WHITE'S LOVE & CARE RESIDENTIAL ELDERLY HOME INCII

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 observationand interview, the licensee did not comply with the section cited above due to no infection control plan being available for review during the visit which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/20/2026 Plan of Correction Licensee will provide an Infection Control Plan and send to LPA Imaculada Vasquez via email by the 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 due to no liability insurance being avaible for review during the visit which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/20/2026 Plan of Correction Licensee will email proof of insurance via email to LPA Imaculada Vasquez by the POC due date.

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

(a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. 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 which we observed several oxygen tanks which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/20/2026 Plan of Correction Licensee will remove oxygen tanks stored in garage by POC date. Licensee will provide confirmation with proof via email to LPA Imaculada Vasquez by 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 observation, interview and record review, the licensee did not comply with the section cited above in which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/20/2026 Plan of Correction Licensee will provide documents of a current Administrator Certificate and associated files via email to LPA Imaculada Vasquez.

Official classification

Type B

Official code

87412(a)(13)(B)

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: (13) For employees that are required to be fingerprinted pursuant to Section 87355, Criminal Record Clearance: (B) Documentation of either a criminal record clearance or a criminal record exemption as required by Section 87355(e). 1. For Certified Administrators, a copy their current and valid Administrative Certification meets this requirement. 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 which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/20/2026 Plan of Correction Licensee will provide a picture of personnel records maintained at the facility for each employee. Licensee will send proof via email to LPA Imaculada Vasquez.

Official classification

Type B

Official code

87355(e)

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: This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview, the licensee did not comply with the section cited above in the Licensee did not have P1 criminally fingerprinted and cleared which poses/posed a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 04/20/2026 Plan of Correction Licensee will provide proof of fingerprinted individuals residing at the facility via email to LPA Imaculada Vasquez by POC date.

Official classification

Type B

Official code

1569.695(a)

Regulation authority

HSC

What the official deficiency says

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

Official plan of correction

POC Due Date: 04/20/2026 Plan of Correction Licensee will provide a copy of Emergency Disaster Plan via email to LPA Imaculada Vasquez by POC date.

Official classification

Type B

Official code

87211(a)(1)(A)

Regulation authority

CCR

What the official deficiency says

(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) 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 met as evidenced by: During a health and visit at the facility, LPA was informed Resident 1 (R1) passed away in the facility on 10/04/2025. However, there is no record the facility reported R1's death to Community Care Licensing. This poses a potential health, safety, or personal rights risk to residents/future residents in care.

Official plan of correction

Licensee reported they will conduct a staff training regarding proper reporting requirements listed in CCR, Title 22, Division 6, Chapter 8 regulation 87211 titled Reporting Requirements. POC to be submitted to LPA by close of business on 10/24/2025.

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

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...shall prior to working, residing or volunteering in a licensed facility:(2) Obtain a California clearance or a criminal record exemption...This requirement was not met as evidenced by: Based on interview,record review, and observation P1 did not have a fingerprint clearance to care for, and be theft alone with R1. This poses an immediate health safety, or personal rights risk to resident in care.

Official plan of correction

The licensee agreed to remove P1 for the facility, and obtain a clearance prior to P1's return to the facility. P1 was immediately escorted out of the facility. The licensee agreed to submit an update LIC500 showing coverage at all times by cleared and transfered staff to care for R1. LIC500 is due by POC due date.

Deadline recorded: Sep 4, 2025. A deadline is not proof that correction was completed.

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...shall prior to working, residing or volunteering in a licensed facility:(2) Obtain a California clearance or a criminal record exemption...This requirement was not met as evidenced by: Based on interview,record review, and observation P1 did not have a fingerprint clearance to care for, and be theft alone with R1. This poses an immediate health safety, or personal rights risk to resident in care.

Official plan of correction

The licensee agreed to remove P1 for the facility, and obtain a clearance prior to P1's return to the facility. P1 was immediately escorted out of the facility. The licensee agreed to submit an update LIC500 showing coverage at all times by cleared and transfered staff to crae for R1. LIC500 is due by POC due date.

Deadline recorded: Aug 5, 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

(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 observation, interview and record review S1's background clearance was not transfered to the facility roster. This poses an immediate health safety, or personal rights risk to resident in care.

Official plan of correction

The licensee agreed to transfer S1's clearance to the facility roster and submit proof by the POC due date.

