KUN BAI CARE #2 HOME

Official classification

Type B

Official code

87411(a)

Regulation authority

CCR

What the official deficiency says

87411(a)Facility personnel shall at all times be... competent to provide the services necessary to meet resident needs... The licensing agency may require any facility to provide additional staff whenever it determines...the facility require... additional staff for the provision of adequate services. Based on observations and attempted interviews, S1 demonstrated an inability to effectively communicate with residents and LPA, impactaing their ability to provide adequate care and supervision to residents, This poses a potential health and safety risk to residents in care.

Official plan of correction

Licensee shall ensure that all staff have the ability to effectively communicate with residents and Licensing staff in order to provide adequate care and supervision. Licensee shall submit a written plan to Licensing describing how communication competency will be ensured for all staff along with an updated LIC 500 Personnel Report indicating staff's full names as they appear on Guardian that coincides with written plan to provide adequate care and supervision to residents by POC due date.

Deadline recorded: May 14, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

1569.168(a)

Regulation authority

HSC

What the official deficiency says

§1569.618 (a) The administrator designated... shall be present at the facility during normal working hours... 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 and interviews, the licensee did not comply with the section cited above by not ensuring that the facility Administrator is present at the facility during working hours as required which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

Licensee stated additional designees will be assigned to ensure an Administrator(s) can be at the facility during working hours as required. Licensee will submit LIC 308(s) to Licesning and provide proof of submission(s) of LIC 308(s), and updated LIC 500, via email to LPA Martinez by POC due date.

Deadline recorded: May 1, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87309(a)

Regulation authority

CCR

What the official deficiency says

87309(a) ... [T]he licensee shall ensure that disinfectants, cleaning solutions,... 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: Based on observation, facility staff did not ensure disinfectants, cleaning solutions, and sharp objects were not left unattended or outside of locked storage areas which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

Caregiver immediately placed disinfectants, cleaning solutions, and sharp objects in locked storage. Licensee to review cited regulation with facility staff and provide a written statement of understanding to Licensing by POC due date.

Deadline recorded: May 1, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

1569.185

Regulation authority

HSC

What the official deficiency says

1569.185 Fees for license... (a)(1)...After initial licensure, a fee shall be charged... annually... (b)(1)(F) A late fee that represents an additional 50 percent of... current annual fee when a licensee fails to pay... on or before the due date as indicated. This requirement was not me as evidenced by: Based on facility file review, the licensee did not comply with the section cited above by not ensuring the facility licensing fees were been paid to the Department by the due date which poses an immediate health and saftey risk to residents in care.

Official plan of correction

LPA advised Licensee facility's annual fees are due to be paid to the Department by POC due date. LPA informed Licensee late fees and/or civil penalties may be assessed if fees not paid in full by POC due date. Licensee to provide proof of payment to LPA via email by close of business on POC due date.

Deadline recorded: May 1, 2026. A deadline is not proof that correction was completed.

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 interview and record review, the licensee did not comply with the section cited above in Resident #1 (R1) was not given their medication as prescribed which poses an immediate health and safety risk to one (1) out of four (4) residents in care.

Official plan of correction

POC Due Date: 12/11/2025 Plan of Correction Licensee agrees to contact R1’s physician, update R1’s prescriptions, and send proof to the Department by POC date of 12/11/2025.

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 and interview, the licensee did not comply with the section cited above in three (3) out three (3) resident bedrooms did not have a chair which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/10/2025 Plan of Correction Staff placed a chair into each of the residents bedrooms during LPA's visit.

Official classification

Type A

Official code

87705(c)(5)

Regulation authority

CCR

What the official deficiency says

Care of Persons with Dementia(c)(5) Each resident with dementia shall have an annual medical assessment as specified in Section 87458, 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 ensuring that Resident1 have an annual medical assessment as required for dementia resident which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

Licensee stated to submit R1 medical appointment date to complete the required annual medical assessmet for resident with dementia to LPA Rico on Plan of Correction (POC) due date. POC due date 6/26/2025.

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

Official classification

Type A

Official code

1569.618(a)

Regulation authority

HSC

What the official deficiency says

Other Provisions(a) The administrator designated.. shall be present at the facility during normal working hours... 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 ensuring that the Administrator's present at the facility during working hours as required which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

Licensee stated to hire an additional Administrator to ensure that Admistrator's at the facility during working hours as required and submit proof to LPA Rico on Plan of Correction (POC) due date. POC due date 6/26/2025.

