EBADAT RESIDENTIAL CARE HOME #6

Official classification

Type A

Official code

87202(a)(2)

Regulation authority

CCR

What the official deficiency says

87202(a)(2) – Fire Clearance: “All facilities shall maintain a fire clearance approved by the...fire department or district providing fire protection services, or the State Fire Marshal. Prior to accepting or retaining any of the following types of persons, the applicant or licensee shall notify the licensing agency and obtain an appropriate fire clearance... (2) Bedridden persons.” This requirement is not met as evidenced by: Deficient Practice Statement Based on interview and record review conducted on 08/17/2026 and 08/20/2026, the licensee did not comply with the section cited above in 1 out of 6 persons, R1, who was retained as a bedridden resident without the appropriate fire clearance, which poses an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 08/21/2026 Plan of Correction Licensee stated they will request reassessment and relocation of R1 through the service coordinator. If R1 remains, Licensee will pursue the appropriate fire clearance. A written plan of correcntion (POC) and memorandum of understanding (MOU) will be submitted to CCL on or before close of busines of 08/21/2026.

Official classification

Type A

Official code

87307(d)(6)

Regulation authority

CCR

What the official deficiency says

87307– Personal Accommodations and Services (d) The following space and safety provisions shall apply to all facilities: (6)All outdoor and indoor passageways and stairways shall be kept free of obstruction. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation conducted on 08/17/2026, the licensee did not comply with the section cited above in 1 out of 1 observed passageway, where a bed obstructed access to a sliding door leading to an exterior ramp, which poses an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 08/21/2026 Plan of Correction Licensee stated that he/she will reposition the bed to keep the passageway unobstructed and submit proof of correction to CCL on or before end of day of 08/21/2026.

Official classification

Type A

Official code

87303(c)

Regulation authority

CCR

What the official deficiency says

87303 Maintenance and Operation (c) All window screens shall be clean and maintained in good repair. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation conducted on 08/17/2026, the licensee did not comply with the section cited above in 1 out of 1 observed window screen, which was damaged and not maintained in good repair, which poses an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 08/21/2026 Plan of Correction Licensee stated that he/she will repair or replace the damaged screen and submit photographic proof to CCL on or before the end of day of 08/21/2026.

Official classification

Type B

Official code

87463(a)

Regulation authority

CCR

What the official deficiency says

87463 Reappraisal (a) The pre-admission appraisal...shall be updated in writing as frequently as necessary or once every 12 months, whichever occurs first...and to keep the appraisal accurate. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review conducted on 08/17/2026, the licensee did not comply with the section cited above in 1 out of 3 resident records reviewed, R3, whose most recent appraisal was dated 01/22/2024 and no current reappraisal was available for review, which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 09/03/2026 Plan of Correction Licensee will complete R3’s reappraisal and submit proof of completion to CCL on or before the POC due date of 09/03/2026.

Official classification

Type B

Official code

87202(a)

Regulation authority

CCR

What the official deficiency says

(a) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, or the State Fire Marshal. Prior to accepting or retaining any of the following types of persons, the applicant or licensee shall notify the licensing agency and obtain an appropriate fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, or the State Fire Marshal: 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. Based on observation, facility shed in the backyard. LPA noted there was a mattress, cloths, medications, with a power cord inside.LPA also noted there was a fan, a heater pointed towards the bed. ADM confirmed there is a staff who sleeps in the shed. which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/11/2025 Plan of Correction LN stated he will remove all personal belongings, and ensure the facility shed is being used as stoarge only. LN stated he will send LPA photo documenation showing the shed in the backyard is only being used as a storage space.

