GRACIOUS CARE HOME

Official classification

Type A

Official code

1569.618(a)

Regulation authority

HSC

What the official deficiency says

(a) The administrator designated by the licensee .. A facility manager designated by the licensee.. shall be responsible for the operation of the facility when the administrator is temporarily absent from the facility.This requirement is not met as evidenced by: Based on observation, interview, and record review , the licensee did not comply with the section cited above by not having an Administrator nor facility manager present which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

The Licensee stated they will send an updated LIC500 for the deisgnated House Manager. POC due date 1/29/2026

Deadline recorded: Jan 29, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

1569.618(b)

Regulation authority

HSC

What the official deficiency says

(b) At least one administrator, facility manager, or designated substitute who is at least 21 years of age and has qualifications adequate to be responsible and accountable for the management and administration of the facility pursuant to Title 22 of the California Code of Regulations shall be on the premises 24 hours per day. The designated substitute may be a direct care staff member who shall not be required to meet the educational, certification, or training requirements of an administrator. The designated substitute shall meet qualifications that include, but are not limited to, all of the following: 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 by not having Administrator on premises and no direct care staff that meet the qualifications which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/12/2025 Plan of Correction The Administrator stated they will submit proof of their designated substitute and send an updated LIC500.

Official classification

Type A

Official code

1569.618(a)

Regulation authority

HSC

What the official deficiency says

(a) The administrator designated by the licensee pursuant to paragraph (11) of subdivision (a) of Section 1569.15 shall be present at the facility during normal working hours. A facility manager designated by the licensee with notice to the department, shall be responsible for the operation of the facility when the administrator is temporarily absent from the facility. 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 by not having an Administrator nor facility manager present which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/12/2025 Plan of Correction The Adminstartor stated they will sumbit proof of their designated house manager and send an updated LIC500.

Official classification

Type B

Official code

87309(a)

Regulation authority

CCR

What the official deficiency says

(a) Except as specified in subsection (b), the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances, knives, matches, tools, sharp objects, and other similar items which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above by having cleaning solutions left under R1/R2 bathroom sink without a lock which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/18/2025 Plan of Correction The Administrator stated they will conduct an in-service training for staff and send a copy to LPA Rico. In addition, the cleaning soultion was removed.

Official classification

Type B

Official code

87458(a)

Regulation authority

CCR

What the official deficiency says

87458(a) Medical Assessment Prior to a person's acceptance.. the licensee shall obtain and keep on file.signed by a physician, made within the last year. Physician's Report, to obtain the medical assessment.This requirement is not met as evidenced by: Based on record review, the licensee did not comply with the section cited above by not having a R1 LIC602 which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Licensee stated they will obtain a copy of R1 LIC602 and will also send a copy to LPA Rico. POC due date 3/23/2025

Deadline recorded: Mar 28, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(c)(3)

Regulation authority

CCR

What the official deficiency says

Incidental Medical and Dental Care Services 87465(c)(3)A record of each dose is maintained in the resident's record. The record shall include the date and time the PRN medication was taken, the dosage taken, and the resident's response. Based on medication audit 1 out of the 3 residents did not have their PRN documented properly. The licensee did not comply with the section cited above which poses an immediate health, safety, or personal rights risk to persons in care.

Official plan of correction

The Licensee stated she will train all caregivers on the regulation cited above and will send LPA a copy to LPA Rico. POC due date 3/24/2025

Deadline recorded: Mar 24, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

1569.618(b)

Regulation authority

CCR

What the official deficiency says

(b) At least one administrator, facility manager, or designated substitute who is at least .. Title 22 ... the premises 24 hours per day... The designated substitute shall meet qualifications that include, but are not limited to, all of the following... Based on observation and interview , the licensee did not comply with the section cited above by not having a designated substitiute that meets qualifications present which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

Administrator stated they will send a copy of their designated substitutes along with their work schedule. Administrator also stated the Licensee will ensure the facility has a designated present on premises 24hours. POC due date 12/12/2024

Deadline recorded: Dec 12, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87509(d)

Regulation authority

CCR

What the official deficiency says

87509(d)Resident Records (d) 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: Based on observation and interview , the licensee did not comply with the section cited above by not having a R1 and R2 records at the facility an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

Administrator stated they will send LPA Rico R2 records. POC due date 12/12/2024

Deadline recorded: Dec 12, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

1569.618(c)(3)

Regulation authority

HSC

What the official deficiency says

1569.618(c)(3) Administration.. qualifications; (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 requirement is not met as evidenced by: Based on record review, the licensee did not comply with the section cited above, S1 did not have a CPR card which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

