TAYLOR COTTAGE, THE

Official classification

Type A

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 cited above as there was a dead roach and debris located in top right drawer on kitchen island. This poses an immediate health and safety risks to persons in care.

Official plan of correction

POC Due Date: 02/14/2026 Plan of Correction Licensee to clean kitchen island and provide proof to LPA by POC due date and exterminator has been called. Licensee to provide proof of exterminator's visit to LPA.

Official classification

Type A

Official code

87303(a)(1)

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. (1) Floor surfaces in bath, laundry and kitchen areas shall be maintained in a clean, sanitary, and odorless condition. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation the licensee did not comply with the cited above as LPA observed R2's toilet to have staining (photo taken) and an odor was present. This poses an immediate health and safety risks to persons in care.

Official plan of correction

POC Due Date: 02/14/2026 Plan of Correction Licensee to clean R2's bathroom and provide proof to LPA by POC due date.

Official classification

Type A

Official code

87303(c)

Regulation authority

CCR

What the official deficiency says

(c) All window screens shall be clean and maintained in good repair. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation the licensee did not comply with the cited above as the shared bathroom in rear of the home is missing a screen. This poses an immediate health and safety risks to persons in care.

Official plan of correction

POC Due Date: 02/13/2026 Plan of Correction Licensee replaced screen during visit.

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 cited above as LPA observed an unsecured lighter in drawer on the right hand of the stove. This poses an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 02/13/2026 Plan of Correction Licensee corrected during visit.

Official classification

Type A

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 observation the licensee did not comply with the cited above as Staff 4 did not have a health screening on record. This poses an immediate health and safety risks to persons in care.

Official plan of correction

POC Due Date: 02/18/2026 Plan of Correction Licensee to provide health screening for S4 by POC due date.

Official classification

Type A

Official code

87463(b)

Regulation authority

CCR

What the official deficiency says

(b) The reappraisal shall document significant changes in the resident's physical, mental, cognitive, behavioral, or functional condition, including those required to be documented as specified in Section 87466, Observation of the Resident. This requirement is not met as evidenced by: Deficient Practice Statement Based on observations the licensee did not comply with the cited above as LPA did not observed assessments/appraisals for R1 and R3. This poses an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 02/20/2026 Plan of Correction Licensee to conduct appraisals and provide proof to LPA by POC due date.

Official classification

Type A

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 observations the licensee did not compy with the cited above as LPA observed LIC 610E Emergency and Disaster Plan for Residential Care Facilities for the Elderly had not been reviewed or updated as former Administrator and former employees are listed on document. This poses an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 02/14/2026 Plan of Correction Licensee corrected during visit and provided updated LIC 610 E

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 observations and records review for Staff 1- 4 did not have training records on file. This poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 02/27/2026 Plan of Correction Licensee to conduct training to include 8 hours of dementia training and 4 hours to include postural supports, restricted health conditions and hospice care.

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 the licensee did not comply with the cited above as there was no emergency water in the facility. This poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 02/13/2026 Plan of Correction Licensee corrected during visit.

Official classification

Type A

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 observations and records reviewed the licensee did not comply with the cited above as R1 is in a room that is not listed approved for bedridden resident. In addition smoke detector in living room were not operational. This poses an immediate health and safety risks to persons in care. * This is a repeat violation, immediate civil penalty issued.

Official plan of correction

POC Due Date: 02/17/2026 Plan of Correction Licensee stated R1 is not bedridden and will provided updated LIC 602 with ambulatory status by POC due date. Licensee added batteries to smoke dector in living room.

Official classification

Type A

Official code

87202(a)

Regulation authority

CCR

What the official deficiency says

f) Basic services shall at a minimum include:(1) Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). This requirement is not met as evidenced by: Deficient Practice Statement Based on observation the licensee did not comply with the cited above as R1 has matted and knotted hair. This poses an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 02/13/2026 Plan of Correction Licensee corrected during visit as R1's hair was cut and combed.

Official classification

Type A

Official code

87355(e)(3)

Regulation authority

CCR

What the official deficiency says

(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (3) Request a transfer of a criminal record clearance as specified in Section 87355(c) or This requirement is not met as evidenced by: Deficient Practice Statement Based on observations and records reviewed Staff 1, Staff 2 and Staff 3 are not associated to the facility. Per Licensee Staff 1 worked 3 days, Staff 2 worked 2days and Staff 3 has worked off and on for over 1 year , Licensee stated more than 5 days. This poses an immediate health and safety risks to persons in care. * An immediate civil penalty issued*

Official plan of correction

POC Due Date: 02/14/2026 Plan of Correction Licensee stated will associate all staff and provide proof to LPA by POC due date

Official classification

Type A

Official code

87555(b)(23)

Regulation authority

CCR

What the official deficiency says

(23) All readily perishable foods or beverages capable of supporting rapid and progressive growth of micro-organisms which can cause food infections or food intoxications shall be stored in covered containers at appropriate temperatures. This requirement is not met as evidenced by: Deficient Practice Statement Based on obseration the licensee did not comply with the cited above as there were eggs in the kicthen pantry, egg box clearly states it should be refridgerated. This poses an immediate health and safety risks to persons in care.

