FAMILY HOUSE

Official classification

Type A

Official code

87465(h)(2)

Regulation authority

CCR

What the official deficiency says

87465(h)(2) Incidental Medical and Dental Care- The following requirements shall apply to medications which are centrally stored: Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. This requirement was not met as evidenced by: R1's prescribed liquid medication had been left out on resident's dresser in their room; This medication was not centrally stored and locked up, as required, This is a risk to the health & safety of residents' in care.

Official plan of correction

Licensee/Administrator to ensure that all resident medications are centrally stored as required. Hold an in-service with all staff to review medication policies of the facility. Submit proof of training by 1/8/26. Submit a plan regarding future compliance with this regulation, and plan of correction by 12/30/25.

Deadline recorded: Dec 30, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(a)(4)

Regulation authority

CCR

What the official deficiency says

Incidental Medical and Dental Care - A plan for incidental medical and dental care shall be developed by each facility. The licensee shall assist residents with self-administered medications as needed. This requirement was not met as evidenced by: Per LPA's review of medication records, the MAR sheet, it was identified that on 10/9 there were two medications that were not provided to R1 as prescribed; One medication is provided once in the am, the other medication is provided twice a day, in the am and in the pm. Administrator could not provide any information why these medications were not provided. This is a risk to residents' health & safety.

Official plan of correction

Licensee/Administrator to ensure that all resident medications are provided to residents' as required. Hold an in-service with all staff to review medication policies of the facility. Submit proof of training by 1/8/26. Submit a plan regarding future compliance with this regulation, and plan of correction by 12/30/25.

Deadline recorded: Dec 30, 2025. A deadline is not proof that correction was completed.

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. This requirement was not met as evidenced by: tour of some facility resident rooms, the facility does have light colored carpet with some stains in different areas that are very visible. Administrator stated the carpet is older and they do clean it, but they will see about replacing the rug because they can see the stains the LPA was seeing/pointing out. This is a risk to residents' personal rights.

Official plan of correction

Licensee/Administrator to ensure the facility carpet is maintained in a clean manner, not dirty and stained, and/or replace the rug if needed. Submit how the facility will ensure compliance with this reguation, how this deficiency was corrected, and how it will be maintained. POC due 1/19/26.

Deadline recorded: Jan 19, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87307(e)(1)

Regulation authority

CCR

What the official deficiency says

87307(e )(1)Personal Accommodations and Services- The licensee shall supervise residents as needed and as determined by the resident's appraisal pursuant to Section 87457, Pre-Admission Appraisal or Section 87463, Reappraisals, when residents are in proximity to or when there is use of the following items: Ranges, ovens, heaters, fireplaces, wood stoves, inserts, and other heating devices. LPA called out to staff Rhonell and told them that there is no staff here in the kitchen supervising the stove that is on, and the pot of corn boiling on the stove. Caregiver Rohnell went to the stove and turned the burner off, and called out to caregiver Mildred, who was cooking the meal. There are residents' in care that are at risk if they have access to the hot stove, and pot of boiling water on a hot stove.This is an immediate health and safety risk to residents' in care.

Official plan of correction

Licensee/Administrator to ensure staff are in-serviced on complaince with regulation in supervising items such as ranges, ovens, heaters, fireplaces, wood stoves, inserts, and other heating devices, that are a risk to certain residents in care, per medical assessments, and behaviors. Submit proof of training to the Department by 10/22/25; Submit plan of correction (POC) by 10/16/25.

Deadline recorded: Oct 16, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(h)

Regulation authority

CCR

What the official deficiency says

87465(h)(2 Incidental Medical and Dental- Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. This requirement is not met as evidenced by: Deficient Practice Statement LPA observed refrigerated medication in a small, unlocked refrigerator in the kitchen; LPA observed that the two medication bottles were left unlocked and accessible to residents in care, the licensee did not comply with the section cited above, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/02/2025 Plan of Correction Licensee to ensure all medications are centrally stored,, and inaccessible to residents in care. Hold an in-service with all staff regarding medication policy & procedures of the facility. Follow-up with proof of training by 7/9/25. Submit plan of correction by 7/2/25.

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 Per LPA record reviews, Licensee lacked proof of conducting required quarterly drills per health & Safety Code, the licensee did not comply with the section cited above, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/14/2025 Plan of Correction Licensee to ensure facility has a required emergency disaster drill, document the drill as required, with all pertinent information. Submit a copy of the drill for Department's review. Licensee to provide written statement of plan to ensure the quarterlydisaster drills are conducted as required by HSC. POC due 7/14/2025.

