CASA DORIS

Official classification

Type A

Official code

87303(e)(2)

Regulation authority

CCR

What the official deficiency says

(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 degrees C) and not more than 120 degree F (49 degrees C). This requirement is not met as evidenced by: Deficient Practice Statement Based on observations on 2/23/2026 and 2/26/2026 , the licensee did not comply with the section cited above. Hot water temperature readings were between 122 degrees F and 125 degrees F, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/27/2026 Plan of Correction Corrected during this visit, Licensee adjusted the hot water tank and LPA rechecked and was within regulation. Per discussion, Licensee agreed to check hot water once a week and document it.

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 observations, the licensee did not comply with the section cited above. During the visit on 2/23/2026, LPA found two resident medications inside the kitchen refrigerator that were accessible to residents. Also, the medication cabinet doors were not secured and LPA was able to open the cabinet doors without using the magnetic key; part of the magnetic lock was secured by tape/adhesive. These pose an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/27/2026 Plan of Correction Corrected during site visit on 2/26/2026, Licensee brought a medication box with a lock for the medications that require refrigeration. Licensee secured the magnetic locks with screws during this visit.

Official classification

Type B

Official code

1569.618(c)(3)

Regulation authority

HSC

What the official deficiency says

(c)The facility shall employ, and the administrator shall schedule, a sufficient number of staff members to do all of the following: (3) Ensure that at least one staff member who has cardiopulmonary resuscitation (CPR) training and first aid training is on duty and on the premises at all times. This paragraph shall not be construed to require staff to provide CPR. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review and interviews, the licensee did not comply with the section cited above. During site visits on 2/23/2026 and 2/26/2026, 3 current staff do not have their first aid/cpr certificate on file for review. This poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/05/2026 Plan of Correction Per discussion, Licensee agrees to submit the first aid/cpr certiicates for the 3 staff that are missing in their files. Submit documents by 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. During site visit on 2/23/2026, all staff files were not available for review upon request. During site visit on 2/26/2026, Beatrice Clark's file was not availbe for review upon request.This poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/05/2026 Plan of Correction Per discussion, Licensee agrees to submit a written of understanding of the regulation relating to personnel records; shall be submitted by POC due date.

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). 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. During site visit on 2/23/2026, staff files were not availabe at the facility and documents of their crmininal records clearance was not available for review, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/05/2026 Plan of Correction Per discussion, Licensee agrees to submit a written of understanding of the regulation relating to personnel records; shall be submitted by POC due date.

Official classification

Type B

Official code

87613(a)(2)

Regulation authority

CCR

What the official deficiency says

(2) Ensure that facility staff who will participate in meeting the resident's specialized care needs complete training provided by a licensed professional sufficient to meet those needs. 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. During site visits on 2/23/26 and 2/26/26, there were no hospice training records provided by hospice professionals available for review, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/05/2026 Plan of Correction Per discussion, Licensee agrees to obtain hospice training provided by the qualified hospice nurse/licensed professional. Submit proof of training by POC due date.

Official classification

Type B

Official code

87468(b)

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: 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. Licensee did not have a signed admisson agreement for 1 of 4 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: 03/05/2026 Plan of Correction Per discussion, Licensee agreed to submit a signed admission agreement by POC due date. If resident or their responsible party refuse to sign the admission agreement, Licensee will submit a documentation that a meeting was held with the resident and their responsible party.

Official classification

Type B

Official code

87465(a)(6)

Regulation authority

CCR

What the official deficiency says

(6) When requested by the prescribing physician or the Department, a record of dosages of medications which are centrally stored shall be maintained by the facility. This requirement is not met as evidenced by: Deficient Practice Statement Based on interview and record reviews, the licensee did not comply with the section cited above. Not all residents have centrally stored medication records on file. Beatrice Clark stated she does not have these records for all 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: 03/05/2026 Plan of Correction Per discussion, Licensee agreed to start documenting residents' centrally stored medication records for each residents. Licensee agreed to submit a written statement of understanding of the regulation cited by POC due date.