Administrator stated they will enroll S1 to a CPR class and will send proof to LPA. Licensee also stated they will send a copy of all staff CPR. POC due date 12/12/2024

Deadline recorded: Dec 12, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87355(e)(1)

Regulation authority

CCR

What the official deficiency says

87355 Criminal Record Clearance (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: (1) Obtain a California clearance... This requirement is not met as evidenced by: Based on observation and interview, the Licensee did not comply with the section cited above by not obtaining Staff #1 (S1) criminal record clearance before allowing S1 to work at the facility since 11/28/2024 which pose immediate health, safety and personal rights risk to residents in care.

Official plan of correction

Licensee stated to not allow S1 to work at the facility without obtaining the required Criminal background clearance and submit copy of Staff Schedule and Personnel Summary Report (LIC500) to LPA Rico at Plan of Correction due date. POC due date 12/6/2024

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

Official classification

Type A

Official code

1569.618(b)

Regulation authority

HSC

What the official deficiency says

(b) At least one administrator, facility manager, or designated substitute who is at least 21 years of age and has qualifications adequate to be responsible and accountable for the management and administration of the facility pursuant to Title 22 of the California Code of Regulations shall be on the premises 24 hours per day. The designated substitute may be a direct care staff member who shall not be required to meet the educational, certification, or training requirements of an administrator. The designated substitute shall meet qualifications that include, but are not limited to, all of the following: 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 by not having a designated substitiute present which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/17/2024 Plan of Correction Licensee stated they will send a copy of their designated substitutes along with their work schedule.

Official classification

Type A

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 by having (8) kitchen cabins dirty which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/17/2024 Plan of Correction Licensee stated they will clean their kitchen cabins, and will send proof to LPA Rico.

Official classification

Type A

Official code

87303(d)

Regulation authority

CCR

What the official deficiency says

(d) There shall be lamps or light appropriate for the use of each room and sufficient to ensure the comfort and safety of all persons in the facility. 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 by not having lights working in the kitchen hallway, living room, and resident's hallway which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/17/2024 Plan of Correction Licensee stated they will repair facility lights, and will send proof to LPA Rico.

Official classification

Type A

Official code

87303(e)(3)

Regulation authority

CCR

What the official deficiency says

(e) Water supplies and plumbing fixtures shall be maintained as follows: (3) Taps delivering water at 125 degree F (52 degrees C) or above shall be prominently identified by warning signs. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation , the licensee did not comply with the section cited above . The water tested at 126 F and did not have warning signs which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/17/2024 Plan of Correction Licensee stated they will post warning signs in resident's bathrooms, and will send proof to LPA Rico.

Official classification

Type A

Official code

1569.618(c)

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: This requirement is not met as evidenced by: Deficient Practice Statement Based on observation interview record review, the licensee did not comply with the section cited above. S1 stated they work all day, based on LIC500 staff schedule were not present which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/17/2024 Plan of Correction Licensee stated they will send an update LIC500 along with staff schedule.

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 record review, the licensee did not comply with the section cited above, S1 did not have a CPR card which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/17/2024 Plan of Correction Licensee stated they will enroll S1 to a CPR class and will send proof to LPA. Licensee also stated they will send a copy of all staff CPR.

Official classification

Type A

Official code

87355(e)(3)

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: (3) Request a transfer of a criminal record clearance as specified in Section 87355(c) or This requirement is not met as evidenced by: Deficient Practice Statement Based on record S1 did not have a request for their criminal record clearance to be transfer, the licensee did not comply with the section cited above, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/17/2024 Plan of Correction Licensee stated they will transfer S1 criminal record clearance and will send proof to LPA Rico.

Official classification

Type A

Official code

87465(d)(3)

Regulation authority

CCR

What the official deficiency says

(d) If the resident is unable to determine his/her own need for a prescription or nonprescription PRN medication, and is unable to communicate his/her symptoms clearly, facility staff designated by the licensee, shall be permitted to assist the resident with self-administration, provided all of the following requirements are met: (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. 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 by not having R1 PRN medication record of the time, date and resident response which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/17/2024 Plan of Correction Licensee stated they will train their staff on the regulation cited above and will send proof to LPA Rico.

