JANIE'S HOME

Official classification

Type B

Official code

1569.605

Regulation authority

HSC

What the official deficiency says

1569.605 Liability insurance; coverage requirements... Based on interview, observation and record review, This requirement is not met as evidenced by the facility did not provide a copy of the current liability insurance which poses a potential risk to residents in care.

Official plan of correction

The administrator/licensee will provide a copy of the current liability insurance to CCL by 2/16/2026.

Deadline recorded: Feb 16, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87303(e)(2)

Regulation authority

CCR

What the official deficiency says

(e) Water supplies and plumbing fixtures shall be maintained as follows: (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) (interview) (record review)], the licensee did not comply with the section cited above as LPA observed the water temperature in the bathrooms were over 157 degrees F which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/30/2026 Plan of Correction This observation was made during last year's annual. The administrator will develop a plan to ensure the water temperature is within range 105-120 degrees F. The administrator will submit a copy of the plan of correction to CCL by 1/30/2026.

Official classification

Type A

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) (interview) (record review)], the licensee did not comply with the section cited above as LPA observed sharps were not locked and 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: 01/30/2026 Plan of Correction The administrator will develop a plan of correction to ensure compliance and the plan shall include staff training. The administrator will provide a copy of the plan of correction to CCL by 1/30/2026

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 as during the course of the inspection, LPA observed the medication room door was unlocked and opened which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/30/2026 Plan of Correction The administrator will develop a plan of correction to ensure compliance and the plan shall include staff training. The administrator will provide a copy of the plan of correction to CCL by 1/30/2026.

Official classification

Type A

Official code

87465(h)(5)

Regulation authority

CCR

What the official deficiency says

(h) The following requirements shall apply to medications which are centrally stored: (5) Each resident's medication shall be stored in its originally received container. No medications shall be transferred between containers. 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 as LPA observed resident's medications were removed from its original container and poured into a cup and the administrator stated that those were prepared for lunch and dinner which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/30/2026 Plan of Correction The administrator will develop a plan of correction to ensure medication is stored in its original container and not pre-poured for later administration times and the plan shall include staff training. The administrator will provide a copy of the plan of correction to CCL by 1/30/2026.

Official classification

Type B

Official code

87463(a)

Regulation authority

CCR

What the official deficiency says

(a) The pre-admission appraisal, as specified in Section 87457, Pre-Admission Appraisal, shall be updated, in writing as frequently as necessary or once every 12 months, whichever occurs first, to note significant changes in condition, as defined in Section 87101, Definitions, and to keep the appraisal accurate. For the purposes of this section, the updated pre-admission appraisal shall be referred to as the reappraisal. 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 as LPA observed R2's reappraisal was last completed on 1/17/2024 which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/06/2026 Plan of Correction The administrator will develop a plan of correction to ensure compliance and a copy of the updated reappraisal of R2 to CCL by 2/6/2026.

Official classification

Type A

Official code

87303(e)(2)

Regulation authority

CCR

What the official deficiency says

(e) Water supplies and plumbing fixtures shall be maintained as follows: (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) (interview) (record review)], the licensee did not comply with the section cited above as based on observation, hot water temperature in the kitchen ad bathroom were measured at 139- 156 degrees F which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/08/2025 Plan of Correction The administrator will develop a plan to ensure hot water temperature is within range, the plan shall include what action the facility will take to ensure compliance and what is the facility going to do to monitor hot water temperature on an on-going basis. In addition, the facility will monitor the hot water temperature from 1/8/2025- 1/15/2025 and submit the results to CCL by 1/16/2025.

Official classification

Type A

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 [(observation) (interview) (record review)], the licensee did not comply with the section cited above based on record review, Staff #1 (S1) did not have proof that on-the- job training was completed which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/08/2025 Plan of Correction The administrator will develop a plan to ensure S1 and all newly hired staff training is completed accordingly. In the plan, it shall indicate when S1 will be completing the required training. (no later than 1/14/2025). The administrator will submit a copy of the plan to CCL by 1/8/2025.