Official plan of correction

POC Due Date: 02/13/2026 Plan of Correction Licensee corrected during visit by disposing of eggs.

Official classification

Type A

Official code

87615(a)(1)

Regulation authority

CCR

What the official deficiency says

87615 Prohibited Health Conditions (a) Persons who require health services for or have a health condition.. shall not be admitted or retained in a residential care facility for the elderly: (1) Stage 3 and 4 pressure injuries. This requirement was not met as evidenced by: Based on record review, resident 1 (R1) had a stage 2 pressure injury while at the facility, then was hospitalized. R1 returned to the facility, with a stage 4 pressure injury that was developed during hospitalization. Per interview, licensee admitted to retaining R1 from 3/2/22 to 3/14/22 with the stage 4 injury without an approved waiver from the department. This poses an immediate health and safety risk to residents in care.

Official plan of correction

As a plan of correction, licensee will review the regulation cited, and provide proof of understanding to the assigned LPA on or by 7/3/2025.

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

Official classification

Type A

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 immediate safety and personal rights risk to persons in care. A wall was built in the middle of the room and was not approved by fire safety.

Official plan of correction

POC Due Date: 02/24/2025 Plan of Correction Licensee stated they will submit a written plan when fire clearance for wall will be conduced or if fire clearance is found, it will be sent to LPA by POC date.

Official classification

Type B

Official code

87465(h)(5)

Regulation authority

CCR

What the official deficiency says

87465...(h)...(5) Each resident's medication shall be stored in its originally received container. No medications shall be transferred between containers. This requirement was not met as evidenced by: Based on observation and interviews, LPA observed that resident #1, resident #2, and resident#3 had medication transferred from original container into a different container for three out of four residents. This poses a potential health, safety, and personal rights risk to all persons in care.

Official plan of correction

Licensee agreed to not to transfer medications from original container to a different container. Licensee will provide training to staff on the section cited above and will send proof to CCLD via email to edward.kim@dss.ca.gov by POC due date.

Deadline recorded: Jan 10, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87405(a)

Regulation authority

CCR

What the official deficiency says

87405... (a) All facilities shall have a qualified and currently certified administrator… When the administrator is not in the facility, there shall be coverage by a designated substitute... This requirement was not met asevidenced by: Based on observation, record review, and interviews, the facility did not have an administrator or designee on premises for at least year and a half. This poses a potential health, safety, and personal rights risk to all persons in care.

Official plan of correction

Licensee stated they agreed to submit the requirements for the change of administrator by POC due date January 10, 2025. Licensee will associated administrator upon approval of the documents..

Deadline recorded: Jan 10, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87307(a)(2)(C)

Regulation authority

CCR

What the official deficiency says

87307 (a) living accommodations and grounds shall be related to the facility's function. The facility shall be large enough to provide comfortable living accommodations and privacy for the residents, staff, and others who may reside in the facility. The following provisions shall apply:(2) resident bedrooms shall be provided which meet, at a minimum, the following requirements: (C) No bedroom of a resident shall be used as a passageway to another room, bath or toilet. This requirement was not met as evidenced by: R1 bedroom 6A is a passageway to staff room 6B. Based on observation the licensee did not comply with section cited above. Interview conducted with Resident 1(R1) confirmed that three male staff (S1, S2 & S4) pass through R1’s bedroom 6A door to access 6B for purposes of either sleeping, using restroom and or gathering personal staff belongings located in 6B. S1 and S2 confirmed that S4 sleeps in 6B next to R1’s bedroom 6A and they also enter through 6A. Based on the department’s observations, it was confirmed that only way through the bedroom 6B is passing through 6A. This poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Licensee agreed to remove wall dividing bedroom #6. Licensee to transfer Resident 1 to bedroom 6Bon and use current 6A as common area until the wall is removed. Licensee agreed to obtain permit from City of Huntington Beach to remove wall inside bedroom 6 by POC due date 12/3/2024.

Deadline recorded: Dec 2, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.1(a)(1)(2)

Regulation authority

CCR

What the official deficiency says

Personal Rights(a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (1)To be accorded dignity in their personal relationships with staff, residents, and other persons. (2)To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This requirement was not met as evidenced by: Staff (S1,S2 & S4) access Resident 1 (R1) bedroom 6A to get Room 6B not allowing R1 privacy. This poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Licensee agrees to conduct in service training with staff regarding personal rights of residents. Licensee provide proof of training by POC due date 12/3/2024

Deadline recorded: Dec 3, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

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 was not met as evidenced by: Per interview with the Licensee/Administrator Weenie Earwood and Staff #2 , a non-ambulatory resident (R# 3) occupies and sleeps in room #5 that is not fire clearance approved. Room does not have proper egress window for fire clearance posing a health and safety threat to resident in care. This poses an immediate Health and Safety risk to residents in care.

