Fire safety and emergency preparedness
Cited in 2 reports, with 4 deficiencies in total.
BERLAND HOME CARE
512 BERLAND WAY, Chula Vista CA 91910
6 bedsLatest official report Oct 28, 2025Licensed
Additional info
- Telephone
- (619) 205-4600
- Licensee
- PARAISO, DENNIS E.
- Administrator
- PARAISO, DENNIS
- Contact
- PARAISO, DENNIS
- License first date
- Nov 14, 2008
- License effective date
- Nov 14, 2008
- District office
- SAN DIEGO RO · (619) 767-2300
- Regional office
- 08
- Clients served
- 983 - RCFE / DEMENTIA
Summary
The available records show 5 Type A and 18 Type B deficiencies for this facility.
- Most recent inspection
- Oct 28, 2025
- Most recent deficiency
- Oct 28, 2025
No later report is available, so the records do not show what happened afterward.
What Type A and Type B mean
- Type A
- Violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
- Type B
- Violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care.
Both classifications are published by California CDSS and are shown as published. SeniorLivingFacts does not rename them or add a severity level of its own.
At a glance
Counts cover the five-year public record. Typical figures are the median for the 444 San Diego County facilities licensed for 6 or fewer beds.
In the available public five-year record, CCLD published 7 reports for this facility: 5 inspections, 2 complaint investigations, and 0 licensing or administrative records.
Those records contain 5 Type A and 18 Type B deficiencies.
0 deficiencies have explicit official correction or clearance evidence in the loaded records.
- Official inspections
- 5
- Recorded deficiencies
- 23
- Type A deficiencies
- 5
- Type B deficiencies
- 18
- Substantiated complaints
- 0
- Repeated topics
- 1
More than the typical 4
1 in the last 12 months
Well above the typical 1
1 in the last 12 months
Most this size have none
1 in the last 12 months
Well above the typical 1
0 in the last 12 months
Most this size also have none
0 in the last 12 months
Last 36 months
Repeated topics
Topics cited in more than one report during the last 36 months. A repeat may show a pattern worth asking about. Each date opens its report below.
Official report history
All preserved reports from the most recent to the oldest, sortable by report type.
Inspection
Fire safety and emergency preparednessType A
- Official classification
- Type A
- Official code
- 87202(a)(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: (2) Bedridden persons 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 in one out of six residents which poses an immediate health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 10/29/2025 Plan of Correction Licensee shall notify the licensing department by submiting the LIC200 requesting the change of status of resident from non-ambulatory to bedridden and send a copy to LPA within the next 24 hour.
Plan of correction recorded
Correction not verified in available records
Inspection
Dementia careType A
- Official classification
- Type A
- Official code
- 87705(f)(1)
- Regulation authority
- CCR
What the official deficiency says
(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 is not met as evidenced by: Deficient Practice Statement Based on LPA observation, Licensee did not store tools, and other items that could constitute a danger, inaccessible to residents with dementia. This posed an immediate safety risk to 6 of 6 residents (R1 through R6) in care.
Official plan of correction
POC Due Date: 11/22/2024 Plan of Correction During LPA's site visit, Licensee locked away the tools and hazardous items, resolving the immediate risk. Licensee agreed to lead a training for facility staff on what items could become hazardous if left accessible to residents, and the importance of keeping them locked away. Licensee agreed to E-mail the training sign-in sheet to LPA, by 12/22/2024
Plan of correction recorded
Correction not verified in available records
Medication handling and storageType A
- 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, as evidenced by: Deficient Practice Statement Based on LPA observation, Licensee did not ensure that centrally stored medications were kept locked and not accessible to persons other than employees responsible for the supervision of the centrally stored medication. This posed an immediate health and safety risk to 6 of 6 residents (R1 through R6) in care.
Official plan of correction
POC Due Date: 11/22/2024 Plan of Correction During LPA's site visit, Licensee locked the cabinet where the centrally stored medicines were kept, and resecured the keys, resolving the immediate risk. Licensee agreed to lead a training for facility staff on storage requirements related to medications, and the importance of maintaining facility keys on one's person. Licensee agreed to E-mail the training sign-in sheet to LPA, by the POC due date.