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

Official classification

Type A

Official code

1569.311

Regulation authority

HSC

What the official deficiency says

Every residential care facility for the elderly shall have one or more carbon monoxide detectors in the facility that meet the standards established in Chapter 8 (commencing with Section 13260) of Part 2 of Division 12. The department shall account for the presence of these detectors during inspections. 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 ensuring that the facilitgy has the required carbon monoxide detectorswhich poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/29/2024 Plan of Correction Licensee stated to obtain/purchase the required carbon monoxide detector and submit proof to LPA Brown on Plan of Correction (POC) due date.

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 observation, interview and record review, the licensee did not comply with the section cited above by not ensuring that the observed one (1) scissor four antibiotic ointments in R1 and R2 bedroom, theb two (2) gallons of bleach, three (3) bottles of cleaning solutions, one bottle of laundry detergent in the garage and one (1) scissor in the hallway closet, were locked and not accessible to residents in care which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/29/2024 Plan of Correction Licensee immediately locked the observed scissors and chemicals during the visit. Licensee stated to train all staff on CCR 87309(a) and submit proof to LPA Brown on Plan of Correction (POC) due date.

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 observation, interview and record review, the licensee did not comply with the section cited above by not ensuring that Staff #2 (S2) who'son duty and on the premises at all times have the required cardiopulmonary resuscitation (CPR) training and first aid training which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/29/2024 Plan of Correction Licensee stated to submit S2 proof of enrollment/certification on cardiopulmonary resuscitation (CPR) training and first aid training to LPA Brown on Plan of Correction (POC) due date.

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, interview, record review)], the licensee did not comply with the section cited above by not ensuring that facility staffs are assisting Resident #1 (R1) with one (1) of R1's medication as evidenced of R1's medication was not given per R1's physician directions which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/29/2024 Plan of Correction Licensee stated to provide additional training to all staff on CCR 87465(a)(4) and submit proof to LPA Brown on POC due date.

Official classification

Type A

Official code

87465(a)(5)(A)

Regulation authority

CCR

What the official deficiency says

(5) Facility staff, except those authorized by law, shall not administer injections, but staff designated by the licensee may assist persons with self-administration as needed. Assistance with self-administered medications shall be limited to the following: (A) Medications usually prescribed for self-administration which have been authorized by the person's physician. 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 by not ensuring that one (1) medication of Resident #2 (R2) has R2's physician authorization which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/29/2024 Plan of Correction Licensee staeted to train all staff on CCR 87465(a)(5)(A) and submit proof to LPA Brown on Plan of Correction (POC) due date.

Official classification

Type A

Official code

87458(a)

Regulation authority

CCR

What the official deficiency says

(a) Prior to a person's acceptance as a resident, the licensee shall obtain and keep on file, documentation of a medical assessment, signed by a physician, made within the last year. The licensee shall be permitted to use the form LIC 602 (Rev. 9/89), Physician's Report, to obtain the medical assessment. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview and record review, the licensee did not comply with the section cited above by admitting Resident #2 (R2) at the facility on 03/29/2023 and not ensuring that R2 physician report has physician signature and signature date which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/29/2024 Plan of Correction Licensee stated to submit R2 medical appointment date to complete the required medical assessment and submit proof to LPA Brown on POC due date.

Official classification

Type A

Official code

87608(a)(5)(B)

Regulation authority

CCR

What the official deficiency says

(B) Bed rails that extend the entire length of the bed are prohibited except for residents who are currently receiving hospice care and have a hospice care plan that specifies the need for full bed rails. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview and record review, the licensee did not comply with the section cited above by allowing Resident #2 (R2) with full bed rail and R2's not on hospice and no letter/waiver was submitted and approved by CCLD which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/29/2024 Plan of Correction Licensee stated to remove R2's full bed rail and submit proof to LPA Brown on Plan of Correction due date. LPA Brown informed Licensee to submit R2 letter/waiver with doctor's written order to CCLD for approval if they prefer R2 to have full bed rail.

Official classification

Type A

Official code

87705(c)(4)(A)

Regulation authority

CCR

What the official deficiency says

(c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following: (4) There is an adequate number of direct care staff to support each resident's physical, social, emotional, safety and health care needs as identified in his/her current appraisal. (A) In addition to requirements specified in Section 87415, Night Supervision, a facility with fewer than 16 residents shall have at least one night staff person awake and on duty if any resident with dementia is determined through a pre-admission appraisal, reappraisal or observation to require awake night supervision. 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 ensuring that there's a staff schedule to work the night shift as required for facility with dementia residents which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/29/2024 Plan of Correction Licensee stated to schedule a staff to work the night shift as required for facility with dementia residents and submit an updated staff schedule and Personnel Report (LIC500) to LPA Brown on POC due date.

