JPS HOME CARE SERVICES

Official classification

Type B

Official code

87211(a)(1)(A)

Regulation authority

CCR

What the official deficiency says

87211 Reporting Requirements (a) Each licensee shall furnish... (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 of any of the events specified in (A) through (D) below. This report shall include the resident's name, age, sex and date of admission; date and nature of event; attending physician's name, findings, and treatment, if any; and disposition of the case. (A) Death of any resident from any cause regardless of where the death occurred, including but not limited to a day program, a hospital, en route to or from a hospital, or visiting away from the facility. This requirement not met by licensee as evidenced by: Based on LPA record review and interview, the licensee did not comply with the section cited above as facility did not report R1s death to CCL which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Licensee to self-certify that they will maintain compiance with all reporting requirements as outlined in regualtion 87211. Plan of Correction to be submitted to CCL by 04/24/2026.

Deadline recorded: Apr 24, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

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... This requirement is not met by licensee as evidence by video review and interviews...... conducted, the licensee did not ensure R1 received assistance from S1 and/or staff on duty. This poses an immediate Health, Safety or Personal Rights risk to persons in care.

Official plan of correction

Facility will submit plan to CCL to conduct personal rights training and training for all direct care staff on care and supervision by plan of correction due date 08/29/2025. Facility to submit proof of completed training to CCL by 09/10/25.

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

Official classification

Type B

Official code

87303(e)(2)

Regulation authority

CCR

What the official deficiency says

87303 Maintenance and Operation (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 degree C) and not more than 120 degree F (49 degree C). This requirement is not met as evidenced by: Deficient Practice Statement Based on LPAs and staff observation, the facility did not comply with the section cited above in 2 out of 2 bathroom sinks accessible to residents were measured above 120 degrees F (49 degree C) which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/08/2025 Plan of Correction Licensee/Administrator shall submit a 7 day water temperature log for both bathrooms accessible to residents showing water temperature is within regulation of 105 degree F to 120 degree F. Water log shall be submitted with pictures of thermotoer in running water with temperature visible. Water log to be submitted to CCL by Plan of Correction (POC) due date 08/08/2025.

Official classification

Type A

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 LPA/Licensee observation the hot water measured 127 and 134.4 degrees Fahrenheit, which is not in compliance with regulation, the licensee did not comply with the section cited above which poses an immediate health, safety risk to persons in care.

Official plan of correction

POC Due Date: 09/20/2024 Plan of Correction Licensee agreed to adjust water heater to ensure the hot water is monitored between 105 to 120 degrees Fahrenheit. Licensee will submit a plan on how the facility will ensure the hot water is maintained in compliance with regulation by POC due date.

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 LPA's/Licensee observation and interview, the licensee did not comply with the section cited above by having cleaning solutions and disinfectans available 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: 09/20/2024 Plan of Correction Licensee will submit a written plan to CCL outlining their protocol to keep items that pose a risk to residents in care inaccessible no later than POC due date, 9/20/2024.

Official classification

Type B

Official code

87412(d)

Regulation authority

CCR

What the official deficiency says

(d) The licensee shall maintain documentation that an administrator has met the certification requirements specified in Section 87406, Administrator Certification Requirements or the recertification requirements in Section 87407, Administrator Recertification Requirements. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA's/Licensee observation, interview and record review, the licensee did not comply with the section cited above by not having an active administrator certificate which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/25/2024 Plan of Correction Licensee agreed to appoint a new administrator and send required documentation (LIC 215 Applicant Information, Administrator Resume, LIC 500 Personnel Report and LIC 501 Personnel Record) to the Department by not later than September 25, 2024.

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 LPA's/Licensee Asst observation, interview and record review, the licensee did not comply with the section cited above in two out of three staff have not completed their additional 20 hours annually, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/25/2024 Plan of Correction Licensee agreed to have all staff complete required 20 hours annual training. Licensee will submit a self-certification form (LIC9098) to CCL ensuring that staff have completed required annual training hours by POC due 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 LPA's/Licensee observation, interview and record review, the licensee did not comply with the section cited above in four out of five residents (R1, R2, R3 & R4) needs an updated care plan, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/25/2024 Plan of Correction Licensee agreed to submit a LIC9098 self-certification form ensuring that resident's care plans have been updated per regulation to CCL by POC due date to clear the citation.

