PROVIDENCE HOME OF ARAGON

Official classification

Type A

Official code

87202(a)

Regulation authority

CCR

What the official deficiency says

(a) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, or the State Fire Marshal. Prior to accepting or retaining any of the following types of persons, the applicant or licensee shall notify the licensing agency and obtain an appropriate fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, or the State Fire Marshal: 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 all fire extinguishers were expired as February 2025 and two out of five residents are bedridden which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/12/2026 Plan of Correction Licensee will follow up on getting fire extinguishers charged. Also, the Licensee will contact updated physician's report for two residents (R1 and R2) to get updated ambulatory status corrected on LIC602s. The facility will submit self-certification as proof that both items were corrected to CCL by POC due date.

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 the temperature reading of hot water facets not used by residents, the kitchen sink facet reading was 135.5 and 124 in the bathrooms which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/12/2026 Plan of Correction Licensee agrees to place warning signs for faucets delivering water 125 or above. To clear this violation, Licensee will submit photo proof of each faucet identified in this report with a warning sign placed near the facet to warn the user of the hot water temperature. Photos to be submitted to CCL by POC date by 3/12/26

Official classification

Type A

Official code

87355(e)(3)

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: (3) Request a transfer of a criminal record clearance as specified in Section 87355(c) or 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 three out of ten staff individuals (I1, I2 & I3) were fingerprint cleared, but their fingerprints have not been transferred and associated to the facility which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/12/2026 Plan of Correction LPA confirmed I1, I2 & I3 has cleared finger prints. Licensee agrees to email/fax required documents to CCL to associate individuals who two of them were working and present at the facility at the time of inspection to clear the citation. ***Civil Penalty assessed in the amount of $1500 for each staff not associated to this facility.

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

(a) 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 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 in shared bathroom between room#5 and 6 shower head is leaking. There was a bucket full of water holding water coming off from shower head which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/25/2026 Plan of Correction Licensee shall submit self-certification (LIC9098) they have read fixed showerhead. Self-certification shall be submitted to CCLD by POC due date.

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/Licensee 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 2 out of 3 caregivers 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: 03/25/2026 Plan of Correction Licensee to ensure that at least one staff on duty has CPR training at all times & all staff have First Aid. Licensee to submit self-certification form (LIC9098) ensuring that staff have current CPR trained per regulation by POC due date.

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/Licensee observation, interviews and record review, the licensee did not comply with the section cited above in that 3 out of 3 staff 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: 03/25/2026 Plan of Correction Licensee 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 including TB test. Self-certification shall be submitted to CCLD by POC due date.

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 observation, interview and record review, the licensee did not comply with the section cited above in one 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: 03/25/2026 Plan of Correction Licensee to ensure that staff S3 obtain required annual training for direct care staff. Licensee shall submit self-certification (LIC9098) they have obtained required annual training hours. Self-certification shall be submitted to CCLD by POC due date.

Official classification

Type B

Official code

87608(a)(5)(A)

Regulation authority

CCR

What the official deficiency says

(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 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 five out of five residents do not have bed rails order on file which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/25/2026 Plan of Correction Licensee to ensure physician orders are on file for the use of postural supports. Licensee will submit self-certification form ensuring that all residents have bed rails orders on file to clear the citation by POC due date 3/25/26.

Official classification

Type A

Official code

1569.686(a)

Regulation authority

HSC

What the official deficiency says

1569.6869a) Licensee notification of specified events; department initiation of compliance plan, noncompliance conference, or other appropriate action; penalties; exception. (a) A licensee shall notify the department, the State Long-Term Care Ombudsman, all residents, and, if applicable, their legal representatives, in writing, within two business days, and shall notify all applicants for potential residence, and, if applicable, their legal representatives, prior to admission, of any of the following events, or knowledge of the event: This requirement was not met as evidenced BY: Based on today's meeting with licensee, the facility failed to notify CCL, Local Ombudsman & resident or their responsible parties as required. This is an immediate risk to the Health and Safety of residents in care.

Official plan of correction

Licensee agrees to issue letters and notify all residents and/Ombudsman by 11/22/2022. Licensee to provide copies of letters to CCL by 1or their responsible parties, Local 1/22/2022 Attention LPA: Araceli Canela A civil Penalty was assessed today for a total of $2,000. for HSC1569.686 violation

Deadline recorded: Nov 22, 2022. A deadline is not proof that correction was completed.