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 on observation, interview and record review, the licensee did not comply with the section cited above by not ensuring that Resident #2 (R2) have an annual medical assessment as required for dementia resident which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/29/2024 Plan of Correction Licensee stated to submit R2 medical appointment date to complete the required annual medical assessmet for resident with dementia to LPA Brown on Plan of Correction (POC) due date.

Official classification

Type B

Official code

1569.605

Regulation authority

HSC

What the official deficiency says

On and after July 1, 2015, all residential care facilities for the elderly, except those facilities that are an integral part of a continuing care retirement community, shall maintain liability insurance covering injury to residents and guests in the amount of at least one million dollars ($1,000,000) per occurrence and three million dollars ($3,000,000) in the total annual aggregate, caused by the negligent acts or omissions to act of, or neglect by, the licensee or its employees. 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 ensuring that the facility that cover injury to residents and guests in the amount of at least one million dollars ($1,000,000) per occurrence and three (3) million dollars ($3,000,000) in the total annual aggregate caused by the negligent acts or omissions to act of, or neglect by, the licensee or its employees which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/07/2024 Plan of Correction Licensee updated the facility's liability insurance as required and submitted a copy to LPA Brown during the visit. Plan of Correction (POC) cleared.

Official classification

Type B

Official code

87307(d)(5)

Regulation authority

CCR

What the official deficiency says

(5) Night lights shall be maintained in hallways and passages to nonprivate bathrooms. 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 ensuring that night lights were maintained in hallways and passages to non-private bathrooms which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/07/2024 Plan of Correction Licensee stated to obtain and install night lights to hallways and passages to nonprivate bathrooms and submit proof to LPA Brown on POC due date.

Official classification

Type B

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 ensuring that the Administrator's present at the facility during working hours as required which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/07/2024 Plan of Correction Licensee stated to hire an additional Administrator to ensure that Admistrator's at the facility during working hours as required and submit proof to LPA Brown on Plan of Correction (POC) due date.

Official classification

Type B

Official code

87219(a)(1)

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: (1) Socialization, achieved through activities such as group discussion and conversation, recreation, arts, crafts, music, and care of pets. 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 ensuring that there's planned activities at the facility for the socialization of residents and not just watching television at teh living room which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/07/2024 Plan of Correction Licensee stated to submit a monthly planned activities for residents socialization to LPA Brown on POC due date.

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, interview and record review, the licensee did not comply with the section cited above by not conducting the required fire and earthquake drill at least quarterly which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/07/2024 Plan of Correction Licensee stated to conduct the required fire and earthquake drill and submit proof to LPA Brown on Plan of Correction (POC) due date.

Official classification

Type B

Official code

1569.695(d)

Regulation authority

HSC

What the official deficiency says

(d) A facility shall review the plan annually and make updates as necessary, including changes in floor plans and the population served. The licensee or administrator shall sign and date documentation to indicate that the plan has been reviewed and updated as necessary. 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 ensuring that the emergency disaster plan was reviewed annually and signed by the Administrator or LIcensee which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/07/2024 Plan of Correction Licensee stated to review and sign the Emergency Disaster Plan and submit proof to LPA Brown on POC due date.

Official classification

Type B

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, interview and record review, the licensee did not comply with the section cited above by not ensuring that the auditory device that alert staff to monitor exits are not in disrepair which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/07/2024 Plan of Correction LIcensee stated to repair the auditory device that alert staff to monitor exits and submit proof to LPA Brown on Plan of Correction (POC) due date.

Official classification

Type A

Official code

87309(a)

Regulation authority

CCR

What the official deficiency says

87309 Storage Space (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: Based on observation and interview, the Licensee did not comply with the section cited above by not storing the five (5) knives observed in the kitchen cabinet where it's inaccessible to residents in care which pose immediate health, safety and personal rights risks to residents in care.

Official plan of correction

Licensee stated to train all staff on CCR 87309(a) and submit proof of all staff training log to LPA Brown on Plan of Correction (POC) due date.