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 plan for incidental medical & 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: The licensee shall assist residents with self-administered medications as needed. This requirement was not met- As evidenced by: During medication audit of 6/10/2024 and today, the facility failed to properly provide some medication to R1. (Prednisone, Albuterol, Doxyclyne/antibiotic, verapamil) This is an immediate risk to the Health & Safety of residents in care

Official plan of correction

Facility to send in written plan on how they will ensure compliance for meeting residents needs and medication training. First POC due date for written plan due 7/9/2024, with follow up by 7/16/2024 for proof of medication training. POC due to LPA Araceli Canela

Deadline recorded: Jul 9, 2024. 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 Incidental Medical and Dental Care (h) The following requirements shall apply to medications which are centrally stored: (6) The licensee shall be responsible for assuring that a record of centrally stored prescription medications for each resident is maintained for at least one year and includes: This requirement was not met as evidenced by: The facility failed to properly document the centrally stored medication log as required for all residents. This is a potential risk to the health & safety of residents in care.

Official plan of correction

Facility to send in written plan on how they will make sure the centrally store log is being properly documented for all residents. Administrators plan to review an make sure the facility is documenting properly. Plan of correction due by 6/28/2024 attention LPA A Canela

Deadline recorded: Jun 28, 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 such reports as the Department may require, including, but not limited to, 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 of any of the events specified in (A) through (D) below. This report shall include the resident's name, age, sex and date of admission; date and nature of event; attending physician's name, findings, and treatment, if any; and disposition of the case. (D) Any incident which threatens the welfare, safety or health of any resident, such as psychological abuse of a resident by staff or other residents, or unexplained absence of any resident. This requirement was not met as evidenced by: The facility failed to report several incidents for resident R1. This is a potential risk to the health & safety of residents in care

Official plan of correction

Facility to send in all missing incident reports that were not submitted regarding resident R1 and any other reportable incidents. Facility to send in written plan on how they will make sure the facility stays in compliance. Plan of correction due by 6/17/2024 attention LPA A Canela

Deadline recorded: Jun 17, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87203

Regulation authority

CCR

What the official deficiency says

All facilities shall be maintained in conformity with the regulations adopted by the State Fire Marshal for the protection of life and property against fire and panic. This requirement is not met as evidenced by: Deficient Practice Statement Based on today's inspection and observation with licensee, Evelyn Serrano, the licensee did not comply with the section cited above in 4 out of 4 fire extingueshers had not been serviced within the last year,which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/20/2022 Plan of Correction Facility to send proof all fire extingueshers have been serviced yearly with proof of service tags. In addition, facility to send in a written statement they understand regulation requirement and how they will insure they follow it. POC due date 9/20/2022 to CCL attention LPA Canela

Official classification

Type A

Official code

87465(a)(5)

Regulation authority

CCR

What the official deficiency says

87465(a)(5) Incidental Medical and Dental Care-A plan for incidental medical & 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: The licensee shall assist residents with self-administered medications as needed. This requirement was not met- As evidenced by: During medication audit of 9/14/21 an d today 9/22 the facility failed to provide some medication to R1. (Metaformin, Docusate & Clozapinerx) was not provided, or correct doze was not provided. This is an immediate risk to the Health & Safety of residents in care

Official plan of correction

Facility to send in written plan on how they will ensure compliance and written plan for medication training. First POC due date 9/23/2021 with follow up by 9/30/2021 for proof of medication training.

Deadline recorded: Sep 23, 2021. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87458(a)

Regulation authority

CCR

What the official deficiency says

87458(a) Medical Assessment- Prior to a person's acceptance as a resident, the licensee shall obtain and keep on file, documentation of a medical assessment, signed by a physician, made within the last year. The licensee shall be permitted to use the form LIC 602 (Rev. 9/89), Physician's Report, to obtain the medical assessment. This requirement was not met as evidenced by: During facility resident record review, 2 of 5 residents did not have the required Physician report for R2 and R3. This is a potential risk to the Health & Safety of residents in care

Official plan of correction

Facility to send in written statement they understand regulation and how they will ensure compliance and have all required records for all residents. POC due date 10/12/2021 to LPA A. Canela FAx (707) 588-5080 or by email: araceli.canela@dss.ca.gov

Deadline recorded: Sep 30, 2021. 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: Facility did not request a transfer of a criminal record clearance for individual (I1) prior to working at the facility. This is an immediate safety risk to the residents in care.

Official plan of correction

Administrator agreed to associate I1 by POC due date 09/15/2021, close of business. Also agreed to send a written statement they understand regulation requirements. **Civil Penalty assessed in the amount of $100.00

Deadline recorded: Sep 15, 2021. A deadline is not proof that correction was completed.