J & M CARE HOME

Official classification

Type A

Official code

87412(a)(13)(B)

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: (13) For employees that are required to be fingerprinted pursuant to Section 87355, Criminal Record Clearance: (B) Documentation of either a criminal record clearance or a criminal record exemption as required by Section 87355(e). 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 [3] facility personnel did not possess proper fingerprint clearance and association to this facility which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/28/2025 Plan of Correction The facility designated representative stated that all facility personnel records will be updated to contain all of the required forms and documents related to fingerprint clearance and association and submit proof of correction into CCL by the due date. Proof of correction will entail copies of the updated forms and documents for facility personnel fingerprint clearance and association along with a statement of correction.

Official classification

Type A

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 record review, the licensee did not comply with the section cited above in [2] out of [3] facility personnel did not possess current First aid training which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/28/2025 Plan of Correction The facility designated representative stated that all facility personnel records will be updated to contain all of the required forms and documents and submit proof of correction into CCL by the due date. Proof of correction will entail copies of the updated forms and documents for first aid training and certification along with a statement of correction.

Official classification

Type A

Official code

1569.69(a)

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: 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 [3] facility personnel was dispensing medications without any certified hours of required medication training which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/28/2025 Plan of Correction The facility designated representative stated that all facility personnel records will be updated to contain all of the required forms and documents and submit proof of correction into CCL by the due date. Proof of correction will entail copies of the updated forms and documents for facility personnel medication training along with a statement of correction.

Official classification

Type A

Official code

87625(b)(3)

Regulation authority

CCR

What the official deficiency says

(b) In addition to Section 87611, General Requirements for Allowable Health Conditions, the licensee shall be responsible for the following: (3) Ensuring that incontinent residents are kept clean and dry and that the facility remains free of odors from incontinence. 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 incontinent odors were prevalent throughout this facility which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/28/2025 Plan of Correction The facility designated representative stated that all facility residents will be changed and toileted on a regular basis and submit proof of correction into CCL by the due date. Proof of correction will entail copies of the updated forms and documents for facility residents' care plan with toileting schedules and incontinence care along with a statement of correction.

Official classification

Type A

Official code

87628(a)

Regulation authority

CCR

What the official deficiency says

(a) The licensee shall be permitted to accept or retain a resident who has diabetes if the resident is able to perform his/her own glucose testing with blood or urine specimens, and is able to administer his/her own medication including medication administered orally or through injection, or has it administered by an appropriately skilled professional. 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 residents was unable to administer and handle any of their medications, including administering injections to oneself, and had to rely on the facility staff which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/28/2025 Plan of Correction The facility designated representative stated that an updated plan of care will be implemented to address the care needs, specifically for diabetes injection, for this resident and submit proof of correction into CCL by the due date. Proof of correction will entail copies of the updated forms and documents for facility resident care plan along with a statement of correction.

Official classification

Type B

Official code

87412(a)

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: 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 [3] facility personnel did not even have a file with all of the 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: 07/04/2025 Plan of Correction The facility designated representative stated that all facility personnel records will be updated to contain all of the required forms and documents and submit proof of correction into CCL by the due date. Proof of correction will entail copies of the updated forms and documents for facility personnel along with a statement of correction.

Official classification

Type B

Official code

87411(d)

Regulation authority

CCR

What the official deficiency says

(d) All personnel shall be given on the job training or have related experience in the job assigned to them. This training and/or related experience shall provide knowledge of and skill in the following, as appropriate for the job assigned and as evidenced by safe and effective job performance: 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 [2] out of [3] facility personnel records did not contain the required hours of initial and ongoing training which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/04/2025 Plan of Correction The facility designated representative stated that all facility personnel will be updated to obtain all of the required hours for initial and ongoing training, with certification, and submit proof of correction into CCL by the due date. Proof of correction will entail copies of the updated initial and ongoing training hours for all facility personnel along with a statement of correction.

Official classification

Type B

Official code

87468.1(a)(3)

Regulation authority

CCR

What the official deficiency says

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: (3) To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature…This requirement was not met as evidenced by: Based on interviews, S1 directed inappropriate language towards R1. This posed a potential health, safety, and resident rights risk to resident in care.

Official plan of correction

Licensee will ensure completed staff training on resident rights and submit proof of completed training to LPA by POC due date. Licensee to include training on staff disengagement from potential negative interactions with residents.

Deadline recorded: May 6, 2024. 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

87303(a)Maintenance and Operation. The facility shall be clean, safe, 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 observation, the licensee failed to repair the wooden gate access so that it provided secure access to the side of the home. Which poses a potential Health, Safety or Personal Rights risk to residents in care

Official plan of correction

Licensee will submit a plan for fixing the side gate post by POC date.

