Hazardous items and storageType A
- 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 LPA observation, Licensee did not ensure that knives which could pose a danger to residents, were in locked storage and not left unattended. 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: 09/19/2025 Plan of Correction During today's visit, LPA handed the knives to staff to be relocated to locked cabinets. This resolved the immediate risk. Licensee agreed to retrain all current staff on what items constitute hazards and on their correct storage, and to E-mail the training sign-in sheet to LPA by 10/19/2025. (This class may count towards the staffs' 20 hours of required annual training.)
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 staff interview, Licensee did not ensure that 8 of 9 staff (S1 through S8) received training on the proper use of all required PPE within the last year. This posed a potential health risk to 6 of 6 residents (R1 through R6) in care.
Official plan of correction
POC Due Date: 10/19/2025 Plan of Correction Licensee agreed to train all current staff on PPE. The training will include hands-on practice and will cover: a) handwashing, b) how and how often to disinfect commonly touched surfaces, c) how to correctly don and doff surgical masks, N-95 respirators, face shields, gowns, and gloves, d) how perform an N-95 seal check, and e) how to correctly set up a COVID-19 isolation bedroom. Licensee agreed to E-mail the training sign-in sheet to LPA, by the POC due date. (This class may count towards the staffs' 20 hours of required annual training.) Going forward, Licensee agreed to repeat this training at least annually.
Facility condition and maintenanceType B
- Official classification
- Type B
- Official code
- 87303(e)(5)
- Regulation authority
- CCR
What the official deficiency says
(e) Water supplies and plumbing fixtures shall be maintained as follows: (5) Slip-resistant mats, strips, or flooring shall be used in all bathtub and shower floors. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA observation, Licensee did not maintain slip-resistant mats on shower floors in 4 of 4 bathrooms. This posed a potential safety risk to 6 of 6 residents (R1 through R6) in care.
Official plan of correction
POC Due Date: 10/19/2025 Plan of Correction Licensee agreed to purchase and install (4) non-slip shower mats to be used inside the showers themselves. (These mats may be hanged to dry when not in active use by/with a resident.) Licensee agreed to E-mail the purchase receipt to LPA, by the POC due date.
Staffing, personnel, and trainingType B
- Official classification
- Type B
- Official code
- 1569.625(b)(2)
- Regulation authority
- HSC
What the official deficiency says
(2) In addition to paragraph (1), training requirements shall also include an additional 20 hours annually, eight hours of which shall be dementia care training, as required by subdivision (a) of Section 1569.626, and four hours of which shall be specific to postural supports, restricted health conditions, and hospice care, as required by subdivision (a) of Section 1569.696. This training shall be administered on the job, or in a classroom setting, or both, and may include online training. This requirement is not met as evidenced by: Deficient Practice Statement Based on records review and staff interview, Licensee did not maintain proof that 7 of 7 direct care staff (S1 through S7) received 20 hours of continuing training within the last year, of which 8 hours shall be on Dementia Care, and of which 4 hours shall be specific to postural supports, restricted health conditions, and hospice care. This posed a potential health and personal rights risk to 6 of 6 residents (R1 through R6) in care.
Official plan of correction
POC Due Date: 10/19/2025 Plan of Correction Licensee agreed to conduct and docuement in writing a total 20 hours of training for S1 thorugh S7, ensure at least 8 of the hours are on Dementia, and at least 4 of the hours are on a combination that includes postural supports, restricted health conditions, and hospice care. Licensee agreed to E-mail proof of training completion to LPA, by the POC due date.
Records and plan of operationType B
- Official classification
- Type B
- Official code
- 87506(b)(15)
- Regulation authority
- CCR
What the official deficiency says
(b) Each resident's record shall contain at least the following information: (15) The admission agreement and pre-admission appraisal, specified in Sections 87507, Admission Agreements and 87457, Pre-admission Appraisal. This requirement is not met as evidenced by: Deficient Practice Statement Based on records review and staff interview, for 2 of 6 residents (R1 and R2), Licensee did not maintain in their record a current Admissions Agreement contract. This posed a potential personal rights risk to persons in care.
Official plan of correction
POC Due Date: 10/19/2025 Plan of Correction Licensee agreed to coordinate with the authorized representatives for R1 and R2 to have Admissions Agreements for The Velasco Homes #5 signed for both residents. Licensee agreed to E-mail copies of R1 and R2's contracts to LPA, by the POC due date.
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 record review and staff interview, Licensee did not provide training to 8 of 9 staff members (S1 through S8) on the facility's written emergency and disaster plan within the last year. This posed a potential safety risk to 6 of 6 residents (R1 through R6) in care.
Official plan of correction
POC Due Date: 10/19/2025 Plan of Correction Licensee agreed to train all current staff on its existing LIC610D Emergency Disaster Plan, to include their responsibilities under it. Licensee agreed to E-mail the training sign-in sheet to LPA, by the POC due date. (This class may count towards the staffs' 20 hours of required annual training.) Going forward, Licensee agreed to repeat this training at least annually.
Staffing, personnel, and trainingType B
- Official classification
- Type B
- Official code
- 87412(a)
- Regulation authority
- CCR
What the official deficiency says
87412 Personnel Records: “(a) The licensee shall ensure that personnel records are maintained on the licensee…” This requirement was not met, as evidenced by: Deficient Practice Statement Based on records review and staff interview, Licensee did not ensure a complete personnel file was maintained on themselves at the facility. This posed a potential health risk to 6 of 6 residents (R1 through R6) in care.
Official plan of correction
POC Due Date: 10/19/2025 Plan of Correction Licensee agreed to gather copies of the following documents on themselves (S9), and add them to their personnel file at the facility: LIC501 Personnel Record, LIC508 Criminal Record Statement, LIC503 Health Screening with negative Tuberculosis test result, government-issued photo ID. Licensee also agreed to E-mail copies of the same to LPA, by the POC due date.
Not classified in the sourceType B
- Official classification
- Type B
- Official code
- 1569.317
- Regulation authority
- HSC
What the official deficiency says
1569.317 Absentee Notification Plan for Missing Residents: “Every residential care facility for the elderly…shall…develop and comply with an absentee notification plan…The plan shall include…a requirement that an administrator of the facility, or his or her designee, inform the resident’s authorized representative when that resident is missing from the facility…and the circumstances in which [they] shall notify local law enforcement.” This requirement was not met, as evidenced by: Deficient Practice Statement Based on record review and staff interview, Licensee did not develop an absentee notification plan for 3 of 6 residents (R2, R3, and R4), which posed a potential safety risk to persons in care.
Official plan of correction
POC Due Date: 10/19/2025 Plan of Correction Licensee agreed to write an Absentee Notification Plan/policy meeting the requirements of CA H & S Code 1569.317 for R2, R3, and R4, and maintain a copy of such in each client’s care file. Licensee agreed to E-mail copies of the Absentee Notification Plan for R2, R3, and R4 to LPA, by the POC due date.