COMFORT HOME 2

Official classification

Type A

Official code

1569.605

Regulation authority

HSC

What the official deficiency says

On and after July 1, 2015, all residential care facilities for the elderly, except those facilities that are an integral part of a continuing care retirement community, shall maintain liability insurance covering injury to residents and guests in the amount of at least one million dollars ($1,000,000) per occurrence and three million dollars ($3,000,000) in the total annual aggregate, caused by the negligent acts or omissions to act of, or neglect by, the licensee or its employees. 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 does not have Liability insurance in the facility for the residents, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/06/2026 Plan of Correction Licensee will provide Liability insurance to LPA Singh by the Plan of Correction (POC) due date via email.

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 observation], the licensee did not comply with the section cited above by not keeping hot water temperature within regulation-which is 125 degrees Fahreheit, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/06/2026 Plan of Correction Licensee will adjust the temperature and provide picture evidence to LPA Singh by the Plan of Correction (POC) due date via email.

Official classification

Type A

Official code

87303(e)(3)

Regulation authority

CCR

What the official deficiency says

(3) Taps delivering water at 125 degree F (52 degrees C) or above shall be prominently identified by warning signs. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and measuring the water temperature in residents bathrooms, the licensee did not comply with the section cited above by not regulating the water temperature in the residents bathrooms, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/06/2026 Plan of Correction Licensee will adjust the temperature and provide picture evidence to LPA Singh by the Plan of Correction (POC) due date via email.

Official classification

Type A

Official code

1569.695(a)(2)

Regulation authority

HSC

What the official deficiency says

(a)In addition to any other requirement of this chapter, a residential care facility for the elderly shall have an emergency and disaster plan that shall include, but not be limited to, all of the following: (2) Plans for the facility to be self-reliant for a period of not less than 72 hours immediately following any emergency or disaster, including, but not limited to, a short-term or long-term power failure. If the facility plans to shelter in place and one or more utilities, including water, sewer, gas, or electricity, is not available, the facility shall have a plan and supplies available to provide alternative resources during an outage. 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 by not providing emergency food supplies for the residents in care during emergency evacuation, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/06/2026 Plan of Correction Licensee will provide a receipt of the emergecy food supplies and send a picture to LPA Singh by the Plan of Correction (POC) due date via email.

Official classification

Type B

Official code

87224(a)(2)

Regulation authority

CCR

What the official deficiency says

Eviction Procedures...(a) A licensee of a licensed residential care facility for the elderly shall, prior to transferring a resident of the facility to another facility or to an independent living arrangement as a result of the forfeiture of a license.... (2) Provide each resident or the resident’s responsible person with a written notice no later than 60 days before the intended eviction. The notice shall include all of the following. This requirement is not met as evidence by: Based on observation, and record review, the licensee did not ensure to follow eviction procedures for 1 out of 1 resident, which poses an immediate Health, Safety, or Personal Rights risk to persons in care.

Official plan of correction

The licensee has agreed to read over the " Eviction Procedures " regulation and provide a written statement that indicates the acknowledgement after the review of the regulation. The acknowledgement shall be reviewed and signed by all facility staff associated to the facility. The licensee will send the acknowledgement to LPA via email on 8/22/2025.

Deadline recorded: Aug 22, 2025. A deadline is not proof that correction was completed.

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 by not completing the required needs and services plan for Resident # (R1), Resident #2 (R2) and Resident #3 (R3 and resident#4 (R#4) which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/04/2025 Plan of Correction Licensee stated to submit Signed Statement of Understanding on HSC15695(e)(2) and submit to LPA Singh at Plan of Correction (POC) due date.

Official classification

Type B

Official code

1569.695(e)(2)

Regulation authority

HSC

What the official deficiency says

(e) A facility shall have all of the following information readily available to facility staff during an emergency: (2) An appraisal of resident needs and services plan for each resident. 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 by not conducting the required drill at least quarterly for each shift which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/04/2025 Plan of Correction Licensee stated to conduct the required fire drill on all shift and submit proof to LPA Singh with Plan of Correction (POC) by the due date.