Official classification

Type B

Official code

87305(a)

Regulation authority

CCR

What the official deficiency says

(a) 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,interview, record review, the licensee did not comply with the section cited above. Based on observation, the facility office and sitting room does not reflect the current facility fire cleareance. LN confirmed he did add a partition wall in the sitting room. LN confirmed the additional bedroom in the office does not have a permit. This poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/11/2025 Plan of Correction LN stated he has already obtained a permit to demolish and rebuild the office. LN stated once it has been completed, he will inform licensing. LN stated, he will get a permit for the partiton wall for the inbetween area of the living room and sitting room. LN stated he will either get a permit to keep the wall, by POC date, August 11, 2025.

Official classification

Type B

Official code

87412(a)(11)

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: (11) A health screening as specified in Section 87411, Personnel Requirements - General. 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. S1's health screening did not have the evaluation of general health/ evaluation of ability to preform work / note any health condition/ the physician's stamp/signature. ADM stated S1 would get a new updated health screening in 1 week. which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/11/2025 Plan of Correction ADM stated S1 will complete a new health screening. ADM stated she will send LPA a copy of the updated health screening to LPA by POC date, August 11, 2025.

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. Based on a review of the facility's disaster drill log, the last drill conducted was on August 20, 2024. This poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/11/2025 Plan of Correction LN stated they will conduct a drill. LN stated he will send documenation showing a drill has taken place. LN stated he will send a letter of understanding regarding the regulation. LN stated he will send the POC letter to LPA by POC date, August 11, 2025.

Official classification

Type A

Official code

87355(e)(2)

Regulation authority

CCR

What the official deficiency says

87355 Criminal Record Clearance (e) All individuals...pursuant to Health and Safety Code Section 1569.17(b) shall prior to working... in a licensed facility: (2)Request a transfer of a criminal record clearance...This section is not met as evidenced by: Based on interview & record review, DADM stated S2 started working at the facility on 2/28/2025 and application to transfer or associate S2 has was not submitted to CCLD prior to S2 working at the facility which pose/poses an immediate health and personal right risks to persons in care.

Official plan of correction

DADM stated that S2s application will be submitted to CCLD within 24 hours.

Deadline recorded: Mar 5, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87211(a)(D)

Regulation authority

CCR

What the official deficiency says

87211 Reporting Requirements (a) Each licensee shall furnish to the licensing agency... reports... (1) A written report shall be submitted to the licensing agency and to the person responsible…within seven days of the occurrence...(D)Any incident which threatens the welfare, Based on the interview and record review, DADM stated that incident report of R1s elopement incident on 1/15/25 was not submitted to CCLD and to person responsible for resident within 7 days, which pose/poses a health, safety & personal rights risk to persons in care.

Official plan of correction

con't. safety or health of any resident, such as…unexplained absence of any resident. This section is not met as evidenced by: DADM stated incident reports will be submitted in a timely manner to CCLD and responsible party within seven days of the occurrence.

Deadline recorded: Mar 5, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87355(c)(1)

Regulation authority

CCR

What the official deficiency says

87355 Criminal Record Clearance (c) A licensee or applicant for a license may request a transfer of a criminal record clearance from one state licensed facility to another…by providing the following documents to the Department: (1) A signed Criminal Background Clearance Transfer Request, LIC 9182 (Rev. 4/02) This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, the licensee did not transfer criminal record clearance of S5 from one facility to another. S5 was observed providing care and supervision to residents in care which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/23/2024 Plan of Correction Licensee stated that he/she is working on the transfer of S5's criminal record clearance and will submit proof of submission and transfer of records to LPA by the due date.

Official classification

Type B

Official code

87506(a)

Regulation authority

CCR

What the official deficiency says

87506 Resident Records (a)The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location… readily available … to licensing agency staff. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review the licensee did not by not completing, maintaining the record of 3 out of 6 resident records. 2 out 3 (R1 to R3) were missing consent form, appraisal needs and services plan. R1 to R3 are missing information on the personal rights document. R1-R3 are missing information on the emergency ID. R3 is missing the second page of the physicians medical report, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/21/2024 Plan of Correction The licensee and adminsitrator stated they will complete the information on the resident's record and will send LPA proof of completion by POC due date.