MAGNOLIA GOLD HOME CARE

Official classification

Type B

Official code

87465(c)(2)

Regulation authority

CCR

What the official deficiency says

(c) If the resident's physician has stated in writing that the resident is unable to determine his/her own need for nonprescription PRN medication, but can communicate his/her symptoms clearly, facility staff designated by the licensee shall be permitted to assist the resident with self-administration, provided all of the following requirements are met: (2) Once ordered by the physician the medication is given according to the physician's directions. 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 in two (2) out of four (4) record of medication administration which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/18/2026 Plan of Correction Licensee to provide evidence of training for staff helping with medicine administration of the need to carefully document when a medicines length of timed administration has been met, removal of records of medicines that are no longer being given and the importance of providing a real time AM vs PM vs twice a day record of medicined administered.

Official classification

Type A

Official code

1569.269(a)(10)

Regulation authority

HSC

What the official deficiency says

HSC:1569.269 Enumerated Rights;severabiltiy (a) Residents of RCFE shall have all the following rights: (10) To be free from neglect, finacial exploitation, involuntary seculsion, punishment, humiliation, intimidation, and verbal, mental, physical, or sexual abuse. This requirement has not been met by evidence by: Based on interviews wtih residents and care partners a prepondrance of evidence has deemed that R1 was subject to sexual abuse.

Official plan of correction

Licensee agrees to review regulation Health and Safety Code (HSC) 1569.269(a)(1) by 02/05/2026 and conduct a training with the staff on current LIC500 personel roster and submit self-certification that the training has been completed by 02/13/2026

Deadline recorded: Feb 5, 2026. A deadline is not proof that correction was completed.

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 seperate complete, and current record is maintained for each resident in the facility...available to facility staff...and licensing. This requirement is not met as evidence by: Based on interview and record review, the licensee did not comply in 2 out of 5 resident records.which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Licensee to read regulation 87506 and to submit a Pre-Placement Appraisal (LIC603) and Appraisal Needs and Service Plan (LIC625) for R1 and a Admissions Agreement, Pre-Placement appraisal & Consent for Emergecy Medical Treatment for R2 by POC date 02/13/2026

Deadline recorded: Feb 13, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

1569.625(b)(1)

Regulation authority

HSC

What the official deficiency says

HSC 1569.625(b)(1) The department shall...require 40 hours of training....staff...shall complete 20 hours...including 6 hours of dementia care...4 hours of postural supports, restricted health conditions, hospice care...the remaining 20 hours shall include 6 hours dementia care within 4 weeks. This requirement is not met as evidenced by:Based on record review, the licensee did not comply with the section cited above in 1 out of 5 staff members which poses a potential health, safety or personal rights risk to persons in care

Official plan of correction

Licensee to provide evidence of 30 hours of required training from an outside provider in a classroom setting or on-line, as well as documented shadow training for S1 by 12/04/2025

Deadline recorded: Nov 14, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87412(a)

Regulation authority

CCR

What the official deficiency says

87412(a) - Personnel Records The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. This requirement is not met as evidence by: Based on observation and record review the licensee did not comply with section cited in 3 out of 5 personnel records as evidence of messing 1st aid training and health screening which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Licensee to submit evidence of 1st aid (CPR) training for S1 and S3 and evidence of a health screening (LIC503) for S2 by 08/29/2025

Deadline recorded: Aug 29, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87405(d)(a)(1)

Regulation authority

CCR

What the official deficiency says

87405(d)(a)(1)- (d)The administrator shall have the qualifications specified... (1) Knowledge of the requirements for providing care and supervision appropriate to the residents. This requirement is not met as evidenced by: inspection, the licensee diLPAs interviews, observations and records reviewed which show that Adminstrator has not been present a sufficent number of hours to properly meet the responsibilities of operating the facility. This is an immediate risk to the health and safety of all residents in care.

