SUNSHINE BOARD & CARE

Official classification

Type B

Official code

87211(1)(D)

Regulation authority

CCR

What the official deficiency says

87211(1) A written report submitted to the licensing.. and to the person responsible... (D) Any incident which threatens the welfare, safety or health of any resident... absence of any resident. This requirement was not met as evidenced by: the Administrator not submitting SIR's of any reportable incidents such as absence of residents, threat of residents safety and welfare which poses a health and safety risk to residents in care.

Official plan of correction

Administrator agrees to complete a statement of understanding of review of regulation and conduct a training with all staff regarding reporting requirement and submit to LPA by POC due date.

Deadline recorded: Dec 1, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87309(a)

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. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above three (3) out of six (6) residents bedrooms and or bathrooms by not ensuring the cleaning supplies were secured and locked which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/07/2025 Plan of Correction Administrator agrees to review the regulation cited above, and provided an statement of understanding acknowledging the regulation. Administrator also agrees to complete a training with all staff regarding the regulation and a list of all participate in the training by 11/20/2025 to LPA.

Official classification

Type A

Official code

87465(h)(4)

Regulation authority

CCR

What the official deficiency says

(h) The following requirements shall apply to medications which are centrally stored: (4) All centrally stored medications shall be labeled and maintained in compliance with state and federal laws. No persons other than the dispensing pharmacist shall alter a prescription label. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, and record review, the licensee did not comply with the section cited above in two (2) out of three (3) residents in care by not ensuring that all medication was listed on the centrally stored medication log, and all dispensed medication has been properly initialed by staff that dispensed the medication which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/07/2025 Plan of Correction Administrator agrees to review the regulation cited and complete a statement of understanding. Review and correct the MARS and Centrally Stored Medication log. Conduct a training with staff regarding medication to include centrally stored medication logs, medication storage, proper medication practices, and commonly known medication errors by 12/1/2025 to LPA Farlow.

Official classification

Type B

Official code

87412(a)

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: This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, and record review, the licensee did not comply with the section cited above in one (1) out of three (3) staff by not ensuring all staff file are complete with health screening and TB test results which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/21/2025 Plan of Correction Administrator agrees to review all personal file and make sure all file are accurate and complete with required forms.

Official classification

Type B

Official code

87412(g)

Regulation authority

CCR

What the official deficiency says

87412 Personnel Records(g)All personnel records shall be maintained at the facility and shall be available to the licensing agency for review...this requirement is not met as evidenced by: The licensee did not comply with the section cited above by not maintaining record of S1's required employment verification, health screening, and training on file for review, which poses a potential health, safety, and/or personal rights risk to residents in care

Official plan of correction

The Administrator stated that a copy of Staff #1's drivers license, Health screening, CPR/first training will be submitted to the Licensing Agency by POC due date.

Deadline recorded: Jul 29, 2024. A deadline is not proof that correction was completed.

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 This requirement is not met as evidenced by: Deficient Practice Statement Based on observations of resident records, the licensee did not comply with the section cited above in nine, 9 out of twelve, (12) resident files containing out of date Physician's Reports (LIC602) which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/05/2024 Plan of Correction Adminisntrator agrees to assist the 9 residents in making and keeping doctor appointments with their Primary Care Phsyicians to obatin an update Phsician's Reports to maintain in their resident files. Administrator agrees to submit verification of the completed documentation to the Community Care Licensing Office in 30 business days.

Official classification

Type A

Official code

87355(e)(2)

Regulation authority

CCR

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: (2) Request a transfer of a criminal record clearance ... This requirement is not met as evidenced by Based on observation & file review, licensee failed to ensure S1 was associated to the facility prior to working. LPA observed that S1 was not associated to the facility. This poses an immediate health & safety risk to the residents in care.

Official plan of correction

Administrator agreed to review the Guardian website to update the list of staff members associated to the facility during the visit. LPA was able to verify the updated list. The POC was completed during the visit. Deficiency Continued: Administrator could not recall the exact date of hire for S1. (g) Violation of Section 80019(e) will result in an immediate assessment of civil penalties of one hundred dollars ($100) per violation for a maximum of 5 days by the Department. "

Deadline recorded: Aug 2, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87458(a)

Regulation authority

CCR

What the official deficiency says

87458 Medical Assessment 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. This requirement is not met as evidenced by: Based on observations and record reviews, the Licensee failed to ensure resident in care maintained documentation of and were provided an annual medical assessment which poses a potential Health, Safety or personal rights risk to persons in care.

Official plan of correction

Administrator agrees to assist residents in care in coordinating doctor appointments to obatin a complete medical assessment by way of an LIC602 - Physician's Report. Administrator will submit completed copies of this documentation to the Community Care Licensing Office to verify the task has been completed within the next 30 business days.

Deadline recorded: Sep 15, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87355(e)(1)

Regulation authority

CCR

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:(1) Obtain a California clearance or a criminal record exemption as required by the Department 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 allowing S1 to work at the facility for four (4) years without a criminal background clearance which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/05/2022 Plan of Correction The licensee has agreed to read regulation 87355 entirely and send LPA self-certify letter that the regulation was read and understood. The licensee has agreed to remove S1 from the facility and not allow S1 to work at the facility until S1 has a criminal background clearance. POC is due 11/5/22.

Official classification

Type A

Official code

87465(h)(5)

Regulation authority

CCR

What the official deficiency says

87465.Incidental Medical and Dental Care. (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 observation and interview, the licensee did not comply with the section cited above by storing and resident's medications in a plastic containers that are not the original prescriptions bottle from the pharmacy which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/05/2022 Plan of Correction The licensee has agreed to read regulation 87465 entirely and send LPA self-certify letter that the regulation was read and understood. The licensee has agreed to train all staff on medication safety and storage. The licensee has agreed to send LPA documentation that a medication safety class has been scheduled. The licensee has agreed to send LPA documentation that each staff member has attended the medication training, this includes staff dates and signatures as evidence of attendance. POC is due 11/5/22.

Official classification

Type A

Official code

87355(e)(1)

Regulation authority

CCR

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:(1) Obtain a California clearance or a criminal record exemption as required by the Department 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 allowing S1 to work at the facility for four (4) years without a criminal background clearance which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/05/2022 Plan of Correction The licensee has agreed to read regulation 87355 entirely and send LPA self-certify letter that the regulation was read and understood. The licensee has agreed to remove S1 from the facility and not allow S1 to work at the facility until S1 has a criminal background clearance. POC is due 11/5/22.

Official classification

Type A

Official code

87465(h)(5)

Regulation authority

CCR

What the official deficiency says

87465.Incidental Medical and Dental Care. (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 observation and interview, the licensee did not comply with the section cited above by storing resident's medications in a plastic weekly containers that are not the received container from the pharmacy which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/05/2022 Plan of Correction The licensee has agreed to read regulation 87465 entirely and send LPA self-certify letter that the regulation was read and understood. The licensee has agreed to train all staff on medication safety and storage. The licensee has agreed to send LPA documentation that a medication safety class has been scheduled. The licensee has agreed to send LPA documentation that each staff member has attended the medication training, this includes staff dates and signatures as evidence of attendance. POC is due 11/5/22.