NEW WORLD VILLA SOUTH

Official classification

Type B

Official code

87207

Regulation authority

CCR

What the official deficiency says

No licensee, officer or employee of a licensee shall make or disseminate any false or misleading statement regarding the facility or any of the services provided by the facility. This requirement was not met as evidenced by: Based on Staff and Outside Source interviews the Licensee statement to the Department that they lacked knowledge regarding the mandated requirements with a change of ownership was falsified. This posed a potential personal rights risk to # of # residents in care.

Official plan of correction

Adninistrator will review the regulations cited and send a letter to CCL acknowledging understanding and expressing a commitment to follow the regulation by POC date.

Deadline recorded: May 25, 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

(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 any of the events specified in (A) through (D) below. This report shall include the resident's name, age, sex and date of admission; date and nature of event; attending physician's name, findings, and treatment, if any; and disposition of the case.This requirement was not met as evidenced by: Based on interviews and record reviews. Based on staff interviews and record reviews, the Licensee did not report the theft of a resident’s (R1) personal belongings by Staff 1 (S1) to the Department This posed a potential personal rights risk to # of # residents in care.

Official plan of correction

Adninistrator will review the regulations cited and send a letter to CCL acknowledging understanding and expressing a commitment to follow the regulation by POC date.

Deadline recorded: May 25, 2026. 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

87468.2 Additional Personal Rights of Residents in Privately Operated Facilities (a)…residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (8) To be free from neglect, financial exploitation…and abuse. This Requirement was not met as evidenced by: Based on record review and interview, one staff member (S1) took a resident’s bracelet valued at $2,000. This posed an immediate personal rights risk to 1 of 5 (R1) residents in care.

Official plan of correction

Per the Administrator (ADM) and the Department's investigation The ADM terminated S1 on November 5, 2025. Deficiency Is cleared.

Deadline recorded: Mar 5, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87468.2(a)(25)

Regulation authority

CCR

What the official deficiency says

87468.2 Additional Personal Rights of Residents in Privately Operated Facilities (a) In addition ...residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (25) To protection of their property from theft or loss according to Health and Safety Code sections 1569.152,1569.153, and 1569.154. This requirement was not met as evidenced by: Based on record review and interview, the licensee did not file a law enforcement report within 36 hours of learning that care staff (S1) stole a $2,000 bracelet from a resident (R1). This posed an immediate personal rights risk to 5 of 5 residents in care.

Official plan of correction

The ADM revealed they attended a CCL approved training regarding Personal Rights post initiation of the investigation. The Licensee and care staff are in process of attendance. Certificate of completion will be provided by the POC due date.

Deadline recorded: Mar 5, 2026. A deadline is not proof that correction was completed.

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 a staff record reveiw S1 and S2 did not have Health Screening forms on file. This posed a potential health risk to 5 out of 5 residents in care.

Official plan of correction

POC Due Date: 10/15/2025 Plan of Correction Licensee will provide CCL copies of S1 and S2's Health screening form as proof of correction.

Official classification

Type B

Official code

87208(a)

Regulation authority

CCR

What the official deficiency says

(a) The licensee shall have and maintain a current, written definitive plan of operation for the facility. The licensee shall operate the facility in accordance with the terms specified in the plan of operation and may be cited for not doing so pursuant to Health and Safety Code section 1569.49. 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: This requirement is not met as evidenced by: Deficient Practice Statement Based on an interview with the licensee they did not have an infection control plan and was in non-compliance with the section cited above for 5 out of 5 residents poses/posed a potential safety risk to persons in care.

Official plan of correction

POC Due Date: 11/05/2025 Plan of Correction Licensee will have an approved infection control plan and attend CCL approved training regarding infection control policy and procedures.

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 a staff record review S1 - S10 did not have records of required training on file. This posed a potential health and safety risk to 5 out of 5 residents in care.

Official plan of correction

POC Due Date: 11/05/2025 Plan of Correction Licensee will provide CCL copies of S1-S10 documentation of training requirements per CCL State mandate

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 observations and interviews the licensee did not comply with the section cited above by not addressing a pest infestation in the facility kitchen which poses/posed a potential health or personal rights risk to 5 out of 5 persons in care.

Official plan of correction

POC Due Date: 10/08/2025 Plan of Correction Based on LPA observations and records the facility had a pest infestation. Licensee had the pest issue treated and erradicated. Deficiency is cleared.

Official classification

Type B

Official code

87633(a)(4)

Regulation authority

CCR

What the official deficiency says

(a) The licensee shall be permitted to accept or retain residents who have been diagnosed as terminally ill by his or her physician and surgeon and who may or may not have restrictive and/or prohibited health conditions, to reside in the facility and receive hospice services from a hospice agency in the facility, when all of the following conditions are met: (4) A written hospice care plan which specifies the care, services, and necessary medical intervention related to the terminal illness as necessary to supplement the care and supervision provided by the facility is developed for each terminally ill resident or prospective resident by that resident's hospice agency and agreed to by the licensee and the resident, or prospective resident, or the resident's or prospective resident's Health Care Surrogate Decision Maker, if any, prior to the initiation of hospice services in the facility for that resident, and all hospice care plans are fully implemented by the licensee and by the hospice(s). This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, the licensee did not comply with an appropriate care plan on file for 1 [R1] out of 5 residents which poses/posed a potential health to R1.

