ROSEHAVEN 1

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 in three out of three faucets with water over 120 degrees F which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/24/2026 Plan of Correction Licensee to adjust water temperature and forward proof to LPA by POC due date.

Official classification

Type B

Official code

1569.618(c)(3)

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: (3) Ensure that at least one staff member who has cardiopulmonary resuscitation (CPR) training and first aid training is on duty and on the premises at all times. This paragraph shall not be construed to require staff to provide CPR. 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 two out of three staff without CPR/ First aid training which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/07/2026 Plan of Correction Licensee to obtain CPR training for staff and forward proof to LPA by POC due date.

Official classification

Type B

Official code

87463(h)

Regulation authority

CCR

What the official deficiency says

(h) The licensee shall request that all residents receive an annual routine visit with a licensed medical professional once every twelve months, either in person or by video appointment. 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 two out of four residents without documentation of an annual assessment which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/07/2026 Plan of Correction Licensee to obtain updated physician reports for Residents 1 and 4 and forward proof to LPA by POC due date.

Official classification

Type B

Official code

87303(a)

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. LPA observed exit gate does not latch and the master restroom is missing drawer pulls on cabinets which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/23/2025 Plan of Correction Please repair/ replace noted items and forward proof to LPA by POC due 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 record review, the licensee did not comply with the section cited above in one out of three staff files. Staff 3 does not have a personnel file which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/23/2025 Plan of Correction Licensee to maintain a personnel file non Staff 3 and forward proof to LPA by 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 three out of three staff without current training which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/23/2025 Plan of Correction Licensee to provide training and forward proof to LPA by POC due date.

Official classification

Type B

Official code

87463(h)(1)

Regulation authority

CCR

What the official deficiency says

(h) The licensee shall request that all residents receive an annual routine visit with a licensed medical professional once every twelve months, either in person or by video appointment. (1) Documentation of the annual routine visit, such as a visit summary, shall be added to the resident's record. 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 one out of three residents without an annual assessment which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/23/2025 Plan of Correction Licensee to obtain an annual assessment for Resident 2 and forward proof to LPA by POC due date.

Official classification

Type B

Official code

87608(a)(3)

Regulation authority

CCR

What the official deficiency says

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 record review, the licensee did not comply with the section cited above in two out of two residents with bed rails did not have a written physician order for rails which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/23/2025 Plan of Correction Licensee to obtain orders for Residents #2 and 3 and forward proof to LPA by POC due date.

Official classification

Type A

Official code

87203

Regulation authority

CCR

What the official deficiency says

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 four out of six smoke detectors which did not work. This poses an immediate health, safety or personal rights risk to persons in care. CIVIL PENALTY ASSESSED

Official plan of correction

POC Due Date: 05/10/2025 Plan of Correction Licensee to repair/ replace smoke detectors and forward proof to LPA by POC due date.

Official classification

Type A

Official code

87355(e)(1)

Regulation authority

CCR

What the official deficiency says

All individuals subject to a criminal record review.. shall prior to working, residing or volunteering in a licensed facility: Obtain a California clearance or a criminal record exemption.. This req is not being met as evidenced by: Based on interview and record review, Licensee failed to ensure two staff obtained criminal record clearance. This poses an immediate health and safety risk to residents in care.

Official plan of correction

Licensee to obtain criminal record clearance and association for Staff 1 and 2 and forward proof to LPA by POC due date.

Deadline recorded: Oct 3, 2024. A deadline is not proof that correction was completed.

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 req is not being met as evidenced by: Based on observation, Licensee failed to ensure facility is clean, safe and sanitary. LPA observed a broken cupboard, buckling tile, and debris in yard. This poses a potential health and safety risk to residents in care.

Official plan of correction

Licensee to repair/ remove noted items and forward proof to LPA by POC due date.

Deadline recorded: Oct 2, 2024. A deadline is not proof that correction was completed.

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 observations the licensee did not comply with the section cited above in 6 of 6 residents which poses safety risk to persons in care.

Official plan of correction

POC Due Date: 08/02/2024 Plan of Correction Licensee cleared up obstructed area during today's visit and will conduct a through cleaning of mold by POC date.