Official plan of correction

Licensee to ensure that the facility has a qualified, certified RCFE Administrator on-site as required by regulation. Licensee will also have a plan to designate designated person listed on LIC308 to ensure continuity of care and operating regulations are met in the absence of Administrator. Submit the following documents to CCL by COB 6/14/2024: LIC500, LIC308, copy of Administrator's Certificate. Attn: LPA Florio

Deadline recorded: Jun 12, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87211(a)(1)(D)

Regulation authority

CCR

What the official deficiency says

87211(a)(1)(D):Reporting Requirements:(a) Each licensee shall furnish to the licensing agency...(1)A written report shall be submitted to the licensing agency...within seven days of the occurrence of...(D)Any incident which threatens the welfare, safety or health of any resident.. This requirement is not met as evidenced by: *Based on records reviewed the Licensee did not comply with the section cited above and did not submit reports to CCL as required. This poses a potential health and safety risk to residents in care.

Official plan of correction

Licensee to provide training to all care staff reviewing the Regulation: 87211 Reporting Requirements and how to properly fill out the LIC 624 form. Inservice Training to include the following information: Date of Training, Training Topics, Job Role, Staff Names and Signatures by POC due date of 05/10/2024.In addition, Licensee to submit past due Incident Reports.

Deadline recorded: May 3, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87608(a)(3)

Regulation authority

CCR

What the official deficiency says

Based on the individual's pre-admission appraisal....(3) a written order from a physician...order. This is evidenced by: Based on review of residents' records there was no written order by physician for 1/2 bed rail which poses a potential risk to the health and safety of residents in care.

Official plan of correction

Administrator to supply Dept. with proof of doctors' orders for residents use of bedrails by 4/10/24, end of business day.

Deadline recorded: Apr 9, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87608(a)(3)

Regulation authority

CCR

What the official deficiency says

87608 Postural Supports (a) Based on the individual's pre-admission appraisal....(3) a written order from a physician...order. This is evidenced by: Based on review of residents' records there was no written order by physician for 1/2 bed rail which poses a potential risk to the health and safety of residents in care.

Official plan of correction

Administrator to supply Dept. with proof of doctors' orders for residents use of bedrails by 1/29/24, end of business day.

Deadline recorded: Jan 26, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87405(a)

Regulation authority

CCR

What the official deficiency says

87405 Administrator - Qualifications and Duties (a) All facilities shall have a qualified and currently certified administrator. licensee and the administrator may be one and the same person. The administrator...This is evidenced by: Based on observation of expired Administrator's Certificate dated 6/30/23 and no renewal on file with the Dept. which poses a potential risk to the health and safety of residents in care.

Official plan of correction

Administrator to apply for a renewal of Administrator's Certificate and supply Dept. with proof of registration by 1/29/24, end of business day.

Deadline recorded: Jan 26, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87309(a)

Regulation authority

CCR

What the official deficiency says

87309(a) STORAGE SPACE - 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 was not met as evidence by:** Based on observations LPA found unlocked cabinet containing chemicals accessible to residents. In addition, LPA 1 knife and 1 scissor located near the kitchen stove in a container, and unlocked laundry room and garage with cleaning supplies. This poses as an immediate health and safety risk to residents in care.

Official plan of correction

Administrator failed to ensure chemicals and sharps were kept secured and inaccessible to residents in care. agrees to create a safety checklist for staff to complete and signage posted in the facility to ensure future compliance. Copy of safety checklist and photos of signage submitted to CCL by POC due date 8/3/2023.

Deadline recorded: Aug 3, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

80087(a)(c)

Regulation authority

CCR

What the official deficiency says

(a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors. (c) All outdoor and indoor passageways, stairways, inclines, ramps, open porches and other areas of potential hazard shall be kept free of obstruction. Based on observation LPA observed a cabinet, head and footboard, tree branches and clothes rack located in the side yard passageway that poses a potential hazard to residents in care.

Official plan of correction

Administrator agreed to remove all items listed and send copies to CCLD no later then POC date 8/10/2023.

Deadline recorded: Aug 10, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87202(a)(2)

Regulation authority

CCR

What the official deficiency says

87202 Fire Clearance: (a)All facilities shall maintain a fire clearance approved by the city, county,... fire department...Prior to accepting or retaining...the following ... the applicant or licensee shall notify the licensing agency & obtain an appropriate fire clearance approved by the... fire department...(2) Bedridden persons This requirement was not met as evidenced by: Based on observation, interviews, and record review - Administrator did not ensure the regulation above due to having bedridden resident (R1) in a non-ambulatory bedroom (not approved for bedridden residents). This is an immediate health & safety risk to residents in care.

