SUNSHINE PETALUMA CARE HOME

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 record review, the licensee did not comply with the section cited above in 3 of 4 resident records. Reappraisals were not updated within the last 12 months, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/07/2026 Plan of Correction Licensee agrees to ensure all resident reappraisals are updated as needed or at least every 12 months. Licensee agrees to send self certification that all appraisals have been updated. Self certification shall be sent to CCL by 08/07/2026.

Official classification

Type B

Official code

87465(a)(2)

Regulation authority

CCR

What the official deficiency says

87465 (a)(2) Incidental Medical and Dental Care - The licensee shall provide assistance in meeting necessary medical and dental needs...This requirement has not been met as evidenced by: Based on LPA's records review and interview with the Licensee, the facility failed to seek timely medical after R1 had an unwitnessed fall on 2/26/2026, as of today the unwitnessed fall hve not been reported to R1's physician for follow up, which is an immediate risk to the health and safety of the resident.

Official plan of correction

Licensee agrees to contact R1's physician to report the incident and will submit self-certification that regulations 87465 Incidental Medical and Dental Care have been reviewed with facility staff and are understood to CCL by POC due date 3/13/2026.

Deadline recorded: Mar 13, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

1569.605

Regulation authority

HSC

What the official deficiency says

On and after July 1, 2015, all residential care facilities for the elderly, except those facilities that are an integral part of a continuing care retirement community, shall maintain liability insurance covering injury to residents and guests in the amount of at least one million dollars ($1,000,000) per occurrence and three million dollars ($3,000,000) in the total annual aggregate, caused by the negligent acts or omissions to act of, or neglect by, the licensee or its employees. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and interview with Licensee, they have not obtained the required liability Insurance to operate an RCFE which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/20/2024 Plan of Correction Licensee to obtain appropriate liability insurance of 1 million per occurance and three million in the total annual aggregate for facility and submit copy to CCL by 9/20/2024 to clear citation. If extension is needed Licensee will contact LPA.

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 LPAs observation, the licensee did not comply with the section cited above in observing door with signal turned off and propped open from kitchen to garage where toxins and cleaning supplies are stored in cabinet in garage with locks that do not work as well as window cleaner in unlocked cabinet under kitchen sink all accessible to residents in care which poses/posed a potential health, safety or personal rights risk to persons in care. Signal system turned on and door locked by Licensee.

Official plan of correction

POC Due Date: 09/20/2024 Plan of Correction An In-Service Training will be done reviewing Regulation Care of Persons with Dementia 87705(f)(1). Training with dates and signatures of staff to be submitted by due date of 9/20/2024.