Official plan of correction

Licensee agreed to move resident to shared bedroom number 1. Licensee providing proof via face time video call by POC due date 11/15/2024.

Deadline recorded: Nov 15, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87307(a)(2)(c)

Regulation authority

CCR

What the official deficiency says

87307 (a) living accommodations and grounds shall be related to the facility's function. The facility shall be large enough to provide comfortable living accomodations and privacy for the residents, staff, and others who may reside in the facility. The following provisions shall apply:(2) resident bedrooms shall be provided which meet, at a minimum, the following requirements: (C) No bedroom of a resident shall be used as a passageway to another room, bath or toilet. This requirement is not met as evidenced by: resident's room is a passageway to staff room. Based on observation the licensee did not comply with section cited above in one resident room which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Licensee agree to correct access from resident bedroom to staff bedroom. by POC date 06/21/2024

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

Official classification

Type B

Official code

87705(c)(5)(A)

Regulation authority

CCR

What the official deficiency says

(c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following: (5) Each resident with dementia shall have an annual medical assessment as specified in Section 87458, Medical Assessment, and a reappraisal done at least annually, both of which shall include a reassessment of the resident's dementia care needs. (A) When any medical assessment, appraisal, or observation indicates that the resident's dementia care needs have changed, corresponding changes shall be made in the care and supervision provided to that resident. 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 three out of five residents missing updated physician's reports and appraisal records for residents with Dementia (R1-R3) which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/05/2024 Plan of Correction Licensee agreed to complete Resident records for R1, R2 and R3. Licensee will submit proof of correction to department via email at jenifer.tirre@dss.ca.gov by POC due date 4/5/24.

Official classification

Type B

Official code

87305(a)

Regulation authority

CCR

What the official deficiency says

87305 Alterations to Exisiting building or new facilities (a) prior to construction or alterations all facilities shall obtain a building permit. This requirement is not met as evidenced by: Licensee failed to notify department of structural alterations to resident bedroom. Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above in one of five resident rooms which posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/05/2024 Plan of Correction Licensee agreed Inquire from the city and to provide proof of building permit if needed via email at jenifer.tirre@dss.ca.gov by POC due date 4/5/2024

Official classification

Type B

Official code

87307(a)(2)(C)

Regulation authority

CCR

What the official deficiency says

87307 Personal Accommodations and Services (a) living accommodations and grounds shall be related to the facility's function. The facility shall be large enough to provide comfortable living accomodations and privacy for the residents, staff, and others who may reside in the facility. The following provisions shall apply:(2) Resident bedrooms shall be provided which meet, at a minimum, the following requirements: (C) No bedroom of a resident shall be used as a passageway to another room, bath or toilet. This requirement is not met as evidenced by: resident's room is a passageway to staff room. Deficient Practice Statement Based on observation and record review, the licensee did not comply with the section cited above in one out of five resident rooms which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/05/2024 Plan of Correction Licensee agree to provide a separate exterior entrance for staff bedroom and remove access from resident bedroom to staff bedroom. by POC date 04/05/2024.

Official classification

Type B

Official code

87412(a)(11)

Regulation authority

CCR

What the official deficiency says

87412 Personnel records (a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the followinginformation:(11) a Health screening as specified in section 87411, Personnel Requirements- General. This requirement is not met as evidenced by: Facility is missing health screening and TB test Deficient Practice Statement Based on record review, the licensee did not comply with the section cited above in one out of three staff which posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/05/2024 Plan of Correction Licensee agreed to provide updated personnel records for all personnel staff by POC due date 4/5/2024

Official classification

Type B

Official code

87411(c)(1)

Regulation authority

CCR

What the official deficiency says

87411 Personnel Requirements-General (c) All RCFE staff who assist residents with personal activites of daily living shall receive initialand annual training as specified in Health and Safety Code sections 1569.625 and 1569.69 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 one out of three staff is missing CPR certification in personnel file which poses potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/05/2024 Plan of Correction Licensee agreed to provide updated CPR documentation for Staff 1 via email to jenifer.tirre@dss.ca.gov by POC due date 4/5/2024

Official classification

Type A

Official code

87465(h)(2)

Regulation authority

HSC

What the official deficiency says

87465(h)(2) incidental medical and dental care (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.

Official plan of correction

Facility put a note in Residents room for aides and nurses not to leave out medications after use. Adminstrator to remind staff about checking medications being locked. Facility will keep track of a medication sign out sheet each time meds are removed from secured location. poc due by 3/23/22

Deadline recorded: Mar 23, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87355(e)(2)

Regulation authority

HSC

What the official deficiency says

87355(e)(2) Criminal record clearance (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (2) Request a transfer of a criminal record clearance as specified in Section 87355(c)

Official plan of correction

facility makes sure prior to working that applicant has fingerprints completed along with criminal record clearance and is associated to facility. poc due by 3/23/22

Deadline recorded: Mar 23, 2022. A deadline is not proof that correction was completed.