Medication handling and storageType A
- 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, the licensee did not comply with the section cited above in that medications were left unsecured in a night stand in the walk in closet located off the bathroom attached to the semi-private room at the rear of the facility. which poses an immediate health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 10/03/2025 Plan of Correction Licensee will provide an LIC 9098 self certifying that medications will be kept secured to Community Care Licensing (CCL) by POC due date of 10/3/2025. Licensee will also conduct medication management training will all staff members and provide proof of training to CCL by 10/20/2025. Proof of training will include staff signatures.
Facility condition and maintenanceType B
- Official classification
- Type B
- Official code
- 87303(d)
- Regulation authority
- CCR
What the official deficiency says
(d) There shall be lamps or light appropriate for the use of each room and sufficient to ensure the comfort and safety of all persons in 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 LPA observed that there were no functioning lights in the bathroom attached to the semi-private room at the rear of the facility which poses a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 10/16/2025 Plan of Correction Licensee to provide photographic proof of functioning lights in the bathroom attached to the semi-private room at the rear of the facility to Community Care Licensing (CCL) by POC due date of 10/16/2025.
Facility condition and maintenanceType B
- Official classification
- Type B
- 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, the licensee did not comply with the section cited above in that Hot water temperatures for a sample of sinks in facility were observed to exceed the Title 22 regulations of 105 to 120 degrees Fahrenheit. Sample of sinks tested were at 142.7, 126 and 140.1 degrees Fahrenheit. which poses a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 10/16/2025 Plan of Correction Licensee to maintain a daily hot water temperature log showing hot water within Title 22 regulations of 105 to 120 degrees Fahrenheit. Licensee to submit daily hot water log to CCL by POC due date of 10/16/2025.
Hazardous items and storageType B
- Official classification
- Type B
- 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, the licensee did not comply with the section cited above in that an unsecured bottle of " Gorilla Glue " was observed in the bathroom attached to the semi-private room at the rear of the facility which poses a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 10/16/2025 Plan of Correction Licensee to conduct training with all staff members to review CCR 87309(a) and provide proof to Community Care Licensing (CCL) by POC due date of 10/16/2025. Proof of training will include staff signatures.
Admission, assessment, and evictionType B
- Official classification
- Type B
- Official code
- 87457(c)
- Regulation authority
- CCR
What the official deficiency says
(c) Prior to admission a determination of the prospective resident's suitability for admission shall be completed and shall include an appraisal of their individual service needs in comparison with the admission criteria specified in Section 87455, Acceptance and Retention Limitations. 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 LPA observed that R1 did not have an LIC 603 Pre-Admission Appraisal form which poses a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 10/16/2025 Plan of Correction Licensee to submit a completed and signed LIC 603 Pre-Admission Appraisal form for R1 to CCL by POC due date of 10/16/2025.
Admission, assessment, and evictionType B
- 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 and record review, the licensee did not comply with the section cited above in that Resident one's (R1) personal file was observed to not have a current LIC 625 Appraisal/Needs and Service Plan (last LIC 625 was done on 8/19/2024) which poses a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 10/16/2025 Plan of Correction Licensee to submit a completed and signed LIC 625 Appraisal/Needs and Service Plan for Resident R1 to Community Care Licensing by POC due date of 10/16/2025.