Official classification

Type B

Official code

87465(b)

Regulation authority

CCR

What the official deficiency says

(b) If the resident's physician has stated in writing that the resident is able to determine and communicate his/her need for a prescription or nonprescription PRN medication, facility staff shall be permitted to assist the resident with self-administration of his/her PRN medication. 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. 4 of 4 residents did not have a PRN Authorization Letter on file, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/05/2026 Plan of Correction Per discussion, Licensee agreed to obtain a signed PRN Authorization Letter from each of the 4 resdients' physicians, submit documents to the Department by POC due date.

Official classification

Type B

Official code

87465(c)(3)

Regulation authority

CCR

What the official deficiency says

(c) If the resident's physician has stated in writing that the resident is unable to determine his/her own need for nonprescription PRN medication, but can 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) A record of each dose is maintained in the resident's record. The record shall include the date and time the PRN medication was taken, the dosage taken, and the resident's response. 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. Facility do not maintain administered PRN records since licensure, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/05/2026 Plan of Correction Per discussion, Licensee agreed to submit a written statement of understanding of the regulation cited by POC due date.

Official classification

Type A

Official code

87355(e)(2)

Regulation authority

CCR

What the official deficiency says

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 as required by the Department . This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interviews, and reviews of Guardian and LIS, S2 was present at this facility on 2/23/26 without association clearance to this facility. This poses immediate safety, health and personal rights risks to persons in care.

Official plan of correction

POC Due Date: 02/27/2026 Plan of Correction During site visit on 2/26/2026, S2 was not present at the facility. LPA instructed Licensee that S2 needs to have clearance from the Department before S2 can come back to this facility. Note that this is a repeat violation. On 9/16/25 visit to this facility, as part of the POC, Licensee has agreed to complete the fingerprint or background clearance for all staff before allowing them access to the facility and submitted a Memo of Understanding.

Official classification

Type A

Official code

87309(a)

Regulation authority

CCR

What the official deficiency says

The licensee shall ensure that disinfectants, cleaning solutions, poisonous substances, knives, matches, tools, sharp objects, and other similar items which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and record review, the licensee did not comply with the regulation cited above. During inspection visit on 2/23/2026, LPA found a knife inside the dishwasher and was accessible to residents; the garage was unlocked and found laundry detergents, floor cleaner and bleach that were accessible to residents in care; the Employee Room was unlocked and found vitamins, hygiene items inside the room and were accessible to residents. Per review of resident Physician's Reports, at least 2 residents in care were assessed to be at risk if they have access to the items listed above; disinfectants were observed under the bathroom sink. These pose immediate safety, health, and personal rights risks to persons in care.

Official plan of correction

POC Due Date: 02/27/2026 Plan of Correction Per discussion, Licensee agreed to submit a written statement of understanding of the regulation cited by POC due date.

Official classification

Type A

Official code

87355(e)(2)

Regulation authority

CCR

What the official deficiency says

87355 (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 as required by the Department . This requirement is not met as evidenced by: S2's name was not found in LIS and Guardian as being associated to this facility. Which poses an immediate Health, Safety or Personal Rights Risk to persons in care.

Official plan of correction

Licensee will complete the fingerprint for all staff before allowing them access to the facility and will submit a Memo of Understanding by the POC due date.

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

Official classification

Type A

Official code

87464(f)(1)(5)

Regulation authority

CCR

What the official deficiency says

Basic services shall at a minimum include: Regular observation of the resident's physical and mental condition, as specified in Section 87466, Observation of the Resident. This requirement is not met as evidenced by: Staff were unavailable to provide regular observation of R1's physical conditions which poses an immediate Health, Safet and/or Personal Risk to persons in care.

Official plan of correction

LIcensees will provide a plan of action to ensure the deficiency will not occur again and submit a Memo of understanding to LPA Campbell for 87464 by the POC date.

Deadline recorded: Oct 3, 2025. A deadline is not proof that correction was completed.