MC HUGH CARE HOME

Official classification

Type A

Official code

87405(a)

Regulation authority

CCR

What the official deficiency says

87405 Administrator - Qualifications and Duties (a)All facilities shall have a qualified and currently certified administrator. The licensee and the administrator may be one and the same person... This requirement is not met as evidenced by: Based on record review, the licensee did not comply with the section cited above in that the facility does not have a currently certified Administrator which poses an immediate health, safety or personal rights risk to persons in care

Official plan of correction

Licensee will provide the documents required to make a currently certified administrator the active Administrator of the facility to Community Care Licensing by the POC due date of 8/25/2025.

Deadline recorded: Aug 25, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87405(a)

Regulation authority

CCR

What the official deficiency says

87405 Administrator - Qualifications and Duties (a)All facilities shall have a qualified and currently certified administrator. The licensee and the administrator may be one and the same person... This requirement is not met as evidenced by: Based on record review, the licensee did not comply with the section cited above in that the facility does not have a currently certified Administrator which poses an immediate health, safety or personal rights risk to persons in care

Official plan of correction

Licensee will provide the documents required to make a currently certified administrator the active Administrator of the facility to Community Care Licensing by the POC due date of 8/1/2025.

Deadline recorded: Aug 1, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

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 observation, the licensee did not comply with the section cited above in that the fire extinguisher in the garage/laundry area was last certified on 6/6/2023 which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/20/2025 Plan of Correction Licensee to provide photographic proof to Community Care Licensing that the fire extinguisher has been serviced by the POC due date of 6/20/2025

Official classification

Type B

Official code

87303(c)

Regulation authority

CCR

What the official deficiency says

(c) All window screens shall be clean and maintained in good repair. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation the sliding screen doors in bedroom one (1) and in bedroom four (4) were damaged which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/20/2025 Plan of Correction Licensee to provide photographic proof to Community Care Licensing that both noted screen doors have been repaired by the POC due date of 6/20/2025

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 observation and record review, the licensee did not comply with the section cited above in that staff member (S1) did not have current First Aid or CPR certification which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/20/2025 Plan of Correction Licensee to provide proof of 1st Aid and CPR certification for staff member S1 to Community Care Licensing by the POC due date of 6/20/2025.

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 observation and record review, the licensee did not comply with the section cited above in that two (2) staff members (S1,S2) did not have proof of annual training on file which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/20/2025 Plan of Correction Licensee to provide proof that staff members S1 and S2 have begun their annual training to Community Care Licensing by POC due date of 6/20/2025.

Official classification

Type B

Official code

87468(b)(1)(A)

Regulation authority

CCR

What the official deficiency says

(b) At the time the admission agreement is signed, a resident and the resident's representative shall be personally advised of and given a copy of: (1) The personal rights of residents specified in Sections 87468.1, Personal Rights of Residents in All Facilities and 87468.2, Additional Personal Rights of Residents in Privately Operated Facilities, as applicable to the facility. (A) The licensee shall have each resident and the resident's representative sign a copy of these rights, and the signed copy shall be included in the resident's record. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and record review, the licensee did not comply with the section cited above in that Resident R3 did not have signed Personal Rights documents in their file which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/20/2025 Plan of Correction Licensee to provide signed Personal Rights documents for resident R3 to Community Care Licensing by POC due date of 6/20/2025.

Official classification

Type B

Official code

87555(b)(23)

Regulation authority

CCR

What the official deficiency says

(b) The following food service requirements shall apply: (23) All readily perishable foods or beverages capable of supporting rapid and progressive growth of micro-organisms which can cause food infections or food intoxications shall be stored in covered containers at appropriate temperatures. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above in that there were two sauce containers that were opened and partially used in the kitchen pantry. Both sauces required refrigeration after opening which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/20/2025 Plan of Correction Licensee to provide proof to Community Care Licensing that staff members S1 and S2 have taken food safety training by POC due date of 6/20/2025.

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 observation and record review, the licensee did not comply with the section cited above in that Residents (R2,R4,R5) did not have current appraisal & needs service plans. For R2, R4 and R5 the last appraisal & needs service plan was dated 5/9/2023 which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/20/2025 Plan of Correction Licensee will submit to Community Care Licensing updated appraisal & needs service plansvfor R2, R4 and R5 by POC due date of 6/20/2025.

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 record review, the licensee did not comply with the section cited above in that the facility is not conducting fire and emergency drills per regulation with the last disaster drill having taken place in July, 2024 which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/20/2025 Plan of Correction Licensee to submit to Community Care Licensing proof that the facility has conducted a fire and emergency drill by POC due dateof 6/20/2025.

Official classification

Type A

Official code

87465(h)(2)

Regulation authority

CCR

What the official deficiency says

87465Incidental Medical and Dental Care (h) The following requirements shall apply to medications which are centrally stored: (2) 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 Based on observation, the licensee did not comply with the section cited above in 2 bubble packs of the medication Geodon 80mg for R1 was left unsecured in the hallway closet which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/26/2025 Plan of Correction Licensee will conduct medication training with staff members S1 and S2 and provide proof of training to Community Care Licensing by POC due date of 5/26/2025.

Official classification

Type A

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

87303 Maintenance and Operation (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 observation, the licensee did not comply with the section cited above in that there was a badly broken window in bedroom seven (7). The window was observed to have been partially covered with cardboard and duct tape which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/26/2025 Plan of Correction Licensee to send photographic proof to Community care Licensing showing that the broken window has been replaced by POC due date of 5/26/2026.

Official classification

Type A

Official code

87465(h)(2)

Regulation authority

CCR

What the official deficiency says

87465(h)(2) Incidental Medical & Dental Care: (h) The following requirements shall apply...(2)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: Based on LPA's/staff observation and interviews conducted with staff, Licensee did not ensure medications to be kept locked and inaccessible to residents. This is an immediate health & safety risk to residents.

Official plan of correction

Staff removed R1's medication and locked during the visit. Licensee to submit documentation of staff training on regulation 87465(h)(2) with date, time, subject, duration, staff names and signatures of attendance by POC due date 12/7/24 to CCL to clear the citation.

Deadline recorded: Dec 7, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87405(a)

Regulation authority

CCR

What the official deficiency says

87405 Administrator - Qualifications and Duties 87405 (a) All facilities shall have a qualified and currently certified administrator. This requirement is not met as evidenced by: Based on LPA's/Licensee observation, interviews and record review, the licensee did not comply with the section cited above in that Nick Aquino does not have a certified administrator from CCL, which poses a immediate health, safety or personal rights risk to persons in care.

Official plan of correction

Licensee will appoint a certified administrator for this facility and will submit required documentation to perform this change to the Department by POC due date 12/16/24. Licensee have been informed that if they don't comply with regulations civil penalties will be warrant until this issue gets resolved.

Deadline recorded: Dec 16, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

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/acting administraor observation and interviews, the licensee did not comply with the section cited above in resident's rooms (room #3 & room #2) and common areas spider webs were observed, Two out of three bathrooms were observed dirty and needing minor repairs on walls. