EXCELCARE

Official classification

Type A

Official code

87355(e)

Regulation authority

HSC

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: This requirement was not met as evidenced by: Based on observation, record review, and interviews the Licensee did not comply with the section cited above by not having a background clearance for tenant(1)

Official plan of correction

Licensee has agreed to either have T1 fingerprinted or evaluated and submit all required LIC documents to become a resident of the facility, Licensee will submit proof to LPA by POC due date.

Deadline recorded: Oct 6, 2025. 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

87303 Maintenance and Operation (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. Based on observation and interviews, the licensee did not ensure the facility to be in good repair at all times, which poses a potential Health, Safety, or Personal Rights risk to persons in care.

Official plan of correction

Licensee has agreed to repair or purchase new refrigerator, and submit proof to LPA by POC due date.

Deadline recorded: Apr 5, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87555(a)

Regulation authority

CCR

What the official deficiency says

87555 General Food Service Requirements(a)The total daily diet shall be of the quality and in the quantity necessary to meet the needs of the residents and shall meet the Recommended Dietary Allowances of the Food and Nutrition Board... All food shall be selected, stored, prepared and served in a safe and healthful manner. Based on observation and interviews, the licensee did not ensure the facility had an adequate food supply for residents in care, which poses an immediate Health, Safety, or Personal Rights risk to persons in care.

Official plan of correction

Licensee has agreed to purchase more fruits and vegetables and submit proof to LPA by POC due date.

Deadline recorded: Mar 29, 2025. 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 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times... Based on observation and interviews, the licensee did not ensure the facility to be kept clean, safe, and sanitary which poses an immediate Health, Safety, or Personal Rights risk to persons in care.

Official plan of correction

Licensee has scheduled an inspector to come to the facility and spray the entire faciliy, an invoice will be provided to LPA upon visit.

Deadline recorded: Mar 29, 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 Planned Activities (a) Residents shall be encouraged to maintain and develop their quality of life through participation in a variety of planned activities.. Based on observation and interviews, the licensee did not ensure the facility to participate in planned activities which poses a potential Health, Safety, or Personal Rights risk to persons in care.

Official plan of correction

Licensee has agreed to create and follow the updated planned activite created for residents. An updated activities schedule will be sumitted to LPA by POC due date.

Deadline recorded: Mar 31, 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...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 met as evidenced by: The licensee did not comply with the section cited above by not ensuring R1 had adequate services and staff to meet their needs, which poses an immediate, health and safety risk to persons in care.

Official plan of correction

R1 no longer resides at the facility. The Licensee shall review the regulation cited and provide a statement of understanding to the Licensing agency by POC due date.

Deadline recorded: Mar 24, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.1

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:...(3)To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature, such as withholding residents’ money or interfering with daily living functions such as eating, sleeping, or elimination. This requirement is not met as evidence by Based on interviews, the licensee did not follow Personal Rights regulation for 1 out of 9 residents which, poses a potential Health, Safety, or Personal Rights risk to persons in care.

Official plan of correction

Licensee has agreed to read over the " Personal Rights of Residents in All Facilities " regulation and provide training to all staff regarding the violation of resident’s rights. Licensee will email LPA a copy of the training signed and dated by all staff by POC due date.

Deadline recorded: Feb 28, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87458(b)(1)

Regulation authority

CCR

What the official deficiency says

(b) The medical assessment shall include, but not be limited to: (1) A physical examination of the resident indicating the physician's primary diagnosis and secondary diagnosis, if any and results of an examination for communicable tuberculosis, other contagious/infectious or contagious diseases or other medical conditions which would preclude care of the person by the facility. 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 by Resident #1 (R1) did not have examination results for tuberculosis on file, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/15/2023 Plan of Correction Licensee shall submit to the Licensing Agency proof of cleared tuberculosis results by POC due date

Official classification

Type A

Official code

87468.2(a)(4)

Regulation authority

CCR

What the official deficiency says

87468.2 Additional Personal Rights...(a)Residents in all residential care facilities... shall have...rights:(4)To care...and services that meet their individual needs.This requirement it not met as evidence by: Licensee not providing R1 and R2 with proper showers which poses an immediate health, safety, and personal rights risk to persons in care.

Official plan of correction

Licensee stated that R1 is leaving the facility today and R2 is no longer at the facility. Licensee shall submit to the licensing agency a statement of understanding on the cited regulation.

Deadline recorded: Sep 11, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87555(a)

Regulation authority

CCR

What the official deficiency says

87555 General Food Service (a)The total daily diet shall be of the quality and in the quantity necessary to meet the needs of the residents… This requirement is not met by: Licensee stated that resident is obese and is limiting in-between meal nourishment or snacks to resident

Official plan of correction

License shall submit a statement of understanding on the cited regulation and understand that dietary limitations shall be prescribe by a physician.

Deadline recorded: Sep 11, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

877555(b)(8)

Regulation authority

HSC

What the official deficiency says

(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 of the facility food pantry on 1/30/23's visit the licensee did not comply with the section cited above in 4 out of 5 food cans being expired; which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/28/2023 Plan of Correction Licensee agrees to go through all kitchen pantries and cabinets to remove and can goods/foods that have been expired.

Official classification

Type B

Official code

87307(a)(3)(a)

Regulation authority

HSC

What the official deficiency says

Equipment and supplies necessary for personal care and maintenance of adequate hygiene practice shall be readily available to each resident. The resident may provide the following items; however, if the resident is unable or chooses not to provide them, the licensee shall assure provision of: (A) A bed for each resident, except that married couples may be provided with one appropriate sized bed. Each bed shall be equipped with good springs, a clean and comfortable mattress, available pillow(s) and lightweight warm bedding. Fillings and covers for mattresses and pillows shall be flame retardant. Rubber sheeting shall be provided when necessary. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation during visit on 1/30/23 of Room #6. Resident observed sleeping on 2 mattresses and 2 box springs stacked on top of one another; the licensee did not comply with the section cited above in not providing resident with furniture to accommodate the resident which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/28/2023 Plan of Correction Licensee agrees to request proper documentation to show support of the resident being a fall risk. If any, demonstrate the need to remove the required furniture for the resident's safety. If such documentation cannot be obtained, Licensee will place all necessary furniture to accommodate the requirement and the needs of the resident.