RESPIT MANOR

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 following information: (11) A health screening as specified in Section 87411, Personnel Requirements - General. This requirement is not met as evidenced by: Deficient Practice Statement Based onrecord review, the licensee did not comply with the section cited above in two of two staff members not having a health screening and T.B test available for review. Which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 02/19/2026 Plan of Correction Administrator agrees to assign employees to receive a health screening and T.B test as soon as possibble. Administrator will send proof of correction to LPA via email by P.O.C due date.

Official classification

Type B

Official code

87555(b)(8)

Regulation authority

CCR

What the official deficiency says

(b) The following food service requirements shall apply: (8) All food shall be of good quality. Commercial foods shall be approved by appropriate federal, state and local authorities. Food in damaged containers shall not be accepted, used or retained. This requirement is not met as evidenced by: Based on LPA observation, 15 expired cans of food in the garage and 5 molded vegeteble item were found in the kitchen refridgerator, which poses a potential health and safety risk to persons in care. LI admitted food items were brought from food banks and provided to residents in care.

Official plan of correction

Licensee and staff discarded the expired food items during visit. Licensee stated they will train staff on CCR 87555 and facilty food storage procedures, and will submit proof to CCLD by POC due date of 2/5/2026.

Deadline recorded: Feb 5, 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’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 of 1/29/2026.

Deadline recorded: Jan 29, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

1569.657(a)(5)(A)

Regulation authority

HSC

What the official deficiency says

Health and Safety Code section 1569.657 provides: (a) …The notice shall include… (5) Refund conditions. (A) ...Will be returned in the event of a resident’s death… This requirement is not met as evidence by: Based on LPAs review of documents, interviews and observations, facility administrator provided direct admission that the refund was not issued. This poses a potential health and safety risk to residents in care.

Official plan of correction

As a plan of correction (POC) facility is to issue the refund to R1's family in the amount of $1,122.54 by 10/29/25. Facility is to provide proof to assigned LPA on 10/29/25.

Deadline recorded: Oct 29, 2025. A deadline is not proof that correction was completed.

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, 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 a tour of the interior portion of the facility, LPA observed two medications to be stored in the refridgerator where they can be accessible to residents in care. LPA observed one Subcutaneous injection pen and one insulin glargine injection capsule stored in the refridgerator.

Official plan of correction

POC Due Date: 02/13/2025 Plan of Correction AD discovered an operational lockbox stored in the garage. AD placed the medications in the lockbox and stored it in the refrigerator. POC cleared at time of visit.

Official classification

Type B

Official code

87412(a)(11)

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: (11) A health screening as specified in Section 87411, Personnel Requirements - General. 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 staff file review, LPA observed that Staff #4 did not have a Health Screening Report on file.

Official plan of correction

POC Due Date: 02/26/2025 Plan of Correction AD agreed to get a Health Screening Report for Staff #4. AD agreed to submit the completed Health Screening Report for Staff #4 and submit it to LPA via email or fax by POC date.