Official plan of correction

Administrator to submit a statement that they understand the regulation and shall be in future compliance. POC due date 03/11/2022 to CCL *** An immediate Civil Penalty in the amount of $500 was assessed.

Deadline recorded: Mar 5, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(h)(2)

Regulation authority

CCR

What the official deficiency says

87465(h)(2) Incidental Medical & Dental Care: (h) The following requirements shall apply...(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 was not met as evidenced by: Based on observation and interviews conducted, Administrator did not ensure medications to be kept locked and inaccessible to residents. This is an immediate health & safety risk to residents.

Official plan of correction

Staff removed S1's medication and locked during the visit. Administrator to submit documentation of staff training on regulation 87465(h)(2) with date, time, subject, duration, staff names and signatures of attendance. POC due date 03/11/2022 to Community Care Licensing to clear the citation.

Deadline recorded: Mar 5, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87355(e)(2)

Regulation authority

CCR

What the official deficiency says

87355 Criminal Record Clearance - (e)All individuals subject to a criminal record review...shall prior to working, residing or volunteering in a licensed facility:(2) Request a transfer of a criminal record clearance as specified in Section 87355(c). This requirement was not met as evidenced by: Based on record review, observation, and interviews conducted: Administrator did not assocaitate individual (I1) prior to working, residing or being present in the facility. This is a potential safety and personal rights risk to the residents in care.

Official plan of correction

Administrator to associate I1 prior to I1 returning to the facility or begining work. Administrator to submit a written statement they understand the requirement and will be in future compliance with the regulation by POC due date 03/11/2022 to Community Care Licensing **Civil Penalty assessed in the amount of $100.00

Deadline recorded: Mar 11, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87608(a)(5)(A)

Regulation authority

CCR

What the official deficiency says

87608 Postural Supports- (a)... Postural supports may be used under the following conditions. (5)... (A) A bed rail that extends from the head half the length of the bed and used only for assistance with mobility shall be allowed. This requirement was not met as evidenced by: Based on LPA's observation and records reviewed, residents (R1 & R2) were observed with half bed rails and the facility does not have prescriptions from the resident's doctors. Administrator did not ensure residents had prescriptions prior to the use of half bed rails. This is a potential safety and personal rights risk to residents in care

Official plan of correction

Administrator to obtain and submit copies of physician's orders for half bed rails for R1 & R2. Copies to be submitted to CCL to clear the citation by POC due date 3/11/22

Deadline recorded: Mar 11, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87999

Regulation authority

CCR

What the official deficiency says

87468.1 Personal Rights of Residents in All Facilities -(a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (13) To have access to individual storage space for private use. This requirement was not met as evidenced by: Based on interviews and observations, Administrator did not ensure the above regulation due to Staff (S1)'s personal belongings were stored in R1's bedroom closet. This is a potential personal rights violation to residents in care

Official plan of correction

Administrator to remove all of staff's personal belongings stored in R1's bedroom or any other resident bedroom. Administrator to submit pictures as proof of correction and staff training on resident's personal rights reg 87468.1 with date, time, duration, subject, staff signatures and names of attendance. Pictures and staff training to be submitted by POC due date 3/11/22 to clear the citation.

Deadline recorded: Mar 11, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87555(b)(7)

Regulation authority

CCR

What the official deficiency says

87555General Food Service Requirements - (b) The following food service requirements shall apply: (7) Modified diets prescribed by a resident's physician as a medical necessity shall be provided. This requirement was not met as evidenced by: Based on interviews and records reviewed, the facility failed to ensure resident (R1) was following a modified diet according to their diabetic diagnosis. Staff provided food items such as apple pie and peanut butter sandwiches because resident had requested it.

Official plan of correction

Administrator to train staff on regulation 87465(h)(2) and submit documentation of training with date, time, subject, duration, staff names and signatures of attendance. POC due date 03/11/2022 to Community Care Licensing to clear the citation. Administrator failed to notify R1’s physician and continued to provide high sugary foods to R1. This is an immediate health & safety risk to the residents in care.

