ANGELA'S CARE HOME

Official classification

Type B

Official code

80088(d)

Regulation authority

CCR

What the official deficiency says

Based on LPA Venus Mixson's observations and interviews, the licensee did not comply with the section cited above in the exterior window screen is lose and/or missing, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

REPLACE WINDOW SCREENS Licensee will repair window and screen and email a photograph to LPA by POC due date.

Deadline recorded: Jul 31, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87507(c)

Regulation authority

CCR

What the official deficiency says

87507(c) Admission Agreements; Admission agreements shall be signed and dated, acknowledging the contents of the document, by the resident or the resident’s representative, if any [...] no later than seven days following admission... This requirement is not met as evidenced by: Licensee, Dulce, Redford, did not ensure all Admission Agreements had the required signatures within seven days of client admittance.

Official plan of correction

Licensee, Dulce Redford, will review the cited section and obtain the required signatures for all current and all future Admission Agreements. Licensee will submit proof via e-mail to Licensing Program Analyst, Jarred Torres. Proof will be a signed training record and scans or photos of all signed agreements.

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

Official classification

Type A

Official code

87303(e)(2)

Regulation authority

CCR

What the official deficiency says

California Code of Regulations, 87303(e)(2), Maintenand and Operation: Faucets used by residents for personal care such as shaving and grooming shall deliver hot water... This requirement is not met as evidenced by: The Administrator, Dulce Reford, did not ensure that hot water was readily available for the clients in care. The facility's water was shut off due to non-payment.

Official plan of correction

Administrator, Dulce Redford, made a payment to Eastern Municipal Water District on April 21, 2026, and provided a printed copy of the receipt. This proof will be received before the end of April 22, 2026.

Deadline recorded: Apr 22, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87411(f)

Regulation authority

CCR

What the official deficiency says

(f) All personnel, including the licensee and administrator, shall be in good health, and physically and mentally capable of performing assigned tasks. Good physical health shall be verified by a health screening, including a chest x-ray or an intradermal test, performed by a physician not more than six (6) months prior to or seven (7) days after employment or licensure. A report shall be made of each screening, signed by the examining physician. The report shall indicate whether the person is physically qualified to perform the duties to be assigned, and whether he/she has any health condition that would create a hazard to him/herself, other staff members or residents. A signed statement shall be obtained from each volunteer affirming that he/she is in good health.Personnel with evidence of physical illness or emotional instability that poses a significant threat to the well-being of residents shall be relieved of their duties. This requirement is not met as evidenced by: Deficient Practice Statement Based on three reviewed staff files, the licensee did not comply with the section cited above where one of those files did not have a chest x-ray nor intradermal test completed, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/27/2026 Plan of Correction Carina Ripotola will provide a picture or scan of the medical form that shows the staff file is current with the required chest x-ray or intradermal test.

Official classification

Type B

Official code

87468(b)(1)(A)

Regulation authority

CCR

What the official deficiency says

(b) At the time the admission agreement is signed, a resident and the resident's representative shall be personally advised of and given a copy of: (1) The personal rights of residents specified in Sections 87468.1, Personal Rights of Residents in All Facilities and 87468.2, Additional Personal Rights of Residents in Privately Operated Facilities, as applicable to the facility. (A) The licensee shall have each resident and the resident's representative sign a copy of these rights, and the signed copy shall be included in the resident's record. 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 in three of three record reviews, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/27/2026 Plan of Correction Manager, Carina Ripotola, will provide a scan of the signed personal rights forms via e-mail to the LPA's e-mail address by 3/27/26.

Official classification

Type A

Official code

87355(e)(2)

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: (2) Obtain a California clearance... This requirement was not met as evidenced by: Based on interview, record review and observation LPA found (2) uncleared staff working at the facility who stated they had been working since 09/13/2025. This poses an immediate health, saftey, or personal rights risk to residents in care.