Deadline recorded: Jul 2, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87608(a)(5)(B)

Regulation authority

CCR

What the official deficiency says

87608 Postural Supports (a) Based on the individual's preadmission appraisal, and subsequent changes to that appraisal, the facility shall provide assistance and care for the resident in those activities of daily living which the resident is unable to do for himself/herself. Postural supports may be used under the following conditions (5) Under no circumstances shall postural supports include tying, depriving, or limiting the use of a resident's hands or feet. (B) Bed rails that extend the entire length of the bed are prohibited except for residents who are currently receiving hospice care and have a hospice care plan that specifies the need for full bed rails. This requirement is not met as evidenced by: Based on observation, interview and records review, the Licensee did not comply with the section cited above by allowing Resident #3 (R3) to have full bed rail at the facility which pose potential health, safety and personal rights risks to resident in care.

Official plan of correction

Licensee stated to train all staff on CCR 87608(a)(5)(B) and submit proof of training log to LPA Brown at POC due date. Licensee will remove R3 full bed rail and submit proof to LPA Brown at POC due date.

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

Official classification

Type B

Official code

1569.618(a)

Regulation authority

HSC

What the official deficiency says

HSC 1569.618 Administration and management of residential care facilities; substituted qualifications; employee scheduling (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: Based on observation, interview and records review, the Licensee did not comply with the section cited above by not having an Administrator present during working hours at the facility which pose potential health, safety and personal rights risks to residents in care.

Official plan of correction

Licensee stated to submit Signed Statement of Understanding on HSC 1569.618(a) and submit to LPA Brown at POC due date.

Deadline recorded: Jul 16, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87458(a)

Regulation authority

CCR

What the official deficiency says

87458 Medical Assessment a) Prior to a person's acceptance as a resident, the licensee shall obtain and keep on file, documentation of a medical assessment, signed by a physician, made within the last year. The licensee shall be permitted to use the form LIC 602 (Rev. 9/89), Physician's Report, to obtain the medical assessment. This requirement is not met as evidenced by: Based on observation, interview and records review, the Licensee did not comply with the section cited above by not ensuring that Resident #3 (R3) has a completed Medical Assessment by R3's Physician prior to acceptance as a resident at the facility as evidenced of R3's Physician Report on file is not complete due to missing Physician signature which pose immediate health, safety and personal rights risk to residents in care.

Official plan of correction

Licensee stated to schedule R3's Medical Assessment and submit proof to LPA Brown on Plan of Correction (POC) due date.

Deadline recorded: Jul 2, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87309(a)(1)

Regulation authority

CCR

What the official deficiency says

87309 Storage Space (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. (1) Storage areas for poisons, and firearms and other dangerous weapons shall be locked. 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 locking the multiple bottle of cleaning solutions, and chemicals under the kitchen sink making it accessible to residents in care which pose immediate health, safety and personal rights risks to residents in care.

Official plan of correction

Licensee stated to train all staff on CCR 87309(a)(1) and submit proof of Staff Training Log to LPA Brown on Plan of Correction (POC) due date. Licensee locked the multiple bottle of chemicals/cleaning solutions during the visit.

Deadline recorded: Jul 2, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(h)(2)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care (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: Based on observation, and interview, the Licensee did not comply with the section cited above by not ensuring that residents centrally stored medications are kept in a safe and locked place that is not accessible to residents in care which pose immediate health, safety and personal rights risks to residents in care.

Official plan of correction

Licensee stated to train all staff on CCR 87465(h)(2) and submit proof of all staff training log to LPA Brown on POC due date. Licensee locked the medicine cabinet where the resindents medications are stored during the visit.

Deadline recorded: Jul 2, 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 interview, observation, and document review, the licensee did not comply with the section cited above evidenced by not having the required staff present in the facility which poses an immediate health, safety, or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/11/2023 Plan of Correction The licensee has agreed to read health and safety code 1569.618 entirely and send LPA a self-certified letter that the regulation was read and understood. The licensee has agreed to hire the required staff to follow the health and safety code and or have the administrator present in the facility. The POC is due by 10/11/2023.

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 interview, observation, and document review, the licensee did not comply with the section cited above evidenced by not having a staff present in the facility with CPR training which poses an immediate health, safety, or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/11/2023 Plan of Correction The licensee has agreed to read health and safety code 1569.618 entirely and send LPA a self-certified letter that the regulation was read and understood. The licensee has agreed to hire the required staff to follow the health and safety code and or have the current staff trained in CPR. The POC is due by 10/11/2023.

Official classification

Type A

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 interview, observation, and document review, the licensee did not comply with the section cited above evidenced by not having staff with the required training/training documents which poses an immediate health, safety, or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/11/2023 Plan of Correction The licensee has agreed to read health and safety code 1569.625 entirely and send LPA a self-certified letter that the regulation was read and understood. The licensee has agreed to hire the required staff to follow the health and safety code and or have the current staff trained. The POC is due by 10/11/2023.