Official classification

Type B

Official code

87608(a)(3)

Regulation authority

CCR

What the official deficiency says

87608 Postural Supports (a) Based on the individuals preadmission appraisal....(3) A written order from a physician indicating the need for the postural support shall be maintained in the residents record. The licensing agency... This requirement is not met as evidenced by: Based on observation, interview and record review, the licensee did not comply with the section cited above by allowing Resident #1 (R1), Resident #3 (R3) and Resident #5 (R5) have half bed rails without their physician order indicating the need for half bed rail for mobility in their facility file which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Licensee stated to obtain doctor's written order indicating the need for half bed rail for R1, R3 and R5 and submit proof to LPA Brown at Plan of Correction (POC) due date.

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

Official classification

Type B

Official code

87470(c)

Regulation authority

CCR

What the official deficiency says

(c) An Infection Control Plan shall be developed by the licensee and shall be included in the Plan of Operation required by Section 87208. 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 by not developing the required Infection Control Plan for the facility which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/15/2024 Plan of Correction Licensee stated to develop the required Infection Control Plan and submit a copy to LPA Brown at Plan of Correction (POC) due date.

Official classification

Type B

Official code

1569.605

Regulation authority

HSC

What the official deficiency says

HSC 1569.605 Other Provisions - On and afetr July 1, 2015, all residential residential care facilities for the elderly, except those facilities that are an integral part of continuing... shall maintain a liability insurance covering injury to residents and guests in the amount of... 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 by not maintaining a liability insurance for the facility which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/29/2024 Plan of Correction Licensee stated to expedite processing of the renewal of their liability insurance and submit proof to LPA Brown at POC due date.

Official classification

Type A

Official code

87705(f)(2)

Regulation authority

CCR

What the official deficiency says

87705(f)(2) Care of Persons with Dementia (2) Over-the-counter medication, nutritional supplements or vitamins, alcohol, cigarettes and toxic substances such as certain plans, gardening supplies, cleaning supplies and disinfectants. 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 by not locking the two (2) bottles of Staff #2 (S2) medications found in the kitchen cabinet and plant fertilizer found in the backyard, making it accessible to residents in care which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/29/2024 Plan of Correction Licensee stated to train all staff on CCR 87705(f)(2) and submit proof of all staff training log to LPA Brown at Plan of Correction (POC) due date.

Official classification

Type A

Official code

87465(h)(5)

Regulation authority

CCR

What the official deficiency says

87465(h)(5) Incidental Medical and Dental Care (5) Each residents medication shall be stored in its originally received containier. NO medications shall be transferred between containers. 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 by pre-pouring all residents medications for the day/transferring all residents medications for the day to a small container per resident which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/29/2024 Plan of Correction Licensee stated to train all staff on CCR 87465(h)(5) and submit proof of all staff training log to LPA Brown at POC due date.

Official classification

Type A

Official code

87705(l)(2)

Regulation authority

CCR

What the official deficiency says

87705(l)(2) Care of Persons with Dementia (2) The Licensee shall ensure that the fire clearance includes approval of locked exterior doors or locked perimeter fence gates. 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 by locking the side fence gate with a padlock without approved fire clearance that includes approval of locked perimeter fence gate which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/29/2024 Plan of Correction Licensee immediately removed the padlock at the side gate of the facility during the visit. Licensee stated to train all staff on CCR 87705(l)(2) and submit proof of all staff training log to LPA Brown at Plan of Correction (POC) due date.

Official classification

Type B

Official code

87303(c)

Regulation authority

CCR

What the official deficiency says

87303(c) Maintenance and OPeration (c) All window screens shall be clean and maintained in good repair. 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 by having one (1) screen door in disrepair which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/15/2024 Plan of Correction Licensee stated to repair/replace the broken screen door and submit proof to LPA Brown at Plan of Correction (POC) due date.

Official classification

Type B

Official code

87303(e)(2)

Regulation authority

CCR

What the official deficiency says

87303(e)(2) Faucets used by residents for personal care such as shaving and grooming... 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 and not more than 120 degree F. 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 by not regulating the hot water temperature in residents' shared bathroom between 105 degree F to 120 degree F which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/08/2024 Plan of Correction Licensee stated to regulate the hot water temperature on residents shared bathroom between 105 degree F to 120 degree F and submit proof to LPA Brown at PLan of Correction (POC) due date.

