GRACE HOME II

Official classification

Type A

Official code

87555(b)

Regulation authority

CCR

What the official deficiency says

87555- (b) The following food service requirements shall apply: This requirement is not met as evidenced by: Based on observation, no snacks were available to residents, multiple food items were not labeled in kitchen area and the licensee did not comply with the section cited above in which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

Licensee shall send a letter of understanding of this regulation, will draft a plan on how facility will provide snacks for residents, and how all open food items will be labeled and shall conduct staff training. All POC documents are due by 07/09/25. Civil penalty of $250.00 was issued as it was a repeat citation within 12 months.

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

Official classification

Type B

Official code

87219(a)

Regulation authority

CCR

What the official deficiency says

87219- (a) Residents shall be encouraged to maintain and develop their quality of life through participation in a variety of planned activities. The activities made available shall include: This requirement is not met as evidenced by: Based on observation, during inpection, no planned activities were available for residents as required, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Licensee shall send a letter of understanding of this regulation, and will draft a plan on how the facility shall ensure residents have planned activities per regulation, and shall conduct staff training. All POC documents are due by 07/15/25. Civil penalty of $250.00 was issued as it was a repeat citation within 12 months.

Deadline recorded: Jul 15, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87309(a)

Regulation authority

CCR

What the official deficiency says

87309- (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. This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above as cleaning chemicals were accessible to residents which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

Licensee shall send a letter of understanding of this regulation and shall conduct staff training. All POC documents are due by 07/09/25. Civil penalty of $250.00 was issued as it was a repeat citation within 12 months.

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

Official classification

Type A

Official code

87309(a)

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. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above as bedbug spray and cleaning chemicals were accessible to residents which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/05/2025 Plan of Correction Licensee shall send a letter of understanding of this regulation and shall conduct staff training. All POC documents are due by 6/5/25.

Official classification

Type A

Official code

87555(a)

Regulation authority

CCR

What the official deficiency says

(a) The total daily diet shall be of the quality and in the quantity necessary to meet the needs of the residents an shall meet the Recommended Dietary Allowances of the Food and Nutrition Board of the National Research Council. All food shall be selected, stored, prepared and served in a safe and healthful manner. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above as 2 out of 5 residents require special diets and facility was not following the diet orders, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/05/2025 Plan of Correction Licensee shall send a letter of understanding of this regulation, will draft a plan on how facility will follow dietary orders for residents per their physicians, and shall conduct staff training. All POC documents are due by 6/5/25.

Official classification

Type A

Official code

87555(b)

Regulation authority

CCR

What the official deficiency says

(b) The following food service requirements shall apply: This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, no snacks were available to residents and the licensee did not comply with the section cited above in which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/05/2025 Plan of Correction Licensee shall send a letter of understanding of this regulation, will draft a plan on how facility will provide snacks for residents, and shall conduct staff training. All POC documents are due by 6/5/25

Official classification

Type A

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, the licensee did not comply with the section cited above as multiple food items were found to have expired dates, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/05/2025 Plan of Correction Licensee shall send a letter of understanding of this regulation, and will make sure all food items are in good qualily and not expired, and shall conduct staff training. All POC documents are due by 6/5/25

Official classification

Type B

Official code

87307(a)(2)

Regulation authority

CCR

What the official deficiency says

(2) Resident bedrooms shall be provided which meet, at a minimum, the following requirements: This requirement is not met as evidenced by: Deficient Practice Statement Based on department inspection, resident (R1) was missing a side table, chair, lamp as required, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/18/2025 Plan of Correction Licensee shall send a letter of understanding of this regulation, and will make sure all residents have reqiured furniture per regulation, and shall conduct staff training. All POC documents are due by 6/18/25

Official classification

Type B

Official code

87412(b)

Regulation authority

CCR

What the official deficiency says

(b) Personnel records shall be maintained for all volunteers and shall contain the following: This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, 3 out of 5 staff files do not contain a physical and TB test as required, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/18/2025 Plan of Correction Licensee shall send a letter of understanding of this regulation, and will make sure all staff have a physical and TB test per this regulation, and shall conduct staff training. All POC documents are due by 6/18/25

Official classification

Type B

Official code

87468.1(a)

Regulation authority

CCR

What the official deficiency says

(a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, during inspection, chairs and personal belongings for residents were found to be locked up, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/18/2025 Plan of Correction Licensee shall send a letter of understanding of this regulation, and will draft a plan on how the facility shall ensure residents personal rights are met per regulation, and shall conduct staff training. All POC documents are due by 6/18/25.