Plan of correction recorded
Correction not verified in available records
Staffing, personnel, and trainingType B
- Official classification
- Type B
- Official code
- 87411(f)
- Regulation authority
- CCR
What the official deficiency says
(f) All personnel, including the licensee and administrator, shall be in good health, and physically and mentally capable of performing assigned tasks. Good physical health shall be verified by a health screening, including a chest x-ray or an intradermal test, performed by a physician not more than six (6) months prior to or seven (7) days after employment or licensure. A report shall be made of each screening, signed by the examining physician. The report shall indicate whether the person is physically qualified to perform the duties to be assigned, and whether he/she has any health condition that would create a hazard to him/herself, other staff members or residents. A signed statement shall be obtained from each volunteer affirming that he/she is in good health.Personnel with evidence of physical illness or emotional instability that poses a significant threat to the well-being of residents shall be relieved of their duties. This requirement is not met as evidenced by: Deficient Practice Statement Based on records review and manager interview, Licensee did not possess a completed and signed health screening for 2 of 9 staff (S2 and S3). This posed a potential health and safety risk to 6 of 6 residents (R1 through R6) in care.
Official plan of correction
POC Due Date: 12/22/2024 Plan of Correction Licensee agreed to have S2 and S3 both go to a doctor in order to each complete an LIC503 Health Screening. Licensee agreed to E-mail the completed and signed LIC503 forms with negative tubeculosis (TB) test result for S2 and S3 to LPA, by the POC due date. Licensee agreed to add the completed LIC503 forms to the personnel records for S2 and S3.
Plan of correction recorded
Correction not verified in available records
Basic services and supervisionType B
- Official classification
- Type B
- Official code
- 87466
- Regulation authority
- CCR
What the official deficiency says
The licensee shall ensure that residents are regularly observed for changes in physical, mental, emotional and social functioning and that appropriate assistance is provided when such observation reveals unmet needs. When changes such as unusual weight gains or losses or deterioration of mental ability or a physical health condition are observed, the licensee shall ensure that such changes are documented and brought to the attention of the resident's physician and the resident's responsible person, if any. This requirement is not met as evidenced by: Deficient Practice Statement Based on records review and manager interview, Licensee did not ensure that 6 of 6 residents (R1 through R6) were regularly observed for changes in physical functioning, in include unusual wieght gains or losses. This posed a potential health risk to persons in care.
Official plan of correction
POC Due Date: 12/22/2024 Plan of Correction Licensee agreed to measure, and record in a log, the body weights for R1 through R6. The method can be a scale, or if this is not possible for the resident, another method (such as measuring body fat with a tape measure). Licensee agreed to send proof of weight assessment for R1 through R6 to LPA, by the POC due date. Going forward, Licensee agreed to periodically measure and record resident's body weights, and to keep such records accessible at the facility.
Plan of correction recorded
Correction not verified in available records
Health conditions and treatmentsType B
- Official classification
- Type B
- Official code
- 87470(b)(2)(C)
- Regulation authority
- CCR
What the official deficiency says
(b) In addition to subsection (a), when one or more residents in the facility are diagnosed with a contagious disease, the following shall apply: (2) All staff and volunteers providing direct care to a resident who has a contagious disease shall wear appropriate Personal Protective Equipment (PPE) to prevent exposure to infectious agents or chemicals through the respiratory system, skin, or mucous membranes of the eyes, nose, or mouth. PPE may include gloves, gowns, masks, respirators, shoe coverings and eye protection. (C) The licensee shall ensure all staff and volunteers are trained in the proper use of all required PPE prior to being around residents and annually thereafter. This requirement is not met as evidenced by: Deficient Practice Statement Based on records review and manager interview, Licensee did not ensure that 9 of 9 facility staff (S1 through S9) were trained in the proper use of all required PPE annually. This posed a potential health risk to 6 of 6 residents (R1 through R6) in care.
Official plan of correction
POC Due Date: 12/22/2024 Plan of Correction Licensee agreed to conduct PPE training for all current staff. The training will include hands-on practice and will cover: a) how perform an N-95 seal check, b) how to correctly don and doff surgical masks, N-95 respirators, face shields, gowns, and gloves, and c) how to set up and manage an isolation bedroom. Licensee agreed to E-mail the training sign-in sheet to LPA, by the POC due date. Going forward, Licensee agreed to repeat and document this training at least once per year.
Plan of correction recorded
Correction not verified in available records
Hazardous items and storageType A
- Official classification
- Type A
- Official code
- 87309(a)
- Regulation authority
- CCR
What the official deficiency says
87309 Storage Space: “(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.” This requirement was not met, as evidenced by: Deficient Practice Statement Based on LPA observation, Licensee did not ensure that disinfectants, cleaning solutions, and other items which chouse pose a danger if readily accessible to clients, were stored where inaccessible to them. This posed an immediate health and safety risk to 6 of 6 residents (R1 through R6) in care.