Official classification

Type B

Official code

87355(e)(3)

Regulation authority

CCR

What the official deficiency says

87355(e)(3) Criminal Record Clearance - Request a transfer of a criminal record clearnace as specified in Section 87355(c) or 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 by not transferring Staff #5 (S5) criminal background clearance to the facility before allowing S5 to work at the facility which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/15/2024 Plan of Correction Licensee stated to transfer S5 criminal record clearance to the facility and submit proof to LPA Brown at Plan of Correction (POC) due date.

Official classification

Type B

Official code

87457(c)

Regulation authority

CCR

What the official deficiency says

87457(c) Pre-Admission Appraisal Prior to admission a determination of the prospective residents' suitability for admission shall be completed and shall include an appraisal of his/her individual service needs in comparison with the... 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 by not having the required Pre-Admission Appraisal for Resident #1 (R1), Resident #3 (R3) and Resident #5 (R5) which posesa potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/15/2024 Plan of Correction Licensee stated to submit Signed Statement of Understanding on CCR 87457(c) to LPA Brown at Plan of Correction (POC) due date.

Official classification

Type B

Official code

15695(e)(2)

Regulation authority

HSC

What the official deficiency says

HSC 15695(e)(2) An appraisal of resident needs and services plan for each resident. 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 by not completing the required needs and services plan for Resident # (R1), Resident #3 (R3) and Resident #5 (R5) which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/08/2024 Plan of Correction Licensee stated to submit Signed Statement of Understanding on HSC15695(e)(2) and submit to LPA Brown at Plan of Correction (POC) due date.

Official classification

Type B

Official code

1569.695(c)

Regulation authority

HSC

What the official deficiency says

HSC 1569.695(c) A facility shall conduct a drill at least quarterly for each shift. The type of emergency covered... 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 by not conducting the required drill at least quarterly for each shift which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/22/2024 Plan of Correction Licensee stated to conduct the required fire drill on all shift and submit proof to LPA Brown at Plan of Correction (POC) due date.

Official classification

Type B

Official code

87608(a)(5)(A)

Regulation authority

CCR

What the official deficiency says

87608(a)(5)(A) Postural Supports A bed rail that extends from the head half the length of the bed and used only for assistance with mobility shall be allowed. 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 by allowing Resident #1 (R1), Resident #3 (R3) and Resident #5 (R5) have half bed rails without their physician order indicating the need for half bed rail for mobility in their facility file which poses a potential health, safety or personal rights risk to persons in care. ***Deficiency will be deleted as it should be CCR 87608(a)(3)*** Please reference new LIC809D created***

Official plan of correction

POC Due Date: 03/15/2024 Plan of Correction Licensee stated to obtain doctor's written order indicating the need for half bed rail for R1, R3 and R5 and submit proof to LPA Brown at Plan of Correction (POC) due date.

Official classification

Type A

Official code

87705(I)(2)

Regulation authority

CCR

What the official deficiency says

87705 Care of Persons with Dementia: (I) The following initial and continuing requirements shall be met by the licensee to lock the exterior doors or perimeter fence gates: (2) The Licensee shall ensure that the Fire Clearance includes approval of locked exterior doors or locked perimeter fence gates. This requirement is not met as evidenced by: Based on observation,interview and records review, the Licensee did not comply with the regulation by locking the side gate/perimeter fence gate in a manner that residents are unable to exit without assistance. This poses an immediate health, safety, and personal rights risk to residents in care.

Official plan of correction

The licensee agrees to remove the lock and agree to not lock the perimeter fence gate without Licensing and Fire Marshall approval. Caregiver unlocked gate during visit. Plan of Correction (POC) cleared.

Deadline recorded: Nov 18, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87608(a)(3)

Regulation authority

CCR

What the official deficiency says

87608 Postural Supports (a) Based on the individuals preadmission appraisal....(3) A written order from a physician indicating the need for the postural support shall be maintained in the residents record. The licensing agency... This requirement is not met as evidenced by: Based on observation, interview andr ecord review, the licensee did not comply with the section cited above by having Resident #3 (R3) half bed rail with no written order from R3's physician indicating the need for the postural support maintained in R3 facility record which poses a potential health, safety or personal rights risk to residents in care.

Official plan of correction

The Licensee stated to submit written order from R3's physician indicating the need for the postural support and submit letter to Community Care Licensing Division (CCLD) requesting approval for R3 half bedrail at the facility by Plan of Correction (POC) due date.

Deadline recorded: Dec 4, 2023. A deadline is not proof that correction was completed.