ANGEL'S GUEST HOME #1

Official classification

Type B

Official code

87412(d)

Regulation authority

CCR

What the official deficiency says

(d) The licensee shall maintain documentation that an administrator has met the certification requirements specified in Section 87406, Administrator Certification Requirements or the recertification requirements in Section 87407, Administrator Recertification Requirements. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA observation, record review, and staff interview, the licensee did not comply with the section cited above in that the Administrator did not have an up to date Administrator's Certificate which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/30/2026 Plan of Correction Licensee stated designated staff will obtain a Administrator's Certificate and submit to LPA by POC due date.

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 LPA observation, the licensee did not comply with the section cited above in 4 out of 4 residents did not have medications stored in originally received container which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 04/30/2026 Plan of Correction Licensee stated that staff will immediately cease placing medications in weekly containers. Staff will take a training on medication administration and provide LPA proof of training by POC due dtae.

Official classification

Type B

Official code

87303(a)(1)

Regulation authority

CCR

What the official deficiency says

The facility shall be clean, safe, sanitary and in good repair at all times. ...maintenance services and procedures for ... employees and visitors. Floor surfaces in bath, laundry and kitchen areas shall be maintained in a clean, sanitary, and odorless condition. This regulation was not met as evidenced by: Based on LPAs observations the facility had accumalated clutter, and surfaces including counter tops and floors were observed to be unsanitary at the time of visit. This posed a potential health risk to 5:5 residnets in care.

Official plan of correction

During today's visit LPA observed the facility was well kempt. Staff have put cleaning procedures in place, and the Licensee cleared out a lot of the clutter. Deficiency had beens cleared.

Deadline recorded: Apr 4, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87506(d)

Regulation authority

CCR

What the official deficiency says

All resident records shall be available to the licensing agency to inspect, audit, and copy upon demand during normal business hours. Records may be removed if necessary for copying.... This requirement was not met as evidence by: Based on a records request the Licensee did not provide resident records to the Department. This posed a potential health and safety risk to 1 out of 5 residents in care.

Official plan of correction

Licensee McEvoy will conduct an audit on resident records to ensure complete and accurate information. Licensee will organize records and house them in an accessible area. POC due date is 4/24/2023.

Deadline recorded: Apr 24, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

1569.652

Regulation authority

HSC

What the official deficiency says

Termination... upon death of resident; removal of resident’s property; refund of fees paid; notice of contract termination and refunds. A refund of any fees...covering the time after the resident’s... property has been removed ...shall be issued...within 15 days... Based on interviews the Licensee did not issue a refund upon the death of R1. This poses a potential personal right violation to 1 out of 6 residents in care.

Official plan of correction

Licensee agreed to conduct a cost analysis utilizing CCL's LIC 401 Monthly Operating Statement form. Licensee also agreed to attend, including facility Administrator, CCL approved vendorized training regarding refunds/reimbursements per Title 22 mandate.

Deadline recorded: Apr 21, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87555

Regulation authority

CCR

What the official deficiency says

87555 General Food Service Requirements (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 was not met as evidenced by: Based on LPA observations, Licensee had an infestation at the facility. This posed a potential health risk to 6 out of 6 residents in care.

Official plan of correction

Licensee stated they would aquire new pest control services, wipe down the kitchen pantry, kitchen drawers and side of the refrigerator daily and implement a kitchen cleaning log for the next month. Licensee stated they would submit verification to the department by 03/09/2023.

Deadline recorded: Mar 9, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87307

Regulation authority

CCR

What the official deficiency says

87307 Personal Accommodations and Services (d)(6) All outdoor and indoor passageways and stairways shall be kept free of obstruction. This requirement was not met as evidenced by: Based on LPA observations, the licensee did not keep pathways free from obstruction. This posed a potential safety risk to 6 out of 6 residents in care.

Official plan of correction

Licensee stated they would remove all trash items from both side exits and the garage and will purchase a storage shed to store remaining items. Pictures will be sent to the deparmtent 03/09/2023.

Deadline recorded: Mar 9, 2023. A deadline is not proof that correction was completed.