Facility condition and maintenanceType A
- Official classification
- Type A
- Official code
- 87303(e)(3)
- Regulation authority
- CCR
What the official deficiency says
(3) Taps delivering water at 125 degree F (52 degrees C) or above shall be prominently identified by warning signs. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA's/Administrator observations, the temperature reading of hot water facets not used by residents, the kitchen sink facet reading was 132.4, 134.8 and 125.8 in the bathrooms which poses an immediate health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 05/19/2026 Plan of Correction Administrator agrees to place warning signs for faucets delivering water 125 or above. Administrator immediately adjusted water heater. To clear this violation, Administrator will submit photo proof of each faucet identified in this report with a warning sign placed near the faucet to warn the user of the hot water temperature. Photos to be submitted to CCL by POC date by 5/19/26.
Background checksType A
- Official classification
- Type A
- Official code
- 87355(e)
- Regulation authority
- CCR
What the official deficiency says
(e) 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 requirement is not met as evidenced by: Deficient Practice Statement Based on LPA's/Administrator observations, record review and interviews, the licensee did not comply with the section cited above in that one caregiver (I1) was not associated with the facility in Guardian which poses an immediate health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 05/19/2026 Plan of Correction Administrator agrees to associate I1 in the Guardian system and submit proof of doing so by POC due date of 5/19/2026. *Civil penalties are been assessed in the amount of $100 for having a person who was not associated to the facility work with residents in care.
Incident reportingType B
- Official classification
- Type B
- Official code
- 87211(a)(1)
- Regulation authority
- CCR
What the official deficiency says
(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. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA's observations, record review and interviews, administrator failed to report incidents that threatened the safety or health of residents, which poses/posed a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 06/01/2026 Plan of Correction Administrator to ensure incidents are reported per regulation. Administrator to review regulation 87211, which was provided, and conduct training for all staff on reporting requirements. Evidence of completed training to be submitted to CCL by POC date of 06/01/2026.
Facility condition and maintenanceType B
- Official classification
- Type B
- Official code
- 87307(d)(6)
- Regulation authority
- CCR
What the official deficiency says
(6) All outdoor and indoor passageways and stairways shall be kept free of obstruction. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA's/administrator observation, records review of facility sketch and interviews with administrator, the facility staff did not ensure that resident's night stand and hoyer lift were blocking an identified exit leading from bedrooms to the patio which poses a potential risk to the health and safety of residents in care.
Official plan of correction
POC Due Date: 06/01/2026 Plan of Correction Administrator agrees to keep all passageways free from obstruction. Administrator moved night stand and hoyer lift machine away from exit doors allowing passage. Administrator agrees to review regulation and conduct staff training with all staff, then administrator will submit LIC9098 certifying that the passageway will be kept cleared at all times by POC due date.
Hazardous items and storageType B
- Official classification
- Type B
- Official code
- 87309(a)
- Regulation authority
- CCR
What the official deficiency says
(a) Except as specified in subsection (b), the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances, knives, matches, tools, sharp objects, and other similar items which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA's/Administrator observation and interview, the licensee did not comply with the section cited above by having toxins and cleaning supplies were unlocked under the kitchen sink which poses/posed a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 06/01/2026 Plan of Correction Administrator agrees to conduct an all staff training to review regulation and items to be stored inaccessible, submit training roster and topics covered to CCL by POC 06/01/2026.
Licensing and administrationType B
- Official classification
- Type B
- Official code
- 1569.618(c)(3)
- Regulation authority
- HSC
What the official deficiency says
(c)The facility shall employ, and the administrator shall schedule, a sufficient number of staff members to do all of the following: (3) Ensure that at least one staff member who has cardiopulmonary resuscitation (CPR) training and first aid training is on duty and on the premises at all times. This paragraph shall not be construed to require staff to provide CPR. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA's/administrator records review and interview, the licensee failed to have at least staff member who has CPR and 1st Aid training on duty at all times. Facility has one out of three caregivers (S2) that work at the facility without a valid CPR certificate which poses a potential health, safety risk to residents in care.