Official classification

Type B

Official code

87303(e)(6)

Regulation authority

CCR

What the official deficiency says

(e) Water supplies and plumbing fixtures shall be maintained as follows: (6) Toilet, handwashing and bathing facilities shall be maintained in operating condition. Additional equipment shall be provided in facilities accommodating physically handicapped and/or nonambulatory residents, based on the residents' needs. This requirement is not met as evidenced by: Deficient Practice Statement Based on the licensee did not comply with the section cited above in six of six resident which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/19/2024 Plan of Correction Licensee agrees to finish construction on double vanity not currently operational and work on non-draining sink by POC date. Licensee request 30 day for construction to be completed.

Official classification

Type B

Official code

1569.626(a)(1)

Regulation authority

HSC

What the official deficiency says

(a) All residential care facilities for the elderly shall meet the following training requirements, as described in Section 1569.625, for all direct care staff: (1) Twelve hours of dementia care training, six of which shall be completed before a staff member begins working independently with residents, and the remaining six hours of which shall be completed within the first four weeks of employment. All 12 hours shall be devoted to the care of persons with dementia. The facility may utilize various methods of instruction, including, but not limited to, preceptorship, mentoring, and other forms of observation and demonstration. The orientation time shall be exclusive of any administrative instruction. This requirement is not met as evidenced by: Deficient Practice Statement Based on records reviewed the licensee did not comply with the section cited above in two of two staff which poses health, risk to persons in care.

Official plan of correction

POC Due Date: 08/16/2024 Plan of Correction Licensee agrees to provide training to staff by POC date and provide LPA proof.

Official classification

Type B

Official code

87467(a)(1)

Regulation authority

CCR

What the official deficiency says

(a) Prior to, or within two weeks of the resident’s admission, the licensee shall arrange a meeting with the resident, the resident’s representative, if any, appropriate facility staff, and a representative of the resident’s home health agency, if any, and any other appropriate parties, to prepare a written record of the care the resident will receive in the facility, and the resident’s preferences regarding the services provided at the facility. (1) At a minimum the written record shall include the date of the meeting, name of individuals who participated and their relationship to the resident, and the agreed-upon services to be provided to the resident. This requirement is not met as evidenced by: Deficient Practice Statement Based on records reviewed the licensee did not comply with the section cited above in six of six residents which poses personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/02/2024 Plan of Correction Licensee agrees to create and discuss needs and services plans with residents and provide proof to LPA by POC date

Official classification

Type B

Official code

87411(c)(1)

Regulation authority

CCR

What the official deficiency says

(1) Staff providing care shall receive appropriate training in first aid from persons qualified by such agencies as the American Red Cross. This requirement is not met as evidenced by: Deficient Practice Statement Based on records reviews the licensee did not comply with the section cited above in two of two staff which poses a potential safety risk to persons in care.

Official plan of correction

POC Due Date: 08/02/2024 Plan of Correction Licensee agrees to provide LPA with proof of first aid training by POC date.

Official classification

Type A

Official code

87355(c)

Regulation authority

CCR

What the official deficiency says

A licensee or applicant for a license may request a transfer of a criminal record clearance from one state licensed facility to another, or from Trust Line to a state licensed facility by providing the following documents to the Department: This requirement is not being met as evidenced by: Based on interview and record review, Licensee failed to ensure S1 is associated to the facility. This poses an immediate health and safety risk to residents in care. CIVIL PENALTY ASSESSED

Official plan of correction

Licensee to submit LIC 9182 or associate the staff in the Guardian system and forward proof to LPA by POC due date.

Deadline recorded: Jul 30, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87464(f)(1)

Regulation authority

CCR

What the official deficiency says

Basic services shall at a minimum include: Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). This requirement is not being met as evidenced by: Based on record review, Licensee failed to ensure care and supervision is being provided to R1. R1 has a physician order to turn resident every 2 hours. Facility documentation indicates R1 was not turned 24 times between July 1-12, 2022. This poses an immediate health and safety risk to residents in care. Civil Penalty Assessed.

Official plan of correction

Licensee to submit a detailed, written plan on ensuring resident is being turned every two hours per physician order and forward proof to LPA by POC due date.

