ST. ANTHONY'S BOARD AND CARE

Official classification

Type B

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 onobservation, the licensee did not comply with the section cited above in 1 of 1 fire extinguishers were not serviced within the last 12 months which posed a potential safety risk to persons in care.

Official plan of correction

POC Due Date: 01/02/2026 Plan of Correction Facility agreed to obtain current fire extinguisher and send LPA current tags via email by POC due date, 01/02/2026.

Official classification

Type B

Official code

1569.69(a)(2)

Regulation authority

HSC

What the official deficiency says

(a) Each residential care facility for the elderly licensed under this chapter shall ensure that each employee of the facility who assists residents with the self-administration of medications meets all of the following training requirements: (2) In facilities licensed to provide care for 15 or fewer persons, the employee shall complete 10 hours of initial training. This training shall consist of 6 hours of hands-on shadowing training, which shall be completed prior to assisting with the self-administration of medications, and 4 hours of other training or instruction, as described in subdivision (f), which shall be completed within the first two weeks of employment. 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 2 of 2 staff did not have training records within their file which posed a potential personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/02/2026 Plan of Correction Facility agreed to submit staff training to LPA by POC due date, 01/02/2026.

Official classification

Type B

Official code

87458(a)

Regulation authority

CCR

What the official deficiency says

(a) Prior to a person's acceptance as a resident, the licensee shall obtain documentation of a medical assessment, signed by a licensed medical professional acting within the scope of their practice and made within the last year, to be kept in the resident's record. 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 2 out of 5 residents [R4 and R5] did not have an updated Physician's Report on file which posed a potential rights risk to persons in care.

Official plan of correction

POC Due Date: 01/02/2026 Plan of Correction Facility agreed to schedule a medical appointment for resident to obtain their LIC602, and email LPA with the schedued date by POC due date, 01/02/2026.

Official classification

Type B

Official code

87507(c)

Regulation authority

CCR

What the official deficiency says

(c) Admission agreements shall be signed and dated, acknowledging the contents of the document, by the resident or the resident's representative, if any, and the licensee or the licensee's designated representative no later than seven days following admission. Attachments to the agreement may be utilized as long as they are also signed and dated as prescribed above. 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 in1 out of 5 residents did not have an admission agreement on file which posed a potential personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/02/2026 Plan of Correction Facility agreed to have the resident/POA sign for the residents admission agreement and submit to LPA by POC due date, 01/02/2026.

Official classification

Type B

Official code

1569.695(e)(2)

Regulation authority

HSC

What the official deficiency says

(e) A facility shall have all of the following information readily available to facility staff during an emergency: (2) An appraisal of resident needs and services plan for each resident. 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 3 of 5 residents did not have an updated needs and service plan [R2, R3, and R4] which posed a potential personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/02/2026 Plan of Correction Facility agreed to submit updated needs and service plans for R2, R3, and R4, via email to LPA by POC due date, 01/02/2026.

Official classification

Type B

Official code

80065(g)(1)

Regulation authority

CCR

What the official deficiency says

Personnel Requirements: ...good physical health shall be verified by a health screening, including a test for tuberculosis... 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 1 out of 2 staff did not have a TB on file which posed a potential health, and personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/02/2026 Plan of Correction The facility sgreed to obtain staff TB and submit to LPA via email by POC due date, 01/02/2026.

Official classification

Type B

Official code

87468.1(a)(1)

Regulation authority

CCR

What the official deficiency says

Personal Rights of Resident in All Facilities (1) To be accorded dignity in their personal relationships with staff, residents, and other persons... This requirement was not met as evidenced by: Based on the Departments investigation during interviews there was confirmation that staff #1 (S1) would yell at three of 5 residents in care which posed an potential risk to residents in care.

Official plan of correction

According to LIcensee, S1 is not currently working at this facility. This is deemed cleared during the visit.