Official classification

Type A

Official code

1569.625(b)(2)

Regulation authority

HSC

What the official deficiency says

(2) In addition to paragraph (1), training requirements shall also include an additional 20 hours annually, eight hours of which shall be dementia care training, as required by subdivision (a) of Section 1569.626, and four hours of which shall be specific to postural supports, restricted health conditions, and hospice care, as required by subdivision (a) of Section 1569.696. This training shall be administered on the job, or in a classroom setting, or both, and may include online training. This requirement is not met as evidenced by: Deficient Practice Statement Based on interview, observation, and document review, the licensee did not comply with the section cited above evidenced by not having staff with the required training/training documents which poses an immediate health, safety, or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/11/2023 Plan of Correction The licensee has agreed to read health and safety code 1569.625 entirely and send LPA a self-certified letter that the regulation was read and understood. The licensee has agreed to hire the required staff to follow the health and safety code and or have the current staff trained. The POC is due by 10/11/2023.

Official classification

Type A

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 interview, observation, and document review, the licensee did not comply with the section cited above evidenced by not having staff with the required training/training documents which poses an immediate health, safety, or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/11/2023 Plan of Correction The licensee has agreed to read health and safety code 1569.625 entirely and send LPA a self-certified letter that the regulation was read and understood. The licensee has agreed to hire the required staff to follow the health and safety code and or have the current staff trained. The POC is due by 10/11/2023.

Official classification

Type A

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 interview, observation, and document review, the licensee did not comply with the section cited above evidenced by not having staff with the required training/training documents which poses an immediate health, safety, or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/11/2023 Plan of Correction The licensee has agreed to read section 87411 entirely and send LPA a self-certified letter that the regulation was read and understood. The licensee has agreed to hire the required staff to follow the regulation and or have the current staff trained. The POC is due by 10/11/2023.

Official classification

Type A

Official code

87458(a)

Regulation authority

CCR

What the official deficiency says

(a) Prior to a person's acceptance as a resident, the licensee shall obtain and keep on file, documentation of a medical assessment, signed by a physician, made within the last year. The licensee shall be permitted to use the form LIC 602 (Rev. 9/89), Physician's Report, to obtain the medical assessment. This requirement is not met as evidenced by: Deficient Practice Statement Based on interview, observation, and document review, the licensee did not comply with the section cited above evidenced by not having the required resident documents which poses an immediate health, safety, or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/11/2023 Plan of Correction The licensee has agreed to read regulation 87458 entirely and send LPA a self-certified letter that the regulation was read and understood. The licensee has agreed to contact the resident’s medical providers and have the resident’s physicians complete a medical assessment. The POC is due by 10/11/2023.

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 interview, observation, and document review, the licensee did not comply with the section cited above evidenced by leaving medication unlocked in the refrigerator and by leaving unlocked medication in a zip lock bag on the desk in the living room area which poses an immediate health, safety, or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/11/2023 Plan of Correction The licensee has agreed to read regulation 87465 entirely and send LPA a self-certified letter that the regulation was read and understood. The licensee has agreed to purchase a lock box for medications that need to be stored in the refrigerator and has agreed to not leave medication in Ziploc bags. The POC is due by 10/11/2023.

Official classification

Type A

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 interview, observation, and document review, the licensee did not comply with the section cited above evidenced by storing a resident’s medications in a plastic weekly container box which poses an immediate health, safety, or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/11/2023 Plan of Correction The licensee has agreed to read regulation 87465 entirely and send LPA a self-certified letter that the regulation was read and understood. The licensee has agreed to store the resident’s medications in the original prescription containers. The POC is due by 10/11/2023.

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 interview, observation, and document review, the licensee did not comply with the section cited above evidenced by not having a non-slip mat in the bathroom shower which poses a potential health, safety, or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/11/2023 Plan of Correction The licensee has agreed to read regulation 87303 entirely and send LPA a self-certified letter that the regulation was read and understood. The licensee has agreed to put a non-slip mat in the bathroom shower. The POC is due by 10/11/2023.