Deadline recorded: Jul 30, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87507(e)

Regulation authority

CCR

What the official deficiency says

The licensee shall provide a copy of the signed and dated current admission agreement.., to the resident or the resident's representative, if any, immediately upon signing the admission agreement or modification...This requirement is not being met as evidenced by: Based on interviews conducted, Licensee failed to ensure an admission agreement was provided to R1/ Responsible Party. This poses a potential health and safety risk to residents in care.

Official plan of correction

Licensee to provide a copy of the signed admission agreement to R1/ Responsible Party and forward proof to LPA by POC due date.

Deadline recorded: Jul 30, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87412(c)

Regulation authority

CCR

What the official deficiency says

Licensees shall maintain in the personnel records verification of required staff training and orientation. This requirement is not being met as evidenced by: Based on record review, Licensee failed to ensure verification of staff training is maintained. Two out of four staff do not have documentation of required training. This poses a potential health and safety risk to residents in are.

Official plan of correction

Licensee to ensure all staff training is up to date and verification is maintained in staff file. Licensee to forward proof to LPA by POC due date.

Deadline recorded: Aug 12, 2022. 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

The following shall be stored inaccessible to residents with dementia: Over-the-counter medication, nutritional supplements or vitamins, alcohol, cigarettes, and toxic substances such as certain plants, gardening supplies, cleaning supplies and disinfectants. 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 items noted in LIC 809 unsecured in the facility. This poses an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 05/18/2022 Plan of Correction Licensee to secure noted items and forward proof to LPA by POC due date.

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 noted items in need of repair on LIC 809. This poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 05/31/2022 Plan of Correction LIcensee to repair/ replace kitchen cupboards, attic door, and cupboard pulls and forward proof to LPA by POC due date.

Official classification

Type B

Official code

87506(d)

Regulation authority

CCR

What the official deficiency says

All resident records shall be available to the licensing agency to inspect, audit, and copy upon demand during normal business hours. Records may be removed if necessary for copying. Removal of records shall be subject to the following requirements: This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and interview, the licensee did not comply with the section cited above. Per staff, resident records are not on-site at facility. This poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 05/31/2022 Plan of Correction Licensee to ensure resident records are on-site at facility and available for licensing to review and forward proof to LPA by POC due date.

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 being met as evidenced by: Based on observation, Licensee failed to ensure facility is clean, safe, and sanitary. LPAs observed discarded items in the front of the driveway. This poses a potential health and safety risk to residents in care. CIVIL PENALTY ASSESSED.

Official plan of correction

Licensee to remove discarded items in front of driveway and forward proof to LPA by POC due date.

Deadline recorded: Apr 4, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.2(a)(2)

Regulation authority

CCR

What the official deficiency says

In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents.. shall have all of the following personal rights: To have a reasonable level of personal privacy in accommodations... and meetings of resident and family groups. This req not being met.. Based on interviews conducted, Licensee failed to ensure a reasonable level of privacy was provided to residents. Administrator admits to putting a video camera up in the living room without any consent from residents or responsible parties. This poses a potential health and safety risk to residents in care.

Official plan of correction

Licensee removed the camera prior to complaint investigation.

Deadline recorded: Mar 28, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87405(d)

Regulation authority

CCR

What the official deficiency says

The administrator shall have the qualifications specified in Sections 87405(d)(1) through (7). If the licensee is also the administrator, all requirements for an administrator shall apply. This requirement is not being met as evidenced by: Based on observation and interviews conducted, Licensee did not have qualifications for operation of facility. Administrator does not have a current certificate and allowed personal rights violations, pests in the facility, and facility to be in disrepair. This poses a potential health, safety, or personal rights violation.

Official plan of correction

Licensee to provide a written statement of understanding administrator qualifications and forward proof to LPA by POC due date.

Deadline recorded: Apr 4, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87468.1(a)(1)

Regulation authority

CCR

What the official deficiency says

Residents in all residential care facilities for the elderly shall have all of the following personal rights: To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement is not being met as evidenced by: Based on interviews conducted, Licensee failed to ensure resident is accorded dignity. During R1's passing, Licensee was involved in a verbal altercation with R1's family member while family member was asking for privacy. This poses an immediate health and safety risk to residents in care.