Deadline recorded: Oct 17, 2025. 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

Personnel Requirements - General: (f) All personnel, including the licensee and administrator, shall be in good health, and physically and mentally capable of performing assigned tasks...this requirement was not met as evidenced by: Based on the Department's investigation, during staff and resident interviews, they confirmed that S1, had hearing and vision conditions that needed to be addressed which posed an potential risk to 5 of 5 residents in care.

Official plan of correction

Per the Licensee, S1 is no longer working at this facility. This is deemed cleared during the visit.

Deadline recorded: Oct 17, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(e)

Regulation authority

CCR

What the official deficiency says

Incidential Medical and Dental: e) For every prescription and nonprescription PRN medication for which the licensee provides assistance there shall be a signed, dated written order from a physician, on a prescription blank, maintained in the residents file, and a label on the medication. Both the physician's order and the label shall contain at least all of the following information... this requirement was not met as evidenced by: Based on the Departments investigation during the records review, the facility did not maintain an accurate MAR for resident #1 (R1) of 5 residents in care which posed an immediate health risk to 1 of 5 residents in care.

Official plan of correction

Licensee agreed to contact R1s pharmacy and obtain medication sheets for all their residents and schedule staff to obtain medication training by POC due date, 10/16/2025.

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

Official classification

Type B

Official code

87303(e)(6)

Regulation authority

CCR

What the official deficiency says

(e) Water supplies and plumbing fixtures shall be maintained as follows: (6) Toilet, handwashing and bathing facilities shall be maintained in operating condition. Additional equipment shall be provided in facilities accommodating physically handicapped and/or nonambulatory residents, based on the residents' needs. 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 2 bathroom sink was broken in bathroom #1 and was leaking which posed a potential personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/25/2024 Plan of Correction Licensee will be contracting a person to fix the leaking pipe and the fixtures to ensure the sink is in operating condition and will contact LPA upon completion by POC due date, 12/25/2024.

Official classification

Type B

Official code

87458(a)

Regulation authority

CCR

What the official deficiency says

(a) Prior to a person's acceptance as a resident, the licensee shall obtain and keep on file, documentation of a medical assessment, signed by a physician, made within the last year. The licensee shall be permitted to use the form LIC 602 (Rev. 9/89), Physician's Report, to obtain the medical assessment. This requirement is not met as evidenced by: Deficient Practice Statement Based on records review, the licensee did not comply with the section cited above in 2 out of 5 residents did not have an updated Physician's Report in their file which posed a potential health risk to persons in care.

Official plan of correction

POC Due Date: 12/19/2024 Plan of Correction Licensee will be scheduling two appointments, one for each resident, and provide LPA with the appoinement scheduled information from their PCP by POC due date, 12/19/2024. Licensee will later submit the residents LIC602 once their PCP completes their form.

Official classification

Type B

Official code

87458(b)(1)

Regulation authority

CCR

What the official deficiency says

(b) The medical assessment shall include, but not be limited to: (1) A physical examination of the resident indicating the physician's primary diagnosis and secondary diagnosis, if any and results of an examination for communicable tuberculosis, other contagious/infectious or contagious diseases or other medical conditions which would preclude care of the person by the facility. 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 1 out of 5 residents did not have their TB clearance on file which posed a potential health risk to persons in care.

Official plan of correction

POC Due Date: 12/25/2024 Plan of Correction Licensee will be contacting the resident's PCP to obtain a copy of their last TB to keep on file and submit a copy to LPA by POC due date, 12/19/24.

Official classification

Type B

Official code

80087(a)(1)

Regulation authority

CCR

What the official deficiency says

Facility shall take measures to keep the facility free of flies and other insects 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 2 bathrooms had cockroaches which posed a potential personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/30/2025 Plan of Correction Licensee will contact their pest control company to increase their services every other week and submit their invoices for at least a total of 4 invoices, to LPA by POC due date, 01/30/24. Once the removal of the insects have been cleared, they will seal the crevice(s).

