ARC FACILITY AT CAMINO 2

Official classification

Type B

Official code

87205(b)

Regulation authority

CCR

What the official deficiency says

(b) If the licensee is a corporation or an association, the governing body shall be active, and functioning in order to assure accountability. This requirement is not met as evidenced by: Based on records reviewed, the licensee did not comply with the section cited above which poses an potential health, safety and personal rights risk to persons in care. LPA observed that the licensee, Adams Residential Care Facilities LLC, is not active and was suspended on 12/1/11.

Official plan of correction

The Administrator stated that he will be submitting a change of ownership application to the centralized application bureau. The Administrator agreed to provide LPA proof of application submission via email or fax by POC date.

Deadline recorded: May 11, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87205(b)

Regulation authority

CCR

What the official deficiency says

(b) If the licensee is a corporation or an association, the governing body shall be active, and functioning in order to assure accountability. 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 which poses an immediate health, safety or personal rights risk to persons in care. LPA observed that the licensee, Adams Residential Care Facilities, LLC, is not active and was suspended on December 1, 2011.

Official plan of correction

POC Due Date: 01/27/2026 Plan of Correction The Administrator stated that they will submit a written plan on how they will address this deficiency. The Administrator agreed to provide the written plan to LPA via email or fax by POC date.

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 documentation of a medical assessment, signed by a licensed medical professional acting within the scope of their practice and made within the last year, to be kept in the resident's record. 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/posed a potential health, safety or personal rights risk to persons in care. LPA observed that there was no Medical Assessment on file for Resident #1 (R1).

Official plan of correction

POC Due Date: 02/23/2026 Plan of Correction The Administrator stated that he will obtain a Medical Asessment for R1. The Adminstrator agreed to provide LPA the Medical Assessment for R1 via email or fax by POC 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/posed a potential health, safety or personal rights risk to persons in care. LPA observed that the most recent Reappraisal on file for Resident #3 (R3) was completed on 11/03/24.

Official plan of correction

POC Due Date: 02/23/2026 Plan of Correction The Administrator stated that he will complete a new Reappraisal for R3. The Administrator agreed to provide the Reappraisal to R3 to LPA via email or fax by POC date.

Official classification

Type B

Official code

87406(g)

Regulation authority

CCR

What the official deficiency says

(g) Certificates issued under this section shall be renewed every two (2) years provided the certificate holder has complied with all renewal requirements. 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 which poses/posed a potential health, safety or personal rights risk to persons in care. LPA observed that the Administrator listed on file, Michael Adams, does not have a valid Administrator certificate on file, and that there is no pending application at this time.

Official plan of correction

POC Due Date: 02/23/2026 Plan of Correction The Administrator stated that he will complete a written plan on how he will submit a renewal application to the Administrator Certification Bureau. The Administrator stated that he will provide the written plan to LPA via email or fax by POC date.

Official classification

Type B

Official code

87156(a)

Regulation authority

CCR

What the official deficiency says

(a) An applicant or licensee shall be charged fees as specified in Health and Safety Code section 1569.185. 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 which poses/posed a potential health, safety or personal rights risk to persons in care. LPA also observed that the annual fees for the facility were not paid in 2024 or in 2025.

Official plan of correction

POC Due Date: 02/23/2026 Plan of Correction The Administrator stated that he will pay the balance for the facility's annual fees. The Administrator agreed to provide LPA proof of payment for the annual fees via email or fax by POC date.

Official classification

Type A

Official code

87468.1(a)(1)

Regulation authority

CCR

What the official deficiency says

To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement is not being met as evidenced by. The Administrator has yelled at residents as reported by staff and residents, this poses an immediate personal rights violation to residents in care.

Official plan of correction

The Administrator agrees to not yell at residents and to sign a statement of understanding for CCR 87468.1 and submit proof to LPA by the POC due date.

Deadline recorded: Nov 14, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87468.2(a)(1)

Regulation authority

CCR

What the official deficiency says

To have a reasonable level of personal privacy in accommodations, medical treatment, personal care and assistance, visits, communications, telephone conversations, use of the Internet, and meetings of resident and family groups. This requirement is not being met as evidenced by The Administrator walked in R1's room without notice on June 24, 2024, which poses an immediate personal rights violation to residents in care.

Official plan of correction

The Administrator agrees to not interupt and not to walk into residents rooms without notice. Administrator agrees to sign a statement of understanding for CCR 87468.2 and submit proof to LPA by the POC due date.

Deadline recorded: Nov 14, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87555(b)(5)

Regulation authority

CCR

What the official deficiency says

Meals shall consist of an appropriate variety of foods and shall be planned with consideration for cultural and religious background and food habits of residents. This requirement is not being met as evidenced by... The facility does not serve a variet of foods as observed by the LPA. This poses a potentional, health, safety and personal righst risk to residents in care.

