Medical and dental care
Cited in 4 reports, with 4 deficiencies in total.
IVY PARK AT ROCKVILLE
4625 MANGELS BLVD, Fairfield CA 94534
199 bedsLatest official report Jul 21, 2026Licensed
Additional info
- Telephone
- (707) 356-2229
- Licensee
- CREPUSCULE PROPERTIES INC; OAKMONT MGMT GROUP LLC
- Administrator
- TEDRA GODFREY
- Contact
- TEDRA GODFREY
- License first date
- Aug 26, 2016
- License effective date
- Aug 26, 2016
- District office
- SANTA ROSA RO · (707) 588-5026
- Regional office
- 21
- Clients served
- 945 - ADULTS / ELDERLY
Summary
The available records show 17 Type A and 12 Type B deficiencies for this facility.
- Most recent inspection
- Jul 21, 2026
- Most recent deficiency
- Jun 16, 2026
1 later report, on Jul 21, 2026, recorded no deficiencies, though the records do not say whether they were follow-ups.
What Type A and Type B mean
- Type A
- Violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
- Type B
- Violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care.
Both classifications are published by California CDSS and are shown as published. SeniorLivingFacts does not rename them or add a severity level of its own.
At a glance
Counts cover the five-year public record. Typical figures are the median for the 12 Solano County facilities licensed for 50 or more beds, except where too few exist to state one — those come from facilities with 7 or more beds.
In the available public five-year record, CCLD published 62 reports for this facility: 21 inspections, 39 complaint investigations, and 2 licensing or administrative records.
Those records contain 17 Type A and 12 Type B deficiencies.
1 deficiencies have explicit official correction or clearance evidence in the loaded records.
- Official inspections
- 21
- Recorded deficiencies
- 29
- Type A deficiencies
- 17
- Type B deficiencies
- 12
- Substantiated complaints
- 19
- Repeated topics
- 2
More than the typical 8
4 in the last 12 months
Well above the typical 9
3 in the last 12 months
Well above the typical 2
2 in the last 12 months
Well above the typical 4
1 in the last 12 months
Well above the typical 2
2 in the last 12 months
Last 36 months
Repeated topics
Topics cited in more than one report during the last 36 months. A repeat may show a pattern worth asking about. Each date opens its report below.
Resident rights
Cited in 2 reports, with 2 deficiencies in total.
Official report history
All preserved reports from the most recent to the oldest, sortable by report type.
Complaint
Allegations2 substantiated · 4 unsubstantiated · 0 unfounded · 2 cited
Resident rightsType A
- Official classification
- Type A
- Official code
- 87468.2(a)(4)
- Regulation authority
- CCR
What the official deficiency says
87468.2 Additional Personal Rights of Residents in... Facilities:(a) in addition to... Section 87468.1...residents...shall...have the following Personal Rights: (4) To care, supervision, and services that meet their...needs and delivered by staff that are sufficient in numbers. This requirement was not met as evidence by: Based on, interviews and record review licensee did not comply with section cited above in ensuring that training in use of R1's medical device was performed by all staff administering R1s medical device.
Official plan of correction
Licensee to submit self-certification that all staff who administer medical devices for R1 and other residents with similar devices have had hands-on training sufficienct to ensure proper application of devices like PureWick Incontinence devices, CPAP devices etc. A list of staff that will apply medical devices such as PureWick and CPAP devices, what was learned, the steps that staff will use to apply these specific device, as well as, the hands-on training they have recevied will be submitted to CCL by 06/26/2026
Deadline recorded: Jun 26, 2026. A deadline is not proof that correction was completed.
Plan of correction recorded
Correction deadline recordedDeadline Jun 26, 2026
Correction not verified in available records
Medical and dental careType A
- Official classification
- Type A
- Official code
- 87465(a)(4)
- Regulation authority
- CCR
What the official deficiency says
87465(a)(4) The Licensee shall assist Residents with self-administered medications as needed: This requirement is not met as evidence by: Based on record review and interviews The licensee did not comply with the section cited above. Licensee did not ensure that Resident 1 (R1) recieved a proper dose of ther Miralax per Physicians orders, which poses and immediate health, safety or personal rights risk to persons in care.
