GOLDEN HORIZON SENIOR CARE

Official classification

Type A

Official code

87202(a)(1)(2)

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 Marshal: (1) Nonambulatory persons. (2) Bedridden persons 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 Resident #1 (R1) and Resident #2 (R2) were ambulatory, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/28/2026 Plan of Correction Licensee submitted LIC200 to LPA. POC will be cleared once STD850 is approved/disapproved.

Official classification

Type B

Official code

87468.1(a)(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 ... (1) To be accorded dignity in their personal relationships with staff, residents, and other persons.

Official plan of correction

Licensee stated moving forward to not put any location objects on residents in care or to notify licensing department before use. Plan of Correction (POC) wil be cleared.

Deadline recorded: Oct 2, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

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 Marshal: This requirement is not met as evidenced by: Deficient Practice Statement Based on observavtion the licensee did not comply with the section cited above by not ensuring side gate was kept unlocked acessible 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: 07/21/2025 Plan of Correction Licensee removed lock off of side gate and stated to keep side gate unlocked.

Official classification

Type A

Official code

87309(a)(1)

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. (1) Disinfectants, cleaning solutions, and poisonous substances shall be stored in areas separate from food supplies as specified in Section 87555, General Food Service Requirements. 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 all sharps such as scissors were kept locked inacessible 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: 07/21/2025 Plan of Correction Licensee removed scissors during LPA's visit.

Official classification

Type A

Official code

87468.1(a)(3)

Regulation authority

HSC

What the official deficiency says

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 evidenced by: based on interview and document review, the licensee did not comply with the section cited above evidenced by not ensuring the resident was safe and free from abuse and intimidation which poses an immediate health, safety, or personal rights risk to persons in care.

Official plan of correction

The licensee has agreed to read regulation 87468 entirely and send LPA a statement of understanding that the regulation was read and understood. The licensee has agreed to send LPA a plan that explains how the facility staff will ensure the residents are safe and how their daily functions will be supervised to ensure their safety. POC is due by 4/28/2025. The licensee has agreed to read regulation 87415 entirely and send LPA a statement of understanding that the regulation was read and understood. The licensee has agreed that moving forward the facility will staff an awake staff to supervise the residents. The licensee has agreed to send LPA a staff schedule that includes staff coverage for 24 hours a day, 7 days a week. POC is due by 5/2/2025.

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

Official classification

Type B

Official code

87415(a)(2)

Regulation authority

CCR

What the official deficiency says

Night Supervision....(a) The following persons providing night supervision from l0:00 p.m. to 6:00 a.m. shall be familiar with the facility's planned emergency procedures, shall be trained in first aid as required in Section 87465, Incidental Medical and Dental Care Services and shall be available as indicated below to assist in caring for residents in the event of an emergency. (2) In facilities caring for sixteen (16) to one hundred (100) residents at least one employee shall be on duty on the premises, and awake. Another employee shall be on call, and capable of responding within ten minutes. This requirement is not met as evidenced by: based on interview and document review, the licensee did not comply with the section cited above evidenced by not having an awake night staff on duty which poses an immediate health, safety, or personal rights risk to persons in care.

Deadline recorded: May 2, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87413(a)(2)

Regulation authority

CCR

What the official deficiency says

87413 Personnel Operations (a) In each facility: (2) Care and supervision of residents shall be provided without physical or verbal abuse, exploitation or prejudice. Based on interview and record review, the licensee did not comply with the section cited above evidenced by Staff #1 (S1) and Resident #1 (R1) admitted to have a sexual relationship while S1 was working at the facility, which imposes an immediate health, safety and personal risk to persons in care.

Official plan of correction

Licensee stated to submit photo documentation of all staff reading over section 87413(2) and submitting to LPA Hernandez by Plan of Correction (POC) due date.

Deadline recorded: Apr 8, 2025. A deadline is not proof that correction was completed.

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, interview, record review, the licensee did not comply with the section cited above by not locking the multiple knives in the kitchen drawer, and 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: 06/20/2024 Plan of Correction Licensee immediately locked the multiple knives in the kitchen drawer during the visit. Plan of Correction (POC) cleared. Licensee stated to train all staff on CCR 87309(a)(1) and submit proof of training log to LPA Brown on 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 observation, interview, record review, the licensee did not comply with the section cited above by not ensuring that Staff #2 (S2) and Staff #4 (S4) have current cardiopulmonary resuscitation (CPR) training and first aid training which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/20/2024 Plan of Correction Licensee submitted S2 current CPR/First Aid Training which was completed during the visit. Licensee stated to submit proof of S4 CPR/First Aid Training to LPA Brown 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 observation, interview, record review, the licensee did not comply with the section cited above by not having a Health Screening Report completed for Staff #2 (S2) and Staff #4 (S4) which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/20/2024 Plan of Correction Licensee stated to submit S2 and S4 completed Health Screening Report and submit proof to LPA Brown on Plan of Correction (POC) due date.

Official classification

Type A

Official code

87412(a)(12)

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: (12) Hazardous health conditions documents as specified in Section 87411, Personnel Requirements - General. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview, record review, the licensee did not comply with the section cited above by not having Staff #2 (S2) and Staff #4 (S4) complete a Tuberculosis (TB) test signed by a physician and no TB Test result maintained in S2 and S4 facility file which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/20/2024 Plan of Correction LIcensee stated to submit S2 and S4 completed TB Test with results and submit proof to LPA Brown on POC due date.