Official classification

Type B

Official code

87411(f)

Regulation authority

CCR

What the official deficiency says

(f) All personnel, including the licensee and administrator, shall be in good health, and physically and mentally capable of performing assigned tasks. Good physical health shall be verified by a health screening, including a chest x-ray or an intradermal test, performed by a physician not more than six (6) months prior to or seven (7) days after employment or licensure. A report shall be made of each screening, signed by the examining physician. The report shall indicate whether the person is physically qualified to perform the duties to be assigned, and whether he/she has any health condition that would create a hazard to him/herself, other staff members or residents. A signed statement shall be obtained from each volunteer affirming that he/she is in good health.Personnel with evidence of physical illness or emotional instability that poses a significant threat to the well-being of residents shall be relieved of their duties. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPAs record review and staff interviews, staff (S2) lacks a health screening chest x-ray or an intradermal test as required. S2 has been working for approximately six (6) months. the licensee did not comply with the section cited above] which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/19/2024 Plan of Correction Licensee/Administrator to ensure staff S2 obtains a TB test and clearance as required by regulation. Submit copy of TB test and clearance (or chest x-ray) by POC due date 8/19/24.

Official classification

Type B

Official code

87458(a)

Regulation authority

CCR

What the official deficiency says

(a) 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 is not met as evidenced by: Deficient Practice Statement Based on LPAs record reviews, resident's (R2) medical assessment was not complete, many sections were left blank on many pages of the assessment. A note on a page of the LIC602 medical assessment referred the reader to see attached " problem list and medication list. " These items were not observed attached to the medical assessment. Administrator couldn't provide the medical assessment documents to the LPAs for review. the licensee did not comply with the section cited above, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/26/2024 Plan of Correction Licensee/Administrator to ensure a completed medical assessment is obtained for resident (R2) as required. Submit copy of medical assessment by POC due date of 8/26/24.

Official classification

Type A

Official code

87465(h)(2)

Regulation authority

CCR

What the official deficiency says

87465(h)(2)Incidental Medical and Dental Care- The following requirements shall apply to medications which are centrally stored: Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication This requirement was not met as evidenced by: LPA observed that there was a medication lock box in a small refrigerator that was not locked, and the key was hanging off the lockbox handle. This left the medications accessible to residents, and those not qualified to handle medications. This is a risk to the health and safety of residents in care.

Official plan of correction

Licensee to ensure that all medications are locked and kept inaccessible to residents in care at all times. Hold an in-service with all staff on policy & procedures of medications. Submit proof of training by 10/25/23. Submit plan of correction, including scheduled date of training by 10/20/23.

Deadline recorded: Oct 20, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

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 interview with the Administrator, and LPA's record review, the licensee did not comply with the section cited above in required emergency plan drills, last emergency drill were completed 1/27/20 & 9/14/20, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/04/2023 Plan of Correction Licensee/Administrator to ensure that the facility conducts emergency disaster drills as required, Quarterly they are to be done & recorded, Licensee stated they will conduct a fire drill, document as required, and submit a copy to Licensing.Copy of the fire drill conducted, a drill on all shifts, will be submitted by 7/10/23. Plan of correction to be submitted by 7/4/23.

Official classification

Type A

Official code

87705(h)

Regulation authority

CCR

What the official deficiency says

87705(h) Care of Persons with Dementia -Outdoor facility space used for resident recreation and leisure shall be completely enclosed by a fence with self-closing latches and gates, or walls, to protect the safety of residents. This requirement is not met as evidenced by: Deficient Practice Statement Based on [(observation), LPA observed the patio/deck to have areas with a drop to the ground and another with a drop to the cement ramp, there is no fencing, the ramp leads directly out to the front of the home and directly to a busy street, this a hazard to residents in care, the licensee did not comply with the section cited above in the facility backyard area and patio/deck, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/04/2023 Plan of Correction Licensee/Administrator to secure and make safe the facility's backyard patio/deck as required by the regulations. Submit plan of correction to enclose the patio/deck, ensure a gate that can be open for use of the fire exit ramp, ensuring safety of residents in care/residents using this common area. POC due by 7/4/23, including a completion date(completed within 4 weeks). POC due 7/4/23.

Official classification

Type A

Official code

87405(d)(2)

Regulation authority

CCR

What the official deficiency says

Administrator Qualifications and Duties- 87405(d)(2) The administrator shall have the qualifications specified in Sections 87405(d)(1) through (7). If the licensee is also the administrator, all requirements for an administrator shall apply: (2) Knowledge of and ability to conform to the applicable laws, rules and regulations. This requirement was not met as evidenced by: LPA's observations upon entering the facility, the staff didn't screen the LPA as required. This is a risk to health & Safety and/or to personal rights of residents in care.

Official plan of correction

Licensee to ensure that all STAFF and VISITORS are screened as REQUIRED before entering the facility and/or being allowed into the facility. Submit how the facility will be in compliance and ensure that all visitors are screened as required, helping ensure health and safety/personal rights of residents in care -and being in compliance with requirements. POC 11/4/22.

