HUNTINGTON MANOR

Official classification

Type B

Official code

87464(f)(4)

Regulation authority

CCR

What the official deficiency says

This requirement is not met as evidenced by: (f) Basic services shall at a minimum include:(4) Personal assistance and care as needed by the resident and as indicated in the pre-admission appraisal, with those activities of daily living such as dressing, eating, bathing... Deficient Practice Statement Based on interview, the licensee did not comply with the section cited above in [1] of [(1)] out of [18] [R1] which poses a potential health and personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/22/2026 Plan of Correction Licensee stated that all staff will receive training by POC due date, The facility will implement a protocol requiring staff to:• Document bathing requests in the daily log• Notify the lead caregiver or med‑tech immediately upon a resident’s request• Complete the task within the resident’s preferred timeframe• Report delays to administration. This procedure will be added to the facility operations manual and will be sent to LPA by POC due date.

Official classification

Type B

Official code

1569.686(a)(4)

Regulation authority

HSC

What the official deficiency says

(a) A licensee shall notify the department, State Long-Term Care Ombudsman, all residents, and, responsible party in writing, within two business days... (4)The licensee receives a written notice of default of payment of rent described in Section 1161 of the Code of Civil Procedure. This requirement was not met, as evidenced by

Official plan of correction

Licensee agreed to notify all required agencies of the eviction notice and provide proof to LPA via email by POC due date.

Deadline recorded: Jun 12, 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 observations, the licensee did not comply with the section cited above in 6 out of 22 persons which poses an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 09/25/2025 Plan of Correction Licensee agreed to tour each resident room and remove all medications accessible to residents and centrally store them inthe locked medication room. In additon, Licensee and staff will attend medication training conducted by a medical professional.

Official classification

Type A

Official code

87611(e)

Regulation authority

CCR

What the official deficiency says

General Requirements for Allowable Health Conditions (e) In addition to Sections 87465(a) and 87464(d) the licensee shall ensure that the resident is cared for in accordance with the physician's orders and that the resident's medical needs are met. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA's observations, the Licensee did not comply with the section cited above in 1 out of 22 [R22] persons which poses an immediate health risk to persons in care.

Official plan of correction

POC Due Date: 09/25/2025 Plan of Correction The Licensee agreed to coordinate with PACE regarding R2's care plan. In addition the Licensee has scheduled 2 trainings by a medical professional including Ostomy care on 10/1/2025, and PRN medication training on 10/3/2025

Official classification

Type A

Official code

87307(D)(6)

Regulation authority

CCR

What the official deficiency says

Personal Accommodations and Services (d)The following space and safety provisions shall apply to all facilities:(6) All outdoor and indoor passageways and stairways shall be kept free of obstruction. 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 22 out of 22 [R1-R22] objects obstructing passageways which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/26/2025 Plan of Correction Licensee agreed to clear all areas for trip hazards and fall safety. Licensee also will provide CCL a fall risk plan and training for staff to follow in the case of a resident fall.

Official classification

Type A

Official code

87204(a)

Regulation authority

CCR

What the official deficiency says

87204(a) Limitations - Capacity and Ambulatory Status: “(a) A licensee shall not operate a facility beyond the conditions and limitations specified on the license, including specification of the maximum number of persons who may receive services at any one time.” This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and record review, the Licensee admitted a twenty-second (22nd) Resident (R22), which was beyond the facility’s licensed capacity of 21 persons. This posed an immediate health, safety and personal rights risk to 22 of 22 residents (R1-R22) in care.

Official plan of correction

POC Due Date: 09/19/2025 Plan of Correction The Licensee understands that they shall not admit any new residents to the facility until Community Care Licensing's (CCL) application review process is complete and CCL's decison has been rendered.

Official classification

Type A

Official code

87464(f)(1)

Regulation authority

CCR

What the official deficiency says

87464 Basic Services (f) Basic services shall at a minimum include (1) Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). This requirement was not met as evidenced by: Based on record review and interview, the licensee did not protect a resident (R1) from access to medications which resulted in overdose and hospitalization. This posed an immediate health, safety and personal rights risk to 1 of 21 Residents in care

Official plan of correction

Administrator agreed to identify and create a list of high-risk residents to ensure incoming packages are checked and logged by staff for any harmful items, including medications. Administrator will provide a copy of the log to CCL by POC due date.

Deadline recorded: Sep 19, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(g)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care (g) The licensee shall immediately telephone 9-1-1 if an injury or other circumstance has resulted in an imminent threat to a resident’s health… This requirement was not met as evidenced by: Based on record review and interview, facility staff did not immediately phone 9-1-1 when a resident (R1) was discovered experiencing a medical emergency, which posed an immediate health, safety and personal rights risk to 1 of 21 Residents in care.

Official plan of correction

Administrator agreed to have facility staff attend training by a CCL approved vendor regarding when to seek immediate medical attention. Administrator will send date of training to CCL by POC due date.

Deadline recorded: Sep 19, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87205(b)

Regulation authority

HSC

What the official deficiency says

Governing Body (a) The licensee... shall exercise general supervision over the affairs of the licensed facility and establish policies concerning its operation in conformance with these regulations and the welfare of the individuals it serves. This requirement was not met as evidenced by: A facility record review revealed the Limited Liability Corporation (LLC) was suspended for non-payment effective May 1, 2025. This poses a potential personal rights risk to 21 out of 21 residents in care.