Official classification

Type B

Official code

87307(a)(3)(C)

Regulation authority

CCR

What the official deficiency says

(C) Clean linen, including blankets, bedspreads, top bed sheets, bottom bed sheets, pillow cases, mattress pads, bath towels, hand towels and wash cloths. The quantity shall be sufficient to permit changing at least once per week or more often when indicated to ensure that clean linen is in use by residents at all times. The linen shall be in good repair. The use of common wash cloths and towels shall be prohibited. This requirement is not met as evidenced by: Deficient Practice Statement Based on interview, observation, and document review, the licensee did not comply with the section cited above evidenced by not having sheets and mattress covers on the resident’s beds which poses a potential health, safety, or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/11/2023 Plan of Correction The licensee has agreed to read regulation 87307 entirely and send LPA a self-certified letter that the regulation was read and understood. The licensee has agreed to put sheets and mattress covers on the resident’s beds. The POC is due by 10/11/2023.

Official classification

Type B

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 interview, observation, and document review, the licensee did not comply with the section cited above evidenced by not having the administrator present in the facility during normal working hours which poses a potential health, safety, or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/17/2023 Plan of Correction The licensee has agreed to read health and safety code 1569.618 entirely and send LPA a self-certified letter that the section was read and understood. The licensee has agreed to have the facility administrator present during normal working hours and or hire additional administrators. The POC is due by 10/17/2023.

Official classification

Type B

Official code

87506(b)(15)

Regulation authority

CCR

What the official deficiency says

(b) Each resident's record shall contain at least the following information: (15) The admission agreement and pre-admission appraisal, specified in Sections 87507, Admission Agreements and 87457, Pre-admission Appraisal. This requirement is not met as evidenced by: Deficient Practice Statement Based on interview, observation, and document review, the licensee did not comply with the section cited above evidenced by not having the required documents in the resident’s facility file which poses a potential health, safety, or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/17/2023 Plan of Correction The licensee has agreed to read regulation 87506 entirely and send LPA a self-certified letter that the section was read and understood. The licensee has agreed to complete the required documents and put the documents in the resident’s facility files. The POC is due by 10/17/2023.

Official classification

Type B

Official code

87456(a)(2)

Regulation authority

CCR

What the official deficiency says

(a) Prior to accepting a resident for care and in order to evaluate his/her suitability, the facility shall, as specified in this article 8: (2) Perform a pre-admission appraisal. This requirement is not met as evidenced by: Deficient Practice Statement Based on interview, observation, and document review, the licensee did not comply with the section cited above evidenced by not having the required documents in the resident’s facility file which poses a potential health, safety, or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/17/2023 Plan of Correction The licensee has agreed to read regulation 87456 entirely and send LPA a self-certified letter that the section was read and understood. The licensee has agreed to complete the required documents and put the documents in the resident’s facility file. The POC is due by 10/17/2023.

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 interview, observation, and document review, the licensee did not comply with the section cited above evidenced by not having a first aid kit which poses a potential health, safety, or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/11/2023 Plan of Correction The licensee has agreed to read regulation 87465 entirely and send LPA a self-certified letter that the section was read and understood. The licensee has agreed to purchase a first aid kit for the facility. The POC is due by 10/11/2023.

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 interview, observation, and document review, the licensee did not comply with the section cited above evidenced by not having a first aid manual which poses a potential health, safety, or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/11/2023 Plan of Correction The licensee has agreed to read regulation 87465 entirely and send LPA a self-certified letter that the section was read and understood. The licensee has agreed to purchase a first aid manual for the facility. The POC is due by 10/11/2023.

Official classification

Type A

Official code

87207

Regulation authority

HSC

What the official deficiency says

False Claims: No licensee, officer or employee of a licensee shall make or disseminate any false or misleading statement regarding the facility or any of the services provided by the facility. The Licensee has failed to meet this requirement as evidence that Licensee provided LPA with a false claim that she issued R1's responsible party a refund

Official plan of correction

Licensee to provide statement of understanding regarding the regulation cited along with an LIC 9098 self certifying that they will no longer provide any agent of this department with misleading statements by POC due date.

Deadline recorded: Jun 21, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87464(c)

Regulation authority

CCR

What the official deficiency says

The admission agreement shall specify which of the basic services are desired and/or needed by, and will be provided for, each resident. The facility did not meet this requirement while the water was turned off as evidenced by residents not having access to water for bathing. This poses a risk to the health and safety of residents in care.

Official plan of correction

Water service has been restored. Licensee agrees to maintain water service at all times.

Deadline recorded: Jun 20, 2023. 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

The facility shall be clean, safe, sanitary and in good repair at all times...The facility did not meet this requirement while the water was turned off. The facility lacked access to water to adequately clean the facility. This poses a risk to the health and safety of residents in care.