Official plan of correction

Licensee to submit a written, detailed plan on how to handle family discussions privately and with dignity and forward proof to LPA by POC due date.

Deadline recorded: Mar 22, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87464(f)(1)

Regulation authority

CCR

What the official deficiency says

Basic services shall at a minimum include: Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). This requirement is not being met as evidenced by: Based on interviews conducted, Licensee failed to ensure R1 was provided care and supervision. Licensee was unable to receive urgent care's calls due to an appointment Administrator was on. R1 was being transferred to the emergency room. This poses an immediate health and safety risk to residents in care.

Official plan of correction

Licensee to submit a statement indicating understanding of care and supervision and forward proof to LPA by POC due date.

Deadline recorded: Nov 24, 2021. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.1(a)(1)

Regulation authority

CCR

What the official deficiency says

Residents in all residential care facilities for the elderly shall have all of the following personal rights: To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement is not being met as evidenced by: Based on interviews conducted, Licensee failed to ensure incontinence care is being provided as needed. This poses a potential health and safety risk to residents in care.

Official plan of correction

Licensee to submit a written plan indicating how incontinence care will be provided and forward proof to LPA by POC due date.

Deadline recorded: Dec 7, 2021. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468(c)(2)(A)

Regulation authority

CCR

What the official deficiency says

Licensees shall prominently post personal rights, nondiscrimination notice, and complaint information in areas accessible to residents...Licensees may use the Residential Care Facility for the Elderly (RCFE) Complaint Poster (PUB 475) ... The poster that is posted shall be 20 " x 26 " in size and be posted in the main entryway of the facility. This req is not being met as evidenced by: Based on observation, Licensee failed to ensure the " Let Us No " poster is posted in the entrance of the facility in regulation size, 20 " X 26. " This poses a potential health and safety risk to residents in care.

Official plan of correction

Licensee to post the poster in regulation size and forward proof to LPA by POC due date.

Deadline recorded: Dec 7, 2021. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87307(d)(2)

Regulation authority

CCR

What the official deficiency says

The following space and safety provisions shall apply to all facilities: The premises shall be maintained in a state of good repair and shall provide a safe and healthful environment. This requirement is not being met as evidenced by: Based on observation, LPA observed live and dead cockroaches in the kitchen and resident bedroom. This poses a potential health and safety risk to residents in care.

Official plan of correction

Licensee to repaire broken cupboards and exterminate cockroaches. Licensee to forward proof to LPA by POC due date.

Deadline recorded: Nov 30, 2021. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87506(b)

Regulation authority

CCR

What the official deficiency says

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 being met as evidenced by: Based on observation and record review, Licensee failed to ensure R1's file is maintained at the facility. This poses a potential health and safety risk to residents in care.

Official plan of correction

Licensee to provide proof of R1's file to LPA by POC due date.

Deadline recorded: Nov 2, 2021. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87211(a)(1)(A)

Regulation authority

CCR

What the official deficiency says

Each licensee shall furnish to the licensing agency such reports as.., including.., the following: Death of any resident from any cause regardless of where the death occurred... This requirement is not being met as evidenced by: Based on interview conducted, Licensee failed to ensure a death report for R1 was submitted to Licensing. This poses a potential health and safety risk to residents in care.

Official plan of correction

Licensee to forward death report to LPA by POC due date.

Deadline recorded: Nov 9, 2021. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87407(a)

Regulation authority

CCR

What the official deficiency says

Administrators shall complete at least forty (40) classroom hours of continuing education during each two (2)-year certification period... 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 Licensee's administrator certificate expired 09/13/2019. This poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 11/16/2021 Plan of Correction Licensee to forward proof of initiatiating the process to renew certificate and forward proof to LPA by POC due date.

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 discarded items on front driveway, tile coming up in master suite, a broken patio set in backyard, broken cupboard in kitchen, an entry ramp needing repair as well as missing molding on kitchen cupboard. This poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 11/16/2021 Plan of Correction Licensee to repair/ replace noted items and forward proof to LPA by POC due date.