FAMOUS HOME

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…fire department, or district…or…Fire Marshal. Prior to accepting or retaining any of the following types of persons, the…licensee shall notify the licensing agency and obtain an appropriate fire clearance approved….(2) Bedridden persons This requirement was not met as evidenced by: Based on observation, interview, and record review R1 is bedridden and the facility does not have approval from the local fire jurisdiction. This poses an immediate health safety or personal rights risk to resident in care.

Official plan of correction

The licensee called their local fire department during the visit and informed them of the bedridden resident. The licensee provided proof of submitting a fire clearance request to the department at the time of the visit. LPA confirmed the request was received 08/18/2025.

Deadline recorded: Aug 19, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.2(a)(4)

Regulation authority

CCR

What the official deficiency says

87468.2 Additional Personal Rights of Residents in Privately Operated Facilities (a)In addition to the rights listed in Section 87468.1…elderly shall have all of the following personal rights:(4) To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers…to meet their needs. This requirement was not met as evidenced by: Based on interviews and records review, the facility is not staffed sufficiently at night from 8pm to 6am to meet night supervision needs documented for residents. Based on resident ambulatory status and ability to evacuate in an emergency, the facility is also not sufficiently staffed to evacuate (3) residents who require total assistance with (1) on call staff on the premises. This poses a potential health safety or personal rights risk to residents in care.

Official plan of correction

The licensee agreed to submit an LIC500 showing staffing at night and for emergency assistance. The licensee agreed to update their LIC610E plan to reflecting staffing and evacuation level. The licensee also agreed to submit a written procedure for staff on how residents needs for turing and repositioning will be met at night.

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

Official classification

Type B

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, the licensee did not comply with the section cited above on keeping cleaning solutions and sharp object inaccessible to the residents in care which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/18/2024 Plan of Correction Licensee will provide staff training for this regulation cited to ensure that items that can pose a danger are locked and inaccessible to residents. Licensee will submit proof of training to LPA by the Plan of Correction date 10/18/2024.

Official classification

Type B

Official code

1569.625(b)(2)

Regulation authority

HSC

What the official deficiency says

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

Official plan of correction

POC Due Date: 10/18/2024 Plan of Correction Licensee will provide proof of training and training materials for all staff working at this facility to LPA by the Plan of Correction date 10/18/2024.

Official classification

Type B

Official code

87555(b)(8)

Regulation authority

CCR

What the official deficiency says

(b) The following food service requirements shall apply: (8) All food shall be of good quality. Commercial foods shall be approved by appropriate federal, state and local authorities. Food in damaged containers shall not be accepted, used or retained. 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 having multiple amounts of expired food in the refrigerator and pantry which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/18/2024 Plan of Correction Licensee will conduct staff training regarding inspection for the quality of food that is stored at the facility. Licensee will purchase food of good quality for the residents in care and will provide proof of receipt and proof of staff training to LPA by the Plan of Correction date by 10/18/2024.

Official classification

Type B

Official code

87465(d)(3)

Regulation authority

CCR

What the official deficiency says

(d) If the resident is unable to determine his/her own need for a prescription or nonprescription PRN medication, and is unable to communicate his/her symptoms clearly, facility staff designated by the licensee, shall be permitted to assist the resident with self-administration, provided all of the following requirements are met: (3) The date and time the PRN medication was taken, the dosage taken, and the resident's response shall be documented and maintained in the resident's facility record. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and record review, the licensee did not comply with the section cited above for resident one (R1) receiving PRN medication without staff documenting dates and time. which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/18/2024 Plan of Correction Licensee will conduct training with staff regarding administering PRNs to residents in care and documenting when given. Licensee will submit proof of training materials and staff signatures of who attended the training to LPA by the plan of correction date 10/18/2024.

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 on not conduct the quarterly drill. Last drill conducted was on 05/16/2024 which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/18/2024 Plan of Correction Licensee agrees to conduct the fire drill on a quarterly basis and will submit the fire drill conducted by the Plan of Correction date 10/18/2024.

Official classification

Type B

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. 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 having a hand rail hanging off the wall by the resident's room located in the hallway which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/18/2024 Plan of Correction Licensee agrees to fix the hand rail so it is not hanging off the wall and will send proof of correction and repair by the Plan of Correction date 10/18/2024.

Official classification

Type B

Official code

87303(e)(6)

Regulation authority

CCR

What the official deficiency says

MAINTENANCE AND OPERATIONS: (e) Water supplies and plumbing fixtures shall be maintained as follows: (6)...bathing facilities shall be maintained in operating condition...based on the residents' needs. This requirement is not being met as evidenced by: LPA observed the sink pressure very low and shower attachment water pressure is extremly low and a knob is used to turn on and off at the top, bath knobs are not working. This poses a potential health and safety risk to the clients in care.

Official plan of correction

Licensee will repair and send copy of invoice to LPA by POC Due date.

Deadline recorded: Apr 9, 2024. A deadline is not proof that correction was completed.