CYPRESS GARDEN HOME CARE

Official classification

Type A

Official code

87303(e)(2)

Regulation authority

CCR

What the official deficiency says

(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 the facility main restroom water tempearture was tested and measured 152.2 F which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/27/2026 Plan of Correction Administrator adjusted the water heater at visit, will retest water tomorrow and make any needed adjustments and provide a 7 day log to CCL of water tempeatures with in requirements of regualtion 105-120 degress Farnheit. Provide log to CCL.

Official classification

Type B

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). 1. For Certified Administrators, a copy their current and valid Administrative Certification meets this requirement. 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 Administrator did not have a current file at the facility and niether administrator ceritifcate was valid on visit which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/01/2026 Plan of Correction Administrator agreed to get files for all administrator and staff present at the facility and will call the administrator ceritircate bearu to follow up on the pending application and submitting a renewal applciation. Send a photo of files and valid certificates.

Official classification

Type B

Official code

1569.625(b)(1)

Regulation authority

HSC

What the official deficiency says

(1) The department shall adopt regulations to require staff members of residential care facilities for the elderly who assist residents with personal activities of daily living to receive appropriate training. This training shall consist of 40 hours of training. A staff member shall complete 20 hours, including six hours specific to dementia care, as required by subdivision (a) of Section 1569.626 and four hours specific to postural supports, restricted health conditions, and hospice care, as required by subdivision (a) of Section 1569.696, before working independently with residents. The remaining 20 hours shall include six hours specific to dementia care and shall be completed within the first four weeks of employment. The training coursework may utilize various methods of instruction, including, but not limited to, lectures, instructional videos, and interactive online courses. The additional 16 hours shall be hands-on 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 4 out of 4 files reviewed did not meet the requirement of hours or subjuect matter for 2025-2026 annual which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/01/2026 Plan of Correction Administrator agreed to have all staff take initials 40 hours or annual 20 hours for the 2026 annual training year. Provide proof of trianing for 4 staff with required hours and subjects to CCL.

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, the licensee did not comply with the section cited above in the facility did not have any records of quarterly disaster drills for the 2 quaters in 2026, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/01/2026 Plan of Correction Administrator agreed to do 2 quarterly disaster drills for 2026 and provide proof of those drills to CCL.

Official classification

Type B

Official code

87465(a)(3)

Regulation authority

CCR

What the official deficiency says

(a)...: (3)When residents require prosthetic devices, vision and hearing aids, the staff shall be familiar with the use of these devices, and shall assist such persons with their utilization as needed. This requirement was not met as evidenced by: Based on interview and medical records R1 wore hearing aid and the facility did not always assist R1 with the hearing aids when needed which poses a potential health, safety and personal rights risk to residents in care.

Official plan of correction

Administrator will review regulation 87465 and understand the requirements of staff and helping residents and provide training to staff in these requirements, send LIC 500 and proof of Licensee, administrator and staff training.

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

Official classification

Type B

Official code

87633(a)(2)

Regulation authority

CCR

What the official deficiency says

(a) The licensee shall be permitted to accept or retain residents who have been diagnosed as terminally ill by his or her physician and surgeon and who may or may not have restrictive and/or prohibited health conditions, to reside in the facility and receive hospice services from a hospice agency in the facility, when all of the following conditions are met: (2) The licensee remains in substantial compliance with the requirements of this section, with the provisions of the Residential Care Facilities for the Elderly Act (Health and Safety Code Section 1569 et seq.), all other requirements of Chapter 8 of Title 22 of the California Code of Regulations governing Residential Care Facilities for the Elderly, and with all terms and conditions of the waiver. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review and interviews, the licensee did not comply with the section cited above in which there are 3 hospice residents when the current wavier is for 2 which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/18/2024 Plan of Correction Administrator to submit Hospice waiver to increase wavier from 2 to 4.

Official classification

Type B

Official code

1569.605

Regulation authority

HSC

What the official deficiency says

On and after July 1, 2015, all residential care facilities for the elderly, except those facilities that are an integral part of a continuing care retirement community, shall maintain liability insurance covering injury to residents and guests in the amount of at least one million dollars ($1,000,000) per occurrence and three million dollars ($3,000,000) in the total annual aggregate, caused by the negligent acts or omissions to act of, or neglect by, the licensee or its employees. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation & record review, the licensee did not comply with the section cited above the Licensee/Administrator was unable to provide up to date liability insurance which poses 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 Licensee/Administrator agreed to obtain current liability insurance and provide copy of policy to CCL.

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 observation & record review, the licensee did not comply with the section cited above 3 staff did not have 2023 annual training which poses 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 Licensee/Administrator argeed to have all 3 staff take 2023 Annual Traning and provide records to CCL.

Official classification

Type A

Official code

87468.1(a)(2)

Regulation authority

CCR

What the official deficiency says

Personal Rights of Residents...: (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This requirement was not met as evidenced by: Based on interview with W1 the licensee did not comply with regulation above due to S2 answered the door without a mask on which poses an immediate health and safety risk to residents in care.

Official plan of correction

Administrator agreed to hold infectious control training, review and train staff on all recent PIN’s released for 2022, including masks wearing mandated, and provide copy of training and staff signatures to CCL.

Deadline recorded: Feb 10, 2022. A deadline is not proof that correction was completed.