Official classification

Type A

Official code

87465(e)

Regulation authority

CCR

What the official deficiency says

(e) For every prescription and nonprescription PRN medication for which the licensee provides assistance there shall be a signed, dated written order from a physician on a prescription blank, maintained in the resident's file, and a label on the medication. Both the physician's order and the label shall contain at least all of 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 by not having R1 medication listed on MAR file which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/17/2024 Plan of Correction Licensee stated they will have R1 medication listed on their file, and will send proof to LPA Rico.

Official classification

Type A

Official code

87705(c)(5)

Regulation authority

CCR

What the official deficiency says

(c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following: (5) Each resident with dementia shall have an annual medical assessment as specified in Section 87458, Medical Assessment, and a reappraisal done at least annually, both of which shall include a reassessment of the resident's dementia care needs. This requirement is not met as evidenced by: Deficient Practice Statement Based onrecord review , the licensee did not comply with the section cited above by R2 not having their annual medical assessment, last annual was dated of the year 2021, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/17/2024 Plan of Correction Licensee stated they will send proof to LPA they have schedule a medical assessment for R2.

Official classification

Type A

Official code

87705(j)

Regulation authority

CCR

What the official deficiency says

(j) The licensee shall have an auditory device or other staff alert feature to monitor exits, if exiting presents a hazard to any resident. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above the facility did not have the alert devices on which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/17/2024 Plan of Correction Licensee stated they will train their staff on the regulation cited above and will send a copy to LPA Rico. Before leaving the facility, LPA Rico requested the devices to be turned on.

Official classification

Type B

Official code

87208(a)

Regulation authority

CCR

What the official deficiency says

(a) Each facility shall have and maintain a current, written definitive plan of operation. The plan and related materials shall be on file in the facility and shall be submitted to the licensing agency with the license application. Any significant changes in the plan of operation which would affect the services to residents shall be submitted to the licensing agency for approval. The plan and related materials shall contain the following: 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 by not having the plan of operation in the faciity file which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/21/2024 Plan of Correction Licensee stated they will read the regulation cited above and will also send proof the plan of operation is located inside the facility file.

Official classification

Type B

Official code

87303(c)

Regulation authority

CCR

What the official deficiency says

(c) All window screens shall be clean and maintained in good repair. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above by not having a window screen by the dining area which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/21/2024 Plan of Correction Licensee stated they install a screen on the window and will send proof to LPA Rico.

Official classification

Type B

Official code

87303(e)(5)

Regulation authority

CCR

What the official deficiency says

(e) Water supplies and plumbing fixtures shall be maintained as follows: (5) Non-skid mats or strips shall be used in all bathtubs and showers. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation the licensee did not comply with the section cited above by not having non-skid mats for R1 and R1 bathroom which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/21/2024 Plan of Correction Licensee stated they will put non-skid mats for R1 and R2 bathroom. Licensee informed LPA they will send proof to LPA Rico.

Official classification

Type B

Official code

87307(a)(3)(B)

Regulation authority

CCR

What the official deficiency says

(B) Bedroom furniture, which shall include, for each resident, a chair, night stand, a lamp, or lights sufficient for reading, and a chest of drawers. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation , the licensee did not comply with the section cited above by not having a chair for R1 and R2 which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/21/2024 Plan of Correction Licensee stated they will provide a chair for R1 and R2 and will send proof to LPA.

Official classification

Type B

Official code

87311

Regulation authority

CCR

What the official deficiency says

All facilities shall have telephone service on the premises. Facilities with a capacity of sixteen (16) or more persons shall be listed in the telephone directory under the name of the facility. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above, S1 and LPA Rico tested the facility phone, the line was out of services which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/21/2024 Plan of Correction Licensee stated they having a working facility phone, and will send proof to LPA Rico.

Official classification

Type B

Official code

1569.618(c)(4)

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: (4) Ensure that the facility is clean, safe, sanitary, and in good repair at all times. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above by having two electric wires hanging off facility wall by residents bedroom which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/21/2024 Plan of Correction Licensee stated they will have electric wires repaired and will send proof to LPA Rico.

Official classification

Type B

Official code

87219(a)

Regulation authority

CCR

What the official deficiency says

(a) Residents shall be encouraged to maintain and develop their fullest potential for independent living through participation in planned activities. The activities made available shall include: 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 the facility did not have activities for residents,and during facility inspection no activities were provided which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/21/2024 Plan of Correction Licensee stated they will train their staff on the regulation cited above and will send a copy of resident activites.

Official classification

Type B

Official code

87465(a)(8)

Regulation authority

CCR

What the official deficiency says

(8) If a facility has no medical unit on the grounds, a complete first aid kit shall be maintained and be readily available in a specific location in the facility. The kit shall be a general type approved by the American Red Cross, or shall contain at least the following: 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 by not having a complete kit approved by American Red Cross which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/21/2024 Plan of Correction Licensee stated they will send proof to LPA the first aid kit contains all the following items.