Official plan of correction

Water service has been restored. Licensee agrees to maintain water service at all times.

Deadline recorded: Jun 20, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87307(a)(3)(F)

Regulation authority

CCR

What the official deficiency says

Basic laundry service (washing, drying, and ironing of personal clothing).The facility did not meet this requirement while the water was turned off. The facility lacked access to water to adequately clean clothing and bedding. This poses a risk to the health and safety of residents in care.

Official plan of correction

Water service has been restored. Licensee agrees to maintain water service at all times.

Deadline recorded: Jun 20, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87507(G)(3)(5)(A)

Regulation authority

CCR

What the official deficiency says

A refund of any fees paid in advance ... shall be issued ..The facility has failed to issue a refund to R1 as per their admission agreement.

Official plan of correction

Licensee will issue a refund to R1's responsible party for the days due. Proof of refund to LPA by POC due date. Failure to issue a refund will result in civil penalties.

Deadline recorded: Jun 20, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87213

Regulation authority

CCR

What the official deficiency says

The licensee shall have a financial plan that conforms to the requirements of Section 87155, Application for License, and that assures sufficient resources to meet operating costs for care of residents; shall maintain adequate financial records; and shall submit such financial reports as may be required upon the written request of the licensing agency. Such request shall explain the need for disclosure. The licensing agency reserves the right to reject any financial report and to request additional information or examination including interim financial statements. Based on interview and record review, the licensee did not comply with the section cited above by not providing all the requested documents to complete a financial audit and did not prove that there is a financial plan in place which poses an immediate health, safety, or personal rights risk to persons in care.

Official plan of correction

The licensee has agreed to read regulation 87213 entirely and send LPA a self certified letter that the regulation was read and understood. The POC is due 5/10/23.

Deadline recorded: May 10, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

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… and other items that could constitute a danger to the resident(s). This requirement is not met as evidenced by: The licensee failed to lock away the knives which poses an immediate risk.

Official plan of correction

Licensee agrees keep the knives locked away to read the regulation in its entiredy and submit a letter stating understanding the regulation to LPA no later than 2/23/2023.

Deadline recorded: Feb 24, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87705(f)(2)

Regulation authority

CCR

What the official deficiency says

(f) The following shall be inaccessible to residents with dementia: (2) … toxic substances such as … cleaning supplies and disinfectants. This requirement is not met as evidenced by: The licensee failed to lock away the chemicals and detergents which poses an immediate risk.

Official plan of correction

Licensee agrees to lock all the detergents and chemicals away inaccessible to residents. Licensee agrees read the regulation in its entiredy and submit a letter stating understanding the regulation to LPA no later than 2/23/2023.

Deadline recorded: Feb 23, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

Maintenance and Operation (a)The facility shall be clean... sanitary and in good repair at all times. This requirement is not met as evidenced by: The Licensee failed to repair the smoke alarm detector hanging in the kitchen ceiling which poses a potential risk to residents in care.

Official plan of correction

Licensee agrees to repair the smoke detector in the kitchen no later than 2/24/2023 and submit a picture to LPA.

Deadline recorded: Feb 24, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87705(j)

Regulation authority

CCR

What the official deficiency says

Care of residents with dementia: (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: The licensee failed to ensure door chimes to all exits are operating.

Official plan of correction

Licensee agrees to repair or replace all door entrance and exit chimes, or install an auditory device in which will sound. Licensee will submit a video to the LPA no later than 2/24/2023.

Deadline recorded: Feb 24, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87555(b)(7)

Regulation authority

CCR

What the official deficiency says

87555. General Food Service Requirements. (b)The following food service requirements shall apply: (7) Modified diets prescribed by a resident's physician as a medical necessity shall be provided. Based on interview and document review, the licensee did not comply with the section cited above evidenced by not following the resident’s medical special diet which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

The licensee has agreed to read regulation 87555 entirely and send LPA self-certify letter that the regulation was read and understood. The licensee has agreed to provide LPA with a written plan on how they will ensure the residents medical special diet will be followed by all the staff in the facility. The POC is due by 12/30/2022.

