA that they do not have to accept the resident back.

Official plan of correction

Licensee/Administrator Kevin Dinh agrees to read and review regulation section 87224 Eviction Procedures, and send LPA Bentley a signed statement of acknowledgement and understanding by end of day on POC due date of July 16, 2026.

Deadline recorded: Jul 16, 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. LPA reviewed S1 & S2’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 & S2 to the facility and submit a written statement of acknowledgement and understanding to CCLD via email by POC due date.

Deadline recorded: Mar 10, 2026. A deadline is not proof that correction was completed.

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 oberservation and interview, the licensee did not comply with the section cited above in three out of three bathrooms and garage cabinet where toxins were found unlocked. LPA also observed caregiver leave kitchen with sharps in kitchen drawer unlocked, which poses an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 05/24/2025 Plan of Correction Facility staff locked up the toxins and sharps during the inspection. LIcensee stated they will re-train the facility staff on safely storing chemicals and sharps. Licensee stated they will email LPA the content covered in the training, training attendees and the date and time of training and email to CCLD by 5pm on 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 oberservation and interview, the licensee did not comply with the section cited above three out of six residents medications, which poses an immediate health and safety risk to persons in care. LPA observed three different residents medications unlocked. Multiple medications in Resident #1 (R1) drawers, three medications in an unlocked refrigerator in the unlocked garage for Resident #2 (R2), and on in a common area in the living room for Resident #3 (R3).

Official plan of correction

POC Due Date: 05/24/2025 Plan of Correction Facility staff locked up all medications during the inspection. LIcensee stated they will re-train the facility staff on safely storing medications. Licensee stated they will email LPA the content covered in the training, training attendees and the date and time of training and email to CCLD by 5pm POC due date.

Official classification

Type B

Official code

87202(a)

Regulation authority

CCR

What the official deficiency says

(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. Prior to accepting or retaining any of the following types of persons, the applicant or licensee shall notify the licensing agency and obtain an appropriate 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 is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above in which poses an potential safety and personal rights risk to persons in care. Bedroom # 1, occupied by two residents Resident #3 (R3) and Resident #4 (R4) with clearance for single resident occupancy. Bedroom #3, occupied by two staff Staff #1 (S1) and Staff #2 (S2), is approved fire clearance for single resident occupancy bedroom.

Official plan of correction

POC Due Date: 05/30/2025 Plan of Correction Licensee stated they will submit a written plan when fire clearance facility sketch for Bedroom #1 and Bedroom #3 will be requested and conducted. LIcensee stated they will provide picture to CCLD via email by POC date.

Official classification

Type B

Official code

87307(d)(2)

Regulation authority

CCR

What the official deficiency says

(2) The premises shall be maintained in a state of good repair and shall provide a safe and healthful environment. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and staff interview, the licensee did not comply with the section cited above as a bed and staff's personal belongings were observed in the living room with curtain hanging from ceiling. Staff indicated they sleep onsite in the living room area, which poses a potential safety and personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/30/2025 Plan of Correction Licensee removed the bed and staff's personal belongings during the visit and stated staff will no longer sleep in the living room. LIcensee stated they will provide letter stating changes and picture of living room to CCLD via email by POC date.

Official classification

Type B

Official code

87405(a)

Regulation authority

CCR

What the official deficiency says

87405(a)Administrator - Qualifications and Duties:(a)All facilities shall have a qualified and currently certified administrator...The administrator shall have sufficient freedom from other responsibilities and shall be on the premises a sufficient number of hours to permit adequate attention to the CONT... management and administration of the facility as specified in this section. When the administrator is not in the facility, there shall be coverage by a designated substitute who shall have qualifications adequate to be responsible and accountable...This requirement was not met as evidenced by:

Official plan of correction

AD Kevin Dinh will read and understand CCR 87405, submit proof of understanding of CCR 87405, LIC 500 and designation of responsibility LIC 308 by POC due date of 4/17/2024. Caregivers indicated AD Kevin Dinh on vacation providing first name and phone number of designated person in charge during his absence. CCLD was not notified of AD Dinh's absence. At 3:45pm, AD Jabonero indicated no knowledge of L/AD Kevin Dinh being on vacation. This poses an immediate risk to residents in care.

Deadline recorded: Apr 17, 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

Maintenance and Operation-87303(a): (a) The facility shall be clean, safe, sanitary and in good repair at all times...This requirement is not met as evidenced by, LPA Quiroz observed On or about 2:35pm while conducting tour and interviewing Resident 3, LPA Quiroz observed centrally stored CONT... medication and vitamins stored on shelves in staff bedroom with door unlocked readily available for residents in care.On or about 2:53am while conducting inspection tour of living room and kitchen area, LPA Quiroz observed loose screen door in living room area and staff struggling to open and close

Official plan of correction

door leading to garage door area. This poses a potential risk to residents in care.

Deadline recorded: Apr 17, 2024. A deadline is not proof that correction was completed.