TESSIE'S PLACE LOVING CARE HOME #1

Official classification

Type A

Official code

87303(e)(2)

Regulation authority

CCR

What the official deficiency says

(e) Water supplies and plumbing fixtures shall be maintained as follows: (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 as multiple faucets and showers dispensed water that was measured to be below 105F in multiple locations throughout the facility which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/10/2025 Plan of Correction Licensee will immediately adjust the water heater to ensure water is being delivered at an appropriate temperature.

Official classification

Type A

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 interview and record review, the licensee did not comply with the section cited above as no current CPR training for staff members on the schedule could be provided during the visit. This poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/10/2025 Plan of Correction Licensee will ensure CPR training is scheduled and conducted for all care staff and will provide proof of completion to licensing staff.

Official classification

Type B

Official code

87706(a)(1)(C)

Regulation authority

CCR

What the official deficiency says

(a) In addition to the requirements in Section 87705, Care of Persons with Dementia, licensees who advertise, promote, or otherwise hold themselves out as providing special care, programming, and/or environments for residents with dementia or related disorders shall meet the following requirements: (1) In addition to the requirements specified in Sections 87208, Plan of Operation, the licensee shall include in the plan of operation a brief narrative description addressing the following additional information: (C) Staff training describing the required training for direct care staff who provide dementia special care. At a minimum, the description shall include information on training to be provided, as specified in Health and Safety Code sections 1569.625 and 1569.626. This requirement is not met as evidenced by: Deficient Practice Statement Based on records reviewe, the licensee did not comply with the section cited above as no current dementia training was provided to staff and documented in staff records on file. This poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/05/2026 Plan of Correction Licensee will conducted annual training on dementia for a minimum of eight hours and provide proof of completion to licensing staff before the plan of corrections due 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 observation, the licensee did not comply with the section cited above as one faucet in the bathroom leading to the laundry room is almost completely detached from the wall, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/05/2026 Plan of Correction Licensee will repair the faucet and provide documentation of the repair to licensing staff.

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 interview and record review, the licensee did not comply with the section cited above as no training records more recent than 2018 were found on file for current staff members which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/05/2026 Plan of Correction Licensee to update all staff members' annual training.

Official classification

Type B

Official code

1569.695(b)

Regulation authority

HSC

What the official deficiency says

(b) A facility shall provide training on the plan to each staff member upon hire and annually thereafter. The training shall include staff responsibilities during an emergency or disaster. 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 no current staff members have receive emergency and disaster training, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/05/2026 Plan of Correction Licensee will conduct training on emergency and disaster planning.

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 interview and record review, the licensee did not comply with the section cited above as only one drill was documented as having been conducted in 2025 which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/05/2026 Plan of Correction Licensee will schedule and conduct quarterly drills as required and document the drills according to the regulation above.

Official classification

Type B

Official code

87608(a)(1)

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: (1) Postural supports shall be limited to appliances or devices such as braces, spring release trays, or soft ties, used to achieve proper body position and balance, to improve a resident's mobility and independent functioning, or to position rather than restrict movement including, but not limited to, preventing a resident from falling out of bed, a chair, etc. 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 a wheelchair bound resident is observed to be equipped with a seat belt which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/31/2025 Plan of Correction Licensee to consult with the primary care provider and hospice staff to determine an alternative to the use of a seat belt.

Official classification

Type B

Official code

87608(a)(5)(B)

Regulation authority

CCR

What the official deficiency says

(B) Bed rails that extend the entire length of the bed are prohibited except for residents who are currently receiving hospice care and have a hospice care plan that specifies the need for full bed rails. 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 as one resident out of three resident found using full rails did not have any physician orders on file, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/05/2026 Plan of Correction Licensee to obtain adequate orders from hospice staff.

Official classification

Type B

Official code

87633(a)(2)

Regulation authority

CCR

What the official deficiency says

(a) The licensee shall be permitted to accept or retain residents who have been diagnosed as terminally ill by his or her physician and surgeon and who may or may not have restrictive and/or prohibited health conditions, to reside in the facility and receive hospice services from a hospice agency in the facility, when all of the following conditions are met: (2) The licensee remains in substantial compliance with the requirements of this section, with the provisions of the Residential Care Facilities for the Elderly Act (Health and Safety Code Section 1569 et seq.), all other requirements of Chapter 8 of Title 22 of the California Code of Regulations governing Residential Care Facilities for the Elderly, and with all terms and conditions of the waiver. 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 as three residents are currently receiving hospice care out of a waiver capacity of two residents. This poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/05/2026 Plan of Correction Licensee will submit a hospice waiver capacity increase once all remaining citations have been cleared.

Official classification

Type A

Official code

87405(a)

Regulation authority

CCR

What the official deficiency says

All facilities shall have a qualified and currently certified administrator. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, the licensee did not comply with the section cited abovewhich poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/02/2025 Plan of Correction Licensee agrees to have a new Administrator with a valid administrator's certificate named as the facility's new Administrator. LIcensee to submit a copy of the required documents to update the facility's administrator.

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 record review, the licensee did not comply with the section cited above in 1 out 5 residents, Resident 1 had no Physician's Report which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/15/2025 Plan of Correction Licensee agrees to have a Physician's report completed for Resident 1 by the POC due date. Licensee to forward proof to LPA by the POC due date.

Official classification

Type B

Official code

87467(a)(3)

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. (3) The licensee shall arrange a meeting with the resident and appropriate individuals identified in Section 87467(a)(1) to review and revise the written record as specified, when there is a significant change in the resident's condition, or once every 12 months, whichever occurs first. Significant changes shall include, but not be limited to occurrences specified in Section 87463, Reappraisals. 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 3 out of 5 residents which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/15/2025 Plan of Correction Licensee agrees to complete resident appraisals for Resident 1, Resident 2 and Resident 4 by the POC due date. Licensee to forward proof to LPA by the POC due date.

Official classification

Type A

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 record review the licensee did not comply with the section cited above, there is no documentation for a recent drill being conducted which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/02/2025 Plan of Correction Licensee agrees to conduct an emergency drill and to document the training. Licensee to submit proof of training to LPA by POC due date.

Official classification

Type B

Official code

Not listed

Regulation authority

Not listed

What the official deficiency says

The California Code of Regulations Section 87705(f) on the Care of Persons with Dementia states: " The following shall be stored inaccessible to residents with dementia: (2) (...) toxic substances such as (...) cleaning supplies(...). This requirement is not met as evidenced by: Laundry detergent, were observed to be accessible due to unlocked doors. Based on observation, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.

Deadline recorded: Jan 15, 2023. 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 and a review of incident reports, Licensee failed to ensure care and supervision was provided to R1. R1 eloped out of the facility and was found by the police and taken to the hospital. This poses an immediate health and safety risk to residents in care.

Official plan of correction

Licensee to provide an elopement in-service to staff and forward proof to LPA by POC due date.

Deadline recorded: Jun 27, 2022. A deadline is not proof that correction was completed.