Official plan of correction

The Licensee agrees to update the facility menu and to serve a variety of foods and to have each meal be well balanced. Licensee to submit a statement of understanding of CCR 87555 to LPA by the POC due date.

Deadline recorded: Nov 20, 2025. 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

The facility shall be clean, safe, sanitary and in good repair at all times. This requirement is not being met as evidenced by LPA observed the facility has torn carpet in the living room, paint is chipping the kitchen and dining room, the kitchen cabinet doors are broken and the vanity in the bathroom in the hallway is broken. This poses a potential, health, safety and personal rights risk to residents in care.

Official plan of correction

Licensee agrees to fix, repair and clean all items mentioned in the report and to submit proof of the repairs to the LPA by the POC due date.

Deadline recorded: Dec 4, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(h)(6)

Regulation authority

CCR

What the official deficiency says

The licensee shall be responsible for assuring that a record of centrally stored prescription mediciations for each resident is maintained for at least one year and includes: 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 which poses an immediate health, safety or personal rights risk to persons in care. During resident medication review, LPA observed that the facility did not have a record of centrally stored prescription medication for Resident #2 (R2). The facility did not have a record R2's Lorazepam and Ondansetron.

Official plan of correction

POC Due Date: 02/04/2025 Plan of Correction AD documented the prescription medications for R2 during the visit. POC cleared at time of visit.

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 record review, the licensee did not comply with the section cited above in which poses/posed a potential health, safety or personal rights risk to persons in care. During resident file review, LPA observed the Reappraisals for Resident #1 (R1) and Resident #2 (R2) were outdated. LPA observed that the most recent Reappraisal on file for R1 was completed on 04/30/23. LPA observed that the most recent Reappraisal on file for R2 was completed on 01/09/23.

Official plan of correction

POC Due Date: 02/17/2025 Plan of Correction AD agreed to complete a new Reappraisal for R1 and R2. AD agreed to submit proof of completion to LPA via email or fax by POC 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 observation and interview, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care. During a tour of the physical plant, LPA observed that the facility does not have a sufficient three day emergency food supply on hand.

Official plan of correction

POC Due Date: 02/10/2025 Plan of Correction AD agreed to purchase a three day emergency food supply. AD agreed to submit proof of purchase by a receipt to LPA via email or fax by POC date.

Official classification

Type A

Official code

87303

Regulation authority

CCR

What the official deficiency says

(a) Maintenance and Operation - The facility shall be clean, safe, sanitary and in good repair at all times. 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 that he Licensee failed to keep the facility clean and in good repair at all times. LPA observed a leak under kitchen sink, kitchen cabinets needing repair, medication cabinet locks needs to be replaced, refrigerator needs deep cleaning, dining area needs to be cleaned and organized, common areas need deep cleaning and electric wires are a tripping hazard, hallway bathroom has a leak under the sink, both bathrooms need deep cleaning, garage needs to be organized and decluttered and walkway on side of garage has items blocking walkway going out to exit gate. Also, window screens need to be repaired/replaced. This poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/05/2024 Plan of Correction Licensee is to ensure the facility is clean, safe, sanitary and in good repair at all times. Licensee to submit a plan areas of concern above and on section cited and submit to LPA by 11/5/2024. LPA to conduct a visit in near future.

Official classification

Type A

Official code

87307

Regulation authority

CCR

What the official deficiency says

Personal Accommodations and Services - (e) Facilities providing services to residents who have physical or mental disabilities shall assure the inaccessibility of fishponds...swimming pools, or similar bodies of water, when not in active use by residents, through fencing, covering, or other means. 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 that the Licensee did not ensure the swimming pool to be secured, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/05/2024 Plan of Correction Licensee to obtain and install a lock on the backyard pool and submit proof to LPA by POC due date.

Official classification

Type A

Official code

87202

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 and interview, the Licensee did not comply with the section cited above; Licensee stated Fire Extinguisher had not been serviced in a couple years; Licensee failed to ensure Fire Extinguisher was serviced annually, which poses an immediate health, and safety risk to the residents in care.

Official plan of correction

POC Due Date: 11/05/2024 Plan of Correction Licensee to purchase or have Fire Extinguisher serviced and submit proof of POC by due date.