Official plan of correction
POC Due Date: 11/22/2024 Plan of Correction During LPA's site visit, Licensee locked away the disinfectants and cleaning solutions, resolving the immediate risk. Licensee agreed to lead a training for facility staff on what items could become hazardous if left accessible to residents, and the importance of keeping them locked away. Licensee agreed to E-mail the training sign-in sheet to LPA, by 12/22/2024
Plan of correction recorded
Correction not verified in available records
Staffing, personnel, and trainingType B
- 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 records review and manager interview, Licensee did not maintain at the facility a personnel record on 1 of 9 staff (S1). This posed a potential health and safety risk to 6 of 6 residents (R1 through R6) in care.
Official plan of correction
POC Due Date: 12/22/2024 Plan of Correction Licensee agreed to E-mail to LPA the following for S1, by the POC due date: LIC501 Personnel Record, LIC503 Health Screening with negative tuberculosis (TB) result, and LIC508 Criminal Record Statement. Going forward, License agreed to maintain at the facility a current personnel file on S1 at all times.
Plan of correction recorded
Correction not verified in available records
Background checksType B
- 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 records review and manager interview, Licensee did not ensure that 1 of 9 staff (S2), who was subject to a criminal record review, requested and received approval for a transfer of a criminal record clearance, prior to working at the facility. This posed a potential safety risk to 6 of 6 residents (R1 through R6) in care.
Official plan of correction
POC Due Date: 12/22/2024 Plan of Correction CCLD records showed that S2 possessed a current Criminal Record Clearance. However, S2 was not yet associated to the facility roster. Licensee agreed to either use Guardian or E-mail the necessary forms to associate S2 to the facility's staff roster, by the POC due date. If updating in Guardian, Licensee will E-mail LPA upon completion of that process. If submitting forms to the CCLD regional office via E-mail, Licensee will Cc: LPA Nguyen.
Plan of correction recorded
Correction not verified in available records
Admission, assessment, and evictionType B
- 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 records review and manager interivew, Licensee did not ensure that 1 of 6 residents (R4) had an examination for communicable tuberculosis, as evideced by a diagnosic test. This posed a potential health risk to 6 of 6 residents (R1 through R6) in care.
Official plan of correction
POC Due Date: 12/22/2024 Plan of Correction Licensee agreed to coordinate with R4's responsible person, doctor, and/or hospice agency, as needed, to accomplish either a PPD test or a chest X-ray to rule out tuberculosis (TB) for R4. Licensee agreed to E-mail proof of the negative TB result to LPA, by the POC due date. Licensee agreed to add R4's TB test result to their care file.
Plan of correction recorded
Correction not verified in available records
Resident rightsType B
- Official classification
- Type B
- Official code
- 87467(a)(3)
- Regulation authority
- CCR
What the official deficiency says
(a) Prior to, or within two weeks of the resident's admission, the licensee shall arrange a meeting with the resident, the resident's representative, if any, appropriate facility staff, and a representative of the resident's home health agency, if any, and any other appropriate parties, to prepare a written record of the care the resident will receive in the facility, and the resident's preferences regarding the services provided at the facility. (3) The licensee shall arrange a meeting with the resident and appropriate individuals identified in Section 87467(a)(1) to review and revise the written record as specified, when there is a significant change in the resident's condition, or once every 12 months, whichever occurs first. Significant changes shall include, but not be limited to occurrences specified in Section 87463, Reappraisals. This requirement is not met as evidenced by: Deficient Practice Statement Based on records review and manager interview, for 6 of 6 residents (R1 through R6), Licensee did not arrange a meeting with the resident and appropriate individuals identified in Section 87467(A)(1) to review and revise the written record of care at least once every 12 months. This posed a potential health and personal rights risk to persons in care.
Official plan of correction
POC Due Date: 12/22/2024 Plan of Correction Licensee agreed to author an LIC625 Appraisal/Needs and Services Plan (or equivalent care document) for R1 through R6, then meet with each of those residents' responsible persons (RPs) to discuss and improve the Plans, as needed. Licensee agreed to E-mail the completed LIC625s, with RP signatures, to LPA, by the POC due date. Licensee agreed to add these documents to the resident's care files, and to calendar care conferences with each RP at least annually to sign updated LIC625s.