Official plan of correction

POC Due Date: 10/15/2025 Plan of Correction Licensee agreed to have all staff attend a CCL approved training regarding health and safety risks to persons regarding the care, services, and medical interventions for appropriate supervision and care of residents under hospice care.

Official classification

Type A

Official code

87411(a)

Regulation authority

CCR

What the official deficiency says

Personnel Requirements - General. Facility personnel shall ... be sufficient in numbers, and competent to provide the services... to meet resident needs... The licensing agency may require any facility to provide additional staff whenever... the extent of services provided, or the physical arrangements of the facility require such additional staff for ... adequate services. This requirement was not met as evidenced by: Based on staff interviews and record reviews they did not have adequate staff to meet Resident 1 (R1) needs. This posed an immediate health risk to one out of five (5) residents in care.

Official plan of correction

Administrator agreed to have all staff scheduled to attend CCL approved training. Administrator will provide proof of completion by POC due date and completion of training by Friday, September 19, 2025. Administrator will send CCL proof by POC due date.

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

Official classification

Type B

Official code

87303(a)(1)

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...for... well-being of residents...(1) Floor surfaces ...and kitchen areas shall be maintained in a clean, sanitary...condition. This requirement was not as evidenced by: Based on LPA observations the facility kitchen had dead, as well as alive pests, in the kitchen cupboards. This posed a potential health and personal rights risk to five (5) residents in care.

Official plan of correction

Administrator agreed to have pest control company service the facility, requiring all items to removed from kitchen cabinets and residents to be relocated for the duration of time specified by the company Administrator will send CCL proof of completion by POC due date.

Deadline recorded: Nov 12, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(a)(5)

Regulation authority

CCR

What the official deficiency says

87465 INCIDENTAL MEDICAL AND DENTAL CARE (a) (5) Facility staff... shall not administer injections... This requirement was not met as evidenced by: Based on observation and record review, the licensee did not ensure that an appropriately skilled professional administered medications to 1 (R5) of 5 residents in care. This posed an immediate health, safety and personal rights risk to R5.

Official plan of correction

Licensee agreed to immediatley re-train all caregivers in providing assistance with injections and submit proof of training, as well as the complete care plan for R5 by the POC due date.

Deadline recorded: Aug 29, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87309(a)

Regulation authority

CCR

What the official deficiency says

87309 Storage Space and Access (a) ...the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances... sharp objects, and other... items which could pose a danger... are... not left unattended if outside the locked storage. This requirement was not met as evidenced by: Based on observation, the licensee did not ensure that rubbing alcohol, injection needles, and lysol were locked and inaccessible to residents which poses an immediate health, safety and personal rights risk to 5 of 5 residents in care (R1-R5).

Official plan of correction

Licensee will esure that all hazardous materials are immediatley locked and provide photographic evidence of facility areas by the POC due date.

Deadline recorded: Aug 29, 2025. A deadline is not proof that correction was completed.

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 review... shall prior to working, residing or volunteering in a licensed facility (3) Request a transfer of a criminal record clearance... This requirement was not met as evidenced by: Based on record review, the licensee did not ensure that a criminal record clearance transfer was complete for 1 of 7 staff members (S5) prior to working in the facility, which poses an immediate health, safety and personal rights risk to 5 of 5 residents in care.

Official plan of correction

S5 is not present and will not work in the facility until a clearance transfer has been completed and S5 is associated to the facility. POC cleared during the visit.

Deadline recorded: Aug 29, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87355(e)(2)

Regulation authority

CCR

What the official deficiency says

87355 Criminal Record Clearance (e) All individuals subject to a criminal record review... shall prior to working... in a licensed facility (2) Obtain a California clearance or a criminal record exemption as required by the Department... This requirement was not met as evidenced by: Based on record review, the licensee did not ensure that a criminal record clearance was obtained for 2 of 7 staff members (S4 and S6) prior to working in the facility, which poses an immediate health, safety and personal rights risk to 5 of 5 residents in care.

Official plan of correction

S4 and S6 are not present and will not work in the facility until obtaining a criminal record clearance and associated to the facility. POC cleared during the visit.

Deadline recorded: Aug 29, 2025. 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 or in a central administrative location readily available to facility staff and to licensing agency staff. This requirement was not met as evidenced by: Based on record review, resident records were incomplete for 5 Residents (R1-R5), which poses a potential health, safety and personal rights risk for 5 of 5 residents in care.

Official plan of correction

The licensee will ensure that a separate, complete, and current record is available for every resident in care by the POC due date, and verify by submitting a copy of every resident record to CCL by the POC due date.

Deadline recorded: Sep 26, 2025. A deadline is not proof that correction was completed.