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

Official classification

Type A

Official code

87464(f)(1)(c)

Regulation authority

CCR

What the official deficiency says

Basic Services (c) " Care and supervision " means the facility assumes responsibility for, or provides... assistance with activities of daily living without which the resident’s physical health, mental health, safety, or welfare would be endangered. Assistance includes ...personal care. This requirement was not met as evidenced by: based on witness observation by the ombudsmen office. This poses an immediate health and safety risk to resident.

Official plan of correction

Licensee will review the regulation listed and submit a letter of understanding on basic services, and care and supervision to the department by COB on 6/21/2023.

Deadline recorded: Jun 21, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

1569.311

Regulation authority

HSC

What the official deficiency says

Every residential care facility for the elderly shall have one or more carbon monoxide detectors in the facility that meet the standards established in Chapter 8 (commencing with Section 13260) of Part 2 of Division 12. The department shall account for the presence of these detectors during inspections. 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 in 1 out of 1 carbon monoxide alarms.There is no carbon monoxide detector, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/09/2023 Plan of Correction Licensee will purchase a carbon monoxide alarm today and provide a proof of purchase with a copy of a receipt and an image of the installed carbon monoxide alarm by end of day on 05.09.2023

Official classification

Type A

Official code

87411(a)

Regulation authority

CCR

What the official deficiency says

87411(a): Personnel Requirements- General (a)Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. This requirement was not met as evidence by: Based on record review, the facility did not comply with section 87411(a). Based on record review, R1 AWOL'd from the facility. The LIC 602 states the resident was not allowed to leave the facility unassisted. This presents an immediate health and safety risk to the resident in care.

Official plan of correction

The facility agreed to conduct an in-service training with staff to go over what and how staff shall ensure that residents do not AWOL. Administrator will submit proof to CCLD by POC date.

Deadline recorded: Apr 8, 2022. 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

(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 LPAs observation, the licensee did not comply with the section cited above in 87465(h)(2). LPAs observed unlocked medications which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/07/2022 Plan of Correction Caregiver locked medications. Administrator agreed to complete in-service training with staff regarding locked medications. Administrator will submit proof to CCLD by POC date.

Official classification

Type A

Official code

87465(i)

Regulation authority

CCR

What the official deficiency says

(i) Prescription medications which are not taken with the resident upon termination of services, not returned to the issuing pharmacy, nor retained in the facility as ordered by the resident’s physician and documented in the resident’s record nor disposed of according to the hospice’s established procedures or which are otherwise to be disposed of shall be destroyed in the facility by the facility administrator and one other adult who is not a resident. Both shall sign a record, to be retained for at least three years, which lists the following: This requirement is not met as evidenced by: Deficient Practice Statement Based on LPAs observation, the licensee did not comply with the section cited above in 87465(i). LPAs observed expired medication not properly disposed which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/13/2022 Plan of Correction Facility agreed to properly dispose medication and submit proof to CCLD by POC date.

Official classification

Type B

Official code

87555(b)(8)

Regulation authority

CCR

What the official deficiency says

(b) The following food service requirements shall apply: (8) All food shall be of good quality. Commercial foods shall be approved by appropriate federal, state and local authorities. Food in damaged containers shall not be accepted, used or retained. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPAs observation, the licensee did not comply with the section cited above in 87555(b)(8). LPAs observed expired canned goods and meat not properly packaged which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/14/2022 Plan of Correction Caregiver removed expired food and threw away packaged meat. Deficiency cleared during inspection

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 LPA observation, the licensee did not comply with the section cited above in 87309(a). LPA observed screw drivers, tools, scissors, cleaning solutions, and hammers which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/14/2021 Plan of Correction Adminsitrator removed tools and cleaning solutions and locked it away. Adminsitrator agreed to complete in-service training and submit proof to CCLD by 05/28/2021

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 the licensee did not comply with the section cited above in87303(a). LPA observed 2 missing knobs on kitchen stove which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/21/2021 Plan of Correction Administrator agreed to provide knobs for kitchen stove and submit photo to CCLD by POC date.

Official classification

Type B

Official code

87307(d)(4)

Regulation authority

CCR

What the official deficiency says

(4) Stairways, inclines, ramps and open porches and areas of potential hazard to residents with poor balance or eyesight shall be made inaccessible to residents unless equipped with sturdy hand railings and unless well-lighted. 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 in 87307(d)(4). LPA observed missing wood from backyard ramp which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/28/2021 Plan of Correction Adminsitrator agreed to repair missing wood from ramp and submit proof to CCLD by POC date.