Official classification

Type B

Official code

87555

Regulation authority

CCR

What the official deficiency says

87555 General Fod Service Requirememts Supplies of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days shall be maintained on the premises. This was not met as evidence by: Based on interviews, staff did not have sufficient food items during an inspection. This posed a potential health risk to 3 of 3 residents in care.

Official plan of correction

POC has been cleared. LPA observed that there is 1 week of non-perishable food items and 2 days of perishable food items on the premise.

Deadline recorded: Mar 18, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.1

Regulation authority

CCR

What the official deficiency says

87468.1 Personal Rights of Residents in All Facilities (14) To have reasonable access to telephones, to both make and receive confidential calls. This was not met as evidence by: Based on interviews, staff did not have a working telephone which posed a potential personal rights risk to 3 of 3 residents in care.

Official plan of correction

POC has been cleared during the visit. LPA observed that there was an operable telephone working on the facility premise.

Deadline recorded: Mar 18, 2024. A deadline is not proof that correction was completed.

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 observation, the licensee did not comply with the section cited above in that there were cockaroaches in the kitchen, bathroom, and garage areas, which posed a potential personal rights risk to 6 of 6 persons in care.

Official plan of correction

POC Due Date: 01/12/2024 Plan of Correction Licensee plans to call their pest control company for their services to be rendered weekly for the next month. Licensee will submit 4 receipts to LPA as confirmation that the pest control services were rendered to the facility and cockroaches were removed, due 1/12/2024.

Official classification

Type B

Official code

80072(a)(9)

Regulation authority

CCR

What the official deficiency says

80072 Personal Rights (a)(9) To receive or reject medical care, or health-related services, except for minors and other residents for whom a guardian, conservator, or other legal authority has been appointed. … this requirement was not met as evidenced by: Based on interviews and records review, staff did not notify resident’s responsible party regarding their medical appointments. This posed a potential health risk to one [R1] of six residents in care.

Official plan of correction

Administrator will obtain training from an outside service agency for residents Personal Rights and submit training certificate and/or documents to LPA by due date, 10/13/23.

Deadline recorded: Oct 13, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

1569.317

Regulation authority

HSC

What the official deficiency says

1569.317 Absentee Notification Plan for Missing Residents: “Every residential care facility for the elderly…shall…develop and comply with an absentee notification plan…The plan shall include…a requirement that an administrator of the facility, or his or her designee, inform the resident’s authorized representative when that resident is missing from the facility…and the circumstances in which [they] shall notify local law enforcement.” This requirement was not met, as evidenced by: Based on records and interview, the Licensee did not develop an absentee notification plan for 5 of 5 residents (R1 through R5), which posed a potential safety risk to persons in care.

Official plan of correction

Licensee agreed to author an Absentee Notification Plan meeting the requirements of California Health and Safety Code 1569.317. Licensee agreed to add it to the written record of care for R1 through R5 (and all future move-ins, too), and to train its direct care staff on it. Licensee agreed to send a copy of its Absentee Notification Plan, and the team training sign-in sheet, to LPA Nguyen, by the POC due date.

Deadline recorded: Sep 29, 2023. 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 shall maintain a fire clearance approved by the…district providing fire protection services, or the State Fire Marshall. Prior to accepting or retaining any of the following types of persons...the licensee shall notify the licensing agency and obtain an appropriate fire clearance…: (2) Bedridden persons.” This requirement was not met, as evidenced by: Based on records review and interviews, Licensee did not notify the licensing agency and obtain an appropriate fire clearance prior to retaining a bedridden resident (R3), who was 1 of 5 residents, which posed an immediate safety risk to persons in care.

Official plan of correction

By the POC due date, Licensee agreed to submit a cover letter and an LIC200 Application to the CCLD San Diego Regional Office (RO). The cover letter will state that R3 became bedridden on 06/28/2023, per their latest LIC602 Physician’s Report. The LIC200 will request permission for bedridden capacity of one (1) resident. These actions will prompt the RO to request a subsequent fire authority re-inspection for the facility.

