ROSE VILLA

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 record review, the licensee did not comply with the section cited above by not ensuring that the facility has an updated infection control plan LIC9282 which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/05/2026 Plan of Correction Licensee will submit the completed LIC9282 form on plan of correction (POC) due date.

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

(a) 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 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 ensuring that the side gate is functioning properly and resident can exit the facility during emergency which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/05/2026 Plan of Correction Licensee will submit pictures that the sidegate is repaired and in working condition on plan of correction (POC) due date.

Official classification

Type B

Official code

87303(e)(5)

Regulation authority

CCR

What the official deficiency says

(5) Slip-resistant mats, strips, or flooring shall be used in all bathtub and shower floors. 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 ensuring that the batroom has the non-slip mat which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/05/2026 Plan of Correction Licensee will submit proof of purchase or a picture of the non-slip mat on plan of correction (POC) due date.

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, the licensee did not comply with the section cited above by not ensuring that staff #1 (S1) has an updated CPR certificate which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/05/2026 Plan of Correction Licensee will submit the current CPR certificate for S1 on plan of correction (POC) due date.

Official classification

Type B

Official code

87555(b)(26)

Regulation authority

CCR

What the official deficiency says

(26) Supplies of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days shall be maintained on the premises. 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 ensuring that the facility has the seven day supply of non perishable food which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/05/2026 Plan of Correction Licensee will submit pictures of non-perishable purchase or a purchase receipt on POC due date.

Official classification

Type B

Official code

87465(a)(8)(A)

Regulation authority

CCR

What the official deficiency says

(8) If a facility has no medical unit on the grounds, a complete first aid kit shall be maintained and be readily available in a specific location in the facility. The kit shall be a general type approved by the American Red Cross, or shall contain at least the following: (A) A current edition of a first aid manual approved by the American Red Cross, the American Medical Association or a state or federal health agency. 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 ensuring that the faciliyt has an updated first aid manual which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/05/2026 Plan of Correction Licensee will submit proof of purchase or picture of first aid manual on plan of correction (POC) due date.

Official classification

Type B

Official code

1569.695(a)

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: This requirement is not met as evidenced by: Deficient Practice Statement Based on observation,record review, the licensee did not comply with the section cited above by not ensuring that the facility has an updated emrgency diasater pla which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/05/2026 Plan of Correction Licensee will submit a completetd copy of the emergency disaster plan LIC610E on plan of correction (POC) due date.

Official classification

Type B

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, the licensee did not comply with the section cited above by not ensuring that the facility has the 72 hour emergency food which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/05/2026 Plan of Correction Licensee will submit of proof of purchase or picture of the emergency food purchased on POC due date.

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 record review, the licensee did not comply with the section cited above by not ensuring that hte facility has an updated emregency disaster drill which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/05/2026 Plan of Correction Licensee will submit the conducted emergency fire and earthquake training on 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 record review, the licensee did not comply with the section cited above by not ensuring that resident #2 (R2) and resident #3 (R3) have a needs and services plan. which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/05/2026 Plan of Correction LIcensee will submit the needs and services plan for R2 and R3 on POC due date.

Official classification

Type A

Official code

87412(a)(11)

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: (11) A health screening as specified in Section 87411, Personnel Requirements - General. 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 by not ensuring that staff#2(S2) has the health screening performed by a license professional on file which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/15/2025 Plan of Correction Licensee shall provide proof of the health screening appointment for staff#2(S2) on plan of correction due date.

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

(a) 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 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 ensuring that the side door handle by the garage is in good repair which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/18/2025 Plan of Correction Licensee will provide proof that the door handle on the side of the garage is in good repair.

Official classification

Type B

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, the licensee did not comply with the section cited above by not ensuring that the facility is equipped with the 72 hour emergency food or emergency kits which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/20/2025 Plan of Correction Licensee will submit a proof of purchase of the emergency food and emergency kits by the plan of correction (POC) due date

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 record review, the licensee did not comply with the section cited above by not ensuring that the staff conduct the emergency/fire/disaster drill which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/20/2025 Plan of Correction Licensee will submit the emergency/disaster/fire drill signed by all staff at the facility on 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 record review, the licensee did not comply with the section cited above by not ensuring that resident #1 (R1) and resident #2(R2) has the needs and services plan on file which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/20/2025 Plan of Correction Licensee will submit the needs and services plan for resident#1(R1) and resident#2(R2) on plan of correction due date.

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 comply with the section cited above by not having sharps locked and inaccessible 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: 10/15/2024 Plan of Correction Licensee immediately locked sharps, he stated he will submit proof of training regarding regulation cited above by POC due date

Official classification

Type A

Official code

87309(a)(1)

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. (1) Storage areas for poisons, and firearms and other dangerous weapons shall be locked. 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 having the garage and kitchen drawers properly locked inaccessible 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: 10/14/2024 Plan of Correction Licensee stated he will submit proof of training and locks adjusted to LPA by POC due date

Official classification

Type A

Official code

87412(a)(11)

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: (11) A health screening as specified in Section 87411, Personnel Requirements - General. 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 a physicians report for Staff #1 which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/15/2024 Plan of Correction Licensee stated he will submit proof of doctors appointment to LPA by POC due date.