Deadline recorded: Nov 4, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87468.1(a)(2)

Regulation authority

CCR

What the official deficiency says

Personal Rights 87468.1(a)(2)- Residents in assisted living.-ensuring personal rights are not violated at any time. This requirement was not met as evidenced by: LPA's observation of a staff caregiver/cook not wearing a mask and cooking food in the facility kitchen.Staff are to wear mask in the facility at all times. This is a risk to health & Safety and/or to personal rights of residents in care.

Official plan of correction

Licensee to ensure the staff wear masks at all times as required, ensuring residents in care health and safety. Submit plan of correction of how the facility will be in future compliance regarding staff wearing masks as required, at all times. POC due no later than 11/4/22..

Deadline recorded: Nov 4, 2022. A deadline is not proof that correction was completed.

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 evidencced by: LPA's investigation, per record reviews, and interviews with staff, the resident visitors were denied visitation with the resident. This is a violation to personal rights of the resident(s) in care.

Official plan of correction

Licensee to ensure that residents rights are not violated at any time. The resident may have visitation per regulations.Please hold an in-service with facility staff on resident personal rights and ensuring they are not violated. Submit proof of training by 11/8/22. Submit plan of correction and Licensee/Administrator to submit written self- certification of their understanding of resident visitation rights/personal rights of the resident. Submit POC by 11/4/22.

Deadline recorded: Nov 4, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87468.1(a)(2)

Regulation authority

CCR

What the official deficiency says

87468.1(a)(2) 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, furnishings and equipment. This requirement was not met per LPA's observation of staff's(S1) mask not fitting them appropriately, it was very large and kept falling under the staff's nose, fully exposing their nostrils. This is not in compliance with the mask guidelines and mask mandate. This is an immediate risk to health and safety and/or immediate risk to personal rights of the residents. CP assessed at $250.

Official plan of correction

Licensee to ensure all staff are in compliance with the mask mandate as required; Licensee to ensure that their mask as well as all staffs masks fit as required, and are worn appropriately at all times per the mask mandate. Submit facility's plan in ensuring all staff, including Licensee, wears masks that fit appropriately and ensuring staff are in compliance with the mask mandate at all times. POC due 7/21/22.at all timesnd are

Deadline recorded: Jul 21, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87405(d)(2)

Regulation authority

CCR

What the official deficiency says

Administrator Qualifications and Duties- 87405(d)(2) The administrator shall have the qualifications specified in Sections 87405(d)(1) through (7). If the licensee is also the administrator, all requirements for an administrator shall apply: (2) Knowledge of and ability to conform to the applicable laws, rules and regulations. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA's observations, staff did not screen the LPA when having them enter the facility or at any time once inside the facility, the licensee did not comply with the section cited above in the required screening of a visitor, which poses an immediate health, safety and/or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/23/2022 Plan of Correction Licensee to ensure that all STAFF and VISITORS are screened as REQUIRED before entering and/or being allowed into the facility. Submit how the facility will be in compliance and ensure that all visitors are screened as required, helping ensure health and safety/personal rights of residents in care -and being in compliance with requirements. POC due 6/23/22

Official classification

Type A

Official code

87468.1(a)(2)

Regulation authority

CCR

What the official deficiency says

Personal Rights 87468.1(a)(2)- Residents in assisted living.-ensuring personal rights are not violated at any time. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA's observations during the inspection. Caregivers Rhunel and Marlyn were not wearing face masks when the LPA arrived to the facility, and did not put a mask on, until the LPA asked the staff to put a mask on as required. which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/23/2022 Plan of Correction Licensee to ensure the staff wear masks at all times as required, ensuring residents in care health and safety. Submit plan of correction of how the facility will be in future compliance regarding staff wearing masks as required, at all times. POC due no later than 6/23/22.

Official classification

Type A

Official code

87705(f)(2)

Regulation authority

CCR

What the official deficiency says

Care of Persons With Dementia (f)(2)- The following shall be stored inaccessible to residents with dementia: (2) Over-the-counter medication, nutritional supplements or vitamins, alcohol, cigarettes, and toxic substances such as certain plants, gardening supplies, cleaning supplies and disinfectants. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA's observation , medications accessible to residents in care. On staff's unlocked bedroom, staff had a weekly medication holder,, which held their daily medications, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/23/2022 Plan of Correction Licensee to ensure that all medications, including staffs, are locked up and inaccessible to residents in care at all times. Licensee to hold an inservice with all staff, and submit how the facility will ensure all medications are inaccessible to residents at all times. POC due by 6/23/22. Follow-up with proof of inservice medication training no later than 6/28/22.