Official plan of correction

During the visit LPA witnessed the removal of S1 and S2, and had the Administrator submit an LIC500 showing staff coverage in S1 and S2's absence. LIC500 shall show coverage that meets resident's needs by cleared staff by the POC due date.

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

Official classification

Type A

Official code

87355(e)(3)

Regulation authority

CCR

What the official deficiency says

87355 Criminal Record Clearance (e) All individuals subject to a criminal record review...shall prior to working, residing or volunteering in a licensed facility: (3) Request a transfer of a criminal record clearance...This requirement was not met as evidenced by: Based on interview, records review and observation the licensee did not ensure S2 and S3 were associated to the facility prior to working at the facility. This poses an immediate health safety or personal rights risk to residents in care.

Official plan of correction

The licensee agreed to associate the staff to the facility and submit proof by the POC due date.

Deadline recorded: Jul 9, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

8702(a)(2)

Regulation authority

CCR

What the official deficiency says

87202 Fire Clearance (a) All facilities shall maintain a fire clearance approved by the...fire department...Prior to accepting or retaining any of the following types of persons...(2) Bedridden persons This requirement was not met as evidenced by: Based on interview, observation and record review the facility has (1) bedridden resident in care and does not have proof of bedridden clearance. This poses an immediate health saftey or personal rights risk to residents in care.

Official plan of correction

The licensee agreed to follow proper eviction procedures to issue the bedridden resident an eviction notice by the POC due date.

Deadline recorded: Jul 9, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87211(a)(1)(A)

Regulation authority

CCR

What the official deficiency says

87211 Reporting Requirements (a) Each licensee shall furnish...such reports...including...(1)A written report...submitted to the licensing agency... within seven days of the occurrence of...(A)Death of any resident from any cause...This requirement was not met as evidenced by: Based on interview observation and record review the licensee did not report a resident death in a timely manner. This poses an immediate health saftey or personal rights risk to residents in care.

Official plan of correction

The licensee agree to submit an incident report for the resident by the POC due date. The licensee also agree to obatin outside resource training on incident reporting and submit proof of training by the POC due date.

Deadline recorded: Jul 9, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87109(b)(1-2)

Regulation authority

CCR

What the official deficiency says

87109 Transferability of License (b)...the property and business shall not be transferred until the buyer qualifies for a license or provisional license...(1)The seller shall notify, in writing, a prospective buyer of the necessity to obtain a license...if the buyer’s intent is to continue operating the facility...The seller shall send a copy of this written notice to the licensing agency.(2)The prospective buyer shall submit an application for a license...within five days of the acceptance of the offer.. This requirement was not met as evidenced by: Based on interview and record review the property was transferred to S2 and a notification of change in ownership was not provided to the department. This poses an immediate health safety or personal rights risk to residents in care.

Official plan of correction

The licensee agreed to provide S2 with a written notice of the intent to change ownership and the need to apply for a license. This is due by the POC due date. The licensee agreed to ensure S2 submits an application for a new license within (5) days as specified in this chapter and send proof to the LPA.

Deadline recorded: Jul 9, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87470(c)(1)(C)

Regulation authority

CCR

What the official deficiency says

(c) An Infection Control Plan shall be developed by the licensee and shall be included in the Plan of Operation required by Section 87208. (1) The Infection Control Plan shall include all of the following: (C) An Infection Control Training Plan. This requirement is not met as evidenced by: Based on record review and interview, the licensee did not comply with the section cited above due to no infection control plan being retained at the facility during the time of the visit which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

The licensee agreed to fill out the courtsey form on file and send the LPA the comcpleted form by the POC due date.

Deadline recorded: Apr 18, 2025. A deadline is not proof that correction was completed.

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: Based on observation, interview, and record review, the licensee did not comply with the section cited above with R1 who is bedridden. The licensee is not approved for bedridden clearance which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

The licensee called the fire department during the time of the visit to notify of the bedridden resident, and agreed to submit a request for a bedridden fire clearance. The licensee agreed to move the resident to a room with an emeregency exit leading to the exterior of the home and exit route. Proof to be submitted by the POC due date.

