FAITHFUL HOME OF ROSSMOOR, A

Official classification

Type A

Official code

87309(b)

Regulation authority

CCR

What the official deficiency says

(b) Residents may have access to items specified in subsection (a) for personal use unless there is documentation, as specified in Section 87457, Pre-Admission Appraisal or Section 87463, Reappraisals, that indicates the resident's or other residents’ safety would be at risk if allowed access. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above as toxic chemicals and cleaning solutions were observed to accessible to residents who are at safety risk if allowed access, which poses an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 09/25/2025 Plan of Correction Staff Curay immediately locked toxic chemicals and cleaning solutions. Licensee stated staff training will be conducted on toxic chemicals, cleaning solutions, and accessibility to residents who are at safety risk if allowed access and proof provided to LPA via email by POC date.

Official classification

Type A

Official code

87309(c)

Regulation authority

CCR

What the official deficiency says

(c) Except as specified in subsection (d), the licensee shall implement reasonable interventions in order to ensure that nutritional supplements, vitamins, alcohol, cigarettes and other potentially toxic substances, such as certain plants, gardening supplies, and auto supplies, are stored so as not to pose a hazard to residents. 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 staffs' personal medication and supplements were observed to be stored in three unlocked drawers in the kitchen, which poses an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 09/25/2025 Plan of Correction Staff Curay immediately locked staffs' personal medication. Licensee stated staff training will be conducted on medication and proper medication storage and proof provided to LPA via email by POC date.

Official classification

Type B

Official code

87465(h)(5)

Regulation authority

CCR

What the official deficiency says

(h) The following requirements shall apply to medications which are centrally stored: (5) Each resident's medication shall be stored in its originally received container. No medications shall be transferred between containers. 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 two of five residents' medications are being transferred from their original container into a plastic weekly medication organizer, which poses a potential health, safety, and personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/24/2025 Plan of Correction Licensee stated meidcation will no longer be transferred between containers and staff training will be conducted on proper medication storage and proof provided to LPa via emaily by POC date.

Official classification

Type B

Official code

87307(a)

Regulation authority

CCR

What the official deficiency says

(a)...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... This requirement is not met as evidenced by: Deficient Practice Statement 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

POC Due Date: 10/24/2025 Plan of Correction Licensee stated staff will no longer reside in the garage and all their personal belongings removed and video proof will be submitted to LPA via email by POC date.

Official classification

Type A

Official code

87204(a)

Regulation authority

CCR

What the official deficiency says

(a) A licensee shall not operate a facility beyond the conditions and limitations specified on the license, including specification of the maximum number of persons who may receive services at any one time. An exception may be made in the case of catastrophic emergency when the licensing agency may make temporary exceptions to the approved capacity. This requirement is not met as evidenced by: Deficient Practice Statement Based on facility visit and review of the terms of the current license, the licensee did not comply with the section cited above as room #6 is currently assigned to a faclity resident, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/22/2024 Plan of Correction Licensee will move the resident from room #6 to the currently vacant room, as well as request an update of the fire clearance and submit an update of the license before resuming admission for potential residents assigned to room #6.

Official classification

Type A

Official code

87309(a)

Regulation authority

CCR

What the official deficiency says

(a) Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation conducted during the visit of the physical plan, the licensee did not comply with the section cited above as multiple spray bottles of cleaning solution and unsecured laundry supplies were observed. This poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/21/2024 Plan of Correction Licensee removed the spray bottles and placed a lock on the laudry cabinet during the visit.

Official classification

Type A

Official code

87355(e)(4)

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: (4) Request and be approved for a transfer of a criminal record exemption, as specified in Section 87356(r), unless, upon request for a transfer, the Department permits the individual to be employed, reside or be present at the facility. This requirement is not met as evidenced by: Deficient Practice Statement Based on record reviewed, the licensee did not comply with the section cited above as one staff member covering the night shift was shown to not be associated to the facility in Guardian. This poses an immediate health, safety or personal rights risk to persons in care. Civil penalty assessed.

Official plan of correction

POC Due Date: 06/22/2024 Plan of Correction Licensee will ensure the adequate association of all staff members to all their licensed locations before rotating staff from one facility to another. Proof of association to be provided to LPA before the plan of corrections due date.

Official classification

Type A

Official code

87705(f)(1)

Regulation authority

CCR

What the official deficiency says

(f) The following shall be stored inaccessible to residents with dementia: (1) Knives, matches, firearms, tools and other items that could constitute a danger to the resident(s). This requirement is not met as evidenced by: Deficient Practice Statement Based on observation made during the facility visit, the licensee did not comply with the section cited above as the magnetic lock securing the drawer in which sharp items are stored is shown to be broken.This poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/22/2024 Plan of Correction Licensee will repair the lock and provide documentation of the repair to LPA before the plan of corrections due date.

Official classification

Type B

Official code

87458(a)

Regulation authority

CCR

What the official deficiency says

(a) Prior to a person's acceptance as a resident, the licensee shall obtain and keep on file, documentation of a medical assessment, signed by a physician, made within the last year. The licensee shall be permitted to use the form LIC 602 (Rev. 9/89), Physician's Report, to obtain the medical assessment. This requirement is not met as evidenced by: Deficient Practice Statement Based on resident records reviewed during the facility visit, the licensee did not comply with the section cited above as one resident file was not shown to include a completed physician report. This poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/21/2024 Plan of Correction Licensee will obtain a completed medical assessment for the resident in question and provide a copy to LPA before the plan of corrections due date.

Official classification

Type B

Official code

87618(b)(3)(B)

Regulation authority

CCR

What the official deficiency says

(3) Ensuring that the use of oxygen equipment meets the following requirements: (B) “No Smoking-Oxygen in Use” signs shall be posted in the appropriate areas. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation made during the facility visit, the licensee did not comply with the section cited above as one resident is receiving oxygen but no corresponding signage is in use throughout the facility. This poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/21/2024 Plan of Correction Licensee to ensure adequate signage is present whenever oxygen is in use and provide documentation thereof to LPA before the plan of corrections due date.

Official classification

Type B

Official code

87211(a)(1)(A)

Regulation authority

CCR

What the official deficiency says

(1) A written report shall be submitted to the licensing agency (...) within seven days of the occurrence of any of the events specified in (A) through (D) below. (...) (A) Death of any resident from any cause regardless of where the death occurred, including but not limited to a day program, a hospital, en route to or from a hospital, or visiting away from the facility. This requirement is not met as evidenced by: Deficient Practice Statement Based on interview, observation and record reviewed, the licensee did not comply with the section cited above as at least one death and one hospitalization were not reported to the Department. This poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/21/2024 Plan of Correction Licensee will review its Reporting Requirements and provide update training to its administrative staff to ensure adequate reporting is done for future events. Evidence of the training will be provided to LPA before the plan of corrections due date.

Official classification

Type B

Official code

87608(a)(5)(B)

Regulation authority

CCR

What the official deficiency says

The California Code of Regulations Section 87608(a)(5)(B) on Postural Supports states: " (B) 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: Based on observation and interview, full rails were shown to be equipped on the bed of resident R1, who is not receiving hospice care at the time of the visit. This constitutes a potential risk to the health, safety and personal rights of residents in care.

Official plan of correction

Licensee stated the bed rails had been equipped on the hospital bed when it was delivered at the facility, however resident does not actually need bedside postural support. The full rails were removed during the visit. Citation cleared during the visit.

Deadline recorded: Aug 9, 2023. A deadline is not proof that correction was completed.