Deadline recorded: Dec 30, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87608(a)(5)

Regulation authority

CCR

What the official deficiency says

87608. Postural Supports. (a) Based on the individual's preadmission appraisal, and subsequent changes to that appraisal, the facility shall provide assistance and care for the resident in those activities of daily living which the resident is unable to do for himself/herself. Postural supports may be used under the following conditions. (5) Under no circumstances shall postural supports include tying, depriving, or limiting the use of a resident's hands or feet. Based on interview and observation, the licensee did not comply with the section cited above evidenced by tying a resident’s legs, a residents waist, and a residents wheelchair to a couch using straps to restrict movement in a wheelchair which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

The licensee has agreed to read regulation 87608 entirely and send LPA self-certify letter that the regulation was read and understood. The licensee has agreed to train all staff on the postural support regulations and send LPA an employee signed and dated documentation that shows that all staff has been trained. The POC is due by 12/30/2022.

Deadline recorded: Dec 30, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87411(a)

Regulation authority

CCR

What the official deficiency says

87411. 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.. Based on interview and observation, the licensee did not comply with the section cited above evidenced by staff not being able to adequately communicate with residents due to language barrier which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

The licensee has agreed to read regulation 87411 entirely and send LPA self-certify letter that the regulation was read and understood. The licensee has agreed to provide LPA with a written plan on how they will ensure compliance related to scheduling staff capable of effectively communicating with residents in care, emergency personnel, licensing personnel, and others. The POC is due by 12/30/2022.

Deadline recorded: Dec 30, 2022. 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 (a) (1) REPORTING REQUIREMENTS A writen report shall be submitted to the licensing agancy and to the person responsible for the resident within seven days of occurrance... This requirement was not met as evidnced by: Adminstrator Na Zhao confirmed with LPA Prieto that an incident report as not send nor was the Licensing office notified of the incident that occurred on 06/23/21

Official plan of correction

POC was issued from previous complaint date of 06/23/21

Deadline recorded: Dec 15, 2022. 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 or a criminal record exemption as required by the Department or Based on observation, interview, and record review, the licensee did not comply with the section cited above by allowing S1 to work at the facility for one (1) day without a criminal background clearance which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

The licensee has agreed to read regulation 87355 entirely and send LPA self-certify letter that the regulation was read and understood. The licensee has agreed to remove S1 from the facility and not allow S1 to work at the facility until S1 has a criminal background clearance. POC is due 11/17/2022.

Deadline recorded: Nov 17, 2022. 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 or a criminal record exemption as required by the Department or Based on observation, interview, and record review, the licensee did not comply with the section cited above by allowing S2 to work at the facility for fifteen (15) days without a criminal background clearance which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

The licensee has agreed to read regulation 87355 entirely and send LPA self-certify letter that the regulation was read and understood. The licensee has agreed to remove S2 from the facility and not allow S2 to work at the facility until S2 has a criminal background clearance. POC is due 11/17/2022.

Deadline recorded: Nov 17, 2022. 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

87303. Maintenance 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 interview, observation, and record review, the licensee did not comply with the section cited above by not have running water in the facility which poses an immediate health, safety, or personal rights risk to persons in care.

Official plan of correction

The licensee has agreed to read regulation 87303 entirely and send LPA self-certify letter that the regulation was read and understood. The licensee has agreed to contact Elsinore Valley Municipal Water District to make a payment to ensure the water service in the facility is turned back on. The licensee has agreed to send LPA invoice and receipt of payment from Elsinore Valley Municipal Water District. POC is due by 11/17/2022.

Deadline recorded: Nov 17, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87412(a)(13)

Regulation authority

CCR

What the official deficiency says

This requirement is not met as evidenced by: Deficient Practice Statement Based on interviews, licensee failed to ensure S2 and S3 were fingerprinted and associated to the facility prior to employment. This is an immediate health and safety risks to the resident in care..

Official plan of correction

POC Due Date: 12/07/2021 Plan of Correction Licensee/Administrator will remove S2 and S3 from the facility immediately. Licensee will submit an LIC 9182 along with clear photo ID by mail or in person to CCL by POC date 12/07/2021. A civil penalty will be assessed.

Official classification

Type A

Official code

87411(a)

Regulation authority

CCR

What the official deficiency says

87411 (a) - PERSONNEL REQUIREMENTS GENERAL Facility personnel shall at all times be sufficient in numbers and competent to provide the services necessary to meet residents needs. This requirement was not met as evidenced by: Based on interviews, residents #1 and #2 were left at the facility unattended by staff on 06/12/21 for approximately 30 minutes until staff returned to the facility, which poses an immediate health and safety risk to the persons in care

Official plan of correction

Licensee to immediately provide in service training to staff and care of clients and provide LPA with staff roster for all staff scheduled and back up staff of necessary

Deadline recorded: Jun 23, 2021. A deadline is not proof that correction was completed.