Deadline recorded: Mar 21, 2025. A deadline is not proof that correction was completed.

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 observation, interview, and record review, the licensee did not comply with the section cited above with (1) resident who is bedridden. The licensee is not approved for bedridden clearance which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/19/2025 Plan of Correction The licensee called the fire department during the time of the visit to notify of the bedridden resident, and agreed to submit a request for a bedridden fire clearance. The licensee agreed to move the resident to a room with an emeregcny exit leading to the exterior of the home and exit route. Proof to be submitted by the POC due date.

Official classification

Type B

Official code

87470(c)(1)(C)

Regulation authority

CCR

What the official deficiency says

(c) An Infection Control Plan shall be developed by the licensee and shall be included in the Plan of Operation required by Section 87208. (1) The Infection Control Plan shall include all of the following: (C) An Infection Control Training Plan. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review and interview, the licensee did not comply with the section cited above due to no infection control plan being retained at the facility during the time of the visit which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/25/2025 Plan of Correction The licensee agreed to submit their infection control plan by the POC due date. The Licensee agreed send a self certified statement appointing a new administrtor that will help audit the facility files and ensure all files are complete at the facility. The POC is due by the due date.

Official classification

Type B

Official code

87218(a)(1)

Regulation authority

CCR

What the official deficiency says

(a) The licensee shall ensure an adequate theft and loss program as specified in Health and Safety Code Section 1569.153. (1) The initial personal property inventory shall be completed by the licensee and the resident or the resident's representative. 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 with (1) resident who did not have a personal property form in their file which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/25/2025 Plan of Correction The licensee agreed to document the form with the residents and submit to the LPA by the POS due date. The licensee agreed to appoint a new administrator have them audit resident files for completion. The POC is due by the POC due date.

Official classification

Type B

Official code

87412(a)

Regulation authority

CCR

What the official deficiency says

(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: This requirement is not met as evidenced by: Deficient Practice Statement Based on interview there was no staff files for (1) staff, and incomplete file for (2) staff. This poses a potential health saftey or personal rights risk to clients in care.

Official plan of correction

POC Due Date: 02/25/2025 Plan of Correction The licensee agreed to submit the complete staff files to the LPA and apoint a new administrator to audit the staff files for completion. The POC is due by the POC due date.

Official classification

Type B

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 and record review, the licensee did not comply with the section cited above there was no personnel record retained at the facility at the time of the visit which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/25/2025 Plan of Correction The Licensee agreed to provide the LPA a staff schedule showing staff coverage at all times. The POC is due by the 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 interview and record review, the licensee did not comply with the section cited above in with staff not having documented training in their file which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/25/2025 Plan of Correction The licensee agreed to send the LPA a copy of the staff training conducted at the facility. Proof to be submitted by the POC due date.

Official classification

Type B

Official code

87467(a)(3)

Regulation authority

CCR

What the official deficiency says

(a) Prior to, or within two weeks of the resident's admission, the licensee shall arrange a meeting with the resident, the resident's representative, if any, appropriate facility staff, and a representative of the resident's home health agency, if any, and any other appropriate parties, to prepare a written record of the care the resident will receive in the facility, and the resident's preferences regarding the services provided at the facility. (3) The licensee shall arrange a meeting with the resident and appropriate individuals identified in Section 87467(a)(1) to review and revise the written record as specified, when there is a significant change in the resident's condition, or once every 12 months, whichever occurs first. Significant changes shall include, but not be limited to occurrences specified in Section 87463, Reappraisals. 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 with (1) of (5) resident who did not have a care plan signed by their representative which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/25/2025 Plan of Correction The licensee agreed to meet with the representative and have the needs and services plan signed for the resident. Proof is due by the POC 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 interview, the licensee did not comply with the section cited above by not conducting a fire drill within the required time frame which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/25/2025 Plan of Correction The licensee agreed to conduct a fire drill and submit documentation according to the regulation cited above. This is due by the POC due date.