Deadline recorded: Jul 13, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87217(b)

Regulation authority

CCR

What the official deficiency says

87217 Safeguards for Resident Cash, Personal Property, and Valuables: “(b) Every facility shall take appropriate measures to safeguard resident cash resources, personal property and valuables which have been entrusted to the licensee or facility staff.” This requirement was not met, as evidenced by: Based on records and interviews, the licensee did not take appropriate measures to safeguard resident cash resources that were entrusted to them, affecting 4 of 5 residents (R2 through R5), which posed a potential personal rights risk to persons in care.

Official plan of correction

Per interviews, on 05/25/2023, Licensee retrained its direct care staff on the importance of keeping the cabinet where resident monies are held locked, whenever it is not in immediate use. Licensee agreed to send to LPA a training sign-in sheet reflecting this, by the POC due date.

Deadline recorded: Aug 11, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87216(a)(1)

Regulation authority

CCR

What the official deficiency says

87216 Bonding: “(a) Each licensee…who is entrusted to safeguard resident cash resources, shall…have on file with the licensing agency a copy of a bond issued by a surety company to the State of California as principal. (1) The amount of the bond shall be in accordance with the following schedule: $750 or less safeguard = $1,000 bond required; $751 to $1,500 safeguarded = $2,000 bond required, $1,501 to $2,500 safeguarded = $3,000 bond required. Every further increment of $1,000 or fraction thereof shall require an additional $1,000 on the bond.” This requirement was not met, as evidenced by: Based on record review and interview, licensee did not possess a surety bond meeting the minimum amount required per regulation, based on the actual amount of resident monies that Licensee was safeguarding, which affected 4 of 5 residents (R1 through R4), and posted a potential personal rights risk to persons in care.

Official plan of correction

Licensee agreed to contact its surety bond company to increase its bond to $5,000. Licensee agreed to send to LPA a copy of a new/updated surety bond certificate, by the POC due date. During today’s visit, LPA printed out the text of 87216(a)(1), and its associated table, and handed it to licensee. Licensee agreed to keep this document inside their private office for future reference.

Deadline recorded: Aug 11, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87218(a)(1)

Regulation authority

CCR

What the official deficiency says

87218 Theft and Loss: “(a) The licensee shall ensure an adequate theft and loss program as specified in Health and Safety Code Section 1569.153. (1) The initial personal property inventory shall be completed by the licensee, and the resident, or the resident’s representative.” This requirement was not met, as evidenced by: Based on records and interviews, for 3 of 5 residents (R2, R3, and R4), Licensee did not maintain a personal property inventory, completed by the licensee and the resident and/or their representative, which posed a potential personal rights risk to persons in care.

Official plan of correction

Licensee agreed to coordinate with persons, as needed, to complete updated LIC621 Personal Property inventory forms for all current residents (R1 through R5), and to send copies of these forms to LPA, by the POC due date. Licensee agreed to review their internal policies/procedures, to ensure that the LIC621 is treated as a required document at time of move-in.

Deadline recorded: Aug 11, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87505(a)

Regulation authority

CCR

What the official deficiency says

87505 Admissions Agreements: “(a) The licensee shall complete an individual written admission agreement, as defined in Section 87101(a), with each resident or the resident's representative, if any.” This requirement was not met, as evidenced by: Based on LPA observation and staff interview, for 1 of 5 residents (R3), licensee did not complete an individual written admission agreement, which posed a potential personal rights risk to persons in care.

Official plan of correction

Licensee agreed to coordinate with persons, as needed, to complete an Admissions Agreement for R3. Licensee agreed to send a copy of the Admissions Agreement to LPA, by the POC due date. Licensee agreed to review their internal policies/procedures, to ensure that the signed Admissions Agreement is treated as a required document at time of move-in.

Deadline recorded: Aug 11, 2023. A deadline is not proof that correction was completed.