Deadline recorded: Aug 5, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87465(i)

Regulation authority

CCR

What the official deficiency says

(i) Prescription medications...not returned to the issuing pharmacy, nor retained in the facility as ordered by the resident’s physician and documented in the resident’s record nor disposed of according to the hospice’s established procedures or which are otherwise to be disposed of shall be destroyed in the facility by the facility administrator and one other adult who is not a resident. Both shall sign a record... This rerquirement was not met as evidenced by: Based on interview and observation, the licensee di not ensure the medications were disposed for one resident. This poses a postential health saftey or personal rights risk to residents in care.

Official plan of correction

The administrator agreed to destroy the medications and submit a record described in the cited section by the POC due date

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

Official classification

Type B

Official code

87412(h)

Regulation authority

CCR

What the official deficiency says

(h) All personnel records shall be retained for at least three (3) years following termination of employment. This requirement was not met as evidecned by: Based on interview and record review the licensee did not have (1) staff's file who had stopped working at the facility (7) months prior. This poses a potential health saftey or personal rights risk to residents in care.

Official plan of correction

The licensee agreed to submit training conducted for the licensee and administrator for record keeping by the POC due date.

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

Official classification

Type B

Official code

87411(c)(1)

Regulation authority

CCR

What the official deficiency says

87411 Personnel Requirements - General (c) All RCFE staff...(1)...providing care shall receive appropriate training in first aid from persons qualified by such agencies as the American Red Cross. This requirement was not met as evidenced by: Based on interview the licensee (prior administrator) and (1) current staff do not have CPR and first aid training. This poses a potential health saftey or personal rights risk.

Official plan of correction

The administrator agreed to obatin training for the licensee and staff and send proof by the POC due date.

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

Official classification

Type B

Official code

87412(f)

Regulation authority

CCR

What the official deficiency says

(f)...personnel, including the licensee and administrator, shall be...physically and mentally capable of performing assigned tasks. Good physical health shall be verified by a health screening...performed by a physician... A report shall be...signed by the examining physician...This requirement is not met as evidenced by: Based on interview and record review, the licensee (prior administrator) did not have a health screening on file to review during the visit. This poses a potential health safety or personal rights risk to residents in care.

Official plan of correction

The administrator agreed to submit a signed copy of a LIC503 conducted by a physician and submit proof by the POC due date.

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

Official classification

Type A

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...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...This requirement is not met as evidenced by: Based on interview and record review, the facility did not have proof of liability insurance to inspect during the visit. This poses an immediate health saftey or personal rights risk to residents in care.

Official plan of correction

The administrator agreed to submit proof of liability insurance by the POC due date.

Deadline recorded: Jul 4, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

1569.695(a)

Regulation authority

HSC

What the official deficiency says

§1569.695 Emergency Plans (a) In addition to any other requirement of this chapter, a residential care facility for the elderly shall have an emergency and disaster plan that shall include, but not be limited to, all of the following: This requirment was not met as evidenced by: Based on interview and record review, the emergency plan does not include the requirements in HSC 1569.695 and needs to be updated. This poses a potential health safety or personal rights risk to residents in care.

Official plan of correction

The administrator agreed to submit an updated LIC610 in complaince with the section cited by the POC due date.

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

Official classification

Type B

Official code

1569.695(c)

Regulation authority

HSC

What the official deficiency says

§1569.695 Emergency Plans (c) A facility shall conduct a drill at least quarterly for each shift...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 requirment was not met as evidenced by: Based on interview and record review the facility did not conduct a quarterly fire drill. This poses a potential health saftey or personal rights risk to residents in care.

Official plan of correction

The administrator agreed to conducted and document an emergency drill and submit proof by the POC due date.

Deadline recorded: Jul 10, 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

87202 Fire Clearance (a)All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department.. 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.. (2) Bedridden persons this requirement is not met as there are (2) bedridden residents this poses an immediate health safety and personal rights risk to persons in care.

Official plan of correction

The licensee agrees to relocate R1 by the 5pm on the due date indicated and begin the process a for an updated fire clearance.

Deadline recorded: Jul 2, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

Maintenance and Operation 87303 (a) The facility shall be clean, safe, sanitary and in good repair at all times... This requirement is not met as evidenced by: Based on observations, the licensee did not comply with the section cited above by not ensuring all smoke alarms were in working condition. This poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

The batteries were replaced at the time of LPAs visit therefore no POC is due at this time. However civil penalties are still being assessed.

Deadline recorded: Jul 2, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87355(b)

Regulation authority

CCR

What the official deficiency says

87355 Criminal Record Clearance (b) Prior to the Department issuing a license, the applicant, administrator and any adults other than a client, residing in the facility shall have a criminal record clearance or exemption. This requirement is not met as evidenced by: There was (1) uncleared adult with an outstanding on the premises with belongings. This posed an immediate health, safety and personal rights risk to persons in care.