Official plan of correction
Licensee to submit self-certification that R1 is now receiving a proper dose of their prescribed medications. Licensee to also submit the specific steps staff will take in measuring out Miralax specfically for R1, as well as all prescribed medications for Residents in general by by 06/18/2026
Deadline recorded: Jun 18, 2026. A deadline is not proof that correction was completed.
Plan of correction recorded
Correction deadline recordedDeadline Jun 18, 2026
Correction not verified in available records
Complaint
Allegations0 substantiated · 1 unsubstantiated · 0 unfounded
No deficiencies recorded in this reportComplaint
Allegations0 substantiated · 1 unsubstantiated · 0 unfounded
No deficiencies recorded in this reportComplaint
Allegations1 substantiated · 0 unsubstantiated · 0 unfounded · 1 cited
Resident rightsType B
- Official classification
- Type B
- Official code
- 1569.269(a)(10)
- Regulation authority
- HSC
What the official deficiency says
1569.269 Enumerated Rights (a) Residents of a Residential Care Facility...shall have the following rights...(10) to be free from neglect, financial exploitation, involuntary seclusion... This requirement was not met as evidence by: Based on interviews and record review, the licensee did not comply in one (1) out of one (1) instance which poses a potential health safety or personal rights risk to persons in care.
Official plan of correction
Licensee to send self-certification that the have read regulation 1569.269 Enumerated Rights of the Health and Safety Code and to provide Community Care Licensing (CCL) of the specific steps/plan they will follow in the future for investigating potential thefts in the communty and the steps they will take to notify CCL when considerable thefts are suspected to have occured.
Deadline recorded: Dec 19, 2025. A deadline is not proof that correction was completed.
Plan of correction recorded
Correction deadline recordedDeadline Dec 19, 2025
Correction not verified in available records
Complaint
Allegations0 substantiated · 1 unsubstantiated · 0 unfounded
No deficiencies recorded in this reportComplaint
Allegations0 substantiated · 1 unsubstantiated · 0 unfounded
No deficiencies recorded in this reportComplaint
Allegations0 substantiated · 1 unsubstantiated · 0 unfounded
No deficiencies recorded in this reportComplaint
Allegations0 substantiated · 0 unsubstantiated · 1 unfounded
No deficiencies recorded in this reportComplaint
Allegations0 substantiated · 1 unsubstantiated · 0 unfounded
No deficiencies recorded in this reportComplaint
Allegations0 substantiated · 0 unsubstantiated · 1 unfounded
No deficiencies recorded in this reportComplaint
Allegations0 substantiated · 2 unsubstantiated · 1 unfounded
No deficiencies recorded in this reportComplaint
Allegations0 substantiated · 1 unsubstantiated · 0 unfounded
No deficiencies recorded in this reportComplaint
Allegations1 substantiated · 5 unsubstantiated · 0 unfounded · 1 cited
Incident reportingType B
- Official classification
- Type B
- Official code
- 87211
- Regulation authority
- CCR
What the official deficiency says
87211 Reporting Requirements. A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below.. Death of any resident….Based upon record review and observation, this requirement not met as evidenced by: Death of R3 was not reported to Licensing by the facility. This poses a potential risk to the welfare of residents in care.
Official plan of correction
Administration will review the requirements of 87211 and provide in service training to staff responsible for making death reports. Proof of training to be submitted to CCL by POC date in order to clear the deficiency.
Deadline recorded: Feb 25, 2025. A deadline is not proof that correction was completed.
