DELTA SENIOR CARE HOME

Official classification

Type B

Official code

87465(a)(2)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility...(2) The licensee shall provide assistance in meeting necessary medical and dental needs...This requirement was not met as evidenced by: Based on interviews and observation, Licensee did not ensure assistance with R1's use of wheelchair. This posed a potential health, safety, and resident rights risk to residents in care.

Official plan of correction

Licensee will develop and submit a plan to assist R1 with utilizing her wheelchair. Plan to include but not be limited to: Additional staff training for bed to wheelchair transfers. Plan to be submitted to LPA by POC due date.

Deadline recorded: Jun 12, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87468.1(a)(2)

Regulation authority

CCR

What the official deficiency says

87468.1 Personal Rights Of Residents in All Facilities. (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: Licensee did not secure an adequate prevention plan as an attempt to address an incident in which R2 awoken R1 at night multiple times. This posed an immediate health, safety risk, and resident rights risk to residents in care.

Official plan of correction

Licensee will complete and submit a plan outlining steps and procedures for prevention of R2 infringing on the rights of R1 and the engagement of altercations. Plan to include but not be limited to: Supervision options at night, and other documented efforts by staff. Plan to be submitted to LPA by POC due date.

Deadline recorded: Jun 3, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87405(d)(1)

Regulation authority

CCR

What the official deficiency says

87405 Administrator-Qualifications and Duties. (d)The administrator shall have the qualifications specified in Sections 87405(d)(1) through (7). (1) Knowledge of the requirements for providing care and supervision appropriate to the residents. This requirement was not as evidenced by: Based on interviews, record reviews, and observations, Licensee did not ensure Administrator initiate appropriate plans to mitigate or prevent known altercations between R1 and R2. This posed a potential health and safety risk to residents in care.

Official plan of correction

Licensee and designee will read regulation 87405(d)(1) and submit a signed declaration of understanding to LPA by POC due date.

Deadline recorded: Jun 12, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(h)(2)

Regulation authority

CCR

What the official deficiency says

Incidental Medical and Dental Care Services. Centrally stored medications shall be kept in a safe locked place that is not accessible to persons other than employees responsible for the supervision of the medication. his requirement was not met as evidencied by observation during the tour LPA observed medications in residents rooms and unlocked in the living room cabinet This is an immediate risk to residents in care.

Official plan of correction

Administrator shall secure all medications in locked area or locked cabinet by close of business of POC date.

Deadline recorded: Oct 16, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(a)(5)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care Services. (a) A plan for incidental medical and dental care shall be developed by each facility. (5) the licensee shall assist residents with self administered medications as needed. this requirement is not met as evidenced by: Based on LPA's observation R1 and R2 are missing medication which poses an immediate potential risk to resident's in care.

Official plan of correction

Administrator agrees to obtain all missing medications for R1 and R2. Licensee to send in a copy of the centrally stored medication record, indicating missing medications are available. By POC date 8/28/2025.

Deadline recorded: Aug 28, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87355(e)(1)

Regulation authority

CCR

What the official deficiency says

Criminal Record Clearance. Prior to working, residing or volunteering in a licensed facility, all individuals subject to a criminal record review shall obtain a clearance or criminal record exemption. This requirement is not met as evidenced by: interviews and records review, S1 is not associated to this facility This poses and immediate health and safety risk to residents.

Official plan of correction

Licensee will immediately ensure (S1) is finger print cleared and associated to facility prior to HER reporting to work. Proof of clearance and association shall be submitted to CCL prior to resuming duties. Administrator shall submit a Statement of Understanding regarding the requirements by POC date via email to CCL.IMMEDIATE CIVIL PENALTY ASSESSED

Deadline recorded: Aug 28, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87411(c)(1)

Regulation authority

CCR

What the official deficiency says

87411-Personnel Requirements - General-Staff providing care shall receive appropriate training in first aid from persons qualified by such agencies as the American Red Cross. LPA observed no first aid certification For S1. Based on this, facility is in violation of this section.

Official plan of correction

Identified individual shall obtain a current valid first aid certification. This shall be done within 1 day. Facility shall forward a copy to the LPA to clear this deficiency.

Deadline recorded: Aug 27, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87355(d)(3)

Regulation authority

CCR

What the official deficiency says

(d) All individuals subject to a criminal record review shall be fingerprinted and sign a Criminal Record Statement (LIC 508 [Rev. 1/03]) under penalty of perjury. (3) The licensee shall submit these fingerprints to the California Department of Justice, along with a second set of fingerprints for the purpose of searching the records of the Federal Bureau of Investigation, or comply with Section 87355(c), prior to the individual's employment, residence, or initial presence in the facility. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA review of staff record, the licensee did not comply with the section cited above. S1 did not have a fingerprint clearance for the facility which poses an immediate health, safety or personal rights risk to persons in care. Immediate Civil Penalty of $500.00 will be assessed on today's date.

Official plan of correction

POC Due Date: 01/20/2022 Plan of Correction Licensee agrees to submit a plan of correction by 1/20/2022 stating that all individuals need to be fingerprint cleared before working at the facility. Plan will be submitted via email to LPA Wallace by 1/20/2022 ruth.wallace@dss.ca.gov

Official classification

Type B

Official code

87303(e)(6)

Regulation authority

CCR

What the official deficiency says

(e) Water supplies and plumbing fixtures shall be maintained as follows: (6) Toilet, handwashing and bathing facilities shall be maintained in operating condition. Additional equipment shall be provided in facilities accommodating physically handicapped and/or nonambulatory residents, based on the residents' needs. 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. Both bathrooms have dry rot, cracked tiles, mold, floors need to be replaced or repaired, tubs/showers need to be repaired or replaced, and bathroom sinks which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/19/2022 Plan of Correction Licensee agrees to find a contractor to do the repairs or replacement in both bathrooms by Plan of Correction date of 4/19/22. If licensee needs an extension, LPA will be contacted because it is difficult to find contractors at this time. Licensee will submit via email the repair receipts, pictures of repairs or replacements in both bathrooms by 4/19/22. ruth.wallace@dss.ca.gov

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 observation, interview, and record review, the licensee did not comply with the section cited above in that items stored not in use in the garage, microwave not working order and kitchen cabinets with built up grease and food splatter, and floors in second resident room peeling not in good repair which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/30/2021 Plan of Correction The licensee agrees to remove, repair or replace all items not clean, safe, sanitary, or in good repair listed above and submit proof of picutres to LPA by POC due date.

Official classification

Type B

Official code

87705(c)(5)

Regulation authority

CCR

What the official deficiency says

(c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following: (5) Each resident with dementia shall have an annual medical assessment as specified in Section 87458, Medical Assessment, and a reappraisal done at least annually, both of which shall include a reassessment of the resident's dementia care needs. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview, and record review, the licensee did not comply with the section cited above in that R1's last update was 1/2020 which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/30/2021 Plan of Correction The licensee agrees to update residents medical assesments and submit a written declaration of plan to maintain compliance to this regulation at all to LPA by POC due date.