ANGELIC MANSIONS

Official classification

Type B

Official code

87411(c)

Regulation authority

CCR

What the official deficiency says

87411 Personnel Requirements - General (c) All RCFE staff who assist residents with personal activities of daily living shall receive initial and annual training as specified in Health and Safety Code sections 1569.625 and 1569.69 This requirement was not met as evidenced by: Based on observation, interviews, and record review staff did not have training logs in their personnel folders which poses a potential health and safety risk to residents in care.

Official plan of correction

Administrator/Licensee has agreed to provide training and obtain logs with signatures for all staff and provide proof to LPA by the POC due date

Deadline recorded: Aug 28, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87211(1)(A)

Regulation authority

HSC

What the official deficiency says

87211 Reporting Requirements (1) A written report shall be submitted to the licensing agency...for the resident within seven days of the occurrence...(A)Death of any resident from any cause... This requirement was not met as evidenced by: Based on observation, interviews, and record review staff are not reporting incidents to the department in a timely manner which poses a potential health and safety risk to residents in care.

Official plan of correction

The Licensee/Administrator will review the Reporting Requirements regulation and submit a Statement of Understanding to LPA by Plan of Correction (POC) due date.

Deadline recorded: Aug 28, 2026. 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 by having bottles of bleach left in the bathroom accessible to residents which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/24/2026 Plan of Correction Administrator has agreed to provide training for the regulation cited and provide proof of signatures to LPA by POC due date.

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 [(observation) (interview) (record review)], the licensee did not comply with the section cited above by not having an infection control plan on file which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/07/2026 Plan of Correction Administrator agreed to provide the Infection Contol Plan to LPA by POC due date.

Official classification

Type B

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 signed health screenings for S4 and S5 which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/10/2026 Plan of Correction Administrator has agreed to provide proof of signed health screenings for S4 and S5 to LPA by POC due date.

Official classification

Type B

Official code

87355(e)(4)

Regulation authority

CCR

What the official deficiency says

(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: (4) Request and be approved for a transfer of a criminal record exemption, as specified in Section 87356(r), unless, upon request for a transfer, the Department permits the individual to be employed, reside or be present at 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 associating S3 and S5 to the facility through guardian which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/10/2026 Plan of Correction Administrator has agreed to associate S3 and S5 through guardian and provide proof to LPA by POC due date

Official classification

Type B

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 S1,2,4,5 did not have training logs in their files which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/23/2026 Plan of Correction Administrator has agreed to provide LPA with training logs for all staff by 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 documentation of a medical assessment, signed by a licensed medical professional acting within the scope of their practice and made within the last year, to be kept in the resident's record. 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 LIC 602A signed for R7 which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/23/2026 Plan of Correction Administrator has agreed to provide proof of signed LIC 602A for R7 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 [(observation) (interview) (record review)], the licensee did not comply with the section cited above by not having an Emergnecy Disaster Plan on file which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/07/2026 Plan of Correction Administrator agreed to provide Emergency Disaster plan to LPA by POC due date.

Official classification

Type A

Official code

87307(e)(1)(A)

Regulation authority

CCR

What the official deficiency says

(e) The licensee shall supervise residents as needed and as determined by the resident's appraisal pursuant to Section 87457, Pre-Admission Appraisal or Section 87463, Reappraisals, when residents are in proximity to or when there is use of the following items: (1) Ranges, ovens, heaters, fireplaces, wood stoves, inserts, and other heating devices. (A) Heating devices shall have protective mechanisms or other measures to prevent access to the device, or to make it inoperable when not in use, in order to reduce the risk of burns or fire. 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 a protective cover for the fireplace which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/12/2025 Plan of Correction Administrator has agreed to cover the fireplace with a protective cover and provide proof to LPA by POC due date

Official classification

Type A

Official code

87411(c)(6)

Regulation authority

CCR

What the official deficiency says

(6) The licensee shall maintain documentation pertaining to staff training in the personnel records, as specified in Section 87412(c)(2). For on-the-job training, documentation shall consist of a statement or notation, made by the trainer, of the content covered in the training. Each item of documentation shall include a notation that indicates which of the criteria of Section 87411(c)(3) is met by the trainer. 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 required trainings for all staff in their personnel files which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/15/2025 Plan of Correction Administrator has agreed to provide proof of trainings to LPA by POC due date.

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 observation, interview, and record review, the licensee did not comply with the section cited above by not having an infection control plan (LIC 9282) on file which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/26/2025 Plan of Correction Administrator has agreed to created and provide proof of LIC 9282 to LPA by POC due date

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

(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. 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 having the bathroom sink handle in disrepair which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/31/2025 Plan of Correction Administrator has agreed to fix the bathroom sink and provide proof to LPA by POC due date.

Official classification

Type B

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 having a health screening or/and TB clearance for S3 and S4 which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/26/2025 Plan of Correction Administrator has agreed to provide LPA with copies of S3 and S4 health screenings and TB results by POC due date.

Official classification

Type B

Official code

87355(e)(4)

Regulation authority

CCR

What the official deficiency says

(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: (4) Request and be approved for a transfer of a criminal record exemption, as specified in Section 87356(r), unless, upon request for a transfer, the Department permits the individual to be employed, reside or be present at 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 S1,3, & 4 associated to the facility through guardian which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/31/2025 Plan of Correction Administrator has agreed to inform and provide proof to LPA when S1,3, & 4 are associated to the facility through guardian by POC due date.