Official classification

Type A

Official code

1569.69(a)(2)

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: (2) In facilities licensed to provide care for 15 or fewer persons, the employee shall complete 10 hours of initial training. This training shall consist of 6 hours of hands-on shadowing training, which shall be completed prior to assisting with the self-administration of medications, and 4 hours of other training or instruction, as described in subdivision (f), which shall be completed within the first two weeks of employment. 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 as Staff #1 did not have proof that this training was completed which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/08/2025 Plan of Correction The administrator will develop a plan to ensure this training is completed for S1 and all newly hired staff. In the plan, it shall indicate when S1 will be completing the required training. (no later than 1/14/2025). The administrator will submit a copy of the plan to CCL by 1/8/2025.

Official classification

Type A

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 [(observation) (interview) (record review)], the licensee did not comply with the section cited above based on observation, record review and interview, the facility provided documentation indicating that the emergency and disaster drills were not completed accordingly which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/08/2025 Plan of Correction The administrator will develop a plan to ensure compliance and will submit a plan to CCL by 1/8/2025.

Official classification

Type A

Official code

87608(a)(3)

Regulation authority

CCR

What the official deficiency says

(a) Based on the individual's preadmission appraisal, and subsequent changes to that appraisal, the facility shall provide assistance and care for the resident in those activities of daily living which the resident is unable to do for himself/herself. Postural supports may be used under the following conditions: (3) A written order from a physician indicating the need for the postural support shall be maintained in the resident's record. The licensing agency shall be authorized to require other additional documentation if needed to verify the order. 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 as 3 out of 4 residents have bedrails by the head of the bed without a physician's order which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/08/2025 Plan of Correction The administrator will develop a plan to ensure a physician's order is obtained for the residents who have bedrails and in the plan, it shall indicate when an order will be obtained for all the residents. The administrator will provide a copy of the plan to CCL by 1/8/2025

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) (interview) (record review)], the licensee did not comply with the section cited above as facility did not have a current Liability Insurance which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/14/2025 Plan of Correction The administrator will provide a copy of the current Liability Insurance to CCL by 1/14/2025.

Official classification

Type A

Official code

87411(f)

Regulation authority

CCR

What the official deficiency says

87411 Personnel Requirements - General This requirement is not met as evidenced by: Based on record review, Staff #1 (S1)'s health screen was incomplete Deficient Practice Statement Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above as based on record review, Staff #1 (S1)'s health screen was incomplete which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/08/2025 Plan of Correction The administrator will develop a plan to ensure all staff's health screen is completed accordingly and the plan shall indicate the date that S1 will be completing the health screen process and the date shall be no later than 1/10/2025. The administrator will provide a copy of the plan to CCL by 1/8/2025.

Official classification

Type B

Official code

87458(a)

Regulation authority

CCR

What the official deficiency says

87458 Medical Assessment (a) Prior to a person's acceptance as a resident, the licensee shall obtain documentation of a medical assessment, signed by a licensed medical professional acting within the scope of their practice and made within the last year, to be kept in the resident's record. 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 based on observation, interview and record review, 2 out of 4 residents did not have a current medical assessment which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/14/2025 Plan of Correction The administrator will develop a plan to ensure all residents have a current medical assessment and the plan shall indicate the date of an updated medical assessment will be obtained for the residents identified.

Official classification

Type A

Official code

87305(a)

Regulation authority

CCR

What the official deficiency says

Prior to construction or alterations, all facilities shall obtain a building permit. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, record review and interview the licensee did not comply with the section cited above as LPA observed an Accessory Dwelling Unit (ADU) as living space in the garage without a proper permit which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/11/2024 Plan of Correction The Licensee/administrator will remove all the furniture in the ADU and send photo(s) to proof that it was completed by 1/11/24. In addition, administrator/licensee will provide a plan to ensure compliance.

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 and interview the licensee did not comply with the section cited above as sharps and chemicals were not locked and accessible to resident in care which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/11/2024 Plan of Correction The administrator/licensee will develop a plan to ensure compliance and will send photos to ensure locks are installed on the storage areas for the chemicals and sharps.

