CARE CELINE 2

Official classification

Type A

Official code

87608(a)(3)

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: (3) A written order from a physician indicating the need for the postural support shall be maintained in the resident's record. The licensing agency shall be authorized to require other additional documentation if needed to verify the order. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and AD interview, the licensee did not comply with the section cited above as two of five residents were observed to be using postural supports without a written order from a physician, which poses an immediate safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/18/2026 Plan of Correction AD immediately removed belt from wheelchair and railing from the resident's bed. AD stated a written order from a physician will be obtained in order to continue use of postural support and a copy provided to LPA via email by POC date.

Official classification

Type B

Official code

87412(a)

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: This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and AD interview, the licensee did not comply with the section cited above as a personnel record for AD/Licensee is not currently being maintained, which poses a potential health and personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/01/2026 Plan of Correction AD stated a personnel record will be maintained for themselves at the facility and a copy provided to LPA via email 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 AD interview and record review, the licensee did not comply with the section cited above in one of five resident files which poses a potential health, safety and personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/01/2026 Plan of Correction AD immediately updated resident's pre-admission appraisal and stated it will be signed by resident's POA and a copy provided to LPA via email by POC date.

Official classification

Type B

Official code

87307(a)

Regulation authority

CCR

What the official deficiency says

(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... This requirement is not met as evidenced by: Based on observation and staff interview, the licensee did not comply with the section cited above as the facility does not have a staff room and staff is residing at the facility and sleeping on the living room couch, which poses a potential personal rights risk to persons in care.

Official plan of correction

AD stated staff will remove personal belongings and no longer live on-site, spend the night, or sleep on the livng room couch and picture proof provided to LPA via email by POC date.

Deadline recorded: Sep 12, 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

(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: Based on observation and staff interview, the licensee did not comply with the section cited above as the master bedroom bathroom located within a resident's bedroom is currently used as the staff bathroom, which poses a potential personal rights risk to persons in care.

Official plan of correction

AD stated the bathroom located with the residents' bedroom will no longer be used as the staff bathroom. AD stated an in-service will be held to ensure all staff is aware and proof will be provided to LPA via email by POC date.

Deadline recorded: Sep 12, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

1569.625(b)(1)

Regulation authority

HSC

What the official deficiency says

(1) The department shall adopt regulations to require staff members of residential care facilities for the elderly who assist residents with personal activities of daily living to receive appropriate training. This training shall consist of 40 hours of training. A staff member shall complete 20 hours, including six hours specific to dementia care, as required by subdivision (a) of Section 1569.626 and four hours specific to postural supports, restricted health conditions, and hospice care, as required by subdivision (a) of Section 1569.696, before working independently with residents. The remaining 20 hours shall include six hours specific to dementia care and shall be completed within the first four weeks of employment. The training coursework may utilize various methods of instruction, including, but not limited to, lectures, instructional videos, and interactive online courses. The additional 16 hours shall be hands-on 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 as one of two staff records did not include documentation consisting of completed 20 hours, including six hours specific to dementia care, four hours specific to postural supports, restricted health conditions, and hospice care before working independently with residents which poses a potential health, safety and personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/07/2025 Plan of Correction Staff Lacwasan stated staff will complete 20 hours, including six hours specific to dementia care, four hours specific to postural supports, restricted health conditions, and hospice care and a copy will be provided to LPA via email by POC date.

Official classification

Type B

Official code

1569.69(a)(2)

Regulation authority

HSC

What the official deficiency says

(a) Each residential care facility for the elderly licensed under this chapter shall ensure that each employee of the facility who assists residents with the self-administration of medications meets all of the following training requirements: (2) In facilities licensed to provide care for 15 or fewer persons, the employee shall complete 10 hours of initial training. This training shall consist of 6 hours of hands-on shadowing training, which shall be completed prior to assisting with the self-administration of medications, and 4 hours of other training or instruction, as described in subdivision (f), which shall be completed within the first two weeks of employment. 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 as two of two staff files did not include documenation of completed 10 hours of initial training, consisting of 6 hours of hands-on shadowing training, and 4 hours of other training or instruction,.which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/07/2025 Plan of Correction AD stated staff training will be completed and a copy will be provided to LPA via email by POC 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 staff interview, the licensee did not comply with the section cited above as emergency drills are not currently being conducted which poses a potential safety risk to persons in care.

Official plan of correction

POC Due Date: 07/07/2025 Plan of Correction AD stated emergency will be conducted at least quarterly for each shift and type of emergency covered in a drill will vary from quarter to quarter, taking into account different emergency scenarios and documentation of the drills will include the date, the type of emergency covered by the drill, and the names of staff participating in the drill and proof submitted to LPA via email by POC.

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: 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 as one of three residents is currently bedridden and the facility's current fire clearance is solely for non-ambulatory residents, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/23/2025 Plan of Correction AD stated an LIC200, updated facility sketch, and a statement indicating changes being made to fire clearance will be submitted to LPA via email by POC date.

Official classification

Type B

Official code

87307(a)

Regulation authority

CCR

What the official deficiency says

(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. This requirement is not met as evidenced by: Deficient Practice Statement Based on staff interview, the licensee did not comply with the section cited above as staff currently residing at the facility and spends the night on the living room couch, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/23/2025 Plan of Correction AD stated staff will remove personal belongings and no longer live on-site or spend the night on the livng room couch and picture proof provided to LPA via email by POC date.

Official classification

Type B

Official code

87307(a)(2)(C)

Regulation authority

CCR

What the official deficiency says

(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: Deficient Practice Statement Based on staff interview, the licensee did not comply with the section cited above as the master bedroom bathroom located within a resident's bedroom is currently used as the staff bathroom, which poses a potential personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/07/2025 Plan of Correction AD stated the bathroom located with the residents' bedroom will no longer be used as the staff bathroom. AD stated an in-service will be held to ensure all staff is aware and proof will be provided to LPA via email by POC date.