EVCO CARE

Official classification

Type A

Official code

1569.618(c)(4)

Regulation authority

HSC

What the official deficiency says

(c)The facility shall employ, and the administrator shall schedule, a sufficient number of staff members to do all of the following: (4) Ensure that the facility is clean, safe, sanitary, and in good repair at all times. 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 resident room #1 and #2 were observed with papers, medications, bedding on the floor, and unknown liquids on a dresser which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/17/2025 Plan of Correction Licensee will submit a plan of correction regarding how the facility will ensure staff are keeping the facility clean, safe and sanitary at all times. Licensee will submit POC by POC due date 11/18/2025.

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 interview and record review, the licensee did not comply with the section cited above. ADM states she did not have documentation of staff training for 3 staff for 2025, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/02/2025 Plan of Correction Licensee will submit a plan of action regarding how the facility will ensure 3 staff will obtain trainings for 2025. Licensee will submit POC to CCL by POC due date 12/2/2025.

Official classification

Type A

Official code

1569.695(c)

Regulation authority

HSC

What the official deficiency says

§1569.695 Emergency Plans (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 interview, record review, the licensee did not comply with the section cited above in not conducting fire drills quarterly for each shift which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/18/2025 Plan of Correction Licensee will submit POC addressing how the facility will conduct a drill at least quarterly for each shift. Licensee will submit POC to CCL by POC due date 11/18/2025. Licensee will conduct a drill by 11/20/2025, and submit documention of drill to CCL by 11/21/2025.

Official classification

Type A

Official code

87309(a)(b)

Regulation authority

CCR

What the official deficiency says

87309 Storage Space and Access (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 and interview the licensee did not comply with the section cited above, the knives and chemical storage areas in the kitchen were not locked and were 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: 11/18/2025 Plan of Correction ADM will submit a plan of action on how the facility will lock away sharps and chemicals and they are not accessible to residents in care. Licensee will submit POC to CCL by 11/18/2025.

Official classification

Type A

Official code

87355(e)

Regulation authority

CCR

What the official deficiency says

87355 Criminal Record Clearance (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility. 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. S1 had not obtained a criminal record clearance before working in the facility which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/18/2025 Plan of Correction ADM stated she will have S1 fingerprinted and associate S1 to the facility. ADM stated she will send a written plan of action on how she will ensure staff are ffingerprinted and associated to the facility. ADM stated she will send this written plan of action by POC date.

Official classification

Type B

Official code

87211(a)(1)(D)

Regulation authority

CCR

What the official deficiency says

87211 Reporting Requirements(a) Each licensee shall furnish to the licensing agency such reports ..., including, (1) A written report shall be submitted to the licensing agency ... within seven days of the occurrence ...(D)Any incident which threatens the welfare, safety or health of any resident ... The requirement was not met as evidenced by: Based on the records reviewed, the facility did not send the incident report of resident R1 and R2 within 7 days of the incident, this poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Licensee stated the facility to send plan of correction by the POC due date ensure the facility to send incident report in writing to CCL office within 7 days.

Deadline recorded: Apr 3, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87464(f)(1)

Regulation authority

CCR

What the official deficiency says

87464 Basic Services(f) Basic services shall at a minimum include:(1) Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). This requirement is not met as evidenced by: Based on interview, the facility did not provide the necessary care and supervision to resident R1 and R2 to meet their care needs and leading in that R2 pushed R1 which poses/posed an immediate Health, Safety risk to persons in care.

Official plan of correction

Licensee agreed to send a plan of correction by the POC due date to ensure to provide the necessary care and supervision to ensure the similare incident not to happen again.

Deadline recorded: Mar 18, 2025. 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

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 in that resident room #1 and #4 were observed with little and waste scattered on the floor which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/26/2024 Plan of Correction Administrator stated to send a plan of correction by the POC due date to ensure the resident rooms without waste scattered on the floor.

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 in that staff S1 and S2 were observed without health screen form which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/26/2024 Plan of Correction Administrator stated to submit a plan of correction by the POC due date to ensure all staff have health screen forms prior to work for the facility.

Official classification

Type B

Official code

87412(c)

Regulation authority

CCR

What the official deficiency says

(c) Licensees shall maintain in the personnel records verification of required staff training and orientation. 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 that the facility was unable to provide the document of staff training information which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/26/2024 Plan of Correction ADM stated to send a plan of correction by the POC due date to ensure the facility maintains the staff training documents.

Official classification

Type B

Official code

87465(h)

Regulation authority

CCR

What the official deficiency says

(h) The following requirements shall apply to medications which are centrally stored: This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, and record review, the licensee did not comply with the section cited above in that the central stored medication forms of resident R1 and R2 were observed not updated and not matched with the residents' medications which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/26/2024 Plan of Correction ADM stated to send a plan of correction by the POC due date to ensure residents' central stored medication forms are maintained up to date.

Official classification

Type B

Official code

87463(c)

Regulation authority

CCR

What the official deficiency says

(c) The licensee shall arrange a meeting with the resident, the resident's representative, if any, appropriate facility staff, and a representative of the resident's home health agency, if any, when there is significant change in the resident's condition, or once every 12 months, whichever occurs first, as specified in Section 87467, Resident Participation in Decision Making. 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 that resident R2's appraisal Needs and Service plan was conducted in year 2021 which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/26/2024 Plan of Correction ADM stated to send a plan of correction by the POC due date to ensure residents' appraisal needs and service plan are up to date.