Official classification

Type B

Official code

87705(b)(2)

Regulation authority

CCR

What the official deficiency says

(b) Licensees shall be responsible for the following: (2)For facilities with fewer than 16 residents, ensuring there is 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 in addition to requirements specified in Section 87415, Night Supervision. This requirement is not met as evidenced by: Deficient Practice Statement Based on interview, the licensee did not comply with the section cited above by not having awake staff at the facility which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/25/2025 Plan of Correction The licensee agreed to submit a staff schedule showing coverage from 10pm to 6am every day. This is due by the POC due date.

Official classification

Type B

Official code

87468.2(a)(1)

Regulation authority

CCR

What the official deficiency says

(a) ...shall have...the following personal rights: (1)...reasonable level of personal privacy in accommodations… This requirement was not met as evidenced by: Based on interview and observation, the private shower in the master bathroom is being used by all staff and residents. This poses a potential personal rights, health or saftey risk to residents incare.

Official plan of correction

The licensee agreed to fix the common shower of the facility and inform the LPA when the repairs are completed. The licensee agreed to send proof of repiar by the POC due date.

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

Official classification

Type B

Official code

87303(e)(2)

Regulation authority

CCR

What the official deficiency says

(e) Water supplies and plumbing fixtures shall be maintained as follows: (2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of...not more than 120 degree F (49 degree C). This requirment was not met as evidenced by: Based on observation the water temperature in the facility restrooms read 122F and 125F. This poses a potential health saftey or personal rights risk to residents in care.

Official plan of correction

The licensee agreed to adjust the water temperature to the required range. The licensee agreed to send proof of the required temperature b y the POC due date.

Deadline recorded: Dec 13, 2024. A deadline is not proof that correction was completed.

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 record review, the licensee did not comply with the section cited above in 1 of 4 residents (R1) which poses an immediate safety risk to persons in care. LPA Colvin observed that according to R1's file, R1 is bedridden. The facility does not have a fire clearance for bedridden residents.

Official plan of correction

POC Due Date: 03/28/2024 Plan of Correction Administrator is going to obtain a new Physician's Report for R1, showing R1 are non-ambulatory. If this this is not the case, Administrator to speak with Licensee about possibly requesting a change of ambulatory status for the facility to see if they can be approved for bedridden residents, otherwise, R1 will need to be relocated. Administrator to provide LPA Colvin with update on plan for R1/facility's application for bedridden clearance by POC date of 3/28/24.

Official classification

Type A

Official code

87355(e)(2)

Regulation authority

CCR

What the official deficiency says

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: (2) 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 review, the licensee did not comply with the section cited above in 1 staff member (acting Administrator) which poses an immediate safety risk to persons in care. LPA Colvin observed that Acting Administrator Aurora Cuasay is not associated to the facility.

Official plan of correction

POC Due Date: 03/28/2024 Plan of Correction Administrator agrees to contact Licensee to have Administrator associated to facility. Administrator may self-certify to LPA Colvin once the association has been completed. Due by Plan of Correction date of 3/28/24.

Official classification

Type A

Official code

87412(g)(1)

Regulation authority

CCR

What the official deficiency says

Personnel Records: (g) All personnel records shall be maintained at the facility and shall be available to the licensing agency for review. (1) The licensee shall be permitted to retain such records in a central administrative location provided that they are readily available to the licensing agency at the facility as specified in Section 87412(f). 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 in 3 of 3 staff files, which poses an immediate health, safety or personal rights risk to persons in care. LPA Colvin observed that there were no staff files present for either the two staff present during today's inspection or for the Acting Administrator.

Official plan of correction

POC Due Date: 03/28/2024 Plan of Correction Administrator agrees to develop a plan to ensure staff files are accessible to Licensing upon request and without notice. Administrator to provide LPA Colvin with plan by Plan of Correction date of 3/28/24.

