ANGELS ASSISTED LIVING,INC.

Official classification

Type B

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 observation, the licensee did not comply with the section cited above in as the temperature in the kitchen sink was measured at 147.7 degrees F, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/15/2026 Plan of Correction Licensee will lower water temperature or include a " Caution Hot Water " sign by all water faucets. Licensee will send photo confirmation of temperature or signage by 06/15/2026 by email to LPA Gunby.

Official classification

Type B

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 in the laundry room containing chemicals and was found unlocked, as well as the kitchen knives being left unlocked in the cabinet which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/15/2026 Plan of Correction Licensee will lock the laundry room and the knives to ensure the health and safety of residents in care. Licensee will submit a statement of sunderstanding by 06/15/2026 to LPA Gunby by email.

Official classification

Type B

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 record review, the licensee did not comply with the section cited above in 2 out of 3 staff which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/15/2026 Plan of Correction Licensee will submit the TB tests for the 2 staff by 06/15/2026 by email to LPA Gunby.

Official classification

Type A

Official code

87356(b)(1)(B)

Regulation authority

CCR

What the official deficiency says

Criminal Record Exemption (b) In addition to the applicant, the provisions of this section shall apply to criminal convictions of the following persons: (1) (B) Any person, other than a client, residing in the facility… This requirement was not met based on records and statement. The presence of non-cleared staff resulted in no qualified staff present and was an immediate risk to residents in care.

Official plan of correction

Licensee will submit a procedure for submitting required documents and process of verification of all new potential employees before their presence in the facility by the POC date of 2/13/26.

Deadline recorded: Feb 13, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87629(b)(1)

Regulation authority

CCR

What the official deficiency says

87629 Injections. (b) In addition to Section 87611, General Requirements for Allowable Health Conditions, the licensees who admit or retain residents who require injections shall be responsible for the following: (1) Ensuring that injections are administered by an appropriately skilled professional should the resident require assistance. This requirement is not met as evidenced by: Based on interviews and record review, the licensee did not comply with the section cited above due to caregiver providing insulin injections to resident which poses an immediate health and safety risk to persons in care.

Official plan of correction

Administrator to send into LPA a copy of their plan for diabetic residents going forward. Plan to be sent into CCL by 12/17/25.

Deadline recorded: Dec 17, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87211(a)(1)(D)

Regulation authority

CCR

What the official deficiency says

87211 Reporting Requirements. (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 written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below. This report shall include the resident's name, age, sex and date of admission; date and nature of event; attending physician's name, findings, and treatment, if any; and disposition of the case. (D) Any incident which threatens the welfare, safety or health of any resident, such as psychological abuse of a resident by staff or other residents, or unexplained absence of any resident. This requirement is not met as evidenced by: Based on interviews and record review, the licensee did not comply with the section cited above due to incidents not being reported into CCL which poses a potential health and safety risk to persons in care.

Official plan of correction

Administrator agrees to review regulation 87211 and submit a statement of understanding into LPA by 12/29/25.

Deadline recorded: Dec 29, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87466

Regulation authority

CCR

What the official deficiency says

Observation of the Resident The 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. When changes such as unusual weight gains or losses or deterioration of mental ability or a physical health condition are observed, the licensee shall ensure that such changes are documented and brought to the attention of the resident's physician and the resident's responsible person, if any. This requirement is not evidenced by: Based on record review and interviews, the licensee did not comply with this section as R1 was not regularly observed for changes. This poses an immediate Health and Safety risk to resident 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 10/29/2025. $500 Civil Penalty

Deadline recorded: Oct 29, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87463(f)

Regulation authority

CCR

What the official deficiency says

Reappraisals (f)The licensee shall immediately, or as soon as reasonably possible, communicate with the resident and, if applicable, the resident's representative, about any significant change in condition and the recommendation, if any, of the appropriate licensed medical professional, and if applicable, other specialized care provider. Documentation of such communication shall be added to the resident’s record. This requirement is not evidenced by: Based on interviews and record review, the licensee failed to notify R1’s responsible party when R1 was admitted to the hospital. This poses an immediate Health and Safety risk to resident 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 10/29/2025.

Deadline recorded: Oct 29, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87468.2(a)(4)

Regulation authority

CCR

What the official deficiency says

Additional Personal Rights of Residents in Privately Operated Facilities (a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the 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, qualifications, and competency to meet their needs. This requirement is not evidenced by: Based on interviews and record review, the licensee failed to provide care and supervision which resulted in R1’s fall leading to a fracture. This poses an immediate Health and Safety risk to resident 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 10/29/2025.

Deadline recorded: Oct 29, 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

87355 Criminal Record Clearance (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: (2) Request a transfer of a criminal record clearance as specified in Section 87355(c) .. This requirement is not met as evidenced by: Based on record review, the licensee did not comply with the section cited above due to caregiver, S1 was not being fingerprint cleared and associated with the facility which poses an immediate health and safety risk to persons in care.

Official plan of correction

Licensee will submit a statement of understanding to LPA that all staff must be fingerprint cleared and/or transferred prior to working in the facility. POC due 04/17/25. Immediate civil penalty of $500.00 was assessed today.

Deadline recorded: Apr 17, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

47411(f)

Regulation authority

CCR

What the official deficiency says

47411(f) Personnel Requirements 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. Based on interviews conducted and records reviewed, this requirement was not met as evident based on facility didn't ensure staff had a Health Screening prior to working at facility, which poses a potential health, safety, and personal rights risk to the residents in care.

Official plan of correction

Licensee shall ensure staff employeed has a Health Screening Prior to working at the facility. Licensee shall document why it is important to ensure this requirement and submit to LPA no later than 10/15/2024.

Deadline recorded: Oct 2, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(c)(3)

Regulation authority

CCR

What the official deficiency says

87465(c)(3) (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 is evident by the facility not having a medical administration record for any of the residents.

Official plan of correction

The Licensee shall have residents medical file at facility at all times and document all medications given to each resident. Licensee shall document why it is important to document all medications given. This shall be completed by 10/15/2024 and submitted to LPA.

Deadline recorded: Oct 2, 2024. A deadline is not proof that correction was completed.