Official classification

Type A

Official code

87465(a)(6)

Regulation authority

CCR

What the official deficiency says

(6) When requested by the prescribing physician or the Department, a record of dosages of medications which are centrally stored shall be maintained by the facility. 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 as 4 out of 4 residents did not have Centrally Stored Medication Record which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/11/2024 Plan of Correction The administrator/licensee will provide a copy of the completed centrally stored medication record for all 4 residents by 1/11/2024.

Official classification

Type A

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 observation, record review and interview the licensee did not comply with the section cited above as drills were not completed accordingly which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/11/2024 Plan of Correction The administrator/licensee will submit a plan of compliance and provide a copy of the plan to CCL by 1/11/2024.

Official classification

Type A

Official code

87608(a)(3)

Regulation authority

CCR

What the official deficiency says

(a) Based on the individual's preadmission appraisal, and subsequent changes to that appraisal, the facility shall provide assistance and care for the resident in those activities of daily living which the resident is unable to do for himself/herself. Postural supports may be used under the following conditions: (3) A written order from a physician indicating the need for the postural support shall be maintained in the resident's record. The licensing agency shall be authorized to require other additional documentation if needed to verify the order. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, record review and interview the licensee did not comply with the section cited above as 3 out of 4 resident's appraisals were not signed by the facility representative and applicant and responsible party which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/11/2024 Plan of Correction The administrator/licensee will provide a copy of the signed and dated appraisal service needs and plans for all 3 residents to CCL by 1/11/2024.

Official classification

Type B

Official code

1569.69(a)(2)

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: (2) In facilities licensed to provide care for 15 or fewer persons, the employee shall complete 10 hours of initial training. This training shall consist of 6 hours of hands-on shadowing training, which shall be completed prior to assisting with the self-administration of medications, and 4 hours of other training or instruction, as described in subdivision (f), which shall be completed within the first two weeks of employment. 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 as staff #1 (S1) did not have documents to proof that the initial training was completed prior to working which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/17/2024 Plan of Correction The administrator/licensee will provide a copy of staff #1's required training record to CCL by 1/17/2024.

Official classification

Type B

Official code

87463(a)

Regulation authority

CCR

What the official deficiency says

(a) The pre-admission appraisal shall be updated, in writing as frequently as necessary to note significant changes and to keep the appraisal accurate. The reappraisals shall document changes in the resident's physical, medical, mental, and social condition. Significant changes shall include but not be limited to: This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, record review and interview the licensee did not comply with the section cited above as 1 out of 4 resident's appraisal service needs and plan was incomplete which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/17/2024 Plan of Correction The administrator/licensee will provide a copy of the completed appraisal service needs and plan to CCL by 1/17/2024.

Official classification

Type A

Official code

87465(h)(2)

Regulation authority

CCR

What the official deficiency says

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 as medications were observed in the living room to be unlocked and 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: 01/11/2024 Plan of Correction The administrator/licensee will provide a plan to ensure compliance to CCL by 1/11/2024.

Official classification

Type A

Official code

87355(e)(1)

Regulation authority

CCR

What the official deficiency says

87355 Criminal Record Clearance..(e) All individuals subject to a criminal record review..(1) Obtain a California clearance or a criminal record exemption as required by the Department This requirement is not met as evidenced by LPA observed S1 to be not fingerprint cleared which poses an immediately health risk to residents in care.

Official plan of correction

S1 was immediately sent home during LPAs visit. Licensee will ensure fingerprints and associations are up to date. A civil penalty of $100 is being assessed today.

Deadline recorded: Nov 6, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87412(a)

Regulation authority

CCR

What the official deficiency says

87412Personnel Records..(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 facility did not have S1 and S3's personnel files which poses an immediate health risks to resident in care.

Official plan of correction

The administrator/licensee will develop a plan to ensure compliance and in the plan, it shall indicate the date that the files will be completed by S1 and S2. The administrator will provide a copy of the signed and dated plan to CCL by 10/20/2023.

Deadline recorded: Oct 20, 2023. 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

87355 Criminal Record Clearance..(e) All individuals subject to a criminal record review..(1) Obtain a California clearance or a criminal record exemption as required by the Department This requirement is not met as evidenced by LPA observed S1 to be not fingerprint cleared which poses an immediately health risk to residents in care.

