MAGNOLIA CARE HOME 1

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 5 out of 5 medication administration records (MAR) were pre signed off prior to administrating evening medications.

Official plan of correction

POC Due Date: 08/03/2026 Plan of Correction Facility staff agrees to conduct a medication audit by a third company by POC August 3, 2026. Facility staff agrees to email audit findings to LPA Oropeza by August 3, 2026 at 5:00pm.

Official classification

Type B

Official code

87411(c)(1)

Regulation authority

CCR

What the official deficiency says

(1) Staff providing care shall receive appropriate training in first aid from persons qualified by such agencies as the American Red Cross. This requirement is not met as evidenced by: Deficient Practice Statement Based on interview and record review, the licensee did not comply with the section cited above in 1 out of 2 staff did not have a current CPR/First Aid certificate which poses an potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/21/2026 Plan of Correction The administrator will have staff take an online CPR/first aide training and provide a copy of the certificate to LPA via e-mail by July 21, 2026 by 5:00pm.

Official classification

Type A

Official code

87555(b)(27)

Regulation authority

CCR

What the official deficiency says

(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)and (interview) , the licensee did not comply with the section cited above, failed to ensure the kitchen area was kept free of insects. During the inspection, multiple live cockroaches were observed in the kitchen, including the food preparation area, cabinets, kitchen counters and dining area,] which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/21/2026 Plan of Correction A licensed pest control company shall inspet and treat the facility for cockroaches. The licensee shall provide proof of pest control treatment by POC date July 21, 2026 by 5:00pm.

Official classification

Type A

Official code

87465(h)(2)

Regulation authority

CCR

What the official deficiency says

(h) The following requirements shall apply to medications which are centrally stored: (2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. 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 that centrally stored mediations were not maintained in a safe and locked location. During the inspection, LPA observed pre-pored medicaitons were left unattended and unsecured in the medication cabinet making them accessible to residents which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/21/2026 Plan of Correction The licensee shall immediately secure all centrally stored mediations are locked and only accessible to staff. All staff will be retrained on medication storage procedures and facility medication policies. The llicensee shall submit proff of staff training by POC date July 21, 2026 by 5:00pm.

Official classification

Type B

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) (interview) (record review)], the licensee did not comply with the section cited above in that the facility was not maintained in a clean, safe, sanitary and good repair. During the inspection, LPA observed a hole in the front screen door and cobwebs were observed throughout the facility, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/03/2026 Plan of Correction The licensee will remove all cobwebs throughout the facility and send a video via text to LPA Oropeza by POC date July 21, 2026 at 5:00pm at (916) 217-0362. The licensee shall repair the damaged front screen and send a picture via e-mail of repair to LPA Oropeza at Melina.Oropeza@dss.ca.gov by POC August 3, 2026 by 5:00pm.

Official classification

Type A

Official code

87468.1(a)(2)

Regulation authority

CCR

What the official deficiency says

87468.1 personal rights (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights:(2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This requirement was not met as evidenced by: record review of staff duty list not documenting wandering resident is checked at night. 2 staff interviews indicating that an inccident occured where wandering resident entered the room of another resident at night, this consitiutes a personal rights risk to clients in care.

Official plan of correction

nightly Logs from awake staff showing observations from the supervision at night, at minimum 2 hour checks to know if the residents are agitated and in need of intervention, should be sent to the LPA end of day tomorrow, 9/4/25 and then again at the end of the month 9/30/25. the practice should continue as long as dementia residents with wandering behavior are in care.

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

Official classification

Type B

Official code

87309(a)

Regulation authority

CCR

What the official deficiency says

(a) Except as specified in subsection (b), the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances, knives, matches, tools, sharp objects, and other similar items which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage. 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 20+ containers of soaps/shampoos/detergents/hair products which posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/29/2025 Plan of Correction Put the chemicals away in lockable storage, no poc requred.

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 3 out of 3 records which posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/29/2025 Plan of Correction Licensee will complete required trainings for topics in dementia care for the staff, send the LPA an signed afidavit that the trainings were completed with a signature by staff, topic titles, and hours completed per training.

Official classification

Type B

Official code

87303(e)(2)

Regulation authority

CCR

What the official deficiency says

87303(e)(2) Maintenance and Operation -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 degree C) and not more than 120 degree F (49 degree C)-This requirement was not met as evidenced by observation: Hot water measured at 68.5*F in residents bathroom.This poses a potential health and safty risks to residents.

Official plan of correction

Administrator shall have the water heater repaired. Administrator shall test the hot water each day for 3 days and send in the hot water measurement sheet to LPA by the POC due date.