Plan of correction recorded
Correction deadline recordedDeadline Feb 25, 2025
Correction not verified in available records
Complaint
Allegations1 substantiated · 0 unsubstantiated · 1 unfounded · 1 cited
Medical and dental careType A
- Official classification
- Type A
- Official code
- 87465(a)(4)
- Regulation authority
- CCR
What the official deficiency says
87465(a)(4) Incidental Medical and Dental Care. The licensee shall assist residents with self-administered medications as needed. *** Based on statements and document reviews, this requirement has not been met as evidenced by: R1 was given wrong dose of Tramadol on 12/09; 12/15; 12/22/2025. This posed an immediate risk to the health of R1.
Official plan of correction
Cleared at time of visit. Administrator has provided extensive retraining for staff and put improved protocols in place.
Deadline recorded: Jan 21, 2025. A deadline is not proof that correction was completed.
Plan of correction recorded
Correction deadline recordedDeadline Jan 21, 2025
Correction not verified in available records
Complaint
Allegations0 substantiated · 3 unsubstantiated · 0 unfounded
No deficiencies recorded in this reportComplaint
Allegations0 substantiated · 3 unsubstantiated · 0 unfounded
No deficiencies recorded in this reportComplaint
Allegations0 substantiated · 2 unsubstantiated · 0 unfounded
No deficiencies recorded in this reportComplaint
Allegations1 substantiated · 0 unsubstantiated · 0 unfounded · 1 cited
Facility condition and maintenanceType A
- Official classification
- Type A
- Official code
- 87303
- Regulation authority
- CCR
What the official deficiency says
87303 Maintenance and Operation. The facility shall be clean, safe, sanitary and in good repair at all times. Based on records and statements, this requirement not met as evidenced by: Facility has presence of bed bugs in multiple rooms in one section of facility. This poses an immediate risk to residents in care.
Official plan of correction
Administrator will continue to work with Clark Pest Control to remedy the situation and ensure there is a long term plan going forward. Facility will ensure all staff (on all shifts), residents and their responsible parties are aware of the bed bug situation and steps to take if they identify a bed bug in their living unit and/or common areas. Administrator will submit plans to RO by POC date of October 24, 2024 along with copies of communication to all staff, residents and their responsible parties.
Deadline recorded: Oct 24, 2024. A deadline is not proof that correction was completed.
Plan of correction recorded
Correction deadline recordedDeadline Oct 24, 2024
Correction not verified in available records
Complaint
Allegations1 substantiated · 2 unsubstantiated · 0 unfounded · 1 cited
Not classified in the sourceType A
- Official classification
- Type A
- Official code
- 87466.2
- Regulation authority
- CCR
What the official deficiency says
87468.2 Additional Personal Rights of Residents in Privately Operated Facilities: (4) To care, supervision, and services that meet their individual needs...This requirement was not met as Based on resident record review and interviews with outside parties (I1), facility did not provide appropriate supervision and assistance with R1's continence care needs. This serves as an immediate health & safety and personal rights risk to residents in care.
Official plan of correction
Administrator to provide in-service training for all caregiving staff to review continence care protocols. Administrator to submit scheduled training date to CCLD by POC date 5/17/2024 and submit completed signed training log to CCLD by POC date 5/31/2024. Administrator to provide in-service training to review continence care protocols and submit signed training log to CCLD by POC date 5/31/2024.
Deadline recorded: May 17, 2024. A deadline is not proof that correction was completed.
Plan of correction recorded
Correction deadline recordedDeadline May 17, 2024
Correction not verified in available records
Complaint
Allegations1 substantiated · 0 unsubstantiated · 0 unfounded · 1 cited
Medical and dental careType A
- Official classification
- Type A
- Official code
- 87465(a)(4)
- Regulation authority
- CCR
What the official deficiency says
87465(a)(4) Incidental Medical and Dental Care: (a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following: (4) The licensee shall assist residents with self-administered medications as needed. This requirement was not met as evidenced by: Based on an observation of the Medication Assessment Record (MAR) that was conducted, LPA learned that during the months of April 2023 there were gaps in the administration of medication for multiple medications which included eye drops for Resident #1. A former staff member missed the administration of eye drops on April 19-23, 2023, April 27 & 28, 2023 and April 30, 2023. An interview with the Administrator confirmed the missed medication administration for said dates. This is an immeidate Health, Safety and Personal Rights risk to the residents in care.
