ROXIES ELDERLY HOMES II

Official classification

Type A

Official code

87355(e)(3)

Regulation authority

CCR

What the official deficiency says

87355(e)(2) " All individuals subject to a criminal record review [...] shall prior to working, residing or volunteering in a licensed facility: (3) Request a transfer of a criminal record clearance as specified in Section 87355(c) " This requirment is not met as evidenced by: Based on LPA file review and interview, the licensee did not comply with the section cited above in ensuring that 2 staff members had their clearances transfered prior to working at the facility, which poses an immediate health, safety, and personal rights risk to 6 out of 6 persons in care.

Official plan of correction

Licensee was able to associate the two (2) staff members during the visit, eliminating immediate risk. Licensee will review the facility association roster to ensure it is up-to-date. Additionally, Licensee will conduct review of regulation 87355 and submit proof to LPA by POC due date.

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

Official classification

Type B

Official code

87219(a)(2)(3)

Regulation authority

CCR

What the official deficiency says

Planned Activities (a) Residents shall be encouraged to maintain and develop their quality of life through participation in a variety of planned activities. The activities made available shall include:(2) Daily living skills/activities which foster and maintain independent functioning. (3) Cognitive and mental stimulation activities such as reading, writing, movies, crossword puzzles, board and card games, and using the computer. This requirement was not met as evidence by: Based on observations and interviews, the licensee failed to provide activities for 6 out of 6 residents (R1-R6) This poses a potential health and safety risk to residents in care.

Official plan of correction

Licensee will purchase games and puzzles for the residents use. POC due by 06/10/2026. Licensee will send a picture to LPA Holmes of reciept

Deadline recorded: Jun 10, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87307(3)(D)

Regulation authority

CCR

What the official deficiency says

Equipment and supplies necessary for personal care and maintenance of adequate hygiene practice shall be readily available to each resident. The resident may provide the following items; however, if the resident is unable or chooses not to provide them, the licensee shall assure provision of:(D) Hygiene items of general use such as soap and toilet paper. This requirement was not met as evidence by: Based on observations and interviews, the licensee failed to provide paper towels for 6 out of 6 residents (R1-R6). This poses a potential health and safety risk to residents in care.

Official plan of correction

Licensee will make sure that there are extra toilet paper and paper towels at the facility at all times. LPA Holmes observed several paper towel rolls at the facility during the visit. Licensee will purchase more paper towels to have extra by POC date of 06/10/2026. Licensee will send a picture to LPA Holmes of reciept

Deadline recorded: Jun 10, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.1(a)(2)

Regulation authority

CCR

What the official deficiency says

87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights(2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This requirement was not met as evidence by: Based on records and interviews the licensee did not provide healfull and comfortable accomodations in 1 of 6 persons in care(R1-R6) which posed a potential Personal Rights risk to persons in care

Official plan of correction

Licensee will turn the fans on early in the am to keep the facility cool. There AC at the facility is ran when it is really hot Licensee will go over with staff when to use ac and the fans. Licensee will send over written documentation that shows she spoke with staff about this. POC due 6/10/2026

Deadline recorded: May 29, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.1(a)(1)

Regulation authority

CCR

What the official deficiency says

87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights:(1) To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement is not met as evidenced by: Based on interviews, the facility failed to treat 6 out of 6 residents with dignity.(R1-R6) This poses a potential personal rights violation to the clients in care.

Official plan of correction

Licensee will have a training by an outside source on personal rights. POC due to CCL by 06/12/2026. Licensee will provide to LPA documentation of training and sign in sheet for all staff

Deadline recorded: Jun 12, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87211(a)(1)

Regulation authority

CCR

What the official deficiency says

87211 Reporting Requirements(a)(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 any of the events... This requirement has not been met as evidenced by: Based on interview and record review, the Licensee did not comply with the section cited above in that written incident reports were not submitted to the Department regarding R1's hospitalizations. This poses a potential safety risk for 6 of 6 residents in care.

Official plan of correction

Administrator will review reporting requirements and submit a written letter stating that the Administrator has reviewed, understands, and will comply with reporting requirements and the incident reports for R1's hospitalizations to the Department by POC due date of 8/15/2025.

Deadline recorded: Aug 15, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87202(a)

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: This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and interview, the licensee did not comply with the section cited above in that staff were sleeping in rest areas located in the facility's garage which poses an immediate health and safety risk to residents in care.

Official plan of correction

POC Due Date: 08/09/2025 Plan of Correction Administrator stated that the beds will be removed from the enclosed area and will use those areas as storage. Administrator will submit photographs of the area with the bed removed to the Department by POC due date of 8/9/2025.

Official classification

Type B

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 observation, the licensee did not comply with the section cited above in that cleaning chemicals were stored in an unlocked storage area which posed a potential health and safety risk to 6 of 6 residents in care.

Official plan of correction

POC Due Date: 08/15/2025 Plan of Correction Staff relocked the cleaning chemical cabinet during the visit. Administrator will conduct in-service training with staff regarding proper storage of dangerous/hazardous items and will provide the sign-in sheet for the training to the Department by POC due date of 8/15/2025.

Official classification

Type B

Official code

87468.1(a)(6)

Regulation authority

CCR

What the official deficiency says

87468.1 Personal Rights of Residents in All Facilities (a) residents… shall have all of the following personal rights (6) … to not be locked in any room, building, or on facility premises by day or night… This requirement has not been met as evidenced by: Based on interviews and observations, the licensee did not comply with the above regulation in that residents were locked in their room, which poses a potential personal rights risk to 6 of 6 residents in care.

Official plan of correction

Licensee removed locking door knob during visit on 8/17/2021. Licensee and staff will attend an outside vendor training on personal rights and will submit a sign in sheet to the Department by POC due date of 7/8/2024.

Deadline recorded: Jul 8, 2024. A deadline is not proof that correction was completed.

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 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 requirements has not been met as evidenced by: Based on interviews and record review, the facility does not have a fire clearance for 2 bedridden residents. This poses an immediate safety risk to 1 of 5 residents in care. A civil penalty of $500 was assessed.

Official plan of correction

Licensee stated they will submit an LIC200 application for increased bedridden clearance and updated facility sketch to Department by POC due date.

Deadline recorded: Aug 3, 2023. A deadline is not proof that correction was completed.