AMISTAD ASSISTED LIVING AND MEMORY CARE HOME

Official classification

Type A

Official code

87608(d)(3)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care (d)(3) The date and time the PRN medication was taken, the dosage taken, and the resident's response shall be documented and maintained in the resident's facility record. Based on interviews and record review, the Administrator did not comply with the section cited above by not documenting R1's PRN which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

The Administrator stated they will create a proper MAR medication, and organize their file. POC 10/10/2025

Deadline recorded: Oct 10, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87209(a)(2)

Regulation authority

CCR

What the official deficiency says

87209 Program Flexibility (a) (2) A written request for a waiver or exception and substantiating evidence supporting the request shall be submitted in advance to the licensing agency by the applicant or licensee. Based on interviews and record review, the Administrator did not comply with the section cited above by not having a camera inside R1 bedroom which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

The Administrator had agreed to remove camera. Administrator also stated that he will review the regulation cited and submit a statement of understanding to LPA via email by POC due date. POC due date 9/26/2025

Deadline recorded: Sep 26, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87468.2(a)(4)

Regulation authority

CCR

What the official deficiency says

87468.2(a)(4) Additional Personal Rights of Residents in Privately Operated Facilities: (a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents.. personal rights: (4) To care, supervision, and services that meet...their needs. This requirement is not met as evidenced by: Based on interviews and record review, the Administrator did not comply with the section cited above by not providing care, supervision, services to meet the residents needs which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

Administrator stated that he will review the regulation cited and submit a statement of understanding to LPA via email by POC due date.

Deadline recorded: Sep 26, 2025. 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

87468.1(a)(2) Personal Rights of Residents in All Facilities: (a) Residents in all residential care facilities for the elderly shall have all.. rights:(2) To be accorded safe, healthful and comfortable.. equipment. This requirement is not met as evidenced by: Based on interviews and record review, the Administrator did not comply with the section cited above by not providing safe, healthful, and comfortable accomodations to the residents which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

Administrator stated that he will review the regulation cited and submit a statement of understanding to LPA via email by POC due date.

Deadline recorded: Sep 26, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

87303Maintenance and Operation (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. Based on interviews and record review, the Administrator did not comply with the section cited above by not providing clean bedding which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

Administrator stated that he will review the regulation cited and submit a statement of understanding to LPA via email by POC due date. POC due 9/26/2025

Deadline recorded: Sep 26, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87705(1)(A)

Regulation authority

CCR

What the official deficiency says

87705 (1)(A)Care of Persons with Dementia(1)(A)Dementia care, including, but not limited to, knowledge about hydration, nutrition, skin care, communication,.. activities, behavioral challenges, the environment, and assisting with activities of daily living; Based on interviews and record review, the Administrator did not comply with the section cited above by not providing care, supervision, services to meet the residents needs which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

Administrator stated that he will review the regulation cited and submit a statement of understanding to LPA via email by POC due date. The facility staff will also complete their dementia training. POC due 9/26/2025

Deadline recorded: Sep 26, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(d)(3)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care (d)(3) The date and time the PRN medication was taken, the dosage taken, and the resident's response shall be documented and maintained in the resident's facility record. Based on interviews and record review, the Administrator did not comply with the section cited above by documenting R1's PRN which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

Administrator stated that he will review the regulation cited and submit a statement of understanding to LPA via email by POC due date. The facility staff complete an in-service training. POC due date 9/26/2025

Deadline recorded: Sep 26, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87208(a)

Regulation authority

CCR

What the official deficiency says

87208Plan of Operation(a) The licensee shall have and maintain a current, written definitive plan of operation for the facility. The licensee shall operate the facility in accordance with the terms specified in the plan of operation and may be cited for not doing.. Based on interviews and record review, the Administrator did not comply with the section cited above by changing visitor hours which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

Administrator stated that he will review the regulation cited and submit a statement of understanding to LPA via email by POC due date. The facility staff post their approved visitor hours. POC due date 9/26/2025

Deadline recorded: Sep 26, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87211(a)(1)

Regulation authority

CCR

What the official deficiency says

87211(a)(1) Reporting Requirements (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. Based on interview and record review, the licensee did not comply with the section cited above by not providing correct reimburstment which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

Licensee stated they will provided a certified letter they have read and understood section 87211(a)(1).

Deadline recorded: Mar 17, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87303(a)(1)

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. (1) Floor surfaces in bath, laundry and kitchen areas shall be maintained in a clean, sanitary, and odorless condition. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation LPA Rico observed which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/17/2025 Plan of Correction The Administrator stated they will ensure the facility odorless and will send LPA Rico the in-service documentation.

Official classification

Type A

Official code

87412(g)

Regulation authority

CCR

What the official deficiency says

(g) All personnel records shall be maintained at the facility. 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 by not having Administrator and S1 records which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/17/2025 Plan of Correction The Administrator stated they will send LPA Rico proof personnel records are maintianed at the facility.

Official classification

Type A

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 by not having a copy of S1 Health Screening which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/17/2025 Plan of Correction The Administrator stated they will send a copy of S1 Health Screening to LPA Rico.

Official classification

Type A

Official code

87355(j)

Regulation authority

CCR

What the official deficiency says

(j) The licensee shall maintain documentation of criminal record clearances or criminal record exemptions of employees in the individual's personnel file as required in Section 87412, Personnel Records. 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 by not having S1 criminal clearance which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/17/2025 Plan of Correction The Administrator stated they will send a copy of S1 criminal clearance to LPA Rico.

Official classification

Type A

Official code

87411(c)(6)

Regulation authority

CCR

What the official deficiency says

(6) The licensee shall maintain documentation pertaining to staff training in the personnel records, as specified in Section 87412(c)(2). For on-the-job training, documentation shall consist of a statement or notation, made by the trainer, of the content covered in the training. Each item of documentation shall include a notation that indicates which of the criteria of Section 87411(c)(3) is met by the trainer. 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 in by S1 and Administrator not having documentation of their trainings which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/17/2025 Plan of Correction The Administrator stated they will send a copies of staff training to LPA Rico.

Official classification

Type A

Official code

87705(b)(1)

Regulation authority

CCR

What the official deficiency says

(b) Licensees shall be responsible for the following: (1) Ensuring staff receive the following training as part of the training requirements specified in Section 87208 Plan of Operation: 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 by not having dementia training for S1 and the Administrator and which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/17/2025 Plan of Correction The Administrator stated they will send copies of staff training to LPA Rico.

Official classification

Type B

Official code

1569.652(c)

Regulation authority

HSC

What the official deficiency says

1569.652(c) Termination of admission agreement upon..; removal of resident’s property; refund of fees paid.. and refund(c)A refund of any fees paid in advance ..removed from the. resident paid the fees.. personal property is .. Based on interview and record review, the licensee did not comply with the section cited above by not providing correct reimburstment which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Licensee stated they will send LPA proof they have provided R1's family correct reimbursement. In addition, proof they have read and understood regulation. POC due date date 12/27/2024

Deadline recorded: Dec 27, 2024. A deadline is not proof that correction was completed.