GOLDEN HOME CARE CENTER

Official classification

Type A

Official code

87412(f)

Regulation authority

CCR

What the official deficiency says

(f) All personnel records shall be available to the licensing agency to inspect, audit, and copy upon demand during normal business hours. Records may be removed if necessary for copying. Removal of records shall be subject to the following requirements: 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 in [count] out of [total count] [(objects) (persons)] [identifiers] which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: Plan of Correction

Official classification

Type A

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 [(observation) (interview) (record review)], the licensee did not comply with the section cited above in [count] out of [total count] [(objects) (persons)] [identifiers] which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: Plan of Correction

Official classification

Type B

Official code

87307(a)(3)(A)

Regulation authority

CCR

What the official deficiency says

(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) (interview) (record review)], the licensee did not comply with the section cited above in [count] out of [total count] [(objects) (persons)] [identifiers] which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: Plan of Correction

Official classification

Type A

Official code

87412(f)

Regulation authority

CCR

What the official deficiency says

(f) All personnel records shall be available to the licensing agency to inspect, audit, and copy upon demand during normal business hours. Records may be removed if necessary for copying. Removal of records shall be subject to the following requirements: 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 in [count] out of [total count] [(objects) (persons)] [identifiers] which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: Plan of Correction

Official classification

Type A

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 [(observation) (interview) (record review)], the licensee did not comply with the section cited above in [count] out of [total count] [(objects) (persons)] [identifiers] which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: Plan of Correction

Official classification

Type B

Official code

87307(a)(3)(A)

Regulation authority

CCR

What the official deficiency says

(a) Living accommodations and grounds shall be related to the facility's function. The facility shall be large enough to provide comfortable living accommodations and privacy for the residents, staff, and others who may reside in the facility. The following provisions shall apply: (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) (interview) (record review)], the licensee did not comply with the section cited above in [count] out of [total count] [(objects) (persons)] [identifiers] which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: Plan of Correction

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 Infection Control Plan was available for review at the of the visit which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/19/2025 Plan of Correction Licensee will submit a completed LIC 9282 Infection Control Plan to LPA by 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 record review, the licensee did not comply with the section cited above by not ensuring that the emergency and disaster plan was completed and ready for review during the site visit which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/19/2025 Plan of Correction Licensee will submit the Emergency Disaster Plan LIC610 E to LPA by 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 the the emergency diaster drill was completed and ready for reviewe during the site visit which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/04/2025 Plan of Correction LIcensee already submitted the emergency disaster drill during the visit.

Official classification

Type A

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 LPA observations, the licensee did not comply with the section cited above by not maintaining resident #1 (R1) bedroom carpet free of odor and not maintaining resident #2 (R2) bedroom floor clean; which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/24/2024 Plan of Correction By POC date, the Licensee shall submit to the Licensing Agency documentation of carpet replacement in R1s bedroom and carpet cleaning in R2s bedroom.

Official classification

Type A

Official code

87307(e)

Regulation authority

CCR

What the official deficiency says

(e) Facilities providing services to residents who have physical or mental disabilities shall assure the inaccessibility of fishponds, wading pools, hot tubs, swimming pools or similar bodies of water, when not in active use by residents, through fencing, covering or other means. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA observations, the licensee did not comply with the section cited above by the backyard swimming pool gate was left opened; which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/20/2024 Plan of Correction The Administrator closed and locked the gate, no further action required.

Official classification

Type A

Official code

87555(b)(23)

Regulation authority

CCR

What the official deficiency says

(b) The following food service requirements shall apply: (23) All readily perishable foods or beverages capable of supporting rapid and progressive growth of micro-organisms which can cause food infections or food intoxications shall be stored in covered containers at appropriate temperatures. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA observations, the licensee did not comply with the section cited above by storing uncovered food and grease in the refrigerator; which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/19/2024 Plan of Correction The Administrator shall immediately remove and discard the uncovered food items from the refrigerator.

Official classification

Type A

Official code

87555(b)(27)

Regulation authority

CCR

What the official deficiency says

(b) The following food service requirements shall apply: (27) All kitchen areas shall be kept clean and free of litter, rodents, vermin and insects. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA observations, the licensee did not comply with the section cited above by not maintaining the kitchen counter near the stove and area around the microwave clean and clutter free; which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/20/2024 Plan of Correction By POC date, the Licensee shall submit to the Licensing Agency documentation of clean and cleared kitchen areas.