Official classification

Type B

Official code

87465(a)(8)(A)

Regulation authority

CCR

What the official deficiency says

(8) If a facility has no medical unit on the grounds, a complete first aid kit shall be maintained and be readily available in a specific location in the facility. The kit shall be a general type approved by the American Red Cross, or shall contain at least the following: (A) A current edition of a first aid manual approved by the American Red Cross, the American Medical Association or a state or federal health agency. 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 by a current edition first aid manual approved by the American Red Cross which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/21/2024 Plan of Correction Licensee stated they will send proof the facility has purchase the current edition first aid manual approved by the American Red Cross

Official classification

Type B

Official code

1569.695(a)

Regulation authority

HSC

What the official deficiency says

(a)In addition to any other requirement of this chapter, a residential care facility for the elderly shall have an emergency and disaster plan that shall include, but not be limited to, all of the following: This requirement is not met as evidenced by: Deficient Practice Statement Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in [count] out of [total count] [(objects) (persons)] [identifiers] which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/21/2024 Plan of Correction Licensee stated they create the disater plan LIC 610 and send a copy to LPA Rico

Official classification

Type B

Official code

87625(b)(3)

Regulation authority

CCR

What the official deficiency says

(b) In addition to Section 87611, General Requirements for Allowable Health Conditions, the licensee shall be responsible for the following: (3) Ensuring that incontinent residents are kept clean and dry and that the facility remains free of odors from incontinence. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above by not having R1 and R2 bathroom free from incontient odor which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/21/2024 Plan of Correction Licensee stated they will train their staff on the regulation listed above, clean R1 and R2 bathroom, and will send proof to LPA Rico.

Official classification

Type B

Official code

87633(b)

Regulation authority

CCR

What the official deficiency says

(b) A current and complete hospice care plan shall be maintained in the facility for each hospice resident and include the following: 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 which poses/posed by not having R1 hospice care plan potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/21/2024 Plan of Correction Licensee stated they will send a copy to LPA Rico and will send proof R1 hospice careplan is maintained at the facility.

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 review of resident records, the licensee did not comply with the section cited above. Resident #2 physician report dated 06/21/2023 indicates bedridden status. This facility does not have a room cleared for a bedridden individual included in the fire clearance, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/12/2023 Plan of Correction Licensee to contact local fire jurisdiction and notify of bedridden status of resident #2 and submit LIC200 to request bedridden fire clearance for bedroom.

Official classification

Type A

Official code

87309(a)

Regulation authority

CCR

What the official deficiency says

(a) Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA observation, the licensee did not comply with the section cited above as evidenced by LPA observation of bleach and laundry soap unlocked and accessible to residents in the laundry room. This poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/13/2023 Plan of Correction Licensee to allocate a locked area for all cleaning solutions by POC due date 10/13/2023.

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 review of records there are no training records available to verify that this requirement has been met.

Official plan of correction

POC Due Date: 10/13/2023 Plan of Correction Licensee to conduct training and retain records by POC due date.

Official classification

Type A

Official code

87411(a)

Regulation authority

CCR

What the official deficiency says

(a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. In facilities licensed for sixteen or more, sufficient support staff shall be employed to ensure provision of personal assistance and care as required in Section 87608, Postural Supports. Additional staff shall be employed as necessary to perform office work, cooking, house cleaning, laundering, and maintenance of buildings, equipment and grounds. The licensing agency may require any facility to provide additional staff whenever it determines through documentation that the needs of the particular residents, the extent of services provided, or the physical arrangements of the facility require such additional staff for the provision of adequate services. This requirement is not met as evidenced by: Deficient Practice Statement Based on Caregiver Interview the licensee did not comply with the section cited above.Caregiver #1 is on duty 24 hours for 5 days straight without assistnce. This facility retains residents with a diagnosis of dementia. Resident #2 has two 1/2 bedrails on their bed and Caregiver #1 tells LPA that the resident moves around a lot at night and she fears that Resident #2 will fall. This poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/13/2023 Plan of Correction Licensee to ensure staffing is sufficient to monitor resident #2 by removing 2nd bed rail and employing an awake caregiver to adequately supervise Resident #2.

