GOLDEN HILLS CARE HOME

Official classification

Type A

Official code

87202(a)(2)

Regulation authority

CCR

What the official deficiency says

(a) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, or the State Fire Marshal. Prior to accepting or retaining any of the following types of persons, the applicant or licensee shall notify the licensing agency and obtain an appropriate fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, or the State Fire Marshal: (2) Bedridden persons This requirement is not met as evidenced by: Deficient Practice Statement Based on records review and interview, R5 is found to be bedridden and the home does not have the required fire clearance which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/24/2026 Plan of Correction R5 will be moved to a related home with bedridden clearance by the POC date of 6/24/26

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 records review, the current licensee failed to associate current staff during a change of ownership which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/24/2026 Plan of Correction Licensee will submit transfer requests for current staff by the POC of 6/24/26

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 records review and interviews evidence was not present for emergency drills which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/24/2026 Plan of Correction Licensee will conduct an emergeny drill to include all staff by the POC date of 6/24/26. Documentation to be submitted.

Official classification

Type B

Official code

87307(d)(6)

Regulation authority

CCR

What the official deficiency says

(6) All outdoor and indoor passageways and stairways shall be kept free of obstruction. This requirement is not met as evidenced by: Deficient Practice Statement Based on observations, external walkways are obstructed and R5's exit door are obstructed which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/30/2026 Plan of Correction Licensee will submit proto evidence of exits and walkways unobstructed and gate opens freely by the POC date of 6/30/26.

Official classification

Type B

Official code

87412(f)

Regulation authority

CCR

What the official deficiency says

(f) All personnel 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 records review, personnel files are not present which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/21/2026 Plan of Correction Licensee will create and maintain staff records as required. This POC to be cleared by visit.

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 based on records review, proof of staff training is not available which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/14/2026 Plan of Correction Licensee will submit proof of required staff training for current employees by the POC date of 7/14/26

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 observations of meds poured for a week in pill boxes which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/30/2026 Plan of Correction Licensee will submit a procedure for Med administration that ensures the 5 Rights of med pass. By the POC date of 6/30/26

Official classification

Type B

Official code

87506(a)

Regulation authority

CCR

What the official deficiency says

87506 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 facility staff and to licensing agency staff. This requirement was not met based on records review.

Official plan of correction

Licensee will submit a statement identifying all records to be in resident files at the facility upon admission of a new resident by the POC date of 12/11/25.

Deadline recorded: Dec 11, 2025. A deadline is not proof that correction was completed.

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 in1 of 1 staff (S1] which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/23/2025 Plan of Correction Licensee will submit proof of S1's first year required 40 hours of staff training by the POC date of 7/23/25.

Official classification

Type B

Official code

87555(b)(8)

Regulation authority

CCR

What the official deficiency says

(b) The following food service requirements shall apply: (8) All food shall be of good quality. Commercial foods shall be approved by appropriate federal, state and local authorities. Food in damaged containers shall not be accepted, used or retained. 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 observed 2 cans of food past use by date in the kitched cabinet which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/23/2025 Plan of Correction Licensee will submit a detailed procedure for food storage, rotation and inventory to ensure safe food by the POC date of 7/23/25

Official classification

Type A

Official code

87411(a)

Regulation authority

CCR

What the official deficiency says

Personnel Requirements - General (a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. This requirement was not met based on report and interviews. This posed an immediate risk to R1.

Official plan of correction

Licnensee will submit a plan for supervision and alarms that ensure close supervion of R1 during all hours of the day, by the POC date of 12/4/24. To be cleared by POC visit.

Deadline recorded: Dec 4, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87203

Regulation authority

CCR

What the official deficiency says

Fire Safety All facilities shall be maintained in conformity with the regulations adopted by the State Fire Marsha... This requirement was not met based on observation of ubstructed exits. This posed and immediate risk to residents.

Official plan of correction

Locks and obstructions were removed while LPA was present. Licensee will submit proof of training for staff to not use such devices and a schedule for Administrator to conduct at least weekly compliance checks of the home, by the POC date of 12/4/24.

