GOLDEN AGE SENIOR HOMES

Official classification

Type B

Official code

87506(a)

Regulation authority

CCR

What the official deficiency says

87506(a) Resident Records. A separate, complete, and current record shall be maintained for each resident in the facility, readily available to facility staff and to licensing agency staff and shall contained specified information. 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 facility resident records were observed to have incomplete records by being blank, no signature, missing, or incomplete forms which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/14/2025 Plan of Correction Licensee to ensure all records are completed by POC due date. License to notify LPA when records are complete.

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 met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above in which licensee failed to ensure that the fire extinguisher was appropriately charged yearly poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/06/2025 Plan of Correction Licensee stated that they will purchase a new fire extinguisher. Licensee to send proof of purchase by sending a picture of the receipt to LPA by email.

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 record review, the licensee did not comply with the section cited above in 2 out of 3 staff members which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/25/2024 Plan of Correction Licensee agrees to have staff members 2 and 3 given a health screening. Licensee agrees to submit the completed health screening to the LPA.

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 record review, the licensee did not comply with the section cited above, the fire clearance and facility sketch which was approved on September 9, 2020 does not have the second floor with the one room and closet, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/25/2024 Plan of Correction Licensee agrees to submit a new application (LIC 200) with a new facility sketch showing the second floor with one room and closet, to request a new fire clearance. Licensee agrees to comply with all the requirements issued by the Fire Authority and to notify of any required changes or delays concerning the new fire clearance request. Licensee agrees to comply with the regulation above.

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. 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, LPA observed the 5 burner gas stove does not light unassisted. LPA observed food debris on the stove and the top of the stove there are grease stains, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/07/2024 Plan of Correction Licensee agrees to repair/clean or to replace the stove by the POC due date. Licensee to submit proof of correction to the LPA by the 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 2 out of 3 staff members which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/14/2024 Plan of Correction Licensee agrees to have staff trained in compliance with the regulation above and to document all staff training. Licensee to forward proof to LPA by POC due date.

Official classification

Type B

Official code

87456(a)(2)

Regulation authority

CCR

What the official deficiency says

(a) Prior to accepting a resident for care and in order to evaluate his/her suitability, the facility shall, as specified in this article 8: (2) Perform a pre-admission appraisal. 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 5 out of 5 residents which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/07/2024 Plan of Correction Licensee will complete a pre-appraisal for each resident. LIcensee to submit proof to LPA by the POC due date.

Official classification

Type B

Official code

87463(a)

Regulation authority

CCR

What the official deficiency says

(a) The pre-admission appraisal shall be updated, in writing as frequently as necessary to note significant changes and to keep the appraisal accurate. The reappraisals shall document changes in the resident's physical, medical, mental, and social condition. Significant changes shall include but not be limited to: 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 5 residents which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/07/2024 Plan of Correction Licensee will complete a reappraisal for the 3 residents who did not have a current appraisal, Residents 1, 2 and 4. Licensee to submit proof of correction 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 record any emergency drill being conducted, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/07/2024 Plan of Correction Licensee agrees to conduct a drill by the POC due date and to conduct drills in compliance with the regulation above and to document all drills. Licensee to provide proof to LPA by POC due date.

Official classification

Type A

Official code

87705(f)(2)

Regulation authority

CCR

What the official deficiency says

Per CCR Section 87705(f)(2) on Care of Persons with Dementia: " The following shall be stored inaccessible to residents with dementia: (...)Over-the-counter medication, nutritional supplements or vitamins, (...) cleaning supplies and disinfectants. " This requirement is not met as evidenced by: Based on a tour of the physical plant, powdered bleach was observed to have been left accessible to residents on the dining room table. This constitutes an immediate risk to the health, safety and personal rights of individuals in care

Official plan of correction

Dangerous item removed during the visit.

Deadline recorded: Apr 20, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87608(a)(5)(B)

Regulation authority

CCR

What the official deficiency says

Per CCR Section 87608(a)(5)(B) on Postural Supports: " Bed rails that extend the entire length of the bed are prohibited except for residents who are currently receiving hospice care(...). " This requirement is not met as evidenced by: The bed for one resident not currently receiving hospice care is observed to be equipped with full bed rails. This constitutes a potential risk to the health, safety and personal rights of residents in care.

Official plan of correction

Licensee replaced the full rails with half rails during the visit based on the physician orders on file.

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

Official classification

Type B

Official code

87705(c)(5)

Regulation authority

CCR

What the official deficiency says

Per CCR Section 87506(a) on Resident Records: " (a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility (...) readily available to (...) licensing agency staff. " This requirement is not met as evidenced by: Based on records reviewed at the facility, two resident files did not include the respective medical assessment form. A third file included an admission agreement that was not dated/signed by the administrator. This constitute a potential risk to the health, safety and personal risks of residents in care.

Official plan of correction

Licensee will be ensuring that complete records for all six residents currently in care are present before the plan of corrections due date.

Deadline recorded: Mar 8, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87705(f)(2)

Regulation authority

CCR

What the official deficiency says

Per CCR Section 87705(f)(2) on Care of Persons with Dementia: " The following shall be stored inaccessible to residents with dementia: (...)Over-the-counter medication, nutritional supplements or vitamins, (...) cleaning supplies and disinfectants. " This requirement is not met as evidenced by: Based on a tour of the physical plant, multiple instances ohe-counter treatments and cleaning supplies left accessible to residents were observed. This constitutes an immediate risk to the health, safety and personal rights of individuals in care

Official plan of correction

Licensee removed and made all dangerous items encountered inaccessible during the present visit.

Deadline recorded: Feb 10, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87615(a)(2)

Regulation authority

CCR

What the official deficiency says

Per CCR 87615(a)(2) on Prohibited Health Conditions: " Persons who (...) have a health condition including (...) those specified below shall not be admitted or retained in a residential care facility for the elderly: (2) Gastrostomy tubes. " This requirement is not met as evidenced by: Based on a tour of the facility and records reviewed, resident R3 is noted to be fed through a gastrostomy tube but has not been admitted to hospice or been issued an exception by licensing staff. This constitutes an immediate risk to the health, safety and personal rights of residents in care.

Official plan of correction

Licensee will submit a written statement that R3's family will be notified that either an hospice admission or discharge to a higher level of care is required at this time, before the plan of corrections due date.

Deadline recorded: Feb 10, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87608(a)(5)(B)

Regulation authority

CCR

What the official deficiency says

Per CCR Section 87608(a)(5)(B) on Postural Supports: " Bed rails that extend the entire length of the bed are prohibited except for residents who are currently receiving hospice care(...). " This requirement is not met as evidenced by: The beds for two of the residents not currently receiving hospice care are seen to be equipped with full bed rails. This constitutes a potential risk to the health, safety and personal rights of residents in care.

Official plan of correction

Licensee replaced the full rails with half rails during the visit and will obtain relevant physician orders for half rails for both residents before the plan of corrections due date.

Deadline recorded: Mar 8, 2024. A deadline is not proof that correction was completed.