Official plan of correction
Plan of Correction (POC) shall include self-certification of an LIC 9098 understanding the regulation. In addition, Administrator/Licensee shall provide a plan for future compliance and conduct staff training on administering and documenting medication assessment records. POC due date for the Plan for Future Compliance will be on October 5, 2023. Training POC due date on October 11, 2023.
Deadline recorded: Oct 5, 2023. A deadline is not proof that correction was completed.
Plan of correction recorded
Correction deadline recordedDeadline Oct 5, 2023
Correction not verified in available records
Complaint
Allegations0 substantiated · 1 unsubstantiated · 1 unfounded
No deficiencies recorded in this reportComplaint
Allegations0 substantiated · 0 unsubstantiated · 1 unfounded
No deficiencies recorded in this reportComplaint
Allegations1 substantiated · 5 unsubstantiated · 0 unfounded · 1 cited
Facility condition and maintenanceType B
- Official classification
- Type B
- Official code
- 87303(a)
- Regulation authority
- CCR
What the official deficiency says
87303(a) Maintenance and Operation: 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 was not met as evidenced by: Based on facility observation on March 23, 2023, LPA and Assistant Administrator observed Resident #1’s room to be smelling of incontinence and clothes on the bathroom floor. This is a potential health, safety and personal rights risk to the residents in care.
Official plan of correction
Plan of Correction will entail submitting a LIC 9098 indicating that staff understand the regulation. In addition, Administrator shall provide a written summary entailing how this regulation will be met in the future. Plan of Correction due on May 22, 2023.
Deadline recorded: May 22, 2023. A deadline is not proof that correction was completed.
Plan of correction recorded
Correction deadline recordedDeadline May 22, 2023
Correction not verified in available records
Complaint
Allegations1 substantiated · 0 unsubstantiated · 0 unfounded · 1 cited
Resident rightsType A
- Official classification
- Type A
- Official code
- 87468.1(a)(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 was not met as evidenced by: Based off of interviews with staff and former staff member, former staff member and Resident #1 was verbally arguing which presents an immediate health, safety and personal rights risk to the residents in care.
Official plan of correction
Licensee shall include a Plan of Correction (POC) regarding staff training and future compliance regarding this regulation.
Deadline recorded: Apr 12, 2023. A deadline is not proof that correction was completed.
Plan of correction recorded
Correction deadline recordedDeadline Apr 12, 2023
Correction not verified in available records
Complaint
Allegations1 substantiated · 0 unsubstantiated · 0 unfounded · 1 cited
Resident rightsType A
- Official classification
- Type A
- Official code
- 87468.1(a)(11)
- 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 (11) To have their visitors, including ombudspersons and advocacy representatives, permitted to visit privately during reasonable hours and without prior notice, provided that the rights of other residents are not infringed upon. This requirement was not met as evidenced by: Based on interviews that were conducted with staff and resident, a visitor was barred from visiting the facility on January 17, 2023 which poses an immeidate health, safety and personal rights risk to the residents in care.
Official plan of correction
Licensee/Administrator shall conduct staff training regarding Personal Rights and visitations. Furthermore, Licensee/Administrator shall provide a written statement on how future compliance will be met. Plan of Correction due on February 15, 2023.
Deadline recorded: Feb 15, 2023. A deadline is not proof that correction was completed.
Plan of correction recorded
Correction deadline recordedDeadline Feb 15, 2023
Correction not verified in available records
Complaint
Allegations0 substantiated · 1 unsubstantiated · 0 unfounded
No deficiencies recorded in this reportComplaint
Allegations3 substantiated · 7 unsubstantiated · 0 unfounded · 3 cited · investigated over 2 visits
Basic services and supervisionType A
- Official classification
- Type A
- Official code
- 87464(f)(1)
- Regulation authority
- CCR
What the official deficiency says
Basic Services. 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). *** Based upon statements, this requirement has not been met as evidenced by: Staff report that residents have been left in soiled clothing and in need of bathing and changing for prolonged periods of time. ***This posed an immediate risk to the health and personal rights of residents in care.