Plan of correction recorded
Correction not verified in available records
Fire safety and emergency preparednessType B
- Official classification
- Type B
- Official code
- 1569.695(b)
- Regulation authority
- HSC
What the official deficiency says
(b) A facility shall provide training on the plan to each staff member upon hire and annually thereafter. The training shall include staff responsibilities during an emergency or disaster. This requirement is not met as evidenced by: Deficient Practice Statement Based on records review and manager interview, Licensee did not ensure that 9 of 9 facility staff (S1 through S9) were trained annually on the facility's written Emergency Disaster Plan, and the staff's responsibiltiies during an emergency or disaster. This posed a potential safety risk to 6 of 6 residents (R1 through R6) in care.
Official plan of correction
POC Due Date: 12/22/2024 Plan of Correction Licensee agreed to conduct training for all current staff on the facility's LIC610E Emergency and Disaster Plan. Licensee agreed to E-mail the training sign-in sheet to LPA, by the POC due date. Going forward, Licnesee agreed to repeat and doucment this training at least once per year.
Plan of correction recorded
Correction not verified in available records
Fire safety and emergency preparednessType B
- 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 records review and manager interview, Licensee did not conduct disaster drills at least quarterly for each shift. This posed a potential safety risk to 6 of 6 residents (R1 through R6) in care.
Official plan of correction
POC Due Date: 12/22/2024 Plan of Correction Licensee agreed to conduct, and document in writing, competion of three (3) disaster drills (one for AM shift, one for PM shift, and one for NOC shift). Licensee agreed to E-mail proof of drill completion to LPA, by the POC due date. Going forward, Licensee agreed to drill each shift at least once per quarter, and to vary the type of emergency covered from quarter to quarter, and to maintain documentation of such.
Plan of correction recorded
Correction not verified in available records
Health conditions and treatmentsType B
- Official classification
- Type B
- Official code
- 87633(b)(6)(B)
- Regulation authority
- CCR
What the official deficiency says
(b) A current and complete hospice care plan shall be maintained in the facility for each hospice resident and include the following: (6) Identification of the training needed, which staff members need this training, and who will provide the training relating to the licensee's responsibilities for implementation of the hospice care plan. (B) The hospice agency will provide training specific to the current and ongoing needs of the individual resident receiving hospice care and that training must be completed before hospice care to the resident begins. This requirement is not met as evidenced by: Deficient Practice Statement Based on records review and manager interview, for 3 of 6 residents (R1, R3, and R4) who were under hospice care, Licensee did not ensure that the hospice agency provided training to 9 of 9 staff (S1 through S9), specific to the current and ongoing needs of the individual resident receiving hospice care, before such care began. This posed a potential health and personal rights risk to persons in care.
Official plan of correction
POC Due Date: 12/22/2024 Plan of Correction Licensee agreed to coordinate with the hospice agencies for R1, R3, and R4, to arrange for personnel from those agencies to conduct seperate in-service training for all current staff. The training sessions will cover the Hospice Care Plans and the current and ongoing needs of R1, R3, and R4, respectively. Licensee agreed to E-mail the training sign-in sheets to LPA, by the POC due date. Going forward, Licensee agreed to have the hospice agency training facility staff each time (and before) a new resident goes onto hospice care services.
Plan of correction recorded
Correction not verified in available records
Dementia careType B
- Official classification
- Type B
- Official code
- 87705(c)(5)
- Regulation authority
- CCR
What the official deficiency says
(c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following: (5) Each resident with dementia shall have an annual medical assessment as specified in Section 87458, Medical Assessment, and a reappraisal done at least annually, both of which shall include a reassessment of the resident's dementia care needs. This requirement is not met as evidenced by: Deficient Practice Statement Based on records review and manager interview, Licensee did not ensure that 4 of 6 residents (R2, R4, R5, and R6), who were each diagnosed with Dementia, had a medical assessment and reappraisal done at least annually. This posed a potential health, safety, and personal rights risk to persons in care.
Official plan of correction
POC Due Date: 12/22/2024 Plan of Correction Licensee agreed coordinate with the responsible persons (RPs) and physicians, as needed, to ensure completion of updated LIC602 Physician's Reports for R2, R4, R5, and R6. Licensee agreed to E-mail the completed and signed LIC602's to LPA, by the POC due date. Licensee agreed to add these documetns to those residents care files. Going forward, Licensee agreed to obtain updated LIC602s at least one a year for any resident diagnosed with Dementia.