Deadline recorded: Dec 4, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87355(c)

Regulation authority

CCR

What the official deficiency says

Criminal Record Clearance (c) A licensee or applicant for a license may request a transfer of a criminal record clearance from one state licensed facility to another. This requirenment was not met based on record review and interview. This posed a potential risk to residents.

Official plan of correction

Licensee will submit a transfer request for S2 to CCLD via fax or Guardian and notify LPA when completed, by the POC date of 12/6/24

Deadline recorded: Dec 6, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87631

Regulation authority

CCR

What the official deficiency says

87631 Healing Wounds (a) ...accept or retain... a healing wound ...: (3) Residents with a stage one or two pressure injury ...(A) ...shall receive care...from a...appropriately skilled professional. This requirement was not met based on lack or records for staging or care. This posed a potential risk

Deadline recorded: Dec 6, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87467

Regulation authority

CCR

What the official deficiency says

Resident Participation in Decisionmaking (a) Prior to, or within two weeks of the resident’s admission, ... to prepare a written record of the care the resident will receive in the facility...This requirement was not met based on records review. This posed a potential risk for resdents.

Official plan of correction

Licensee will create Needs and Services Plans using the LIC 625, or the information on the form, for all residents and submit the forms to LPA by the POC date of 12/24/24. If not signed by residents or responsible parties, Licensee will stae when meetings are scheduled.

Deadline recorded: Dec 24, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87405(a)

Regulation authority

CCR

What the official deficiency says

Administrator - Qualifications and Duties (a) ...The administrator shall ... shall be on the premises a sufficient number of hours to permit adequate attention to the management and administration of the facility as specified in this section. This requirement was not met based on the issues and citations noted in this visit. This poses a potential risk to residents.

Official plan of correction

Licensee will submit a LIC 500 identifying when Admin and staff will regularly be present at the faciliy. Additionally, Licensee will submit a written plan for the duties and task to be completed when present to ensure compliance with Title 22 requirements. Documents to be submitted by 12/24/24.

Deadline recorded: Dec 24, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

1569.696(a)

Regulation authority

HSC

What the official deficiency says

(a) All residential care facilities for the elderly shall provide training to direct care staff on postural supports, restricted conditions or health services, and hospice care as a component of the training requirements specified in Section 1569.625. The training shall include all of the following: This requirement is not met as evidenced by: Deficient Practice Statement Based on records review the licensee did not comply with the section cited above in 2 of 2 staff were in need of some annual training and training for restricted health conditions which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/26/2024 Plan of Correction Licensee will have all staff training up to date by the POC date of 6/26/24. To be cleared by visit.

Official classification

Type B

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 observations the licensee did not comply with the section cited above in drawers and cabinets in the kitchen not locked when staff left the area which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/26/2024 Plan of Correction Licensee will ensure items to be locked are secured and locked. T be cleared by visit.

Official classification

Type A

Official code

87411(a)

Regulation authority

CCR

What the official deficiency says

87411(a) Personnel Requirements - General (a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. This requirement was not met as evidenced by: It was determined that staff did not provide adequate care and supervision to R1 which resulted in R1 eloping to an elementary school six minutes away from the facility. It took staff approxmiately 22-30 minutes to locate R1 which poses an immediate health and safety risk to residents in care.

Official plan of correction

The administrator agrees to provide a detailed plan explaining how they will ensure facility staff are competent and aware of how to properly provide care and supervision to residents. Proof of completion shall be sent to the licensing agency by 9/1/2023.

Deadline recorded: Sep 1, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87211(a)(1)

Regulation authority

CCR

What the official deficiency says

87211 Reporting Requirements. (a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: (1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below. This report shall include the resident's name, age, sex and date of admission; date and nature of event; attending physician's name, findings, and treatment, if any; and disposition of the case. This requirement is not met as evidenced by: Based on interviews the licensee did not report incident which lead to R1's pressure injury which poses a potential health and safety risk to residents in care.

Official plan of correction

Administrator agrees to review 87211 reporting requirements and send into LPA a statement of understanding. Statement to be sent into CCL by 6/09/23. Since incident occurred facility has begun to complete thorough documentation for each resident.

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