Official plan of correction

The Licensee agreed to pay the Federal Tax Buearu (FTB) fee to bring the LLC back into active status. The Licensee will provide CCL proof of payment by the POC due date.

Deadline recorded: Sep 30, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87307(e)(2)(A)

Regulation authority

CCR

What the official deficiency says

The licensee shall supervise...as needed...pursuant to Section 87457 or ...87463...when residents are in proximity to...Fishponds...licensee shall ensure...bodies of water are inaccessible through...fencing, covering, or other.. when not in...use by residents. This requirement was not met as evidenced by: A facility tour revealed the gate to a fishpond had deteriorated to a point of ability to access the body of water. This posed an immediate safety risk to 18:21 residents in care.

Official plan of correction

Staff boarded up the fishpond during site visit. Staff will be replacing the fence with a new gate by Monday August 18, 2025. And provide Licensing with proof of replacement.

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

Official classification

Type A

Official code

87307(D)(6)

Regulation authority

CCR

What the official deficiency says

The following space and safety provisions shall apply to all facilities: All outdoor and indoor passageways and stairways shall be kept free of obstruction. This requirement was not met as evidenced by: A facility tour revealed the flooring in the facility hallway into the main dining hall was damaged and buckled creating a trip hazard. This posed an immediate safety risk to 18:21 residents in care.

Official plan of correction

Licensee will temporarily fix the damaged areas with plywood in the interim of replacing the damaged floors. Licensee will provide proof of correction by POC due date.

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

Official classification

Type B

Official code

87307(D)(2)

Regulation authority

CCR

What the official deficiency says

Personal Accommodations and Services: The following... safety provisions shall apply...The premises shall be maintained in... good repair and shall provide a safe and healthful environment. This requirement was not met as evidenced by: A facility tour revealed several areas of disrepair throughout the facility housing and grounds. This posed a potential safety and personal rights risk to 21:21 residents in care.

Official plan of correction

Licensee will contact maintenance to fix issues of disrepair throughout the facility by POC due date.

Deadline recorded: Sep 16, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87468.2(a)(8)

Regulation authority

CCR

What the official deficiency says

Additional Personal Rights of Residents in Privately Operated Facilities: “…residents in privately operated residential care facilities shall have all of the following personal rights:…to be free from mental, physical, or sexual abuse.” This requirement is not met as evidenced by: Based on interviews the licensee did not protect 1 out of 21 residents in care from sexual abuse [R1] which posed an immediate safety and personal rights risk to residents in care.

Official plan of correction

Administrator stated Staff #1 was terminated on 11/01/23, which removed the immediate threat, POC corrected.

Deadline recorded: May 2, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87466

Regulation authority

CCR

What the official deficiency says

Observation of the Resident. The licensee shall ensure...residents are regularly observed for changes in physical...when such observation reveals unmet needs. When changes...are observed...the attention of the resident's physician and the resident's responsible person, if any. This requirement is not met as evidenced by: Based on interviews and records, the licensee did not ensure 1 out of 21 [R1] residents were observed for a medical condition requiring medical treatment, which poses a potential health and safety risk to residents in care.

Official plan of correction

Administrator stated she will conduct In-Service training regarding observations of the residents and reporting observations. Training is due by POC due date.

Deadline recorded: Mar 4, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87303(i)(2)

Regulation authority

CCR

What the official deficiency says

Maintenance and Operation. Facilities shall have signal systems which shall meet the following criteria: Facilities having more than one wing, floor or building shall be permitted to have a separate system in each, provided each meets the above criteria. This requirement is not met as evidenced by: Based on observations and interviews, the licensee did not ensure 1 out of 21 [R1] residents call buttons were operable, which poses a potential health and safety risk to residents in care.

Official plan of correction

Administrator stated she will implement a new policy to ensure call buttons are operable and by having staff check/test the call buttons on an ongoing basis. The administrator also stated she will provide an In-Service training to staff regarding the call buttons. Proof of new policy and training are due by POC date.

Deadline recorded: Mar 4, 2024. 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

Personal Rights of Residents in All Facilities. To be accorded safe, healthful, and comfortable accommodations, furnishings, and equipment. This requirement is not met as evidenced by: Based on interviews, the licensee did not ensure 1 out of 21 [R1] residents were afforded healthful accommodations due to not following universal precautions for bed bug infestation, which poses a potential health and safety risk to resident in care.

Official plan of correction

Administrator stated she will conduct In-Service training on universal precautions regarding bed bugs and provide proof of training by POC due date.

Deadline recorded: Mar 4, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87224(a)

Regulation authority

CCR

What the official deficiency says

EVICTION PROCEDURES 87224(a) The licensee may evict a resident...Thirty (30) days written notice to the resident is required.... This requirement is not met as evidenced by: Based on observations, interviews, and record reviews, the licensee did not give thirty (30) days written notice to evict in one of nineteen residents which posed a potential personal rights risk to residents in care.

Official plan of correction

Administrator agreed to conduct in-service training to adminstrative staff regarding eviction procedures. Administrator agreed to submit signed acknowledament of training by staff by POC date.

Deadline recorded: Oct 28, 2022. A deadline is not proof that correction was completed.