Deadline recorded: Mar 5, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.1(a)(2)

Regulation authority

CCR

What the official deficiency says

87468.1 Personal Rights of Residents in All Facilities -(a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (2) To be accorded safe, healthful and comfortable accommodations... This requirement was not met as evidenced by: Based on interviews, records reviewed,and observations made, the facility did no ensure the regualtion due to staff observed without wearing a mask and not screening visitors for COVID symptoms. This is a potential health & safety risk to residents in care.

Official plan of correction

Administrator to submit a statement that they understand the regulation and shall be in future compliance. Statement to be submitted to CCL to clear the citation by POC due date 3/11/2022

Deadline recorded: Mar 11, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87355(e)(2)

Regulation authority

CCR

What the official deficiency says

87355 (e)(2) - Criminal Record Clearance (e) All individuals subject to a criminal record review...(b) shall prior to working, residing or volunteering in a licensed facility: (2) Request a transfer of a criminal record clearance... This requirement was not met as evidenced by: Based on record review, observations, and interviews conducted: Administrator did not request a transfer of a criminal record clearance for individuals (I1 & I2) prior to working at the facility. This is an immediate safety risk to the residents in care.

Official plan of correction

Administrator to associate I1 & I2 by POC due date 09/03/2021 by close of business. Administrator to submit a written statement they understand the requirement and will be in future compliance by POC due date 09/08/2021 to Community Care Licensing

Deadline recorded: Sep 3, 2021. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(h)

Regulation authority

CCR

What the official deficiency says

87465(h)(2) Incidental Medical & Dental Care: (h) The following requirements shall apply...(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 was not met as evidenced by: Based on observation and interviews conducted, Administrator did not ensure medications to be kept locked and inaccessible to residents. This is an immediate health & safety risk to residents.

Official plan of correction

Administrator to submit a statement they understand the regulation and facility staff will be in future compliance with regulation 87465(h)(2) to ensure the health and safety of residents in care. POC due date 09/08/2021 to Community Care Licensing

Deadline recorded: Sep 3, 2021. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(h)(5)

Regulation authority

CCR

What the official deficiency says

87465(h)(5) Incidental Medical & Dental Care: (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 was not met as evidenced by: Based on observations and interviews conducted, Administrator stated they pre-poured medication for 5 of 5 residents. This is a potential health & safety risk to residents in care.

Official plan of correction

Administrator to transfer medication by 09/03/2021 to original containers and submit a statement they completed this as proof to LPA.... Administrator to train all staff on the regulation 87465(h)(5). Administrator to submit a copy of proof of training to Community Care Licensing by POC due date 09/08/2021 Proof of training to include: date, time, duration, subject, names and signatures of staff.

Deadline recorded: Sep 3, 2021. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87555(b)(8)

Regulation authority

CCR

What the official deficiency says

87555(b)(8) General Food Service Requirements: (b) The following food service requirements shall apply: (8) All food shall be of good quality. This requirement was not met as evidenced by: Based on observations, Administrator did not ensure the regulation above due to 3 yogurt containers and citrus slices observed with mold and expired dates. This a potential health & safety risk to residents in care.

Official plan of correction

LPA asked staff to immediately throw away the spoiled food. Administrator to submit a written plan/statement of future compliance regulation 87555(b)(8) POC due 09/08/2021

Deadline recorded: Sep 7, 2021. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87307(a)

Regulation authority

CCR

What the official deficiency says

87307(a) Personal Accommodations and Services: (a) Living accommodations and grounds shall be related to the facility's function. The facility shall be large enough to provide comfortable living accommodations and privacy for the residents, staff, and others who may reside in the facility. This requirement was not met as evidenced by: Based on observation and interviews conducted, Administrator did not ensure the regulation above due to allowing S1 to sleep in a metal twin bed inside resident (R1)'s bedroom (#2). This is a personal rights risk to residents (R1) in care.

Official plan of correction

Administrator to ensure staff’s portable bed in Resident (R1)’s bedroom (#2) is removed from R1’s bedroom and not to be placed in any common area or resident's bedroom. Administrator to ensure that No staff, including licensee/administrator, are sleeping in any common areas and/or in a resident's room at any time. Administrator to submit pictures of R1’s bedroom in which staff’s bed is removed, as proof of correction. Administrator submit a written plan/statement of future compliance regulation 87307(a). POC of pictures and statement due 09/08/2021

Deadline recorded: Sep 8, 2021. A deadline is not proof that correction was completed.