Official plan of correction
Administration to provide written plan to ensure the timely hygiene assessments of residents in care and the documentation of care provided. Submit to CCL for approval by POC date in order to clear the deficiency.
Deadline recorded: Dec 23, 2022. A deadline is not proof that correction was completed.
Plan of correction recorded
Correction deadline recordedDeadline Dec 23, 2022
Correction not verified in available records
Staffing, personnel, and trainingType B
- Official classification
- Type B
- Official code
- 87411(c)
- Regulation authority
- CCR
What the official deficiency says
Personnel Requirements - General. All RCFE staff who assist residents with personal activities of daily living shall receive initial and annual training as specified in Health and Safety Code sections 1569.625 and 1569.69. *** Based upon records and statements, this requirement has not been met as evidenced by: Training records for S1 are incomplete prior to S1 assisting residents with personal activities of daily living. ***This posed a potential risk to the health and safety of residents in care.
Official plan of correction
Administration and Management/training staff will review the training requirements for caregiving staff and Administration will submit documentation of training on subject to CCL by POC date in order to clear the deficiency.
Deadline recorded: Jan 3, 2023. A deadline is not proof that correction was completed.
Plan of correction recorded
Correction deadline recordedDeadline Jan 3, 2023
Correction not verified in available records
Complaint
Allegations0 substantiated · 1 unsubstantiated · 0 unfounded
No deficiencies recorded in this reportComplaint
Part of the complaint whose outcome is recorded on Dec 20, 2022 · Control 21-AS-20220825085024
Background checksType A
- 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..prior to working...in a licensed facility:(1)Obtain a California clearance or a criminal record exemption as required by the Department...This requirement was not met as evidenced by: Based on Staff Interview conducted, Licensee did not ensure that staff member (S1) had the proper background clearance needed to provide care at the facility. This poses an immediate health and safety risk to residents in care.
Official plan of correction
Licensee to submit self-certification that they will review staff background clearances prior to conducting in-person/direct care training by POC date of 8/30/2022. Licensee immediately removed staff member from facility when notified they did not have proper clearance.
Deadline recorded: Aug 30, 2022. A deadline is not proof that correction was completed.
Plan of correction recorded
Correction deadline recordedDeadline Aug 30, 2022
Correction not verified in available records
Complaint
Allegations0 substantiated · 5 unsubstantiated · 0 unfounded
No deficiencies recorded in this reportComplaint
Allegations1 substantiated · 0 unsubstantiated · 0 unfounded · 1 cited
Facility condition and maintenanceType B
- Official classification
- Type B
- Official code
- 87303(a)
- Regulation authority
- CCR
What the official deficiency says
87303(a)-Maitenance and Operation: 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 was not met as evidenced by: Based on observation of the facility with Administrator on June 30, 2022, R1's room had a very strong odor of urine which presents a potential healthy, safety or personal rights risk to the resident in care.
Official plan of correction
Licensee shall ensure that ALL rooms are kept clean, sanitary and in good condition at ALL times. In addition, LPA requested a summary on how future compliance will be met moving forward. Plan of Correction due on: August 2, 2022.
Deadline recorded: Aug 2, 2022. A deadline is not proof that correction was completed.
Plan of correction recorded
Correction deadline recordedDeadline Aug 2, 2022
Correction not verified in available records
Complaint
Allegations2 substantiated · 1 unsubstantiated · 0 unfounded · 2 cited
Medical and dental careType A
- Official classification
- Type A
- Official code
- 87465(g)
- Regulation authority
- CCR
What the official deficiency says
87465 Incidental Medical and Dental Care:(g) The licensee shall immediately telephone 9-1-1 if an injury or other circumstance has resulted in an imminent threat to a resident’s health including, but not limited to, an apparent life-threatening medical crisis...This requirement is not met as evidenced by: Based on Resident File Review, Facility Document Review, and Interviews conducted, the Licensee did not comply with the above regulation and did not call 911 per protocol after observing the resident experience a lot of bleeding. This poses an immediate health and safety risk to residents in care.
