NEW HOPE GUEST HOME-ALPINE

Official classification

Type A

Official code

87303(a)

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 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 observation, the licensee did not comply with the section cited above in that there were cockroaches observed on the counters near the stove in the kitchen area which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/22/2026 Plan of Correction The facility designated representative stated that a licensed pest control company will be contracted to provide pest control services to eliminate, any and all pests, from this facility. A statement of correction, along with proof of contracted pest control services, will be completed and submitted into CCL by the due date.

Official classification

Type A

Official code

87309(d)(1)

Regulation authority

CCR

What the official deficiency says

(d) Residents may have access to items specified in subsection (c) for personal use unless there is documentation as specified in Section 87457, Pre-Admission Appraisal or Section 87463, Reappraisals, that indicates the resident's or other residents’ safety would be at risk if allowed access. (1) The licensee shall implement reasonable interventions in order to ensure that access to the items specified in subsection (c) does not pose a hazard to other residents. 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 the cabinets below the kitchen sink was left unsecured making knives and cleaning chemicals accessible which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/22/2026 Plan of Correction The facility designated representative stated that all cabinets housing knives, sharps, and cleaning supplies will always be locked to make them inaccessible to the residents in care at all times. A statement of correction, along with proof of updated staff training, for no less than (1) hour in duration, for properly securing storage areas with items that could possibly cause harm to the residents, will be completed and submitted into CCL by the due for review by this LPA.

Official classification

Type B

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 [1] out of [4] facility staff files did not have updated annual training hours which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/28/2026 Plan of Correction The facility designated representative stated that all staff files will be audited to make sure that they all contain the proper number of hours for initial/annual training. A statement of correction, along with proof of updated training for all facility staff, will be completed and submitted into CCL by the due date for review by this LPA.

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 [3] 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: 07/28/2026 Plan of Correction The facility designated representative stated that all resident files will be audited to make sure that they all contain the proper forms and documents. A statement of correction, along with proof of updated forms and documents for all facility resident files, will be completed and submitted into CCL by the due date for review by this LPA.

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, cleaning fluid, paint can, and gardening hedge clippers were accessible to residents in care, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/17/2023 Plan of Correction Licensee locked dangerous supplies to secure location during LPA's visit Licensee will submit a plan to ensure toxins and other dangerous items will remain inaccessible to residents in care. Plan to be submitted to LPA by POC due date.

Official classification

Type B

Official code

1569.695(c)

Regulation authority

HSC

What the official deficiency says

(c) A facility shall conduct a drill at least quarterly for each shift. The type of emergency covered in a drill shall vary from quarter to quarter, taking into account different emergency scenarios. An actual evacuation of residents is not required during a drill. While a facility may provide an opportunity for residents to participate in a drill, it shall not require any resident participation. Documentation of the drills shall include the date, the type of emergency covered by the drill, and the names of staff participating in the drill. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review and interview, the licensee did not ensure a quarterly fire drill due in June of 2023 which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/24/2023 Plan of Correction Licensee will ensure fire drill to be conducted by POC due date and submit proof of completion to LPA by POC due date. Licensee will submit a plan which ensures on-going timely fire drills conducted at least quarterly. Plan to be submitted to LPA by POC due date.

Official classification

Type B

Official code

87632(a)

Regulation authority

CCR

What the official deficiency says

87632 Hospice Waiver. (a) In order to accept or retain terminally ill residents and permit them to receive care from a hospice agency, the licensee shall have obtained a facility hospice waiver from the Department... This requirement is not met as evidenced by: Deficient Practice Statement Based on record review and interview, the licensee is currently providing hospice care for resident1 (R1) which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/17/2023 Plan of Correction Licensee will submit a hospice waiver request to LPA by POC due date. Licensee will read regulation 87632 and submit a signed declaration of understanding to LPA by POC due date.

Official classification

Type A

Official code

87405(h)(4)(5)

Regulation authority

CCR

What the official deficiency says

Administrator - Qualifications and Duties. The administrator shall perform the following duties…(4) Recruit, employ and train qualified staff… (5) 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 is not met as evidenced by: Based on incident from 1/3/23 administrator did not insure residents in care had basic services after a power outage ( heat, power, food), and did not report the incident to CCL until after a Health and safety check was conducted by LPA Johnson. This poses a immediate health and safety risk to clients in care.

Official plan of correction

Licensee/Administrator shall submit to LPA a written statement of understanding regarding Administrator Qualifications and Duties regulation section 87405 and its requirements by POC due date. Kesha.Lewis@dss.ca.gov

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

Official classification

Type B

Official code

87211

Regulation authority

CCR

What the official deficiency says

87211 Reporting Requirements (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... 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 was not met as evidenced by: An incident report for the facility power outage occurring on 12/31/2022 through 01/03/2023 was not reported to Community Care Licensing until LPA Johnson was notified by other means on 01/03/2023 which is beyond the required regulatory time frame. This poses a potential risk to the health, safety and personal rights of residents in care.

Official plan of correction

Licensee will submit a proposal for a Plan of Correction by Plan of Correction due date for review and approval by CCLD.

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

Official classification

Type A

Official code

80020(a)

Regulation authority

CCR

What the official deficiency says

80020(a) Fire Clearance. All facilities shall secure and maintain a fire clearance approved by the city or county fire department, the district providing fire protection services, or the State Fire Marshal. This requirement is not met as evidenced by: LPA observed 7 Clients at the facility. The facility is licensed for 6. This poses an immediate health and safety risk to clients in care.

Official plan of correction

Administrator/Licensee Robert Felix will remove one client to get into capacity.

Deadline recorded: Oct 19, 2022. 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

(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. LPA observed cleaning supplies unlocked in the garage and weed killer solution unlocked in a shed outside both accessible to residents in care. This poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/08/2022 Plan of Correction Licensee secured items during LPA's visit Licensee will conduct staff training on regulation 87309(a) and submit training date to LPA by POC due date. Proof of training to be submitted to LPA no later than one week from today's date of 7-8-22. Licensee will read regulation 87309(a) and submit a signed declaration of understanding to LPA by POC due date.