Plan of correction recorded
Correction not verified in available records
Dementia careType B
- Official classification
- Type B
- Official code
- 87705(j)
- Regulation authority
- CCR
What the official deficiency says
(j) The licensee shall have an auditory device or other staff alert feature to monitor exits, if exiting presents a hazard to any resident. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA observation and manager interview, Licensee did not maintain an auditory device or other staff alert feature to monitor exits on 2 of 4 exterior exit doors which residents had direct access to. This posed a potential safety risk to 4 of 6 residents in care (R2, R4, R5, and R6) who were diagnosed with Dementia.
Official plan of correction
POC Due Date: 12/31/2024 Plan of Correction During LPA's site visit, Licensee added a working auditory staff alert device to both of the referenced exit doors. The Plan of Correction is Satisfied. Going forward, Licensee agreed to periodically test door sensors, and replace them when needed.
Plan of correction recorded
Correction not verified in available records
Staffing, personnel, and trainingType B
- Official classification
- Type B
- Official code
- 87411(c)(1)
- Regulation authority
- CCR
What the official deficiency says
87411 Personnel Requirements – General: “(c)(1) Staff providing care shall receive appropriate training in first aid from persons qualified by such agencies as the American Red Cross.” This requirement was not met, as evidenced by: Deficient Practice Statement Based on records and interviews, Licensee did not ensure that 2 of 9 staff (S4 and S5) had current first aid training from a qualified agency. This posed a potential health and safety risk to 6 of 6 residents (R1 through R6) in care.
Official plan of correction
POC Due Date: 12/22/2024 Plan of Correction Licensee agreed to coordinate with S4 and S5 to have each person complete First Aid Training from a qualified agency. Licensee agreed to E-mail S4 and S5’s updated First Aid Certification cards to LPA, by the POC due date.
Plan of correction recorded
Correction not verified in available records
Fire safety and emergency preparednessType A
- Official classification
- Type A
- Official code
- 87202(a)
- Regulation authority
- CCR
What the official deficiency says
87202 Fire Clearance: (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…” This requirement was not met, as evidence by: Deficient Practice Statement Based on LPA observation and manager interview, Licensee did not maintain ongoing compliance with the facility’s prior approved fire clearance. This posed an immediate safety risk to 6 of 6 residents (R1 through R6) in care.
Official plan of correction
POC Due Date: 11/22/2024 Plan of Correction During today’s visit, the facility’s Co-Administrator phoned a professional vendor to obtained an appointment to inspect and service the facility’s fire extinguishers on 11-26-2024. Licensee agreed to E-mail to LPA both the paid invoice and photographs of the updated service tags for the facility’s three (3) fire extinguishers, as soon as completed, but not later than 12-22-2024.
Plan of correction recorded
Correction not verified in available records
Admission, assessment, and evictionType B
- Official classification
- Type B
- Official code
- 87459(a)
- Regulation authority
- CCR
What the official deficiency says
87459 Functional Capabilities: “(a) The facility shall assess the person's need for personal assistance and care by determining his/her ability to perform specified activities of daily living…” This requirement was not met, as evidenced by: Deficient Practice Statement Based on records review, for 6 of 6 residents (R1 through R6), Licensee did not assess the person’s need for personal assistance and care by determining his/her ability to perform specified activities of daily living. This posed a potential health and personal rights risk to persons in care.
Official plan of correction
POC Due Date: 12/22/2024 Plan of Correction Licensee agreed to complete form LIC9172 Functional Capability Assessment for R1 though R6, and to E-mail them to LPA, by the POC due date. Licensee agreed to add the completed forms to the residents’ care files. Going forward, License agreed to complete the LIC9172 for all new move-ins.
Plan of correction recorded
Correction not verified in available records
Records and plan of operationType B
- Official classification
- Type B
- Official code
- 87506(b)
- Regulation authority
- CCR
What the official deficiency says
87506 Resident Records: “(b) Each resident’s record shall contain at least the following information: (9) Name, address and telephone number of physician and dentist to be called in an emergency.” This requirement was not met, as evidenced by: Deficient Practice Statement Based on records review and manger interview, Licensee did not ensure that the care records for 6 of 6 residents (R1 through R6) contained the name, address, and telephone number of a dentist to be called in an emergency. This posed a potential health risk to persons in care.
