REMOLONA FAMILY GUEST HOME

Official classification

Type A

Official code

87202(a)(2)

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: (2) Bedridden persons 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 [13] facility residents were deemed to be bedridden and this facility did not have an appropriate bedridden fire clearance approved by the responsible fire department which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/28/2026 Plan of Correction The facility designated Administrator stated that all required forms and documents will be completed and submitted into CCL requesting for the appropriate bedridden fire clearance. A statement of correction, along with all completed forms and documents, will be submitted into CCL by the due date for review by this LPA.

Official classification

Type A

Official code

87303(e)(2)

Regulation authority

CCR

What the official deficiency says

(e) Water supplies and plumbing fixtures shall be maintained as follows: (2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degrees C) and not more than 120 degree F (49 degrees C). 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 [2] out of [2] resident restroom faucets where the hot water temperature was measured at 134.2 degrees which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/24/2024 Plan of Correction The facility designated Administrator stated that the hot water heater will be turned down to make sure that the hot water that is dispensed will always be within the allowed range of 105-120 degrees. A statement of correction, along with readings for the next 24 hours, will be recorded and submitted into CCL by the due date.

Official classification

Type A

Official code

87456(a)(3)

Regulation authority

CCR

What the official deficiency says

(a) Prior to accepting a resident for care and in order to evaluate his/her suitability, the facility shall, as specified in this article 8: (3) Obtain and evaluate a recent medical assessment. 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] facility resident files did not have an updated annual medical assessment completed for a dementia diagnosis resident which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/24/2024 Plan of Correction The facility designated Administrator stated that all resident files diagnosed with dementia will be reviewed and updated as necessary. A statement of correction, along with copies of the updated LIC 602s for the dementia diagnosed residents, will be completed and submitted into CCL by the due date.

Official classification

Type B

Official code

87303(c)

Regulation authority

CCR

What the official deficiency says

(c) All window screens shall be clean and maintained in good repair. 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 several window screens had holes, rips, or tears in them which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/30/2024 Plan of Correction The facility designated Administrator stated that a review of all window screens will be conducted. Any window screens with holes, rips, or tears in them will be repaired/replaced as needed. A statement of correction, along with a copy of all receipts for services rendered, will be completed and submitted into CCL by the due date.

Official classification

Type B

Official code

87506(a)

Regulation authority

CCR

What the official deficiency says

(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 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] 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: 04/30/2024 Plan of Correction The facility designated Administrator stated that the resident records will be reviewed and updated to contain all required forms and documents at all times. A statement of correction, along with copies of all updated forms and documents, will be completed and submitted into CCL by the due date.

Official classification

Type A

Official code

87303(e)(2)

Regulation authority

CCR

What the official deficiency says

(e) Water supplies and plumbing fixtures shall be maintained as follows: (2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degrees C) and not more than 120 degree F (49 degrees C). 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 [2] out of [2] resident restroom faucets where the hot water temperature was measured at 141.2 degrees which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/22/2023 Plan of Correction The facility designated Administrator stated that the hot water heater will be turned down to make sure that the hot water that is dispensed will always be within the allowed range of 105-120 degrees. A statement of correction, along with readings for the next 24 hours, will be recorded and submitted into CCL by the due date.

Official classification

Type A

Official code

87309(a)

Regulation authority

CCR

What the official deficiency says

(a) Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients. 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 [2] out of [2] resident restrooms had disinfectants present, and made available, to residents. In addition, the exterior laundry room was found to be unlocked which housed detergents, bleach, and additional cleaning supplies which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/22/2023 Plan of Correction The facility designated Administrator stated that the disinfectants will be removed from all resident restrooms and properly stored and made inaccessible to the residents at all times. In addition, the laundry room will be locked and made inaccessible to residents at all times. A statement of correction will be submitted into CCL by the due date.

Official classification

Type A

Official code

87412(a)(11)

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: (11) A health screening as specified in Section 87411, Personnel Requirements - General. 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] personnel records were missing required forms and documents related to TB clearance which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/22/2023 Plan of Correction The facility designated Administrator stated that the personnel records will be reviewed and all facility staff providing care and supervision to the residents will be TB cleared with documented proof on file at all times. A statement of correction, along with documented cleared TB and updated health screenings, will be completed and submitted into CCL by the due date.

Official classification

Type A

Official code

87412(c)

Regulation authority

CCR

What the official deficiency says

(c) Licensees shall maintain in the personnel records verification of required staff training and orientation. 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] personnel files were missing required initial/ongoing staff training which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/28/2023 Plan of Correction The facility designated Administrator stated that the personnel records will be reviewed and all facility staff providing care and supervision to the residents will be properly trained with documented proof on file at all times. A statement of correction, along with documented training, will be completed and submitted into CCL by the due date.

Official classification

Type A

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 [1] out of [5] persons did not have documented required 10 hours of initial training which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/28/2023 Plan of Correction The facility designated Administrator stated that the personnel records will be reviewed and all facility staff providing care and supervision to the residents will receive and complete the required 10 hours of initial training with documented proof on file at all times. A statement of correction, along with documented completion of 10 hours of initial training, will be completed and submitted into CCL by the due date.

Official classification

Type B

Official code

87412(b)

Regulation authority

CCR

What the official deficiency says

(b) Personnel records shall be maintained for all volunteers and shall contain the following: 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] personnel records were missing 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: 04/28/2023 Plan of Correction The facility designated Administrator stated that the personnel records will be reviewed and all facility staff providing care and supervision to the residents will be updated to contain all required forms and documents at all times. A statement of correction, along with copies of the updated staff files, will be completed and submitted into CCL by the due date.

Official classification

Type B

Official code

87507(d)

Regulation authority

CCR

What the official deficiency says

(d) The licensee shall retain in the resident's file the original signed and dated admission agreement and all subsequent signed and dated modifications. This does not apply to rate increases which have specific notification requirements as specified in Health and Safety Code section 1569.655. 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] 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: 04/28/2023 Plan of Correction The facility designated Administrator stated that the resident records will be reviewed and updated to contain all required forms and documents at all times. A statement of correction, along with copies of all updated forms and documents, will be completed and submitted into CCL by the due date.

Official classification

Type A

Official code

80088(e)(1)

Regulation authority

CCR

What the official deficiency says

80088(e)(1) Fixtures, Furniture Equipment and Supplies. Hot water delivered to fixtures used by clients shall attain a hot water temperature of not less than 105 degrees F (40.5 degrees C) and not more than 120 degrees F (48.8 degrees C). This requirement is not met as evidenced by: Based off of LPA and S1 observation the hot water when measured at 130.5 This poses immediate risk to residents in care.

Official plan of correction

Licensee will lower hot water temperature and tested hot water daily from same location hot water was tested (4) days and write down hot water daily testing to LPA. Fax to 916-263-4744

Deadline recorded: Oct 30, 2021. A deadline is not proof that correction was completed.