Official plan of correction

The uncleared adult was escorted off grounds, therefore there is no POC due at this time. Civil penalties are still being assessed.

Deadline recorded: Jul 1, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87205(b)

Regulation authority

CCR

What the official deficiency says

87205 Accountability of Licensee Governing Body (b) If the licensee is a corporation or an association, the governing body shall be active, and functioning in order to assure accountability. This requirement was not met as evidenced by: Based on records review the licensee is in a state of suspension with the FTB at this time. This poses an immediate health, saftey, or personal rights risk to residents in care.

Official plan of correction

The licensee said she will contact Franchise Tax Board (FTB) & make arrangements to lift suspension. Proof from FTB will be submitted by 6/20/25. Licensee will submit proof governing body is active by 7/11/25. *This deficency has been amended

Deadline recorded: Jun 20, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87465(e)

Regulation authority

CCR

What the official deficiency says

(e) For every prescription and nonprescription PRN medication for which the licensee provides assistance there shall be a signed, dated written order from a physician, on a prescription blank, maintained in the residents file, and a label on the medication. Both the physician's order and the label shall contain at least all of the following information. This requirement is not met as evidenced by: Deficient Practice Statement Based on interview and record review, the licensee did not comply with the section cited above due to no discontinuation of medication that was not on file for (1) resident which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/18/2024 Plan of Correction The licensee agreed to obtain dicontinuation orders from the resident physican and send LPA proof by POC due date

Official classification

Type B

Official code

87412(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: 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 the licensee/administrtor's and staff's health screening which was not avaible for licensing to inspect during the visit which posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/11/2024 Plan of Correction The licensee agreed to send the LPA a copy of the health screening by the 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 interview, the licensee did not comply with the section cited above with the liability insurance that was not avaible for licensing to inspect during the visit which posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/04/2024 Plan of Correction The licensee agreed to send the LPA a copy of the liability insurance by the pOC due date.

Official classification

Type B

Official code

87412(f)

Regulation authority

CCR

What the official deficiency says

(f) All personnel records shall be available to the licensing agency to inspect, audit, and copy upon demand during normal business hours. Records may be removed if necessary for copying. Removal of records shall be subject to the following requirements: This requirement is not met as evidenced by: Deficient Practice Statement Based on interview and record review, the licensee did not comply with the section cited above based on self admission that training records were not at the facility and were not present to LPA for inspection. The licensee also did not have complete records for staff at the facility for inspection which posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/04/2024 Plan of Correction The licensee agreed to send the LPA training records for staff by the POC due date.

Official classification

Type B

Official code

87465(h)(5)

Regulation authority

CCR

What the official deficiency says

(h) The following requirements shall apply to medications which are centrally stored: (5) Each resident's medication shall be stored in its originally received container. No medications shall be transferred between containers. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above with resident medication that was kept in a weekly pill box which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/11/2024 Plan of Correction The licensee agreed to remove this practve and send the LPA a written statment of in-service of new medication procedure to comply with section cited above. This is due by the POC due date.

Official classification

Type B

Official code

1569.695(a)

Regulation authority

HSC

What the official deficiency says

(a)In addition to any other requirement of this chapter, a residential care facility for the elderly shall have an emergency and disaster plan that shall include, but not be limited to, all of the following: This requirement is not met as evidenced by: Deficient Practice Statement Based on interview, the licensee did not comply with the section cited above by not having an emergency diaster plan for the LPA to inspect during the time of the visit which posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/04/2024 Plan of Correction The licensee agreed to send the LPA a copy of the LIC610 form completed by the 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 interview, the licensee did not comply with the section cited above with no documented drill conducting within th required timeframe stated above which posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/04/2024 Plan of Correction The licensee agreed to send the LPA a copy of drill conducted by the POC due date. The documentation should comply with the above.

Official classification

Type A

Official code

87355(e)(1)

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: (1) Obtain a California clearance or a criminal record exemption as required by the Department... 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 (2) indivudals who did not have valid department criminal clearance which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/23/2024 Plan of Correction The licensee agreed to remove the inviduals from the premisis and agreed to send the LPA their staffing plan to ensure they have enough they have sufficent staffing to meet the residents needs from qualified cleared staff. This is due by the 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 interview and record review, the licensee did not comply with the section cited above by not being able to provide record of a valid CPR and first aide card for any staff on premisis which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/23/2024 Plan of Correction The licensee agreed to send the record of the administrtor's CPR card to the LPA, and send a written statement certifying that they will use the LIC311C to review staff records and for onboarding staff and ensure at least (1) staff on shift has valid CPR and first aide.