HAVEN'S HOUSE OF ASSISTED LIVING

Official classification

Type A

Official code

87468.1

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: (1) To be accorded dignity in their personal relationships with staff, residents, and other persons.This requirement is not met as evidenced by: Based on interview and observation with Licensee, they have conducted physical redirection of at least one resident, This poses an immediate Personal Rights risk to residents.

Official plan of correction

The licensee agreed to submit a self-certified declaration stating that all resident personal rights regulations have been reviewed with facility staff. Licensee shall submit the declaration as proof of correction to Community Care Licensing (CCL) by the Plan of Correction (POC) due date 07/25/2026.The licensee also agreed to ensure that all residents' personal rights are protected.

Deadline recorded: Jul 25, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87468.2

Regulation authority

CCR

What the official deficiency says

87468.2 Additional Personal Rights... (a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated... To be served food of the quality and quantity necessary to meet their nutritional needs. This requirement is not met as evidenced by: Based on interviews, record review, and observations, LPA determined that the Licensee failed to provide meals at scheduled times and failed to meet the residents' dietary needs. This poses an immediate Personal Rights risk to residents.

Official plan of correction

Licensee to ensure that meals are served at appropriate times and in a timely manner as per regulations. Licensee to submit a food service menu showing facility schedule of meal times and meals served. Submit POC by due date of 07/25/2026.

Deadline recorded: Jul 25, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87705(d)

Regulation authority

CCR

What the official deficiency says

87705 Care of Persons with Dementia:(d) The licensee shall ensure that the facility has an auditory device or other staff alert feature to monitor exits on exterior doors and perimeter fence gates accessible to those residents who may be at risk for elopement, as defined in Section 87101, Definitions. This requirement is not met as evidenced by: Based on records reviewed and interviews conducted, Licensee did not ensure staff were aware when resident left the building without assistance. This poses an immediate Health, Safety or Personal Rights risk to persons in care.

Official plan of correction

Licensee agrees to ensure elopement plan; and address frequency of awol drills for staff. In addition, to conduct staff training regarding elopment and wandering behaviors. Proof of training with participants signature to be submittet Community Care Licensing by plan of correction due date 06/05/2026

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

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 observation, interview, and record review, the licensee did not comply with the section cited above facility Unable to provide proof of disaster drills being conducted which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/20/2026 Plan of Correction Licensee agrees to conduct disaster drill and submit proof of correction to Community Care Licensing by due date 03/20/2026

Official classification

Type B

Official code

87211(a)(1)(B)

Regulation authority

CCR

What the official deficiency says

Reporting Requirements (a)Each licensee shall furnish ..., the following: (1)A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence... (B)Any serious injury as determined ... . This requirement was not met as evidenced by: Based on observations made, Licensee did not comply with the section cited above, Licensee failed to submit special incident report to the CCL as required which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Licensee will ensure all resident incidents are reported to CCL as required. Licensee will complete training from an outside vendor on reporting requirements for whole staff and submit a plan for ongoing compliance by 10/21/2025.

Deadline recorded: Oct 21, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87465(h)(5)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental (h) The following requirements...:(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 made, Licensee did not comply with the section cited above. LPAs observed multiple instances of resident medication being pre-poured over 24 hours in advance. This is a potential health and safety risk to residents in care.

Official plan of correction

Licensee agreed to conduct all staff training in medication administration to submit CCL with centrally store medication log for all residents in care by plan of correction date (POC) 08/18/2025.

Deadline recorded: Aug 18, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87465(h)(6)

Regulation authority

CCR

What the official deficiency says

87465 (h) The following requirements shall apply to medications which are centrally stored: (6) The licensee shall be responsible a record of centrally stored prescription medications for each resident...: This requirement was not met as evidenced by: Based on observations made, Licensee didnot comply with the section cited above and did not ensure that there was a completed LIC622 or similar document with the all of the regulatory information required. This is a potential health and safety risk to residents in care.

Official plan of correction

Licensee agreed to conduct all staff training in medication administration to submit CCL with centrally store medication log for all residents in care by plan of correction date (POC) 08/18/2025.

Deadline recorded: Aug 18, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87412(a)(13)(B)

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: (13) For employees that are required to be fingerprinted pursuant to Section 87355, Criminal Record Clearance: (B) Documentation of either a criminal record clearance or a criminal record exemption as required by Section 87355(e). This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, interview and observation the licensee did not comply with the section cited above in [1} out of [4} staff which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/11/2025 Plan of Correction 1)Licensee to submit in writting to CCL that employee S1 will not work by 03/11/2025 2)Licensee to submit proof of S1 being associated to the facility on the Guardian website by 03/14/2025

Official classification

Type B

Official code

87467(a)(3)

Regulation authority

CCR

What the official deficiency says

(a) Prior to, or within two weeks of the resident's admission, 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, and any other appropriate parties, to prepare a written record of the care the resident will receive in the facility, and the resident's preferences regarding the services provided at the facility. (3) The licensee shall arrange a meeting with the resident and appropriate individuals identified in Section 87467(a)(1) to review and revise the written record as specified, when there is a significant change in the resident's condition, or once every 12 months, whichever occurs first. Significant changes shall include, but not be limited to occurrences specified in Section 87463, Reappraisals. 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 4 out of 5 files did not have care plans or signatures for meetings which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/27/2024 Plan of Correction Copies of care plans to be submitted by the POC date of 3/27/24.

Official classification

Type B

Official code

87705(f)(1)

Regulation authority

CCR

What the official deficiency says

(f) The following shall be stored inaccessible to residents with dementia: (1) Knives, matches, firearms, tools and other items that could constitute a danger to the resident(s). This requirement is not met as evidenced by: Deficient Practice Statement Based on observations, the licensee did not comply with the section cited above in items were found unsecured in kitchen, laundry room, bathroom and resident room which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/20/2024 Plan of Correction Items were secured while LPA present. Licensee will designate areas to be locked and submit photos of locks and lock boxes by the POC date of 3/20/24

Official classification

Type A

Official code

87355(e)

Regulation authority

CCR

What the official deficiency says

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 was not met as evidence by:** Based on record review and interview with Licensee, the facility did not comply with the section cited above in 1 out of 1 individuals (I1) without proof of background clearance or association to the facility, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

Licensee agrees to submitt in writing; a plan to ensure I1 is considered a resident and provide all documents required per regulation (admission agreement, 602, needs/service etc) by POC date 10/20/2023. In addition, Licensee completed an updated LIC200 for increase in capacity and provided to CCLD.

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

Official classification

Type A

Official code

87355

Regulation authority

CCR

What the official deficiency says

87355 Criminal Record Clearance (a) The Department shall conduct a criminal record review of all individuals specified in Health and Safety Code section 1569.17 and shall have the authority to approve or deny a facility license, or employment, residence, or presence in the facility, based upon the results of such review. (b) Prior to the Department issuing a license, the applicant, administrator and any adults other than a client, residing in the facility shall have a criminal record clearance or exemption. This requirement was not met as evidenced by: During the opening of the complaint on March 14, 2023 at approximately 01:00 PM, LPA was greeted at the door by a Staff Member who was not background clearand associated to the facility

Official plan of correction

Licensee shall ensure that ALL staff members are fingerprint cleared and associated to the facility prior to working at the facility. In addition, LPA shall provide a written summary on how future compliance will be met. POC due date on March 15, 2023.

Deadline recorded: Mar 14, 2023. A deadline is not proof that correction was completed.