Official plan of correction

S1 was immediately sent home during LPAs visit. Licensee will ensure fingerprints and associations are up to date. A civil penalty of $500 is being assessed today.

Deadline recorded: Oct 20, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87405(d)(2)

Regulation authority

CCR

What the official deficiency says

87405 Administrator - Qualifications and Duties..(d) The administrator shall have the qualifications..(2) Knowledge of and ability to conform to the applicable laws, rules and regulations...This requirement is not met as evidenced by The administrator failed to ensure facility staff personnel files are adequate and staff is fingerprint cleared and associated prior to employment which poses an immediate health risks to resident in care.

Official plan of correction

The administrator will reviewed all the regulations that are cited today and will provide a signed/dated statement of acknowledgement after the review. The administrator will submit a copy of the signed/dated acknowledgement to CCL by 10/20/2023.

Deadline recorded: Oct 20, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87405(d)(2)

Regulation authority

CCR

What the official deficiency says

87405 Administrator - Qualifications and Duties..(d) The administrator shall have the qualifications..(2) Knowledge of and ability to conform to the applicable laws, rules and regulations...This requirement is not met as evidenced by administrator build a room in the garage without going through the proper procedure(s), administrator failed to provide notification to residents, CCL, and responsible parties of the construction, and failed to ensure the facility is clean, safe, sanitary and in good repair at all times which poses an immediately health risk to residents in care.

Official plan of correction

The administrator will reviewed all the regulations that are cited today and will provide a signed/dated statement of acknowledgement after the review. The administrator will submit a copy of the signed/dated acknowledgement to CCL by 10/20/2023.

Deadline recorded: Oct 20, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87305(a)

Regulation authority

CCR

What the official deficiency says

87305 Alterations to Existing Building or New Facilities... (a)Prior to construction or alterations, all facilities shall obtain a building permit. This requirement is not met as evidenced by facility build a room in the garage without a proper building permit which poses an immediate health risks to residents in care.

Official plan of correction

During today's visit, administrator/licensee provided a copy of the permit, however, inspection is incomplete as the administrator has not paid the fee. Licensee/administrator shall submit a plan in writing to ensure compliance Licensee/administrator will provide a copy of the plan to CCL by 10/20/2023.

Deadline recorded: Oct 20, 2023. 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

87468.1Personal Rights of Residents in All Facilities..(a) Residents in all residential care facilities shall have all of the following personal rights:..(2) To be accorded safe, healthful and comfortable accommodations.. This requirement is not met as evidenced by residents and responsible parties reported that the facility was very noise during the construction and resulted one resident moved out which poses an immediate health risks to residents in care.

Official plan of correction

The administrator will develop a plan to ensure residents are safe, and comfortable at all times and will submit a copy of the plan to CCL by 10/20/2023.

Deadline recorded: Oct 20, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

87303 Maintenance and Operation..a) The facility shall be clean, safe, sanitary and in good repair at all times. This requirement is not as evidenced by facility is under construction, facility appeared cluttered with construction supplies on the floor, kitchen supplies and spices on the floor, and kitchen appliances in the living room table. In addition, in the temporary kitchen, LPA cooking spices on the floor, cleaned and dirty bottles/containers were co-mingled on the floor, white unidentified powers on powder on the table, and kitchen utensils on the floor which poses an immediate health risk to resident in care.

Official plan of correction

The administrator will develop a plan to ensure the facility is clean, safe, and sanitary and in good repair at all times. The administrator will provide a copy of the plan to CCL by 10/20/2023

Deadline recorded: Oct 20, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.1(a)(4)

Regulation authority

CCR

What the official deficiency says

87468.1 Personal Rights of Residents in All Facilities..(a) Residents in all residential care facilities.. shall have all of the following personal rights:4) To be informed by the licensee of the provisions of law regarding complaints and of procedures for confidentially registering complaints,.. this requirement is not met as evidenced by facility removed all the required posters due to the construction which poses a potential health risks to residents in care.

Official plan of correction

The administrator will ensure all the required posters are posted and will send a photo to CCL by 10/26/2023 to proof that all the required posters are posted.

Deadline recorded: Oct 26, 2023. A deadline is not proof that correction was completed.