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 LPA observations, the licensee did not comply with the section cited above by LPA observed overgrown Trumpet plant blocking backyard passageway; which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/14/2024 Plan of Correction By POC date, the Licensee shall submit to the Licensing Agency documentation of cleared passageway.

Official classification

Type B

Official code

87412(c)

Regulation authority

CCR

What the official deficiency says

(c) Licensees shall maintain in the personnel records verification of required staff training and orientation. 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 not maintaining documentation of staff #1 (S1s) care supervision with a hospice component training and dementia care training on file, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/14/2024 Plan of Correction By POC date, The Licensee shall submit to the Licensing Agency documentation of staff training.

Official classification

Type B

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 LPA observations, the licensee did not comply with the section cited above by not maintaining a record of resident #2 (R2s) medications for review; which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/14/2024 Plan of Correction By POC date, the Licensee shall submit to the Licensing Agency a record of residents medications.

Official classification

Type B

Official code

87212(a)

Regulation authority

CCR

What the official deficiency says

(a) Each facility shall have a disaster and mass casualty plan of action. The plan shall be in writing and shall be readily available. 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 not having a complete emergency disaster plan on file for review; which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/14/2024 Plan of Correction By POC date; the Licensee shall submit to the Licensing Agency documentation of emergency plan.

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 LPA observations the licensee did not comply with the section cited above by not maintaining record of a current emergency drill conducted with staff for review; which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/14/2024 Plan of Correction By POC date, the Licensee shall submit to the Licensing Agency documentation of emergency drill.

Official classification

Type A

Official code

87303

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, interview and record review, the Licensee did not comply with the section cited above by having Resident 1 doorknob in disrepair due to it being difficult to open which poses an immediate Health, Safety or Personal Rights risk to residents in care.

Official plan of correction

Licensee stated that they will replace all residents room doorknobs and will submit proof of purchase/installation to LPA Brown by POC due date. Licensee already replaced all residents room doorknob during the visit, POC cleared.

Deadline recorded: Apr 12, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87705(c)(4)(A)

Regulation authority

CCR

What the official deficiency says

87705 Care of Persons with Dementia (c) Licensees who accept and retain residents with dementia ...(4) There is an adequate number of direct care staff to support each resident’s ... (A) In addition to requirements specified in Section 87415, Night Supervision, ... Based on observation, interview and record review, the Licensee did not comply with the section cited above by not having at least one (1) night person always awake and on duty at the facility due to R1’s primary which poses an immediate risk to residents in care.

Official plan of correction

Licensee stated to have one (1) awake night person, on duty at the facility at all times and submit proof (LIC500) to LPA Brown by POC due date. Licensee stated to submit Statement of Understanding on CCR 87705(c)(4)(A) to LPA Brown by POC due date.

Deadline recorded: Jun 25, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87211(a)(1)

Regulation authority

CCR

What the official deficiency says

87211 Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: (1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven ... Based on observation, interview and record review, the Licensee did not comply by not reporting R1's incident to Community Care Licensing Department (CCLD) which poses a potential risk to resident in care.

Official plan of correction

Licensee stated to report all incidents at the facility to CCLD. Also, Licensee will submit Statement of Understanding to 87211 Reporting Requirements (a)(1) to LPA Melody Brown by POC due date.

Deadline recorded: Apr 18, 2022. 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. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. Based on observation, interview and record review, the Licensee did not comply by having resident 1 door knob in disrepair due to being difficult to open which poses an immediate Health, Safety or Personal Rights risk to residents in care.

Official plan of correction

Licensee stated that they will replace all residents room door knobs and will submit proof of purchase/installation to LPA Brown by POC due date. Licensee already replaced all residents room door knob during the visit, POC cleared.

Deadline recorded: Apr 12, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87211(a)(1)

Regulation authority

CCR

What the official deficiency says

87211 Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: (1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven ... Based on observation, interview and record review, the Licensee did not comply by not reporting the incident that resdient 1 fell last 02/22/20022 to Community Care Licensing Department (CCLD) which poses a potential risk to resident in care.

Official plan of correction

Licensee stated to report all incidents at the facility to CCLD. Also, Licensee will submit Statement of Understanding to 87211 Reporting Requirements (a)(1) to LPA Melody Brown by POC due date.

Deadline recorded: Apr 18, 2022. A deadline is not proof that correction was completed.