Official classification

Type A

Official code

87411(d)

Regulation authority

CCR

What the official deficiency says

(d) All personnel shall be given on the job training or have related experience in the job assigned to them. This training and/or related experience shall provide knowledge of and skill in the following, as appropriate for the job assigned and as evidenced by safe and effective job performance: This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview, record review, the licensee did not comply with the section cited above by not providing the required on the job training to Staff #2 (S2), Staff #3 (S3) and Staff #4 (S4) which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/20/2024 Plan of Correction LIcensee stated to submit Signed Statement of Understanding on CCR 87411(d) to LPA Brown on Plan of Correction (POC) due date.

Official classification

Type A

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 observation, interview and record review, the licensee did not comply with the section cited above by not providing the required 40 hours of training to staff which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/20/2024 Plan of Correction Licensee stated to provide the required 40 hours training to all staff and submit proof to LPA Brown on Plan of Correction (POC) due date.

Official classification

Type A

Official code

1569.696(a)(1)

Regulation authority

HSC

What the official deficiency says

(a) All residential care facilities for the elderly shall provide training to direct care staff on postural supports, restricted conditions or health services, and hospice care as a component of the training requirements specified in Section 1569.625. The training shall include all of the following: (1) Four hours of training on the care, supervision, and special needs of those residents, prior to providing direct care to residents. The facility may utilize various methods of instruction, including, but not limited to, preceptorship, mentoring, and other forms of observation and demonstration. The orientation time shall be exclusive of any administrative instruction. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview, record review, the licensee did not comply with the section cited above by not providing the required four hours of training to staffs on the care, supervision, and special needs of those residents, prior to providing direct care to residents which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/20/2024 Plan of Correction Licensee stated to provide the required four hours of training to staffs on the care, supervision, and special needs of those residents and submit proof to LPA Brown on POC due date.

Official classification

Type A

Official code

1569.696(a)(2)

Regulation authority

HSC

What the official deficiency says

(a) All residential care facilities for the elderly shall provide training to direct care staff on postural supports, restricted conditions or health services, and hospice care as a component of the training requirements specified in Section 1569.625. The training shall include all of the following: (2) Four hours of training thereafter of in-service training per year on the subject of serving those residents. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview, record review, the licensee did not comply with the section cited above by not providing the required four hours of training per year to staffs which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/20/2024 Plan of Correction Licensee stated to submit Signed Statement of Understanding on HSC 1569.696(a)(2) to LPA Brown on POC 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, record review, the licensee did not comply with the section cited above by not having a record of one (1) medication for Resident #2 (R2) in R2's Medication Administration Record (MAR) at the facility and LPA Brown observed that the facility's dispensing or giving R2's medication which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/20/2024 Plan of Correction Licensee stated to train all staff on 87465(a)(6) and submit proof of training log to LPA Brown on PLan of Correction (POC) due date.

Official classification

Type A

Official code

87465(c)(2)

Regulation authority

CCR

What the official deficiency says

(c) If the resident's physician has stated in writing that the resident is unable to determine his/her own need for nonprescription PRN medication, but can communicate his/her symptoms clearly, facility staff designated by the licensee shall be permitted to assist the resident with self-administration, provided all of the following requirements are met: (2) Once ordered by the physician the medication is given according to the physician's directions. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview, record review, the licensee did not comply with the section cited above by not updating Resident #9 (R9) Medication Administration Record (MAR) after dispensing/giving R9's medication per physician's directions which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/20/2024 Plan of Correction Licensee statedto train all staff on CCR 87465(c)(2) and submit proof of training log to LPA Brown on POC due date.

Official classification

Type B

Official code

87303(f)(4)

Regulation authority

CCR

What the official deficiency says

(f) Solid waste shall be stored and disposed of as follows: (4) Movable bins when used for storing or transporting solid wastes from the premises shall have tight-fitting covers on the containers; shall be in good repair; and shall be rodent-proof unless stored in a room or screened enclosure. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview, record review, the licensee did not comply with the section cited above by having a movable waste bin in the kitchen without a cover which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/28/2024 Plan of Correction Licensee stated to purchase/obtain movable bin with cover and submit proof to LPA Brown on Plan of Correction (POC) due date.

Official classification

Type B

Official code

87303(i)(1)

Regulation authority

CCR

What the official deficiency says

(i) Facilities shall have signal systems which shall meet the following criteria: (1) All facilities licensed for 16 or more and all residential facilities having separate floors or buildings shall have a signal system which shall: 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 signal system which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/18/2024 Plan of Correction Licensee stated to obtain/purchase/install the required signal syatem and submit proof to LPA Brown on Plan of Correction (POC) due date.

Official classification

Type B

Official code

87219(a)

Regulation authority

CCR

What the official deficiency says

(a) Residents shall be encouraged to maintain and develop their fullest potential for independent living through participation in planned activities. The activities made available shall include: This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview, record review, the licensee did not comply with the section cited above not having the required planned activities for the residents at the facility which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/28/2024 Plan of Correction Licensee stated to submit the required planned Activities/Activity Calendar to LPA Brown on Plan of Correction (POC) due date.

Official classification

Type B

Official code

87458(a)

Regulation authority

CCR

What the official deficiency says

(a) Prior to a person's acceptance as a resident, the licensee shall obtain and keep on file, documentation of a medical assessment, signed by a physician, made within the last year. The licensee shall be permitted to use the form LIC 602 (Rev. 9/89), Physician's Report, to obtain the medical assessment. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview, record review, the licensee did not comply with the section cited above by not having a completed Physician Report with Physician Signature Date for five (5) of eight (8) residents which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/08/2024 Plan of Correction Licensee stated to submit completed Physician Reports with Physician Signature Date for five (5) residents to LPA Brown on POC due date.