Official classification

Type A

Official code

87412(e)

Regulation authority

CCR

What the official deficiency says

(e) In all cases, personnel records shall demonstrate adequate staff coverage necessary for facility operation by documenting the hours actually worked. This requirement is not met as evidenced by: Deficient Practice Statement Based on Interview the licensee did not comply with the section cited above. Staff member #1 indicated that resident #2 is awake all night and may require supervision to not fall out of bed. There is no awake supervision provided on night shift. This poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/12/2023 Plan of Correction Licensee to provide CCL with updated staff schedule demonstrating adequate night supervision of residents with dementia.

Official classification

Type A

Official code

1569.69(a)(3)

Regulation authority

HSC

What the official deficiency says

(a) Each residential care facility for the elderly licensed under this chapter shall ensure that each employee of the facility who assists residents with the self-administration of medications meets all of the following training requirements: (3) An employee shall be required to complete the training requirements for hands-on shadowing training described in this subdivision prior to assisting any resident in the self-administration of medications. The training and instruction described in this subdivision shall be completed, in their entirety, within the first two weeks of employment. This requirement is not met as evidenced by: Deficient Practice Statement Based on review of records there is no documentation on file to support that this requirement is met. This poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/19/2023 Plan of Correction Licensee to provide training to employees that dispense medications by POC due date 10/19/2023.

Official classification

Type A

Official code

87465(h)(2)

Regulation authority

CCR

What the official deficiency says

(h) The following requirements shall apply to medications which are centrally stored: (2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA observation. LPA observed that the medication cabinet lock does not prevent access to others. LPA was able to open the medication cabinet. It is only secured with a baby type device and is easily opened by non employees and residents. This poses a risk to the health and safety of the persons in care.

Official plan of correction

POC Due Date: 10/13/2023 Plan of Correction Licensee to allocate a locked are for medications that rendes them inaccessible to persons other than employees responsible for supervision of the centrally stored medication by POC due date 10/13/2023.

Official classification

Type B

Official code

1569.153(b)

Regulation authority

HSC

What the official deficiency says

(b) Orientation to the policies and procedures for all employees within 90 days of employment. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review there are no training records available to verify that the requirement is met. This poses a health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/19/2023 Plan of Correction Licensee will conduct and maintain training record by POC due date.

Official classification

Type B

Official code

87411(d)

Regulation authority

CCR

What the official deficiency says

(d) All personnel shall be given on the job training or have related experience in the job assigned to them. This training and/or related experience shall provide knowledge of and skill in the following, as appropriate for the job assigned and as evidenced by safe and effective job performance: This requirement is not met as evidenced by: Deficient Practice Statement Based on record review there are no training records available to verify that the requirement is met. This poses a health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/19/2023 Plan of Correction Licensee will conduct and maintain training records by POC due date.

Official classification

Type B

Official code

87613(a)(2)(B)

Regulation authority

CCR

What the official deficiency says

(2) Ensure that facility staff who will participate in meeting the resident's specialized care needs complete training provided by a licensed professional sufficient to meet those needs. (B) Training shall be completed prior to the staff providing services to the resident. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review there are no training records available to verify that the requirement is met. This poses a health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/19/2023 Plan of Correction Licensee to conduct training and maintain training records by POC due date 10/19/2023.

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 record review there are no training records available to verify that the requirement is met. This poses a health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/19/2023 Plan of Correction Licensee to conduct training and maintain training records 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 there are no training records available to verify that the requirement is met. This poses a health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/19/2023 Plan of Correction Licensee to conduct training and maintain training record by POC due date.

Official classification

Type B

Official code

1569.625(c)(1)

Regulation authority

HSC

What the official deficiency says

(c) The training shall include, but not be limited to, all of the following: (1) Physical limitations and needs of the elderly. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review there are no training records available to verify that the requirement is met. This poses a health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/19/2023 Plan of Correction Licensee to conduct training and maintain training record by POC due date.

Official classification

Type B

Official code

1569.625(c)(2)

Regulation authority

HSC

What the official deficiency says

(c) The training shall include, but not be limited to, all of the following: (2) Importance and techniques for personal care services. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review there are no training records available to verify that the requirement is met. This poses a health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/19/2023 Plan of Correction Licensee to conduct training and maintain training record by POC due date.

Official classification

Type B

Official code

1569.625(c)(3)

Regulation authority

HSC

What the official deficiency says

(c) The training shall include, but not be limited to, all of the following: (3) Residents’ rights. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review there are no training records available to verify that the requirement is met. This poses a health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/19/2023 Plan of Correction Licensee to conduct training and maintain trainng record by POC due date.