Official classification

Type B

Official code

87411(C)(1)

Regulation authority

CCR

What the official deficiency says

Personnel Requirements – General: (c) All RCFE staff who assist residents with personal activities of daily living shall receive initial and annual training as specified in Health and Safety Code sections 1569.625 and 1569.69 (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, the licensee did not comply with the section cited above in 1 of 3 staff (S1) which poses a potential health risk to persons in care. LPA Colvin observed that S1's CPR Certification is expired.

Official plan of correction

POC Due Date: 04/10/2024 Plan of Correction Administrator agrees to have S1 re-certify for CPR/First Aid and provide LPA Colvin with a copy of the new Certification by the Plan of Correction date of 4/10/24.

Official classification

Type B

Official code

87303(e)(2)

Regulation authority

CCR

What the official deficiency says

Maintenance and Operation: (e) Water supplies and plumbing fixtures shall be maintained as follows: (2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degree C) and not more than 120 degree F (49 degree C). This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above in 2 of 2 resident bathrooms, which poses a potential health or personal rights risk to persons in care. LPA Colvin observed that the hot water in the resident bathrooms was measuring at 100.9 degrees.

Official plan of correction

POC Due Date: 04/10/2024 Plan of Correction Administrator agrees to adjust hot water to ensure it is between 105 - 120 degrees. Administrator to test hot water and provide LPA Colvin with the new measurement by the Plan of Correction Date of 4/10/24.

Official classification

Type A

Official code

87158(a)

Regulation authority

CCR

What the official deficiency says

Capacity: A license shall be issued for a specific capacity which shall be the maximum number of residents which can be provided care at any given time. This requirement was not being met as evidenced by: Based on interview with Licensee, Licensee indicated that they are over capacity by one resident. This presents an immediate health and safety risk to residents in care.

Official plan of correction

Licensee agrees to provide a plan to relocate a resident by POC date. The plan will include the new location of the resident and submit by POC date.

Deadline recorded: Jul 29, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(a)(1)

Regulation authority

CCR

What the official deficiency says

Incidental Medical and Dental Care: (a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following:(1) The licensee shall arrange, or assist in arranging, for medical and dental care appropriate to the conditions and needs of residents.The licensee shall arrange, or assist in arranging, for medical and dental care appropriate to the conditions and needs of residents. This requirement was not met as evidenced by: Based on interview with Licensee, Resident was admitted to the facility with pressure injuries, without an assessment. Staff were alleged to have been caring for R1; however, the Licensee admitted that R1 had eventually moved to skilled nursing due to the inability to care for R1's wounds. This poses an immediate health and safety and/or personal rights risk to residents in care.

Official plan of correction

Licensee agrees to review the regulation, and provide proof of in-service training provided to Licensee and staff.

Deadline recorded: Aug 4, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87458(a)

Regulation authority

CCR

What the official deficiency says

Medical Assessments: (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 was not being met as evidenced by: Based on interview with Licensee, R1 was not offered a proper assessment upon admission to the facility. Licensee understood that R1's pressure injuries got worse under her care. Licensee indicated that R1 was turned every 2-3 hours, but the wound to her coccyx got larger. Even though R1 was allegedly to have been assessed, Licensee does not have documentation to prove that it did. This poses a potential health and safety risk to residents in care.

Official plan of correction

Licensee agrees to submit a plan to improve intake assessments, and submit that plan by POC date. Additionally, Licensee agrees to review the regulation, and provide proof of in-service training provided to Licensee and staff.

Deadline recorded: Aug 4, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

80072(a)(3)

Regulation authority

CCR

What the official deficiency says

PERSONAL RIGHTS (a)..each client shall have personal rights which include..(3)..withholding of shelter.. This requirement is not being met as evidenced by: Based on LPA interviews, Licensee did not provide R1 the means to have shelter. This poses a potential health and safety risk and personal rights to residents in care.

Official plan of correction

Licensee agrees to pick up R1, and review regulation. Licensee to conduct in-service training to staff including themselves and provide proof of such by POC date.

