SENIOR CARE & COMFORT LIVING

Official classification

Type A

Official code

87202(a)(2)

Regulation authority

CCR

What the official deficiency says

87202 Fire Clearance (a)All facilities...Prior to accepting or retaining any of the following types of persons, the...licensee shall notify the licensing agency and obtain an appropriate fire clearance...(2)Bedridden persons This requirement was not met as evidenced by: LPA observations, records reviewed, and staff interviews revelaed that R1 and R2 are bedbound. The Licensee does not have a fire clearance to accept bedbound residents. This posed an immediate health and saftey risk for 2 of 4 residents in care.

Official plan of correction

Licensee stated they will submit an LIC200 application for bedridden clearance, update the facility sketch, and contact the Fire Marshall. The Licensee will submit proof to LPA by POC due date.

Deadline recorded: Mar 4, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87632(a)

Regulation authority

CCR

What the official deficiency says

87632 Hospice Care Waiver (a) In order accept or retain terminally ill residents and permit them to receive care from a hospice agency, the licensee shall have obtained a facility hospice care waiver from the Department ... This requirement is not met as evidenced by: Per records review, R1, R2, and R4 were accepted as residents requireing hospcie care services without the Licensee having a Hospice Care Waiver. This posed a health and safety risk to 3 of 4 residents in care.

Official plan of correction

Licensee stated they will submit hospice exceptions for R1, R2, and R3 by POC due date and submit proof to LPA.

Deadline recorded: Mar 13, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87458(a)

Regulation authority

CCR

What the official deficiency says

87458 Medical Assessment (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...to be kept in the resident's record. This requirement was not met as evidenced by: Records reviewed revealed R1, R2, and R3 had incompleted Medical Assessments (LIC 602A). This posed a poetential health and safety risk to 3 of 4 residents in care.

Official plan of correction

Licensee stated they will get updated and completed Physician's Reports for R1, R2, and R3. Licensee will submit proof to LPA by POC due date.

Deadline recorded: Mar 13, 2026. 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

(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 is not met as evidenced by: Deficient Practice Statement Based on LPA, the licensee did not comply with the section cited above in medications were left accessible which poses an immediate health, safety or personal rights risk to 5 out of 5 residents in care.

Official plan of correction

POC Due Date: 10/17/2025 Plan of Correction LPA had staff immeditaley lock all medications, making them inaccessible to residents in care - citation cleared.

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: (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 record review, the licensee did not comply with the section cited above in 1 out of 5 residents (R1) did not have a completed and signed admission agreement and pre-admission appraisal which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/31/2025 Plan of Correction Licensee will submit a copy of admissions agreeement and pre-admission appraisal for R1 to LPA by POC due date.

Official classification

Type B

Official code

87555(b)(9)

Regulation authority

CCR

What the official deficiency says

(b) The following food service requirements shall apply: (9) Procedures which protect the safety, acceptability and nutritive values of food shall be observed in food storage, preparation and service. 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 in 4 out of 10 objects which poses/a potential health, safety or personal rights risk to 5 persons in care.

Official plan of correction

POC Due Date: 01/03/2025 Plan of Correction Licensee will purchase storage containers, clips and labels and will properly store and label all food.

Official classification

Type B

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 observation, the licensee did not comply with the section cited above in 2 out of 10 objects , which posed a potential health, safety or personal rights risk to 5 persons in care.

Official plan of correction

POC Due Date: 01/03/2025 Plan of Correction Licensee will properly store food in labeled containers and will create a checklist. Food will be checked every 5 days to ensure there is no spoiled food and marked on the checklist.

Official classification

Type B

Official code

87555(b)(26)

Regulation authority

CCR

What the official deficiency says

(b) The following food service requirements shall apply: (26) Supplies of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days shall be maintained on the premises. 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 in 2 out of 2 counts, of non-perishable and perishable food items, which posed a potential health, safety or personal rights risk to 5 persons in care.

Official plan of correction

POC Due Date: 01/03/2025 Plan of Correction Licensee will purchase 2 days worth of perishable food items and 7 days worth of non-perishable food items.

Official classification

Type B

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 in 1 count which posed a potential health, safety or personal rights risk to 5 persons in care.

Official plan of correction

POC Due Date: 01/03/2025 Plan of Correction Licensee will ensure that the kitchen is cleaned daily and free of any perishable foods or trash that can attract insects. Also, all opened food items will be clipped and closed properly.

Official classification

Type B

Official code

87625(b)(3)

Regulation authority

CCR

What the official deficiency says

(b) In addition to Section 87611, General Requirements for Allowable Health Conditions, the licensee shall be responsible for the following: (3) Ensuring that incontinent residents are kept clean and dry and that the facility remains free of odors from incontinence. 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 in 3 out of 3 bedrooms which poses a potential health, safety or personal rights risk to 5 persons in care.

Official plan of correction

POC Due Date: 01/03/2025 Plan of Correction Licensee will replace carpet and any other items in the bedrooms that are causing odors.

Official classification

Type B

Official code

87208(a)(12)

Regulation authority

CCR

What the official deficiency says

87208 Plan of Operation (a) Each facility shall have and maintain a current, written definitive plan of operation. The plan and related materials shall be on file in the facility and shall be submitted to the licensing agency with the license application. Any significant changes in the plan of operation which would affect the services to residents shall be submitted to the licensing agency for approval. The plan and related materials shall contain the following: (12) The Infection Control Plan pursuant to Section 87470. This requirement is not met as evidenced by: Deficient Practice Statement Based on interview, the licensee did not comply with the section cited above in, which poses/posed a potential health, safety or personal rights risk to 6 of 6 persons in care.

Official plan of correction

POC Due Date: 12/28/2023 Plan of Correction Licensee agreed to submit an Infection Control Plan to the Department, by 12/28/23.

Official classification

Type B

Official code

87458(a)

Regulation authority

CCR

What the official deficiency says

87458 Medical Assessment (a) Prior to a person's acceptance as a resident, the licensee shall obtain and keep on file, documentation of a medical assessment, signed by a physician, made within the last year. The licensee shall be permitted to use the form LIC 602 (Rev. 9/89), Physician's Report, to obtain the medical assessment. This requirement is not met as evidenced by: Deficient Practice Statement Based on interview, observation and review of records, the licensee did not comply with the section cited above, which poses/posed a potential health, safety or personal rights risk to 3 of 6 persons in care.

Official plan of correction

POC Due Date: 12/28/2023 Plan of Correction Liecensee agreed to obtain missing physician's reports for residents, and updated physician's reports for residents with dementia. The Licensee will submit these physician's reports to the LPA, by 12/28/23.

Official classification

Type B

Official code

87411(c)(1)

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 (1) Staff providing care shall receive appropriate training in first aid from persons qualified by such agencies as the American Red Cross. This requirement is not met as evidenced by: Deficient Practice Statement Based on interview and review of records, the licensee did not comply with the section cited above in 2 out of 2 staff, which poses/posed a potential health, safety or personal rights risk to 6 of 6 persons in care.

Official plan of correction

POC Due Date: 12/28/2023 Plan of Correction Licensee agreed to obtain first aid training for the two staff and submit proof to the LPA, by 12/28/23.