Official plan of correction
Licensee to review Regulation 87465 Incidental Medical and Dental Care, Facility Policy and Procedure Manual, and circumstances when 911 should be called with all staff. Licensee to submit planned training date(s) to CCL by POC due date, 7/19/2022. Licensee to conduct an Inservice Training for all Staff. Inservice Training to include following information: Date of Training, Training Topics, Job Role, Staff Names and Signatures by POC due date of 8/1/2022.
Deadline recorded: Jul 19, 2022. A deadline is not proof that correction was completed.
Plan of correction recorded
Correction deadline recordedDeadline Jul 19, 2022
Correction not verified in available records
Staffing, personnel, and trainingType B
- Official classification
- Type B
- Official code
- 87411(c)(1)
- Regulation authority
- CCR
What the official deficiency says
87411 Personnel Requirements – General (c) All RCFE staff who assist residents with personal activities of daily living shall receive initial and annual training...(1)Staff providing care shall receive appropriate training in first aid from persons qualified by such agencies as the American Red Cross. This requirement is not met as evidenced by: Based on LPA’s observations and Interviews conducted, the Licensee did not comply with the above regulation and did not ensure that all staff that assist residents with personal activities of daily living have completed and documented training. This poses a potential health & safety risk to residents in care.
Official plan of correction
Licensee to ensure that all staff who assist residents with personal activities of daily living have the required First Aid and CPR Training completed and certificates placed on file. Licensee to send Staff Roster and Proof of Training to CCL by POC due date of 8/1/2022.
Deadline recorded: Aug 1, 2022. A deadline is not proof that correction was completed.
Plan of correction recorded
Correction deadline recordedDeadline Aug 1, 2022
Correction not verified in available records
Complaint
Allegations1 substantiated · 1 unsubstantiated · 0 unfounded · 1 cited
Food serviceType A
- Official classification
- Type A
- Official code
- 87555(b)
- Regulation authority
- CCR
What the official deficiency says
87555 General 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 is not met as evidenced by: Based on LPA Observations and File Records reviewed, the Licensee failed to ensure Resident (R1) was following the modified diet as prescribed by their Physician. This poses an immediate health & safety risk to the residents in care.
Official plan of correction
Licensee to update facility whiteboard with resident’s dietary needs under the correct section and send a picture as proof by POC due date of 7/19/2022. Licensee to conduct Inservice Training to review regulation and updated dietary needs of resident with all staff. Inservice training to include the following information: Date of Training, Training Topics, Job Role, Staff Names and Signatures by POC due date of 8/1/2022.
Deadline recorded: Jul 19, 2022. A deadline is not proof that correction was completed.
Plan of correction recorded
Correction deadline recordedDeadline Jul 19, 2022
Correction not verified in available records
Complaint
Allegations3 substantiated · 0 unsubstantiated · 0 unfounded · 4 cited
Food serviceType A
- Official classification
- Type A
- Official code
- 87555(a)
- Regulation authority
- CCR
What the official deficiency says
87555 General Food Service Requirements (a) The total daily diet shall be of the quality and in the quantity necessary to meet the needs of the residents...All food shall be selected, stored, prepared and served in a safe and healthful manner. This requirement is not met as evidenced by: Based on LPA observations and interviews conducted, the Licensee did not comply with the above regulation and did not ensure that food was properly stored. This poses an immediate health and safety risk to the residents in care.
Official plan of correction
Licensee to provide In-service Training regarding Food Service Operations and the importance of properly preparing, storing and serving food. Inservice training to include the following information: Date of Training, Training Topics, Job Role, Staff Names and Signatures by POC due date of 8/1/2022.
Deadline recorded: Jul 19, 2022. A deadline is not proof that correction was completed.
