SUNNY SIDE CARE HOME

Official classification

Type A

Official code

87465(h)(5)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care (h) The following requirements shall apply to medications which are centrally stored: (5) Each resident's medication shall be stored in its originally received container. No medications shall be transferred between containers. Based on facility observation the licensee did not comply with the section cited above in 3 out of 3 resident medications which poses an immediate health and safety risk to residents in care. LPA observed 3 residents medications transferred from the original container to alternative storing methods.

Official plan of correction

Licensee agrees to remain in compliance with Title 22 regulation 87465 at all times. Licensee will review methods with pharmacy and residents for storing medications (ex: bubble packs). Licensee will preform staff re-training on the topic of Medication Administration, and provide proof of training to LPA by 04/20/2026 via email at shakaricka.hughes@dss.ca.gov.

Deadline recorded: Apr 20, 2026. A deadline is not proof that correction was completed.

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: During review of residents medications for (R1) and (R2) LPA observed the Medication Administration Record (MAR) incomplete for 4 days. Which poses a potential health and safety risk to persons in care.

Official plan of correction

Licensee agrees to remain in compliance with Title 22 regulation 87465 at all times. Additionally, licensee will preform staff re-training on the topic Medication Administration for all facility staff by 04/20/2026

Deadline recorded: Apr 20, 2026. A deadline is not proof that correction was completed.

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 observation and review the licensee did not comply with the section cited above for 2 out of 2 residents medications which poses a potential health and safety risk to persons in care. During review of residents medications for (R1) and (R2) LPA observed the Medication Administration Record (MAR) incomplete for 4 days.

Official plan of correction

POC Due Date: 03/27/2026 Plan of Correction Licensee agrees to remain in compliance with Title 22 regulation 87465 at all times. Additionally, licensee will preform staff re-training on the topic Medication Administration for all facility staff by 03/27/2026.

Official classification

Type A

Official code

87465(h)(5)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care (h) The following requirements shall apply to medications which are centrally stored: (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 facility observation the licensee did not comply with the section cited above in 3 out of 3 resident medications which poses an immediate health and safety risk to residents in care. LPA observed 3 residents medications transferred from the original container to alternative storing methods.

Official plan of correction

POC Due Date: 03/25/2026 Plan of Correction Licensee agrees to remain in compliance with Title 22 regulation 87465 at all times. Licensee will review methods with pharmacy and residents for storing medications (ex: bubble packs). Licensee will preform staff re-training on the topic of Medication Administration, and provide proof of training to LPA by 03/27/2026 via email at shakaricka.hughes@dss.ca.gov. If additional time is needed to preform training please contact LPA Hughes by 03/25/2026.

Official classification

Type B

Official code

87457(c)(1)(A)

Regulation authority

CCR

What the official deficiency says

" Prior to admission a determination of the prospective resident's suitability for admission shall be completed and shall include an appraisal of their individual service needs ... The appraisal shall document, at a minimum: ... An evaluation of the prospective resident's functional capabilities, mental condition, and social factors... " This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, more than one resident's preplacement appraisals were not completed or signed by the resident and/or their responsible party prior to admission, which poses a potential health, safety, and/or personal rights risk.

Official plan of correction

POC Due Date: 03/14/2025 Plan of Correction Licensee agrees to provide LPA Moleski with the residents' completed and signed appraisal and needs and services plan by POC due date. vincent.moleski@dss.ca.gov

Official classification

Type A

Official code

87202(a)

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: This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, this facility admitted a greater number of non-ambulatory residents than permitted by fire clearance, which poses an immediate health, safety, and/or personal rights risk.

Official plan of correction

POC Due Date: 03/04/2025 Plan of Correction Licensee agrees to send LPA Moleski a written plan identifying which steps they plan to take to address this deficiency, either requesting an updated fire clearance or evicting a resident, by POC due date. vincent.moleski@dss.ca.gov

Official classification

Type A

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 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 observation, water temperature was not maintained within the required range, which poses an immediate health, safety, and/or personal rights risk,

Official plan of correction

POC Due Date: 03/04/2025 Plan of Correction Licensee agrees to provide LPA Moleski with a photograph of an updated temperature reading within the required range by POC due date. vincent.moleski@dss.ca.gov

Official classification

Type A

Official code

87309(a)(1)

Regulation authority

CCR

What the official deficiency says

(a) Except as specified in subsection (b), 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. (1) Disinfectants, cleaning solutions, and poisonous substances shall be stored in areas separate from food supplies as specified in Section 87555, General Food Service Requirements. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, cleaning solutions were not kept in locked storage, as required, which poses an immediate health, safety, and/or personal rights risk.

Official plan of correction

POC Due Date: 03/04/2025 Plan of Correction Licensee agrees to provide LPA Moleski with a plan for staff training regarding chemical storage by POC due date. vincent.moleski@dss.ca.gov

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 pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (3) 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 and interview, two staff members worked without having criminal record clearance/association, which poses an immediate health, safety, and/or personal rights risk.

Official plan of correction

POC Due Date: 03/04/2025 Plan of Correction Licensee agrees to associate S2 and to provide LPA Moleski with a written statement acknowledging all criminal record clearance requirements by POC due date. vincent.moleski@dss.ca.gov

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, two staff members did not have completed staff files on the premises upon arrival, which poses a potential health, safety, and/or personal rights risk.

