GOLDEN ACRES HOME AND CARE

Official classification

Type B

Official code

87465(h)(6)

Regulation authority

CCR

What the official deficiency says

87465(h)(6) Incidental Medical and Dental Care: The following requirements shall apply to medications which are centrally stored: The licensee shall be responsible for assuring that a record of centrally stored prescription medications for each resident is maintained… This requirement is not met as evidenced by: Deficient Practice Statement Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in 2 out of 2 medication administration records (MAR) were pre signed off prior to administrating evening medications. In addition medication, Cetirizine 10mg was not documented on the MAR which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/24/2026 Plan of Correction Facility staff agrees to conduct a medication audit by a third company by POC June 24, 2026. Facility staff agrees to email audit findings to LPA Oropeza by June 24, 2026 at 5:00pm.

Official classification

Type B

Official code

87470(c)

Regulation authority

CCR

What the official deficiency says

(c) An Infection Control Plan shall be developed by the licensee and shall be included in the Plan of Operation required by Section 87208. This requirement is not met as evidenced by: Deficient Practice Statement Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in which the licensee did not ensure that the facility had a an Infection Control. Plan which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/24/2026 Plan of Correction The facility staff agrees to complete the LIC 9282 Infection Control Plan and email to LPA Oropeza by POC June 24, 2026 by 5:00pm. The facility also agrees to update the Plan of Operation to reflect the Infection Control Plan.

Official classification

Type B

Official code

87307(d)(2)

Regulation authority

CCR

What the official deficiency says

(2) The premises shall be maintained in a state of good repair and shall provide a safe and healthful environment. This requirement is not met as evidenced by: Deficient Practice Statement Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in which the licensee did not ensure the bathroom vanity drawer was in good repair and ensure the non slip mat was in good repair and bedroom L ceiling was in good repair and ensure bathrooms were sanity and free of dust build up which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/24/2026 Plan of Correction Facility staff agrees to repair vanity door, remove hanging paint from the bedroom L ceiling, replace non slip mats and clean the dust. Facility staff agrees to email pictures of repairs to LPA Oropeza by POC date June 24, 2026 by 5:00pm.

Official classification

Type B

Official code

87506(b)

Regulation authority

CCR

What the official deficiency says

(b) Each resident's record shall contain at least the following information: 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 that [3] out of [5] facility resident files were missing required updated forms and documents which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/21/2025 Plan of Correction The facility designated Administrator stated that an audit of all facility resident files will be conducted. All files will be updated so that all required forms and documents will be present and complete at all times. A statement of correction, along with copies of the updated missing forms and documents, will be completed and submitted into CCL by the due date.

Official classification

Type A

Official code

1569.625(b)(2)

Regulation authority

HSC

What the official deficiency says

(2) In addition to paragraph (1), training requirements shall also include an additional 20 hours annually, eight hours of which shall be dementia care training, as required by subdivision (a) of Section 1569.626, and four hours of which shall be specific to postural supports, restricted health conditions, and hospice care, as required by subdivision (a) of Section 1569.696. This training shall be administered on the job, or in a classroom setting, or both, and may include online training. 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] out of [5] facility personnel files did not have updated annual training hours which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/16/2024 Plan of Correction The facility designated co-Administrator stated that all facility personnel providing care and supervision to the residents will receive the required number of annual training hours. A statement of correction, along with proof of updated training hours, will be completed and submitted into CCL by the due date. Proof of training will include name and length of the training courses given, name of trainer(s), and list of all attendees.

Official classification

Type B

Official code

87506(b)

Regulation authority

CCR

What the official deficiency says

(b) Each resident's record shall contain at least the following information: 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 [5] out of [5] facility resident files were missing required forms and documents which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/16/2024 Plan of Correction The facility co-Administrator stated that all facility resident files (26) will be reviewed to make sure that they are complete containing all required forms and documents. A statement of correction, along with copies of updated resident forms, will be completed and submitted into CCL by the due date.

Official classification

Type B

Official code

80087(a)

Regulation authority

CCR

What the official deficiency says

Buildings and Grounds The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors. This requirement was not met as evidenced by: Based on LPA Jensen's review of the supplemental invoice # 47973 for mold abatement from Indoor Restore and Licensee's own admission that mold abatement in the facility hallways has not been completed. This poses a potential risk to the health, safety and personal rights of residents in care.

Official plan of correction

The Licensee agrees to complete mold abatement and remediation and all work associated with the mold abatement and remediation such as ceiling repairs by a licensed contractor by 9/14/23 and will email the invoice to maja.jensen@dss.ca.gov by POC due date.