Plan of correction recorded
Correction deadline recordedDeadline Jul 19, 2022
Correction not verified in available records
Records and plan of operationType B
- Official classification
- Type B
- Official code
- 87212(c)
- Regulation authority
- CCR
What the official deficiency says
87212 Emergency Disaster Plan (c) Emergency exiting plans and telephone numbers shall be posted. This requirement is not met as evidenced by: Based on LPA’s observations, the Licensee did not comply with the above regulation and did not ensure that Facility had emergency exit plans/maps posted. This poses a potential health and safety risk to residents in care.
Official plan of correction
Licensee to post Emergency Exits/Evacuation Maps throughout facility by POC due date of 8/1/2022. LPA Observations on 7/18/22 show that facility has posted exit plans/maps at Elevators. Deficiency cleared during visit.
Deadline recorded: Aug 1, 2022. A deadline is not proof that correction was completed.
Official record says corrected or clearedRecorded in report dated Jul 18, 2022
Plan of correction recorded
Correction deadline recordedDeadline Aug 1, 2022
Resident rightsType B
- 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 LPA’s observations, the Licensee did not comply with the Department of Public Health and Department of Social Services Guidelines and Requirements related to COVID-19. LPA observed multiple individuals not wearing a mask and/or not being screened for COVID related symptoms. This poses a potential health and safety risk to residents in care.
Official plan of correction
Licensee to review COVID Infection Control plan and submit a written plan to CCL on how they will ensure that COVID procedures will be followed. Licensee to provide In-service Training stating that Facility has read and understood COVID procedures based on current Public Health and Social Services Departmental guidelines. Inservice training to include the following information: Date of Training, Training Topics, Job Role, Staff Names and Signatures by POC due date of 8/1/2022.
Deadline recorded: Aug 1, 2022. A deadline is not proof that correction was completed.
Plan of correction recorded
Correction deadline recordedDeadline Aug 1, 2022
Correction not verified in available records
Complaint
Allegations1 substantiated · 0 unsubstantiated · 0 unfounded · 1 cited
Food serviceType A
- Official classification
- Type A
- Official code
- 87555(b)(31)(A)
- Regulation authority
- CCR
What the official deficiency says
87555 General Food Service Requirements: (b) The following food service requirements shall apply: (31) Dishes and utensils shall be disinfected: (A) In facilities using mechanical means, by...maintaining hot water at a minimum temperature of 170 degrees F (77 Degrees C) at the final rinse cycle of dishwashing machines... This requirement is not met as evidenced by: Based on observations and interviews, LPAs observed that Dishwasher was not maintaining proper water temperature required by regulation. This poses an immediate health, safety, and personal risk to residents in care.
Official plan of correction
Licensee to submit signed self-certification stating that facility will take steps to bring dishwashing machine water temperature into compliance with regulation and verify with temperature logs over a one week period by POC date of 6/3/2022. Temperature Logs and Proof of Repair to be submitted to CCL by POC date of 6/20/2022.
Deadline recorded: Jun 3, 2022. A deadline is not proof that correction was completed.
Plan of correction recorded
Correction deadline recordedDeadline Jun 3, 2022
Correction not verified in available records
Complaint
Allegations2 substantiated · 3 unsubstantiated · 0 unfounded · 2 cited
Food serviceType A
- Official classification
- Type A
- Official code
- 87555(a)
- Regulation authority
- CCR
What the official deficiency says
87555 General Food Service Requirements (a) The total daily diet shall be of the quality and in the quantity necessary to meet the needs of the residents and shall meet the Recommended Dietary Allowances of the Food and Nutrition Board of the National Research Council. All food shall be selected, stored, prepared and served in a safe and healthful manner. This requirement has not been met based on interviews and observations showing that food service is inadequate including: food running out, food not being stored appropriately, and food portions being too small. This poses an immediate health and safety risk to residents.
Official plan of correction
Adminstrator agrees to submit a written plan that includes: a designated individual to ensure quality assurance of food. This ensures that food is adequate, good quality, and prepared, stored, and served in a safe and healthful manner. Additionally, plan must also include a way for residents to communicate concerns regarding food by POC due date 4/7/2022.
