VERSA-CARE HOME I

Official classification

Type A

Official code

87464(f)(1)

Regulation authority

CCR

What the official deficiency says

87464 Basic Services (f) Basic services shall at a minimum include: (1) Care and supervision as defined in... Health and Safety Code section 1569.2(c). This requirement is not met as evidenced by: Based on staff interviews and record review, the Licensee did not comply with the section cited above as R1 developed two unstageable pressure injuries while in care due to staff neglect, which posed an immediate health, safety, and personal rights risks to persons in care.

Official plan of correction

AD stated staff training regarding resident care and supervision will be conducted and a written plan of action, ensuring facility staff will provide basic services to residents, will be provided to LPA via email by POC date.

Deadline recorded: Jul 25, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87303(e)(2)

Regulation authority

CCR

What the official deficiency says

(2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degrees C) and not more than 120 degree F (49 degrees C). This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above due to water temperature testing between 125.4 and 127.2 degrees Fahrenheit which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/22/2026 Plan of Correction Licensee stated a statement of understanding will be sent to LPA via email by POC dude date. Licensee to log water temperature for 7 consecutive days and send to LPA by July 31, 2026.

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 due to medication closet being unlocked and accessible to residents in care which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/22/2026 Plan of Correction Licensee stated a statement of understanding will be sent to LPA via email by POC dude date. Licensee to conduct in-service training and send to LPA via email by July 31, 2026.

Official classification

Type A

Official code

87506(a)

Regulation authority

HSC

What the official deficiency says

Resident Records (a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available... to licensing agency staff. This requirement is not met as evidenced by: Based on AD interview, the Licensee did not comply with the section cited above as AD was unable to provide any documentation pertaining to Home Health for R1, which poses an immediate health, safety, and personal rights risk to persons in care.

Official plan of correction

AD stated they will obtain a complete and current Home Health record for R1 and a copy will be submitted to LPA via email by POC date.

Deadline recorded: Oct 8, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87307(a)

Regulation authority

HSC

What the official deficiency says

Personal Accommodations and Services (a)... 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: Based on observation, the licensee did not comply with the section cited above as staff is currently residing in the garage, which poses a potential safety and personal rights risk to persons in care.

Official plan of correction

AD stated staff will no longer reside in the garage and all their personal belongings removed. AD stated video proof will be submitted to LPA via email by POC date.

Deadline recorded: Nov 7, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

8703(2)

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 section cited above, which poses a potential health and safety risk to persons in care. LPA observed unsanitary conditions in the hallways where spider webs and filters needed to be clean and a missing mirror door and bath towel rack in staff bathroom. Liighting in three out of four resident rooms and resident bathroom were in need of repair. LPA also observed a dirty toilet, shower, and bathmat in unsanitary condition.

Official plan of correction

POC Due Date: 09/17/2025 Plan of Correction Administrator will have both bathrooms a deep cleaned, clean all areas in hallway, check and replace all lighting throughout the facility, and replace mirror door and bath towel rack in staff bathroom. Administrator will email LPA Bentley photos of the repaired/replaced items, cleaned bathrooms and hallways by POC due date.

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 observation, staff interview, and record review, the licensee did not comply with the section cited above in two of two staff records, which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 09/17/2025 Plan of Correction Administrator stated health screening will be obtained for staff and proof provided to LPA via email by POC date.

Official classification

Type A

Official code

87506(a)

Regulation authority

CCR

What the official deficiency says

(a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and staff interview, the licensee did not comply with the section cited above in one of three resident files which poses an immediate health, safety and personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/10/2024 Plan of Correction AD stated a separate, complete, and current record will be maintained for each resident in the facility and proof provided to LPA via email by POC date.

Official classification

Type B

Official code

1569.618(c)(4)

Regulation authority

HSC

What the official deficiency says

(c)The facility shall employ, and the administrator shall schedule, a sufficient number of staff members to do all of the following: (4) Ensure that the facility is 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 the bathroom floor tile and in three of six smoke detectors, which poses a potential safety risk to persons in care.

Official plan of correction

POC Due Date: 10/09/2024 Plan of Correction AD stated bathroom floor tile and smoke detectors will be repaired and proof 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, staff interview, and record review, the licensee did not comply with the section cited above in two of two personnel records, which poses a potential health, safety, and personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/09/2024 Plan of Correction AD stated personnel records will be maintained on each employee and proof provided to LPA via email by POC date.

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 observation, staff interview, and record review, the licensee did not comply with the section cited above in two of two staff records, which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 10/09/2024 Plan of Correction AD stated health screening will be obtained for staff and proof provided to LPA via email by POC date.

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 observation and record review, the licensee did not comply with the section cited above in two of two staff files which poses a potential health, safety and personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/09/2024 Plan of Correction AD stated staff training will be completed immediately and proof provided to LPA via email by POC date.

Official classification

Type B

Official code

1569.267(d)

Regulation authority

HSC

What the official deficiency says

(d) The licensee shall provide initial and ongoing training for all members of its staff to ensure that residents’ rights are fully respected and implemented. 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 in two of two staff files, which poses a potential personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/09/2024 Plan of Correction AD stated staff training will be conducted immediately and proof provded to LPA via email by POC date.

Official classification

Type B

Official code

87219(a)

Regulation authority

CCR

What the official deficiency says

(a) Residents shall be encouraged to maintain and develop their fullest potential for independent living through participation in planned activities. The activities made available shall include: This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and staff interview, the licensee did not comply with the section cited above as planned activites are provided, which poses a potential personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/09/2024 Plan of Correction AD stated planned activities will be provided and proof provided to LPA via email by POC date.

Official classification

Type B

Official code

1569.695(a)

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: This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, and staff interview, the licensee did not comply with the section cited above as an emergency and disaster plan was not available for review, which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 10/09/2024 Plan of Correction AD stated an emergency and disaster plan will be completed and maintained and proof 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 observation and staff interview, the licensee did not comply with the section cited above as documentation of drills was not available for review, which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 10/09/2024 Plan of Correction AD stated documentation of drills will be completed and proof provided to LPA via email by POC date.