Deadline recorded: Aug 4, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87465(a)(1)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following:(1) The licensee shall arrange, or assist in arranging, for medical and dental care appropriate to the conditions and needs of residents. This requirement was not being met as evidenced by: Based on interview with Licensee, Licensee did not maintain R1's care when R1 ran out of medications and was out of medications for approximately 1 week. This is a potential health and safety and/or personal rights risk for residents in care.

Official plan of correction

Licensee agrees to conduct in-service training for all staff, including themselves on the cited regulation and provide proof of such by POC date.

Deadline recorded: Aug 4, 2023. 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

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 record review, LPA found that S1 did not have an approved clearance to provide care to residents. This is an immediate risk to residents in care.

Official plan of correction

Licensee agrees to immediately remove S1 from the facility. Licensee will further conduct in-service training on the cited reguation and provide proof of such by POC

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

Official classification

Type B

Official code

87468.1(a)(16)

Regulation authority

CCR

What the official deficiency says

Personal Rights of Residents in All Facilities:(a) Residents in all residential care facilities for the elderly shall have all of the following personal rights:(16) To receive or reject medical care or other services. This requirement was not being met as evidenced by: Based on LPA interview with Licensee, Licensee indicated that they contacted Hospice to intiate services for R1. This is a potential personal rights risk for residents in care.

Official plan of correction

Licensee agrees to conduct in-service training on the cited regulation, and will provide proof of training with all staff by POC date.

Deadline recorded: Jul 7, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87633(h)(4)

Regulation authority

CCR

What the official deficiency says

Hospice Care of Terminally Ill Residents:(h) For each terminally ill resident receiving hospice services in the facility, the licensee shall maintain the following in the resident’s record: (4) A copy of the resident’s current hospice care plan approved by the licensee, the hospice agency, and the resident, or the resident’s Health Care Surrogate Decision Maker if the resident is incapacitated. This requirement was not being met as evidenced by: Based on document review, and LPA observation, and staff interview, R1 did not have any records related to the needs, and care that R1 had received by the Licensee. This is a potential health and safety risk to residents in care.

Official plan of correction

Licensee reported that R1 is no longer in care within the facility to develop new records. Licensee agrees to conduct in-service training on the cited regulation and submit by POC date.

Deadline recorded: Jul 7, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87625(b)(3)

Regulation authority

CCR

What the official deficiency says

Managed Incontinence:(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 was not being met as evidenced by: Based on observation and staff interview, LPA found that R1 had incontinent challenges and those needs were not being met by Licensee. This is a potential personal rights risk to residents in care.

Official plan of correction

Licensee agrees to conduct in-service training on the cited regulation, and provide proof of such by POC date.

Deadline recorded: Jul 7, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87211(a)(1)(A)

Regulation authority

CCR

What the official deficiency says

Reporting Requirements: (a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: (1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below. This report shall include the resident's name, age, sex and date of admission; date and nature of event; attending physician's name, findings, and treatment, if any; and disposition of the case. (A) Death of any resident from any cause regardless of where the death occurred, including but not limited to a day program, a hospital, en route to or from a hospital, or visiting away from the facility. This requirement was not being met as evidenced by: Based on staff interview, Licensee indicated that the death report for R1 was not submitted to the Department. This is a potential health and safety risk to residents in care.

Official plan of correction

Licensee agrees to submit the death report and hospital visit for R1 by COB on June 30, 2023. Further, Licensee agrees to conduct in-service training with staff regarding the cited regulation. This will be submitted by POC date.

Deadline recorded: Jul 7, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87506(d)

Regulation authority

CCR

What the official deficiency says

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: This requirement was not being met as evidenced by: Based on the lack of resident record for R1, Licensee could not prove that R1's records were being dispensed as required. This is a potential health and safety risk for residents in care.

Official plan of correction

Licensee agrees to ensure a complete record is maintained for each resident. Licensee further agrees that in-service training will be conducted for all staff including Licensee on the maintenance of records. This training is due by POC date.

Deadline recorded: Jul 7, 2023. A deadline is not proof that correction was completed.