Deadline recorded: Apr 7, 2022. A deadline is not proof that correction was completed.
Plan of correction recorded
Correction deadline recordedDeadline Apr 7, 2022
Correction not verified in available records
Facility condition and maintenanceType B
- Official classification
- Type B
- 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 has not been met based on review of pictures showing that bushes were overgrown blocking the sidewalk. This poses a potential health and safety risk to residents in care.
Official plan of correction
Administrator agrees to submit self-certification that passageways will always be kept cleared at all times by POC due date 4/11/2022.
Deadline recorded: Apr 11, 2022. A deadline is not proof that correction was completed.
Plan of correction recorded
Correction deadline recordedDeadline Apr 11, 2022
Correction not verified in available records
Complaint
Allegations1 substantiated · 1 unsubstantiated · 0 unfounded · 1 cited
Resident rightsType B
- Official classification
- Type B
- Official code
- 1569.269(a)(6)
- Regulation authority
- HSC
What the official deficiency says
1569.269 Enumerated rights; severability (a) Residents of residential care facilities for the elderly shall have all of the following rights: (6) To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs. This has not been met as evidence by: Based on observation and interviews, LPA observed that staff are not assisting residents in a timely manner which poses a potential health & safety risk to residents in care.
Official plan of correction
Facility will submit proof of staff training to attend residents call system is answered in a timely manner and submit a written plan on how facility will ensure that staff is meeting the residents needs in a timely manner when residents use the call system by 1/11/22.
Deadline recorded: Jan 11, 2022. A deadline is not proof that correction was completed.
Plan of correction recorded
Correction deadline recordedDeadline Jan 11, 2022
Correction not verified in available records
Complaint
Allegations2 substantiated · 2 unsubstantiated · 0 unfounded · 2 cited
Resident rightsType A
- Official classification
- Type A
- Official code
- 1569.269
- Regulation authority
- HSC
What the official deficiency says
1569.269 Enumerated rights; severability (a) Residents of residential care facilities for the elderly shall have all of the following rights: (6) To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs. This requirement was not met as evidenced by: Resident R1 sustained several falls, R1 was observed to require additional needs and services for their safety along with staff escort to meals. This is an immediate risk to the health and safety of residents in care
Official plan of correction
Facility to send in written plan on how they will ensure residents needs are being met per H & S 1569.269 POC due date 11/19/2021 To LPA A. Canela
Deadline recorded: Nov 18, 2021. A deadline is not proof that correction was completed.
Plan of correction recorded
Correction deadline recordedDeadline Nov 18, 2021
Correction not verified in available records
Resident rightsType B
- Official classification
- Type B
- Official code
- 87218(a)
- Regulation authority
- CCR
What the official deficiency says
87218(a) Theft and Loss (a) The licensee shall ensure an adequate theft and loss program as specified in Health and Safety Code Section 1569.153. This requirement was not met as evidenced by: Resident R1 had several clothing items missing and after moving out, family found several items of clothing that did not belong to R1 along with a wheelchair that belong to another resident. This is a potential risk to the personal rights of residents in care Residents property,
Official plan of correction
Facility to send in written plan on how residents belongings/clothing items are not lost or misplaced during laundry time and that facility has an inventory of all durable equipment, identified per resident and how they will ensure residents have their own items. POC due date 11/29/2021 To LPA A. Canela
Deadline recorded: Nov 29, 2021. A deadline is not proof that correction was completed.
Plan of correction recorded
Correction deadline recordedDeadline Nov 29, 2021
Correction not verified in available records
Complaint
No deficiencies recorded in this report
Source and limits
California Department of Social Services, Community Care Licensing Division. Public facility history is described by the source as a five-year window. Older records and previous-licensee history may require a regional-office request. Type 741 RCFE-CCRCs, nursing homes, and other care settings are excluded from this page.
Read the data methodology