Official plan of correction

POC Due Date: 03/14/2025 Plan of Correction Licensee agrees to provide LPA Moleski with copies of both staff members' personnel files by POC due date. vincent.moleski@dss.ca.gov

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 observation and interview, complete centrally stored medication records were not maintained on each resident, which poses a potential health, safety, and/or personal rights risk.

Official plan of correction

POC Due Date: 03/14/2025 Plan of Correction Licensee agrees to provide LPA Moleski with completed centrally stored medication records for all residents by POC due date. vincent.moleski@dss.ca.gov

Official classification

Type B

Official code

87458(a)

Regulation authority

CCR

What the official deficiency says

(a) Prior to a person's acceptance as a resident, the licensee shall obtain documentation of a medical assessment, signed by a licensed medical professional acting within the scope of their practice and made within the last year, to be kept in the resident's record. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, a resident did not have a medical assessment on file prior to admission to this facility, which poses a potential health, safety, and/or personal rights risk.

Official plan of correction

POC Due Date: 03/14/2025 Plan of Correction Licensee agrees to provide LPA Moleski with the outstanding LIC 602 by POC due date. vincent.moleski@dss.ca.gov

Official classification

Type B

Official code

87458(c)(1)

Regulation authority

CCR

What the official deficiency says

(c) The medical assessment shall include, but not be limited to: (1) A physical examination of the resident indicating the licensed medical professional's diagnosis or diagnoses and results of an examination for all of the following: This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, a resident did not receive tuberculosis test results during their medical assessment, nor did they receive results of a chest x-ray, which poses a potential health, safety, and/or personal rights risk.

Official plan of correction

POC Due Date: 03/14/2025 Plan of Correction Licensee agrees to send LPA Moleski documentation of either a negative TB test or results from a chest x-ray indicating no evidence of active, communicable tuberculosis by POC due date. vincent.moleski@dss.ca.gov

Official classification

Type A

Official code

87611(b)(1-3)

Regulation authority

CCR

What the official deficiency says

" (b) The licensee shall complete and maintain a current, written record of care for each resident that includes, but is not limited to, the following: (1) Documentation from the physician of the following: (A) Stability of the medical condition(s); (B) Medical condition(s) which require incidental medical services; (C) Method of intervention; (D) Resident's ability to perform the procedure; and (E) An appropriately skilled professional shall be identified who will perform the procedure if the resident needs assistance. (2) The names, address and telephone number of vendors, if any, and all appropriately skilled professionals providing services. (3) Emergency contacts. " This requirement is not met as evidenced by: Deficient Practice Statement Based on record review and interview, the licensee did not ensure R1 had a current record of care on file as described above, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/17/2024 Plan of Correction Licensee agrees to arrange a medical appointment for R1 and will send LPA Moleski confirmation of an appointment as soon as one is made. vincent.moleski@dss.ca.gov

Official classification

Type A

Official code

87309(a)

Regulation authority

CCR

What the official deficiency says

(a) Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not ensure cleaners were locked up, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/17/2024 Plan of Correction Licensee agrees to fix the lock on the cabinet by POC due date. Licensee agrees to send LPA Moleski a photograph of the replacement by POC due date. vincent.moleski@dss.ca.gov

Official classification

Type A

Official code

1569.69(a)(2)

Regulation authority

HSC

What the official deficiency says

(a) Each residential care facility for the elderly licensed under this chapter shall ensure that each employee of the facility who assists residents with the self-administration of medications meets all of the following training requirements: (2) In facilities licensed to provide care for 15 or fewer persons, the employee shall complete 10 hours of initial training. This training shall consist of 6 hours of hands-on shadowing training, which shall be completed prior to assisting with the self-administration of medications, and 4 hours of other training or instruction, as described in subdivision (f), which shall be completed within the first two weeks of employment. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review and interview, the licensee did not ensure S1 was trained on medication administration prior to assisting with medications, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/17/2024 Plan of Correction Licensee agrees to conduct staff training and to send LPA Moleski a sign-in sheet by POC due date. vincent.moleski@dss.ca.gov

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

" The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. " This was not met as evidenced by LPA observation of the front yard, back yard, untrimmed grass, broken gate and sagging fence.

Official plan of correction

Licensee will cut grass and fix fence and gate, or have a work order to fix the fence and gate.

Deadline recorded: Apr 28, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87203

Regulation authority

CCR

What the official deficiency says

87203 Fire Safety. All facilities shall be maintained in conformity with the regulations adopted by the State Fire Marshal for the protection of life and property against fire and panic. This was not met as evidenced by: Licensee did not ensure the Fire Marshall cleared the facility changes prior to making changes to the facility. LPAs observed the facility has changed the facility by dividing one room into two. Community Care Licensing (CCL) has not received an updated cleared facility sketch. This poses an potential health and safety risk to persons in care.

Official plan of correction

Licensee stated there will be an appointment scheduled with the Sacraemnto County Fire Marshall to obtain an updated cleared facility sketch and send a copy via email to facility LPA No Later Than (NLT) 04/04/2023.

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

Official classification

Type A

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 LPA record review and observation, the licensee did not comply with the section cited above in which 2 out of 3 personnel files did not have Health Screening reports and TB test in accordance to Title 22, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/08/2023 Plan of Correction Licensee will email LPA email confirmation of scheduled Health Screening and TB Test appointment date by COB 3/8/2023.