Official classification

Type B

Official code

1569.625(c)(4)

Regulation authority

HSC

What the official deficiency says

(c) The training shall include, but not be limited to, all of the following: (4) Policies and procedures regarding medications. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review there are no training records available to verify that the requirement is met. This poses a health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/19/2023 Plan of Correction Licensee to conduct training and maintain training records by POC due date.

Official classification

Type B

Official code

1569.625(c)(5)

Regulation authority

HSC

What the official deficiency says

(c) The training shall include, but not be limited to, all of the following: (5) Psychosocial needs of the elderly. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review there are no training records available to verify that the requirement is met. This poses a health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/19/2023 Plan of Correction Licensee to conduct training and maintain trainnig records by POC due date.

Official classification

Type B

Official code

1569.625(c)(6)

Regulation authority

HSC

What the official deficiency says

(c) The training shall include, but not be limited to, all of the following: (6) Building and fire safety and the appropriate response to emergencies. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review there are no training records available to verify that the requirement is met. This poses a health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/19/2023 Plan of Correction Licensee to conduct training and maintain trainng records by POC due date.

Official classification

Type B

Official code

1569.625(c)(7)

Regulation authority

HSC

What the official deficiency says

(c) The training shall include, but not be limited to, all of the following: (7) Dementia care, including the use and misuse of antipsychotics, the interaction of drugs commonly used by the elderly, and the adverse effects of psychotropic drugs for use in controlling the behavior of persons with dementia. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review there are no training records available to verify that the requirement is met. This poses a health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/19/2023 Plan of Correction Licensee to conduct training and maintain training records by POC due date.

Official classification

Type B

Official code

1569.625(c)(8)

Regulation authority

HSC

What the official deficiency says

(c) The training shall include, but not be limited to, all of the following: (8) The special needs of persons with Alzheimer’s disease and dementia, including nonpharmacologic, person-centered approaches to dementia care. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review there are no training records available to verify that the requirement is met. This poses a health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/19/2023 Plan of Correction Licensee to conduct training and maintain training records by POC due date.

Official classification

Type B

Official code

1569.625(c)(9)

Regulation authority

HSC

What the official deficiency says

(c) The training shall include, but not be limited to, all of the following: (9) Cultural competency and sensitivity in issues relating to the underserved, aging, lesbian, gay, bisexual, and transgender community. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review there are no training records available to verify that the requirement is met. This poses a health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/19/2023 Plan of Correction Licensee to conduct training and maintain training record by POC due 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 record review there are no training records available to verify that the requirement is met. This poses a health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/23/2023 Plan of Correction Licensee to have employees trained in CPR and first aid and maintain training record by POC due date

Official classification

Type B

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 record review there are no training records available to verify that the requirement is met. This poses a health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/19/2023 Plan of Correction Licensee to conduct training and maintain training records by POC due date.

Official classification

Type B

Official code

1569.696(a)(1)

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: (1) Four hours of training on the care, supervision, and special needs of those residents, prior to providing direct care to residents. 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 record review there are no training records available to verify that the requirement is met. This poses a health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/19/2023 Plan of Correction Licensee to conduct traiing and retain training record by POC due date.

Official classification

Type B

Official code

1569.696(a)(2)

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: (2) Four hours of training thereafter of in-service training per year on the subject of serving those residents. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review there are no training records available to verify that the requirement is met. This poses a health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/19/2023 Plan of Correction Licensee to conduct training and maintain training record by POC due date.

Official classification

Type A

Official code

8770(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 residents. This requirement is not met as evidenced by: knife drawer does not have a lock and/or was not locked at the time of inspection. Deficient Practice Statement Based on LPA observation of knife drawer does not have a lock and/or was not locked at the time of inspection, the licensee did not comply with the section cited above and this poses an immediate health, safety risk to persons in care.

Official plan of correction

POC Due Date: 11/09/2021 Plan of Correction Please allocate a space to store knives which is inaccessible to residents in care by POC due date of 11/09/2021, which is 24 hours from the issue of this deficiency.

Official classification

Type A

Official code

87705(f)(2)

Regulation authority

CCR

What the official deficiency says

(f) The following shall be stored inaccessible to residents with dementis: (2) Over-the-counter medications, 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: Laundry and other cleaning supplies stored in an unlocked laundry room accessible to residents and others. Deficient Practice Statement Based on LPA observation of unlocked cleaning supplies, the licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/09/2021 Plan of Correction Please allocate a space to store the items listed above in section (2) by POC due date of 11/09/2021, which is 24 hours from the issue of this deficiency.