Official classification

Type B

Official code

87555

Regulation authority

CCR

What the official deficiency says

General Food Service Requirements - (a) The total daily diet shall be of the quality and in the quantity necessary to meet the needs of the residents and shall meet the Recommended Dietary Allowances of the Food and Nutrition Board of the National Research Council. All food shall be selected, stored, prepared and served in a safe and healthful manner. (26) Supplies of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days shall be maintained on the premises. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and interview, the licensee did not comply with the section cited above in that Licensee failed to ensure food on hand met the minimum of one week non-perishable and minimum of two days perishables. Food observed is not enough to feed 5 residents for 7 days. This poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/05/2024 Plan of Correction Licensee to ensure there is enough food on hand at all times, agrees to have perishable and non-perishable food items to meet the requirement. Proof of correction will be provided to CCL by the POC date of 11/5/2024

Official classification

Type B

Official code

87156

Regulation authority

CCR

What the official deficiency says

Annual Fees (a) An applicant or licensee shall be charged fees as specified in Health and Safety Code section 1569.185. (e) The failure of an applicant for licensure or a licensee to pay all applicable and accrued fees and civil penalties shall constitute grounds for denial or forfeiture of a license. 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 in that Licensee failed to pay the annual licensing fees which were due 02/20/2024; however; the Licensee has not paid the annual fees by the due date in the past 3 years, and for this reason, late fees have been accrued. This poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/05/2024 Plan of Correction Licensee to pay balance of $1,236.50 and provide LPA with proof of the full payment by POC due date of 11/5/2024..

Official classification

Type B

Official code

87608

Regulation authority

CCR

What the official deficiency says

(a) Based on the individual's preadmission appraisal, and subsequent changes to that appraisal, the facility shall provide assistance and care for the resident in those activities of daily living which the resident is unable to do for himself/herself. Postural supports may be used under the following conditions. (5) Under no circumstances shall postural supports include tying, depriving, or limiting the use of a resident's hands or feet. (A) A bed rail that extends from the head half the length of the bed and used only for assistance with mobility shall be allowed. (B) Bed rails that extend the entire length of the bed are prohibited except for residents who are currently receiving hospice care and have a hospice care plan that specifies the need for full bed rails. 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 in R1 had a full bed rail and is not receiving hospice services, R2 and R3 have 1/2 bed rails no written order from a physician were found in files. This poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/15/2024 Plan of Correction Licensee to remove the bed rails and/or obtain physician orders for half-bed rails if there is a need and submit copy of orders to CCL by 11/15/2024

Official classification

Type A

Official code

87468.1(a)(16)

Regulation authority

CCR

What the official deficiency says

To receive or reject medical care or other services. This requirement is not being met as evidenced by... R1 ran out of their Venlafaxine 225MG for 16 days which poses an immediate health, safety and personal rights risk to residents in care.

Official plan of correction

Licensee agrees to retrain staff on medication management. Licensee agrees to set policies in place to properly have medication reordered prior to residents running out of medication. Licensee to submit proof of training and a new medication policy to LPA.

Deadline recorded: Aug 7, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87464(f)(4)

Regulation authority

CCR

What the official deficiency says

Basic Services. Basic services shall at a minimum include: Personal assistance and care as needed by the resident and as indicated in the pre-admission appraisal with those activities of daily living such as dressing, eating, bathing... , as specified in Section 87608...This requirement is not being met as evidenced by: Based on interviews the Administrator did not transfer R1 on July 24, 2024 when they requested to be transferred, This poses an immediate health and safety risk to residents in care.

Official plan of correction

Licensee agrees to transfer all residents when they request assistance. LIcensee agrees to submit a statement of understanding for CCR 87464 Basic Services.

Deadline recorded: Jul 26, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87208(a)(12)

Regulation authority

CCR

What the official deficiency says

Plan of Operation (a)Each facility shall have and maintain a current, written definitive plan of operation...The plan and related materials shall contain the following:(12)The Infection Control Plan pursuant to Section 87470. This requirement was not met as evidence by: Based on LPA observations S1 was not wearing Personal Protective Equipment (PPE) during the initial visit. Based on interviews conducted R1 was not allowed to have an in-person visit. This poses an immediate risk to resident’s health and safety.

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: Jan 26, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87307(e)

Regulation authority

CCR

What the official deficiency says

87307 Personal Accommodations and Services. (e) Facilities providing services to residents who have physical or mental disabilities shall assure the inaccessibility of fishponds, wading pools, hot tubs, swimming pools, or similar bodies of water, when not in active use by residents .... This requirement was not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not ensure the pool in the backyard was lockable, which poses an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 03/19/2022 Plan of Correction Licensee stated they will obtain and install a lock on the backyard pool and submit proof to LPA by POC due date.

Official classification

Type B

Official code

87307(d)(7)

Regulation authority

CCR

What the official deficiency says

87307 Personal Accommodations and Services. (d) The following space and safety provisions shall apply to all facilities: (7) Fireplaces and open-faced heaters shall be adequately screened. This requirement was not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not ensure the fireplace in the living room had a screen, which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 04/01/2022 Plan of Correction Licensee stated they will obtain a screen for the fireplace and submit proof to LPA by POC due date.