LUCY'S PLACE

Official classification

Type A

Official code

87355(e)(3)

Regulation authority

CCR

What the official deficiency says

87355 Criminal Record Clearance (e) All individuals subject to a criminal record... shall prior to working, residing or volunteering in a licensed facility: (3) Request a transfer of a criminal record clearance... This requirement has not been met as evidenced by: Based on record review, the Licensee did not ensure that the criminal background clearance for S1, S2, or S3 were transferred to the facility. This poses an immediate safety risk to 1 of 1 residents in care.

Official plan of correction

House Manager will submit LIC9182 forms requesting the criminal background clearance transfer for S1, S2, and S3 to the Department by POC due date of 1/13/2026.

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

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, administrator and each employee... This requirement has not been met as evidenced by: Based on interview, the Licensee did not ensure that personnel records were completed and maintained for S1, S2, and S3. This poses a potential safety risk to 1 of 1 residents in care.

Official plan of correction

House Manager will create personnel records for S1, S2, and S3 and will provide written notice of completion to the Department by POC due date of 2/13/2026.

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

Official classification

Type B

Official code

87506(a)

Regulation authority

CCR

What the official deficiency says

87506 Resident Records (a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility... This requirement has not been met as evidenced by: Based on records review, the Licensee did not ensure that R1's record was complete, which poses a potential health risk to 1 of 1 residents in care.

Official plan of correction

House Manager will review and update R1's record and will provide written notice of completion to the Department by POC due date of 2/13/2026.

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

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 record review, the licensee did not comply with the section cited above in that there is no Infection Control Plan document that is maintained at the facility for staff and licensing review. This poses a potential health risk to 2 of 2 residents in care.

Official plan of correction

POC Due Date: 02/09/2025 Plan of Correction Caregiver Dao stated that Licensee will create an Infection Control Plan. Licensee will notify the Department that the Infection Control Plan document is completed by the POC due date of 2/9/2025.

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 record review, the licensee did not comply with the section cited above in that personnel records for S1 and S2 were not complete or available for licensing review which poses a potential safety risk to 2 of 2 residents in care.

Official plan of correction

POC Due Date: 02/09/2025 Plan of Correction Caregiver Dao stated that Licensee will update personnel records for S1 and S2. Licensee will notify the Department that the personnel records for S1 and S2 are complete and maintained at the facility by POC due date of 2/9/2025.

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 record review, the licensee did not comply with the section cited above in that there is no Emergency and Disaster Plan document that is maintained at the facility for staff and licensing review. This poses a potential safety risk to 2 of 2 residents in care.

Official plan of correction

POC Due Date: 02/09/2025 Plan of Correction Caregiver Dao stated that Licensee will create an Emergency and Diaster Plan. Licensee will notify the Department that the Emergency and Diaster Plan document is completed by the POC due date of 2/9/2025.

Official classification

Type B

Official code

87465(h)(5)

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: (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 LPA observation, the licensee did not comply with the section cited above in that 1 of 1 resident's medications are stored in a weekly pill box and medication cup, which poses a potential health risk to 1 of 1 residents in care.

Official plan of correction

POC Due Date: 12/31/2024 Plan of Correction Licensee will instruct caregivers to give resident medications directly from the pill bottle and not from the pillbox and to not pre-pour medication. Licensee will have caregivers participate in vendor training on medication storage and administration and will submit copies of the certificate of completion to the Department by POC due date of 12/31/2024.

Official classification

Type B

Official code

87465(h)(2)

Regulation authority

CCR

What the official deficiency says

87465 Incidental and Medical 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 is not met as evidenced by: Deficient Practice Statement Based on LPA observation, the licensee did not comply with the section cited above in that a pillbox and medication cup containing 1 of 1 resident's medications was stored in an unlocked cabinet located in a common area of the facility, which posed a potential safety risk to 1 of 1 residents in care.

Official plan of correction

POC Due Date: 12/31/2024 Plan of Correction LPA observed Caregiver Dietsch lock the medications contained in the pill box and medication cup in the locked medication cabinet during the visit. Licensee will instruct caregivers to store the medication in the locked medication cabinet. Licensee will have caregivers participate in vendor training on medication storage and administration and will submit copies of the certificate of completion to the Department by POC due date of 12/31/2024.

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 4 of 4 residents medications which poses health and safety risk to 4 of 4 persons in care.

Official plan of correction

POC Due Date: 11/22/2023 Plan of Correction Administrator stated staff will no longer prepour resident medications ahead of time or store in pill boxes. Administrator stated she will arrange an outside trainer to provide medication training to Administrator and staff. Administrator will submit training certificate or sign-in sheet to the Department by POC due date of 11/22/2023.

Official classification

Type B

Official code

87506(a)

Regulation authority

CCR

What the official deficiency says

a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff 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 4 out of 4 resident files which poses health risk to 4 of 4 persons in care.

Official plan of correction

POC Due Date: 11/22/2023 Plan of Correction Administrator stated that she will review and update 4 of 4 resident records to ensure the resident records are complete and accurate. Administrator will submit LIC9098 form to the Department by POC due date of 11/22/2023.