WHITE ORCHID GUEST HOME

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 LPA observation, the licensee did not comply with the section cited above in multiple counts of debris (palettes, old movable toliets, etc... pictures taken by LPA) in the backyard which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/20/2026 Plan of Correction Licensee will have all debris removed by the POC date by taking a picture and emailing the cleared area to the LPA.

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 record review, the licensee did not comply with the section cited above in one (1) count out of three (3) total count Staff#3 not having a health screening in file which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/03/2026 Plan of Correction Licensee will have staff#3 get a health screening by the POC date and document submitted to LPA via email.

Official classification

Type A

Official code

87465(a)(4)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical anddental care and provide for assistance in obtaining such care, by compliance with the following: (4) The licensee shall assistresidents with self-administered medications as needed. This requirement is not met as evidenced by: Based on records review and interviews conducted, the licensee did not comply with the section cited above as S1 didn't give R1 Metoprolol Succinate on 6/21/23 as prescribed. Which posed an immediate safety, or personal rights risk to persons in care.

Official plan of correction

Licensee will ensure compliance by reviewing regulation Title 22 87465 (a)(4) for understanding and will retrain all staff on Medication Administration. Submit Training sign-in sheet by due date to LPA Deborah.Lee@dss.ca.gov.

Deadline recorded: Apr 24, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87456

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical anddental care and provide for assistance in obtaining such care, by compliance with the following: (4) The licensee shall assistresidents with self-administered medications as needed. This requirement is not met as evidenced by: Based on records review and interviews conducted, the licensee did not comply with the section cited above as S1 didn't give R1 Metoprolol Succinate on 6/21/23 as prescribed. Which posed an immediate safety, or personal rights risk to persons in care.

Official plan of correction

Licensee will ensure compliance by reviewing regulation Title 22 87465 (a)(4) for understanding and will retrain all staff on Medication Administration. Submit Training sign-in sheet by due date to LPA Deborah.Lee@dss.ca.gov.

Deadline recorded: Apr 23, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

67465(a)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical anddental care and provide for assistance in obtaining such care, by compliance with the following: (4) The licensee shall assistresidents with self-administered medications as needed. This requirement is not met as evidenced by: Based on records review and interviews conducted, the licensee did not comply with the section cited above as S1 didn't give R1 Metoprolol Succinate on 6/21/23 as prescribed. Which posed a potential safety, or personal rights risk to persons in care.

Official plan of correction

Licensee will ensure compliance by reviewing regulation Title 22 67465 (a)(4) for understanding and will retrain all staff on Medication Administration. Submit Training sign-in sheet by due date to LPA Deborah.Lee@dss.ca.gov.

Deadline recorded: Apr 23, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87211(a)(1)(D)

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 days of the occurrence of...(D) Any incident which threatens the welfare, safety or health of any resident, such as psychological abuse of a resident by staff or other residents, or unexplained absence of any resident. This requirement is not met as evidenced by: Based on interviews and records review, the licensee did not comply with the section cited above as the faciltiy was unable to provide incident report for incident on 6/21/23 where 911 and law enforcement were call.

Official plan of correction

Licensee will ensure compliance by reviewing regulation Title 22 87211(a)(1)(D) for understanding and develop a plan for future compliance. Submit plan to LPA Lee Deborah.Lee@dss.ca.gov by due date.

Deadline recorded: Apr 23, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87465(h)(5)

Regulation authority

CCR

What the official deficiency says

(h) The following requirements shall apply to medications which are centrally stored: (5) Each resident's medication shall be stored in its originally received container. No medications shall be transferred between containers. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above in 1 out of 3 persons which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/30/2023 Plan of Correction Licensee will conduct a refresher training on proper dispursement of medication. Licensee will email documentation of training to LPA.

Official classification

Type B

Official code

87465(d)(3)

Regulation authority

CCR

What the official deficiency says

(d) If the resident is unable to determine his/her own need for a prescription or nonprescription PRN medication, and is unable to 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: (3) The date and time the PRN medication was taken, the dosage taken, and the resident's response shall be documented and maintained in the resident's facility 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 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: 06/30/2023 Plan of Correction Licensee will update medication list. Licensee will provide refresher training on medication record keeping. Licensee will email documents of updated medication list and proof of refresher training.