Official classification

Type A

Official code

87613(a)(2)(B)

Regulation authority

CCR

What the official deficiency says

(2) Ensure that facility staff who will participate in meeting the resident's specialized care needs complete training provided by a licensed professional sufficient to meet those needs. (B) Training shall be completed prior to the staff providing services to the resident. 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 a log of trainings for all staff which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/22/2024 Plan of Correction Licensee stated he will provide proof of trainings to LPA by 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, and record review, the licensee did not comply with the section cited above by not properly documenting the dates the medication which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/22/2024 Plan of Correction Licensee stated he will submit proof of training and letter in writing understanding the regulation cited above to LPA by POC due date.

Official classification

Type B

Official code

87355(e)(3)

Regulation authority

CCR

What the official deficiency says

(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: (3) Request a transfer of a criminal record clearance as specified in Section 87355(c) 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 not associating Staff #1 and #2 to guardian which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/25/2024 Plan of Correction Licensee stated he will submit proof of association to LPA by POC due date.

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 was not met based on evidence of observation and interview. LPA was informed that S1 has been working at the facility for two (2) months without a criminal background clearance.

Official 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 license has agreed to remove S1 from the facility and not allow S1 to work at the facility until S1 has a criminal background clearance.

Deadline recorded: Jul 2, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87623(a)(B)

Regulation authority

CCR

What the official deficiency says

87623.Indwelling Urinary Catheter. (a)The licensee shall be permitted to accept or retain a resident who requires the use of an indwelling catheter under the following circumstances: (B) A catheter shall only be inserted and removed by an appropriately skilled professional under physician's orders. This requirement was not met based on evidence of observation and interview. LPA was shown the condom catheter in the resident’s bedroom closet. The Administrator admitted that staff puts the condom catheter on the resident at bedtime.

Official plan of correction

The licensee has agreed to read regulation 87623 entirely and send LPA self-certify letter that the regulation was read and understood. The license has agreed that staff will stop the use of condom catheter. A catheter shall only be inserted and removed by an appropriately skilled professional under physician's orders.

Deadline recorded: Jul 2, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87303(e)(2)

Regulation authority

CCR

What the official deficiency says

87303.Maintenance and Operation. (e) Water supplies and plumbing fixtures shall be maintained as follows: (2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degree C) and not more than 120 degree F (49 degree C). This requirement was not met based on evidence by observation. LPA measured the water temperature in the bathroom sink at 102.5 degrees Fahrenheit.

Official plan of correction

The licensee has agreed to read regulation 87303 entirely and send LPA self-certify letter that the regulation was read and understood. The license has agreed to adjust the facility water heater to meet the requirement of 105-120 degrees Fahrenheit.

Deadline recorded: Jul 2, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87555(b)(3)

Regulation authority

CCR

What the official deficiency says

87555. General Food Service Requirements. (b)The following food service requirements shall apply: (3) Between-meal nourishment or snacks shall be made available for all residents unless limited by dietary restrictions prescribed by a physician. This requirement was not met based on evidence by interview of the Administrator. LPA was informed by the Administrator that the facility restricts food in between meals. If a resident requests food in between meals, they are told they need to wait until the next mealtime or snack time.

Official plan of correction

The licensee has agreed to read regulation 87555 entirely and send LPA self-certify letter that the regulation was read and understood. The license has agreed to allow residents food in between meals unless there is a dietary restriction prescribed by a physician.

Deadline recorded: Jul 2, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87705(f)(2)

Regulation authority

CCR

What the official deficiency says

87705. Care of Persons with Dementia. (f)The following shall be stored inaccessible to residents with dementia: (2)Over-the-counter medication, nutritional supplements or vitamins, alcohol, cigarettes, and toxic substances such as certain plants, gardening supplies, cleaning supplies and disinfectants. This requirement was not met based on evidence of observation. LPA observed an unlocked cabinet underneath the kitchen sink with toxic chemicals accessible to residents. LPA observed bleach and raid.

Official plan of correction

The licensee has agreed to read regulation 87705 entirely and send LPA self-certify letter that the regulation was read and understood. The license has agreed store toxic chemicals in a locked area that is inaccessible to residents.

Deadline recorded: Jul 2, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(h)(2)

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: (2)Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. This requirement was not met based on evidence of observation. LPA observed an unlocked cabinet in the kitchen pantry with medication accessible to residents.

Official 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 license has agreed store medications in a locked area that is inaccessible to residents.

Deadline recorded: Jul 2, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87705(f)(1)

Regulation authority

CCR

What the official deficiency says

87705.Care of Persons with Dementia.(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 was not met based on evidence of observation. LPA observed an unlocked cabinet in the kitchen pantry with sharp knives accessible to residents.

Official plan of correction

The licensee has agreed to read regulation 87705 entirely and send LPA self-certify letter that the regulation was read and understood. The license has agreed store sharp knives in a locked area that is inaccessible to residents.

Deadline recorded: Jul 2, 2022. 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. This requirement was not met based on evidence by observation. LPA found cockroaches in the hallway and in the living room, as well as a hole in the wall in the living room.

Official plan of correction

The licensee has agreed to read regulation 87303 entirely and send LPA self-certify letter that the regulation was read and understood. The license has agreed send LPA an action plan of how they plan to correct the hole in the wall, as well as pictures of the corrected hole in the wall. The licensee has agreed to send LPA statement proof of cockroach exterminator visits to LPA.

Deadline recorded: Jul 8, 2022. 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, record review, and interview, the licensee did not comply with the section cited above by not obtaining a criminal background clearance for S1 which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/14/2022 Plan of Correction The administrator has agreed to read regulation 87355 entirely and send LPA a self-certify letter that they have read and understood the regulation. The administrator has agreed get S1 criminal record cleared and to not allow S1 into the facility until they are obtain their criminal record clearance.