Medical and dental careType A
- Official classification
- Type A
- Official code
- 87465(a)(4)
- Regulation authority
- CCR
What the official deficiency says
(4) The licensee shall assist residents with self-administered medications as needed. 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 which poses an immediate health, safety or personal rights risk to persons in care. LPA observed the facility was providing three over the counter dietary supplements to Resident #2 (R2) without a valid prescription.
Official plan of correction
POC Due Date: 11/07/2025 Plan of Correction The Licensee stated that they will immediately stop providing the over the counter dietary supplements to R2 without a valid presription. The Licensee stated that they will either get prescriptions for the three dietary supplements, or permanently stop providing them. The Licensee stated that they will also conduct an in service training with staff regarding proper medication administration. The Licensee agreed to provide the training to LPA via email or fax by POC date.
Licensing and administrationType B
- 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 observation, interview, and record review, 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. LPA observed that neither of the two care giving staff present during the visit, Staff #2 (S2) and Staff #3 (S3), had valid CPR training cards on file.
Official plan of correction
POC Due Date: 12/01/2025 Plan of Correction The Licensee stated that she will have S2 and S3 complete CPR training. The LIcensee agreed to provide LPA the CPR training cards for S2 and S3 via email or fax by POC date.
Staffing, personnel, and trainingType B
- 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 and record review, 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. LPA observed that there was no Health Screening report on file for Staff #2 (S2) or Staff #3 (S3).
Official plan of correction
POC Due Date: 12/01/2025 Plan of Correction The Licensee stated that she will obtain Health Screening reports for S2 and S3. The Licensee agreed to provide the Health Screening reports for S2 and S3 to LPA via email or fax by POC date.
Staffing, personnel, and trainingType B
- 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 which poses/posed a potential health, safety or personal rights risk to persons in care. LPA observed there was no documented initial training on file for Staff #2 (S2) or Staff #3 (S3).
Official plan of correction
POC Due Date: 12/01/2025 Plan of Correction The Licensee stated that she will have S2 and S3 complete the required initial training. The Licensee agreed to provide the training records for S2 and S3 to LPA via email or fax by POC date.
Resident rightsType B
- Official classification
- Type B
- Official code
- 87468(c)(2)(A)
- Regulation authority
- CCR
What the official deficiency says
(c) Licensees shall prominently post personal rights, nondiscrimination notice, and complaint information in areas accessible to residents, representatives, and the public. (2) Information on the appropriate reporting agency in case of a complaint or emergency, including procedures for filing confidential complaints, shall be posted as follows: (A) Licensees may use the Residential Care Facility for the Elderly (RCFE) Complaint Poster (PUB 475) or may develop their own poster as provided in this section. A poster developed by the licensee shall contain the same content as the PUB 475. The poster that is posted shall be 20” x 26” in size and be posted in the main entryway of the facility. PUB 475 may be accessed, downloaded, and printed from the www.ccld.ca.gov website. 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/posed a potential health, safety or personal rights risk to persons in care. LPA observed that the facility does not have a See Something, Say Something poster (PUB 475) mounted in the facility.
Official plan of correction
POC Due Date: 12/01/2025 Plan of Correction The Licensee stated that she will obtain a See Something, Say Something poster for the facility. The Licensee agreed to provide LPA proof of the poster via email or fax by POC date.
Admission, assessment, and evictionType B
- 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 observation and record review, 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. LPA observed that there are no Reappraisals on file for Resident #1 (R1) or Resident #2 (R2).
Official plan of correction
POC Due Date: 12/01/2025 Plan of Correction The Licensee stated that she will complete the Reappraisals for R1 and R2. The Licensee agreed to provide LPA the Reappraisals for R1 and R2 via email or fax by POC date.
Fire safety and emergency preparednessType B
- 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 record review, 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. LPA observed that there were no documented emergency disaster drills on file.
Official plan of correction
POC Due Date: 12/01/2025 Plan of Correction The Licensee stated that she will conduct an emergency disaster drill with all facility staff. The Licensee agreed to provide LPA proof of the emergency disaster training via email or fax by POC date.
Fire safety and emergency preparednessType B
- Official classification
- Type B
- Official code
- 87203
- Regulation authority
- CCR
What the official deficiency says
87203 Fire Safety: 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 which poses/posed a potential health, safety or personal rights risk to persons in care. LPA observed the facility has one fire extinguisher mounted on the wall by the kitchen. LPA observed the fire extinguisher to be charged, however it has not been serviced since August 23, 2023.
Official plan of correction
POC Due Date: 12/01/2025 Plan of Correction The Licensee said that she will have the fire extinguisher serviced. The Licensee agreed to provide LPA proof of service via email or fax by POC date.