GOLDEN YEARS RESIDENTIAL CARE

Official classification

Type A

Official code

87204(a)

Regulation authority

CCR

What the official deficiency says

(a) A licensee shall not operate a facility beyond the conditions and limitations specified on the license, including specification of the maximum number of persons who may receive services at any one time. An exception may be made in the case of catastrophic emergency when the licensing agency may make temporary exceptions to the approved capacity. 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 ensuring that they obtained a fire clearance for a third bedridden resident (the facility has a clearance for , which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/08/2025 Plan of Correction Administrator will contact the local fire department to obtain clearance and submit proof to LPA by Plan of Correction (POC) due date.

Official classification

Type A

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 and obervation, the licensee did not comply with the section cited above by not ensuring that staff 2 completed a CPR/First Aid certification, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/08/2025 Plan of Correction Administrator will enroll Staff 2 in a CPR/First Aid class and submit proof of completion to LPA by Plan of Correction (POC) due date.

Official classification

Type A

Official code

1569.72(f)

Regulation authority

HSC

What the official deficiency says

(f) Notwithstanding the length of stay of a bedridden resident, every facility admitting or retaining a bedridden resident, as defined in this section, shall, within 48 hours of the resident’s admission or retention in the facility, notify the local fire authority with jurisdiction in the bedridden resident’s location of the estimated length of time the resident will retain his or her bedridden status in the facility. 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 ensuring that the fire department was notified, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/08/2025 Plan of Correction Administrator will notify the local fire department and submit proof of response from the fire authority to LPA by Plan of Correction (POC) due date.

Official classification

Type B

Official code

87307(d)(4)

Regulation authority

CCR

What the official deficiency says

(4) Stairways, inclines, ramps and open porches and areas of potential hazard to residents with poor balance or eyesight shall be made inaccessible to residents unless equipped with sturdy hand railings and unless well-lighted. 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 the the lower railings on the outdoor ramp in resident room # 1 were in good repair, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/14/2025 Plan of Correction Administrator will either remove the railings or secure them and submit proof to LPA by Plan of Correction (POC) due date.

Official classification

Type B

Official code

87307(d)(6)

Regulation authority

CCR

What the official deficiency says

(6) All outdoor and indoor passageways and stairways shall be kept free of obstruction. 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 resident bedroom 1's exit door was unobstructed, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/14/2025 Plan of Correction Administrator relocated the wheelchair that was blocking the door during the visit and will conduct a training on doorways and exit obstructions and submit proof to LPA by Plan of Correction (POC) due date.

Official classification

Type A

Official code

1569.311

Regulation authority

HSC

What the official deficiency says

Every residential care facility for the elderly shall have one or more carbon monoxide detectors in the facility that meet the standards established in Chapter 8 (commencing with Section 13260) of Part 2 of Division 12. The department shall account for the presence of these detectors during inspections. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and interview the licensee did not comply with the section cited above by not ensuring facility had an identifiable carbon monoxide detector, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/07/2024 Plan of Correction Administrator purchased and installed a carbon monoxide detector during the facility visit and LPA observed it to be operable.

Official classification

Type A

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 observation, interview and record review, the licensee did not comply with the section cited above by not ensuring that staff members have completed First Aid/CPR certification, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/09/2024 Plan of Correction Administrator will register the staff for First Aid/CPR certification and send proof to LPA by Plan of Correction 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 ensuring that staff have a physician's report and tuberculosis clearance, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/09/2024 Plan of Correction Administrator will make doctor's appointments for staff and send proof of physician's resport with tuberculosis clearance to LPA by Plan of Correction due date.

Official classification

Type A

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, interview and record review, the licensee did not comply with the section cited above by not ensuring resident files contain physician's orders for residents, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/09/2024 Plan of Correction Administrator placed several phone calls to responsible parties to obtain physician's orders during the facility visit. Administrator will submit physician's orders for residents file to LPA by the Plan of Correction due date.

Official classification

Type A

Official code

87705(f)(1)

Regulation authority

CCR

What the official deficiency says

(f) The following shall be stored inaccessible to residents with dementia: (1) Knives, matches, firearms, tools and other items that could constitute a danger to the resident(s). 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 scissors and knives were kept 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: 12/09/2024 Plan of Correction Administrator removed items from accessible drawer and placed them in a locked cabinet during the visit. Administrator will conduct employee training and submit proof to LPA by the Plan of Correction due date.

Official classification

Type B

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 Marshall. This requirement was not met as evidenced by: Based on LPA observations and Staff interviews, Resident 1 was observed in a room next to the kitchen labeled as staff room. This pose as a potential health and safety risk to resident in care.

Official plan of correction

Licensee shall relocate Resident 1 to a resident room approved by the Fire Marshal. Licensee shall provide proof of correction no later than end of POC date.

Deadline recorded: Jan 19, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87465(h)(5)

Regulation authority

CCR

What the official deficiency says

(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 LPA observation and staff interview the licensee did not comply with the section cited above in which medication was prepoured for residents in medicine cups. Which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/30/2023 Plan of Correction Licensee shall provide in house training to all staff administrator medication. Proof of training shall be submitted to the department no later then POC date.

Official classification

Type B

Official code

87705(c)(5)(A)

Regulation authority

CCR

What the official deficiency says

(c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following: (5) Each resident with dementia shall have an annual medical assessment as specified in Section 87458, Medical Assessment, and a reappraisal done at least annually, both of which shall include a reassessment of the resident's dementia care needs. (A) When any medical assessment, appraisal, or observation indicates that the resident's dementia care needs have changed, corresponding changes shall be made in the care and supervision provided to that resident. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA record review, the licensee did not comply with the section cited above one of four physicians report was not completed within the year.

Official plan of correction

POC Due Date: 12/22/2023 Plan of Correction Licensee shall produce a current physician's report, completed & signed by resident's physician no later then the POC date. Licensee will provide proof of correction no later then the POC date.