Official classification

Type B

Official code

87219(a)

Regulation authority

CCR

What the official deficiency says

(a) Residents shall be encouraged to maintain and develop their quality of life through participation in a variety of planned activities. The activities made available shall include: This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, during inpection, no planned activities were available for residents as required, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/18/2025 Plan of Correction Licensee shall send a letter of understanding of this regulation, and will draft a plan on how the facility shall ensure residents have planned activities per regulation, and shall conduct staff training. All POC documents are due by 6/18/25.

Official classification

Type A

Official code

87466

Regulation authority

CCR

What the official deficiency says

87466-Observation of the Resident- licensee shall ensure that residents are regularly observed for changes in physical, mental, emotional and social functioning and that appropriate assistance is provided when such observation reveals unmet needs……. This requirement is not as evidence by…. Based on record review and interviews, it has been concluded that facility did not reassess R1 for unmet needs despite multiple falls incidents from 08/2024 till 01/15/25, which poses immediate health and safety risks for residents in care.

Official plan of correction

Licensee will make sure that Observation of for any resident per their health care needs/changes will be done in timely manner so residents care needs can be met per RCFE regulation 87466. Licensee shall submit letter of understanding of this regulation to CCL by POC date-05/14/25. resident’s who are identified as a fall risk. Additionally, the facility shall develop a plan on how the facility will address resident’s who are identified as a fall risk. Immediate civil penalty of $500.00 was assessed during today’s visit.

Deadline recorded: May 14, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87463(a)

Regulation authority

CCR

What the official deficiency says

87463(a) Reappraisals- The pre-admission appraisal, as specified in Section 87457, Pre-Admission Appraisal, shall be updated in writing as frequently as necessary or once every 12 months......... This requirement is not as evidence by… Based on record review and interviews, it has been concluded that facility did not provide proper care and supervision for R1 which resulted R1s fall and death on 01/28/25 which poses an immediate health and safety risks for residents in care.

Official plan of correction

Licensee will make sure that Reappraisals requirements all residents can be met per RCFE regulation 87463. Licensee shall submit letter of understanding of this regulation to CCL by POC date-05/14/25. Additionally, the facility shall submit an addendum to the facility plan of operation regarding reappraisals addressing regulation requirements.

Deadline recorded: May 14, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

80078(a)

Regulation authority

CCR

What the official deficiency says

80078(a) Responsibility for providing care and supervision. The licensee shall provide care and supervision as necessary to meet the client's needs. This requirement is not met as evidenced by: Based off of observation and record reviews ,it has been concluded that resident, R1 AWOL'd from the facility on 09/05/24 due to lack of care and supervision of staff which presents an immediate health and safety risk to the resident in care.

Official plan of correction

Facility agrees to hold a training on the AWOL procedure with all staff and send a copy of topics covered and a list of attendees name/date/signature by POC date, 09/11/24 and provide staffing as necessary to meet residents needs. Facility agrees to revisit AWOL procedure and to submit in a written AWOL procedure to CCL within 15 days.

Deadline recorded: Sep 11, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87405

Regulation authority

CCR

What the official deficiency says

87405-Administrator - Qualifications and Duties- (d) The administrator shall have the qualifications .......If the licensee is also the administrator, all requirements for an administrator shall apply.(1) Knowledge of the requirements ......(2)Knowledge of and ability to conform to the applicable laws, rules and regulations……this requirement is not met as evidence by; Based on facility's observations and staff's interviews, facility does not have a qualified Administrator which poses health and safety risks to residents in care.

Official plan of correction

Licensee shall hire a qualified administrator and shall notify Department when hired. All POC documents are due by POC date-09/15/24.