Official classification

Type B

Official code

87507(a)

Regulation authority

CCR

What the official deficiency says

(a) The licensee shall complete an individual written admission agreement, as defined in Section 87101(a), with each resident or the resident's representative, if any. 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 that no resident R1's admission agreement was maintained in the resident file which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/26/2024 Plan of Correction ADM stated to send a plan of correction by the POC due date to ensure to maintain all the residents' admission agreement with signatures.

Official classification

Type A

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, the licensee did not comply with the section cited above in that carbon monoxide detector was observed out of battery which poses an immediate health, safety risk to persons in care.

Official plan of correction

POC Due Date: 05/11/2024 Plan of Correction ADM stated to submit the plan of correction by the POC due date to install new battery for carbon monoxide detector.

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, the licensee did not comply with the section cited above in that dish washing soap closet was observed unlocked which poses an immediate health, safety risk to persons in care.

Official plan of correction

POC Due Date: 05/11/2024 Plan of Correction ADM stated to submit the plan of correction by the POC due date to lock the dish washing soap closet.

Official classification

Type A

Official code

87309(a)(1)

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. (1) Storage areas for poisons, and firearms and other dangerous weapons shall be locked. 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 knives closet was observed unlock which poses an immediate health, safety risk to persons in care.

Official plan of correction

POC Due Date: 05/11/2024 Plan of Correction ADM stated to submit a plan of correction by the POC due date to lock the knives closet.

Official classification

Type A

Official code

87468(c)(1)

Regulation authority

CCR

What the official deficiency says

(c) Licensees shall prominently post personal rights, nondiscrimination notice, and complaint information in areas accessible to residents, representatives, and the public. (1) The personal rights of residents specified in Sections 87468.1, Personal Rights of Residents in All Facilities and 87468.2, Additional Personal Rights of Residents in Privately Operated Facilities shall be posted as applicable to the facility. 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 personal rights poster were not posted in the common area which poses an immediate personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/11/2024 Plan of Correction ADM stated to submit a plan of correction by the POC due date to put the personal rights poster on the common area.

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 in that little were observed on the floor of dining room, kitchen and resident bedrooms which poses/posed a potential health, safety risk to persons in care.

Official plan of correction

POC Due Date: 05/17/2024 Plan of Correction ADM stated to submit a plan of correction by the POC due date to clean up the facility.

Official classification

Type B

Official code

87303(c)

Regulation authority

CCR

What the official deficiency says

(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, the licensee did not comply with the section cited above in that one of the resident bedroom's screen window was observed missing which poses/posed a potential health, safety risk to persons in care.

Official plan of correction

POC Due Date: 05/17/2024 Plan of Correction ADM stated the facility will submit a plan of correction by the POC due date to install a new screen window for the resident bedroom.

Official classification

Type B

Official code

87303(e)(5)

Regulation authority

CCR

What the official deficiency says

(e) Water supplies and plumbing fixtures shall be maintained as follows: (5) Non-skid mats or strips shall be used in all bathtubs and showers. 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 no-skid mats was observed in the bathrooms which poses/posed a potential health, safety risk to persons in care.

Official plan of correction

POC Due Date: 05/17/2024 Plan of Correction ADM stated to submit a plan of correction by the POC due date to put the non-skid mats in the bathrooms.

Official classification

Type B

Official code

87303(h)

Regulation authority

CCR

What the official deficiency says

(h) Emergency lighting shall be maintained. At a minimum this shall include flashlights, or other battery powered lighting, readily available in appropriate areas accessible to residents and staff. Open-flame lights shall not be used. 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 the flashlights were observed out of battery which poses/posed a potential health, safety risk to persons in care.

Official plan of correction

POC Due Date: 05/17/2024 Plan of Correction ADM stated to submit a plan of correction by the POC due date to install batteries for the flashlights.

Official classification

Type B

Official code

87307(d)(6)

Regulation authority

CCR

What the official deficiency says

(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, the licensee did not comply with the section cited above in that 3 mattress were observed at the side of the building blocking the walkways which poses/posed a potential health, safety risk to persons in care.

Official plan of correction

POC Due Date: 05/17/2024 Plan of Correction ADM stated to submit a plan of correction by the POC due date to remove the 3 mattress.

Official classification

Type B

Official code

1569.618(c)(3)

Regulation authority

HSC

What the official deficiency says

(c)The facility shall employ, and the administrator shall schedule, a sufficient number of staff members to do all of the following: (3) Ensure that at least one staff member who has cardiopulmonary resuscitation (CPR) training and first aid training is on duty and on the premises at all times. This paragraph shall not be construed to require staff to provide CPR. 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 that 3 out 3 staff without first aid certificate which poses/posed a potential health, safety risk to persons in care.

Official plan of correction

POC Due Date: 05/17/2024 Plan of Correction ADM stated to submit a plan of correction by the POC due date to have staff obtain first aid training and certificate.

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 in that 3 out of 3 staff were observed no health screening form in the staff files which poses/posed a potential health, safety risk to persons in care.

Official plan of correction

POC Due Date: 05/17/2024 Plan of Correction ADM stated to submit a plan of correction by the POC due date to have staff to obtain health screening forms.

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 record review, the licensee did not comply with the section cited above in that 3 out of 3 staff were observed without annual continuing training document in the staff files which poses/posed a potential health, safety risk to persons in care.

Official plan of correction

POC Due Date: 05/17/2024 Plan of Correction ADM stated to have staff obtain and finish the annual continue training.

Official classification

Type B

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 record review, the licensee did not comply with the section cited above in that 2 out of 2 residents were observed no central stored medications form in the resident files which poses/posed a potential health, safety risk to persons in care.

Official plan of correction

POC Due Date: 05/17/2024 Plan of Correction