Official plan of correction
POC Due Date: 12/22/2024 Plan of Correction Licensee agreed to contact the responsible persons (RPs) for R1 though R6 to ask them who they would like to be the default/preferred dentist for their loved one. Licensee may offer the RPs possible choices, such a mobile/visiting dentist who can visit the facility. Once this information is obtained, Licensee will update the Face Sheets for R1 through R6 with the dentist’s name, address, and phone number. Licensee agreed to E-mail the updated Face Sheets to LPA, by the POC due date.
Plan of correction recorded
Correction not verified in available records
Resident rightsType B
- Official classification
- Type B
- Official code
- 87218(a)(1)
- Regulation authority
- CCR
What the official deficiency says
87218 Theft and Loss: “(a) The licensee shall ensure an adequate theft and loss program as specified in Health and Safety Code Section 1569.153. (1) The initial personal property inventory shall be completed by the licensee, and the resident, or the resident’s representative.” This requirement was not met, as evidenced by: Deficient Practice Statement Based on records review and manager interview, Licensee did not ensure that an initial personal property inventory was completed for 6 of 6 residents (R1 through R6). This posed a potential personal rights risk to persons in care.
Official plan of correction
POC Due Date: 12/22/2024 Plan of Correction Licensee agreed to coordinate with responsible persons (RPs) as needed to populate form LIC621 (or an equivalent Personal Property Inventory sheet) for R1 through R6. Licensee agreed to E-mail to LPA copies of the competed and signed Personal Property Inventories, by the POC due date. Going forward, Licensee agreed to keep these forms updated in real time, for all current and future residents.
Plan of correction recorded
Correction not verified in available records
Resident rightsType B
- Official classification
- Type B
- Official code
- 87468(b)(1)(A)
- Regulation authority
- CCR
What the official deficiency says
87468 Personal Rights: “(b) At the time the admission agreement is signed, a resident and the resident's representative shall be personally advised of and given a copy of: (1) The personal rights of residents…(A) The licensee shall have each resident and the resident's representative sign a copy of these rights, and the signed copy shall be included in the resident's record.” This requirement was not met, as evidenced by: Deficient Practice Statement Based on records review and manager interview, Licensee did not have signed copies of the latest resident personal rights for 6 of 6 residents (R1 through R6). This posed a potential personal rights risk to persons in care.
Official plan of correction
POC Due Date: 12/22/2024 Plan of Correction Licensee agreed to have form LIC613C-2 Personal Rights of Residents in Privately Operated Residential Care Facilities for the Elderly signed by the responsible persons (RPs) for R1 through R6, and to E-mail copies of such to LPA, by the POC due date. Licensee agreed to file these forms in the residents' care files. Going forward, Licensee agreed to have this forms completed for all new move-ins.
Plan of correction recorded
Correction not verified in available records
Not classified in the sourceType B
- Official classification
- Type B
- Official code
- 1569.159
- Regulation authority
- HSC
What the official deficiency says
1569.159 Telephone services and equipment; notice to residents of availability: “The State Department of Social Services shall provide to residential care facilities for the elderly a form, which the residential care facility for the elderly shall attach to each resident admission agreement, notifying the resident that he or she is entitled to obtain services and equipment from the telephone company...” This requirement was not met, as evidenced by: Deficient Practice Statement Based on records review and manager interview, for 6 of 6 residents (R1 through R6), Licensee did not attach to their admission agreement and have signed the required Telecommunications Device Notification form. This posed a potential personal rights risk to persons in care.
Official plan of correction
POC Due Date: 12/22/2024 Plan of Correction Licensee agreed to have form LIC9158 Telecommunications Device Notification signed by the responsible persons (RPs) for R1 through R6, and to E-mail copies of such to LPA, by the POC due date. Licensee agreed to file these forms in the residents' care files. Going forward, Licensee agreed to have this forms completed for all new move-ins.
Plan of correction recorded
Correction not verified in available records
Inspection
No deficiencies recorded in this report
Complaint
Allegations0 substantiated · 3 unsubstantiated · 0 unfounded
No deficiencies recorded in this reportComplaint
Allegations0 substantiated · 4 unsubstantiated · 0 unfounded
No deficiencies recorded in this reportInspection
No deficiencies recorded in this report
Inspection
No deficiencies recorded in this report
Source and limits
California Department of Social Services, Community Care Licensing Division. Public facility history is described by the source as a five-year window. Older records and previous-licensee history may require a regional-office request. Type 741 RCFE-CCRCs, nursing homes, and other care settings are excluded from this page.
Read the data methodology