Deadline recorded: Sep 14, 2023. 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 Residents in all residential care facilities for the elderly shall have all of the following personal rights:... To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This requirement was not met as evidenced by: Based on LPA Jensen's review of the supplemental invoice # 47973 for mold abatement from Indoor Restore and Licensee's own admission that mold abatement in the facility hallways has not been completed. This poses a potential risk to the health, safety and personal rights of residents in care.

Official plan of correction

The Licensee agrees to provide a certificate of clearance for all areas where mold abatement work was conducted and all sample results for clearance testing of work and non-work related areas including Dining Room, Hallway by Dining Area, Piano Room, Front Desk Lobby Area, Back Exit Hallway, Room E.

Deadline recorded: Sep 14, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87405(h)(5)

Regulation authority

CCR

What the official deficiency says

Administrator Qualifications and Duties The administrator shall have the responsibility to: …Provide or ensure the provision of services to the residents with appropriate regard for the residents' physical and mental well-being and needs…This requirement was not met as evidenced by: Based on the License's inability to provide evidence that the hallways have been addressed for mold remediation during the course of a site visit on 7/20/23 and based on LPA Jensen receiving notification that the Licensee was provided an estimate for the work required on 5/25/23. This poses a potential risk to the health, safety and personal rights of residents in care.

Official plan of correction

The Licensee agrees to have the Administrator and the co-Administrator sign an attestation that CCR 87405 has been read, understood and will be complied with by 8/3/23

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

Official classification

Type A

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

Maintenance and Operation The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement was not met as evidenced by: Based on LPA Jensen's review of a Mold Inspection Report and visual inspection of the facility staff did not ensure the facility was kept free of mold. This poses a potential risk to the health, safety and personal rights of residents in care.

Official plan of correction

The Licensee has begun mold abatement and remediation and agrees to schedule additional testing of other areas in the facility by 5/24/23. The Licensee also agrees to schedule by 5/24/23, mold abatement and remediation work for the 2 remaining areas where air samples were taken.

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

Official classification

Type B

Official code

87211(a)(1)(D)

Regulation authority

CCR

What the official deficiency says

Reporting Requirements 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.... Any incident which threatens the welfare, safety or health of any resident...This requirement was not met as evidenced by: Based on interviews conducted the roof leaks occurred in January of 2023 and were not reported to the Department. This poses a potential health, safety and personal rights risk to residents in care.

Official plan of correction

The Licensee agrees to conduct in-service training on reporting requirements and submit proof of completion via email to maja.jensen@dss.ca.gov by 5/26/23.

Deadline recorded: Jun 2, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87755(c)

Regulation authority

CCR

What the official deficiency says

Inspection Authority of the Licensing Agency ... The licensing agency shall have the authority to inspect, audit, and copy resident or facility records upon demand during normal business hours....This requirement was not met as evidenced by: This requirement was not met as evidenced by LPA Jensen's written request that consent be provided on 5/10/23 which did not yet occur as of the date of this report. This poses a potential risk to the health, safety and personal rights of residents in care.

Official plan of correction

The Licensee agrees to provide written consent to the environmental services company contracted with for mold abatement and provide a copy of said consent to maja.jensen@dss.ca.gov by 5/26/23.

Deadline recorded: May 26, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPAs observation of ceiling damage in teh bedrooms and water pooling in the resident bedroom sink, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/05/2023 Plan of Correction The Licensee agrees to have the roof, ceiling and plumbing repaired and to email repair invoices to maja.jensen@dss.ca.gov by Plan of Correction due date.

Official classification

Type B

Official code

87211(a)(1)(D)

Regulation authority

CCR

What the official deficiency says

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... (D) Any incident which threatens the welfare, safety or health of any resident, such as psychological abuse of a resident by staff or other residents, or unexplained absence of any resident. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPAs review of a resident file and an interview with Administrator Maricel Tapo-Teske, the licensee did not comply with the section cited which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/11/2023 Plan of Correction The Licensee agrees to conduct in service training on reporting requirements and email proof of completion to maja.jensen@dss.ca.gov by Plan of Correction due date.

Official classification

Type B

Official code

87307(d)(2)

Regulation authority

CCR

What the official deficiency says

Personal Accomodations (2) The premises shall be maintained in a state of good repair and shall provide a safe and healthful environment. The licensee did not meet this requirement as evidenced by: Based on LPA Jensen's observation of debris stored on grounds including broken toilet and damaged shopping carts as well as observation of unsanitary vents in shower. This poses a potential health and safety risk to residents in care.

Official plan of correction

Licensee agrees to remove debris from backyard and email photos as proof of correction to maja.jensen@dss.ca.gov by 5/18/22. Licensee agrees to deep clean shower area and vents and email proof of correction to maja.jensen@dss.ca.gov by 5/18/22.

Deadline recorded: May 18, 2022. A deadline is not proof that correction was completed.