Official plan of correction
POC Due Date: 06/01/2026 Plan of Correction Administrator to ensure that at least one staff on duty has CPR training at all times & all staff have First Aid. Administrator to submit self-certification form (LIC9098) ensuring that staff (S2) have current CPR trained per regulation by POC due date.
Staffing, personnel, and trainingType B
- Official classification
- Type B
- Official code
- 87412(a)(11)
- 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: (11) A health screening as specified in Section 87411, Personnel Requirements - General. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA's/administrator observation, interviews and record review, the licensee did not comply with the section cited above in that 3 out of 3 staff (S1, S2 & S3) did not have Heatth Screens including TB tes on file, which poses a potential health, safety or personal rights risk to persons in care. which poses/posed a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 06/01/2026 Plan of Correction Administrator to ensure staff have health screening including TB test done and shall submit self-certification (LIC9098) they have obtained health screening for all three staff (S1, S2 & S3) including TB test. Self-certification shall be submitted to CCLD by POC due date.
Staffing, personnel, and trainingType B
- Official classification
- Type B
- Official code
- 1569.625(b)(1)
- Regulation authority
- HSC
What the official deficiency says
(1) The department shall adopt regulations to require staff members of residential care facilities for the elderly who assist residents with personal activities of daily living to receive appropriate training. This training shall consist of 40 hours of training. A staff member shall complete 20 hours, including six hours specific to dementia care, as required by subdivision (a) of Section 1569.626 and four hours specific to postural supports, restricted health conditions, and hospice care, as required by subdivision (a) of Section 1569.696, before working independently with residents. The remaining 20 hours shall include six hours specific to dementia care and shall be completed within the first four weeks of employment. The training coursework may utilize various methods of instruction, including, but not limited to, lectures, instructional videos, and interactive online courses. The additional 16 hours shall be hands-on training. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA's/administrator observation, interview and record review, the licensee did not comply with the section cited above in three out of three staff there was no proof of staff having obtained required annual direct care staff training, which poses/posed a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 06/01/2026 Plan of Correction Administrator to ensure that all staff (S1, S2 & S3) obtain required annual training for direct care staff. Administrator shall submit self-certification (LIC9098) they have obtained required annual training hours. Self-certification shall be submitted to CCLD by POC due date.
Food serviceType B
- Official classification
- Type B
- Official code
- 87555(b)(26)
- Regulation authority
- CCR
What the official deficiency says
(26) Supplies of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days shall be maintained on the premises. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA's/administrator observation and interview, the licensee did not comply with the section cited above by having one orange and cantaloupe as only fruits for five residents in care which poses/posed a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 06/01/2026 Plan of Correction Administrator shall submit self-certification (LIC9098) ensuring they have obtained adequate supplies of fresh fruits and vegatables for at least two days for residents in care. Self-certification shall be submitted to CCLD by POC due date.
Admission, assessment, and evictionType B
- Official classification
- Type B
- Official code
- 87463(a)
- Regulation authority
- CCR
What the official deficiency says
(a) The pre-admission appraisal, as specified in Section 87457, Pre-Admission Appraisal, shall be updated, in writing as frequently as necessary or once every 12 months, whichever occurs first, to note significant changes in condition, as defined in Section 87101, Definitions, and to keep the appraisal accurate. For the purposes of this section, the updated pre-admission appraisal shall be referred to as the reappraisal. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA's/administrator observation, interview and record review, the licensee did not comply with the section cited above in one out of two out of five residents (R2 & R3) care plans wwere not completed which poses/posed a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 06/01/2026 Plan of Correction Administrator shall submit self-certification (LIC9098) they have completed required care plans for R2 & R3. Self-certification shall be submitted to CCLD by POC due date.
Fire safety and emergency preparednessType B
- 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 file review and interview, the facility failed to conduct an emergency drill within the past quarter which poses/posed a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 06/01/2026 Plan of Correction Administrator agrees to conduct and document disaster drills every 3 months on all shifts with all direct care staff. Licensee agrees to conduct a disaster drill on all shifts with all direct care staff and submit self-certification (LIC9098) form to CCL by POC 6/1/2026.