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 observation, interview, and record review, the licensee did not comply with the section cited above by not having Staff #2 associated to facility which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/15/2024 Plan of Correction Licensee stated he will submit proof to LPA association of Staff #2 by POC due date.

Official classification

Type B

Official code

87468(c)(2)(A)

Regulation authority

CCR

What the official deficiency says

(c) Licensees shall prominently post personal rights, nondiscrimination notice, and complaint information in areas accessible to residents, representatives, and the public. (2) Information on the appropriate reporting agency in case of a complaint or emergency, including procedures for filing confidential complaints, shall be posted as follows: (A) Licensees may use the Residential Care Facility for the Elderly (RCFE) Complaint Poster (PUB 475) or may develop their own poster as provided in this section. A poster developed by the licensee shall contain the same content as the PUB 475. The poster that is posted shall be 20” x 26” in size and be posted in the main entryway of the facility. PUB 475 may be accessed, downloaded, and printed from the www.ccld.ca.gov website. 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 having a CCLD complaint poster posted which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/18/2024 Plan of Correction Licensee stated he will submit proof of poster in common area to LPA by POC due date.

Official classification

Type A

Official code

87355(e)

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: This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA file review, the licensee did not comply with the section cited above with (1) staff not having proper background clearance prior to employment which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/23/2023 Plan of Correction Administrator to read the cited regulation and write a statement of understanding that uncleared staff shall not work at the facility until staff has received california clearance and/or exemption. Administrator shall submit this statement to the licensing agency by POC date

Official classification

Type B

Official code

1569.625(b)(1)

Regulation authority

HSC

What the official deficiency says

(1) The department shall adopt regulations to require staff members of residential care facilities for the elderly who assist residents with personal activities of daily living to receive appropriate training. This training shall consist of 40 hours of training. A staff member shall complete 20 hours, including six hours specific to dementia care, as required by subdivision (a) of Section 1569.626 and four hours specific to postural supports, restricted health conditions, and hospice care, as required by subdivision (a) of Section 1569.696, before working independently with residents. The remaining 20 hours shall include six hours specific to dementia care and shall be completed within the first four weeks of employment. The training coursework may utilize various methods of instruction, including, but not limited to, lectures, instructional videos, and interactive online courses. The additional 16 hours shall be hands-on training. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA staff file review, the licensee did not comply with the section cited above by (3) staff not having record of required care training and/or hours which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/05/2023 Plan of Correction Adminstrator has a file documenting training at the offsite office and will submit proof of required training by POC date.

Official classification

Type A

Official code

87465(h)(5)

Regulation authority

CCR

What the official deficiency says

Incidental Medical and Dental Care: Each resident's medication shall be stored in its originally received container. No medications shall be transferred between containers. This requirement was not met as evidenced by: LPAs and lead staff observed one pill box with pills inside days marked TUE, WED, THU.

Official plan of correction

Licensee shall immediately conduct an audit of all current medications for all current residents and conduct training on medication administration as noted in CCR section 87465. Proof of correction shall be submitted to LPA no later than end of POC date.

Deadline recorded: Feb 14, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(i)

Regulation authority

CCR

What the official deficiency says

Prescription medications which are not taken with the resident upon termination of services, not returned to the issuing pharmacy...or which are otherwise to be disposed of shall be destroyed in the facility by the facility administrator and one other adult who is not a resident. Both shall sign a record, to be retained for at least three years... This requirement is not met as evidenced by: LPAs and lead staff observed exipred as needed medication in resident's basket mixed with current medications.

Official plan of correction

Licensee shall immediately conduct an audit of all current medications for all current residents and destroy non current medications or medications with no active prescriptions in accordance to CCR section 87465(i) Proof of correction shall be submitted to LPA no later than end of POC date.

Deadline recorded: Feb 14, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87622(b)(1)

Regulation authority

CCR

What the official deficiency says

(1) Ensuring that the administration of enemas or suppositories or manual fecal impaction removal is performed by an appropriately skilled professional should the resident require assistance. This requirement was not met as evidenced by: LPA Bueno reviewed medication records showing that facility staff were administering suppositories.

Official plan of correction

Licensee shall provide to the Department a memorandum of understanding of CCR section 87622. Proof shall be submitted to the Department no later than end of POC date.

Deadline recorded: Mar 3, 2023. A deadline is not proof that correction was completed.

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 requirement is not met as evidenced by: Deficient Practice Statement Based on LPAs observation and records review, the licensee did not comply with the section cited above as LPAs observed live pests in the kitchen area which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/09/2022 Plan of Correction Licensee shall provide to the Department proof of service on 5/27/2022 and proof of re-occurring service for the pests found today, 6/6/2022.

Official classification

Type B

Official code

87246(c)(2)(a)

Regulation authority

CCR

What the official deficiency says

Facility for the Elderly (RCFE) Complaint Poster (PUB 475) or may develop their own poster as provided in this section. A poster developed by the licensee shall contain the same content as the PUB 475. The poster that is posted shall be 20” x 26” in size and be posted in the main entryway of the facility. PUB 475 may be accessed, downloaded, and printed from the www.ccld.ca.gov website. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPAs observations, the licensee did not comply with the section cited above as PUB 475 was not posted in the facility which poses a potential safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/15/2022 Plan of Correction Licensee shall provide proof of PUB475 posting in the facility.