Deadline recorded: May 12, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87705(c)(5)

Regulation authority

CCR

What the official deficiency says

Care of Persons with Dementia Licensees who accept and retain residents with dementia shall ensure that each resident with dementia has an annual medical assessment and a reappraisal done at least annually. LPA observed that R1 diagnosed with dementia didn't have an updated LIC 602

Official plan of correction

All residents diagnosed with dementia will be scheduled with their physician and be assessed for any changes to their needs with an updated LIC 602.

Deadline recorded: May 19, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87705(I)(8)

Regulation authority

CCR

What the official deficiency says

87705(I)(8) Care of Persons with Dementia. Fire and earthquake drills shall be conducted at least once every three months on each shift and shall include, at a minimum, all direct care staff. This requirement is not met based on: LPA was observed that the last drill was conducted on 8/29/2022, which posed an immediate risk to residents in care.

Official plan of correction

The facility shall develop and implement a policy regarding fire drill and earthquake drill practices and procedures that include conducting fire drills at least once every three months on each shift and shall include, at a minimum, all direct care staff. Send copy of updated policy and fire drill log by POC date

Deadline recorded: Apr 29, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87411(c)

Regulation authority

CCR

What the official deficiency says

All staff who assist residents with personal activities of daily living shall receive at least ten hours of initial training within the first four weeks of employment and at least four hours annually thereafter. LPA did not observe any documentation of annual staff training for S1 and S2

Official plan of correction

Facility representative stated that all staff providing care and supervision to the residents will receive the required annual hours of training. Proof of training to be submitted into CCL by the due date with info regarding trainer, training topics with length of duration, and attendees.

Deadline recorded: May 12, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87224(b)

Regulation authority

CCR

What the official deficiency says

87224 Eviction Procedures (b) The licensee may, upon obtaining prior written approval from the licensing agency, evict the resident upon three (3) days written notice to quit. The licensing agency may grant approval for the eviction upon a finding of good cause. Good cause exists if the resident is engaging in behavior which is a threat to the mental and/or physical health or safety of himself or to the mental and/or physical health or safety of others in the facility. This regulation was not met as evidence by based on the interviews conducted, the licensee did not ensure proper procedures and approval was received prior to not accepting the resident back into care. This poses a potential risks to resident in care.

Official plan of correction

Licensee will write a letter acknowledging understanding of regulation and submit to LPA by POC date.

Deadline recorded: Dec 2, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87463(a)

Regulation authority

CCR

What the official deficiency says

Reappraisals. (a) The pre-admission appraisal shall be updated in writing…as frequently as necessary to note significant changes and to keep the appraisal accurate. This requirement is not met as evidenced by: text message saying that R1's rent increase would take place on August 4 the same day they said her level of care changed. On 8/16 the facility gave the family a 30 day notice to move R1. This poses a potential health and safety risk to residents in care.

Official plan of correction

Licensee will develop a plan to ensure all resident appraisals are updated as appropriate to meet the needs of residents in care. Plan to be submitted to LPA by POC due date.

Deadline recorded: Dec 2, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

80075(k)(1)

Regulation authority

CCR

What the official deficiency says

80075(k)(1) Health Related Services. Medication shall be kept in a safe and locked place that is not accessible to persons other than employees... Based on observation, the licensee failed to keep medications in a safe and locked place. LPA observed unlocked medication in the kitchen drawer and the refrigerator. This poses an immediate health and safety risk to residents in care.

Official plan of correction

The facility immediately lock/secure medications. The licensee shall conduct a staff in-service pertaining to medication storage and toxins (topic, instructor, date, time, names, signatures) and provide to LPA via email by 8/30/2022.

Deadline recorded: Aug 30, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

80088(e)(1)

Regulation authority

CCR

What the official deficiency says

Hot water temperature controls shall be maintained to automatically regulate temperature of hot water delivered to plumbing fixtures used by clients to attain a hot water temperature of not less than 105 degrees F and not more than 120 degrees F. This requirement is not met as evidenced by: Hot water temperature was measured at 126.5' This poses an immediate health and safety risk to residents in care.

Official plan of correction

Facility shall adjusted hot water temperature to not less than 105 degrees F and not more than 120 degrees F. LPA requested hot water temperature logs over the course of the next 7 days to clear the cited deficiency Hot water logs are to provide proof that hot water is being maintained within the regulatory requirements.

Deadline recorded: Aug 30, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87705(l)(8)

Regulation authority

CCR

What the official deficiency says

87705 (l)(8)-Care of persons with dementia. Fire and earthquake drills shall be conducted at least once every three months on each shift and shall include, at a minimum, all direct care staff.- There was no documentation that a recent fire drill had been conducted. This poses an immediate health and safety risk

Official plan of correction

Administrator shall conduct a fire drill and send proof of that a fire drill was conducted to CCL by the POC due date.

Deadline recorded: Aug 30, 2022. A deadline is not proof that correction was completed.