Deadline recorded: Sep 15, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87468.1(a)(6)

Regulation authority

CCR

What the official deficiency says

87468.1 -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:(6) To leave or depart the facility at any time and to not be locked into any room, building, or on facility premises by day or night. This does not prohibit a licensee from establishing house rules, such as locking doors at night to protect residents....this requirement is not as evidenced by; CCL staff observed that facility has locked front entry doors with padlocks which pose a immediate health and safety risks for residents in care.

Official plan of correction

Administrator shall submit a letter of understanding of this regulation and will train staff as well. Administrator shall ensure that all exits are accessible to residents at all times. All POC documents are due by 07/10/24. Administrator removed all padlocks from front entrance doors while CCL staff were present. Civil Penalties assess in the amount $500.

Deadline recorded: Jul 10, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87219(e)

Regulation authority

CCR

What the official deficiency says

87219(e)-Planned Activities -In facilities licensed for sixteen (16) to forty-nine (49) persons, one staff member, designated by the administrator, shall have primary responsibility for the organization, conduct and evaluation of planned activities. ....this requiement is not met as evidenced by; CCL staff observed that there were no schdueld activties for residents and there was no staff assigned to do activities as required per this regulation which poses a potential health and safety risks for residents in care.

Official plan of correction

Administrator shall submit a letter of understanding of this regulation to CCL and will appoint staff to do activities for residents by POC due date- 08/10/24.

Deadline recorded: Aug 10, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87468(a)(13)

Regulation authority

CCR

What the official deficiency says

87468(a)(13)- Personal Rights of Residents in All Facilities- (13)To have access to individual storage space for private use....this requirement is not met as evidenced by; CCL staff observed that residents personal belongings were locked in thier closet(s) and were inaccessible to residents which poses immediate health and safety risks for residents in care.

Official plan of correction

Administartor shall submit a plan on how all resident's will be given full access to thier belongings at all times. Additionally, the Administrator shall submit a plan on how the facility will ensure resident's belongings are safeguarded. All POC documents are due by 07/10/24. **Administrator will provide all resident's who have locks on thier closets either the key to the locks or remove the lock, which ever the resident's request.**

Deadline recorded: Jul 10, 2024. 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

87303(a)- Maintenance and Operation-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 requiement is not as evidenced by; CCL staff observed that resident room # 9 bathroom was not operating well and 2nd building resident's bathroom has broken mirror which poses immediate health and safety risks for residents in care.

Official plan of correction

Administrator shall submit a work order and/or any documentations regarding the repair to bathroom #9. Administrator shall provide the Department with a timeframe of when work will be completed. Plan shall be submitted by 07/10/2024 and will send proof to CCL upon completetion.

Deadline recorded: Jul 10, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87555(b)(8)

Regulation authority

CCR

What the official deficiency says

87555-(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: During visit, LPA observed food supply with multiple expired items, and food items without date or label, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Administrator shall submit a letter of understanding and shall do staff training regarding this regulation and ensure that facility shall not any expired food items and food shall be labeled and dated per requiement. All POC documents are due by 06/27/24. Immediate Civil penalties of $250.00 were assessed on LIC421FC today due to repeat violations of the same regulations within 12 months for Regulation 87555.

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

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 During visit, LPA observed food supply with multiple expired items, and food items without date or label, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/31/2024 Plan of Correction Administrator shall submit a letter of understanding and shall do staff training regarding this regulation and ensure that facility shall not any expired food items and food shall be labeled and dated per requiement. All POC documents are due by 05/31/24.

Official classification

Type A

Official code

85078(a)(1)

Regulation authority

CCR

What the official deficiency says

85078(a)(1): Responsibility for Providing Care and Supervision-The licensee shall provide those services identified in the client's needs and services plan as necessary to meet the client's needs. This requirement was not met as evidenced by: documentation, record review and interview. Administrator and facility staff failed to supervise client in care resulting in C1s unsupervised AWOL, who then stayed overnight at a local mall. This poses an immediate risk to clients in care.

Official plan of correction

Licensee agrees to implement room checks every 60 minutes when C1 is inside C1's room, and when outside of C1's room, C1's should be in line of sight. Licensee will provide Letter of Understanding POC to LPA by COB on 1/27/2022.

Deadline recorded: Jan 27, 2022. A deadline is not proof that correction was completed.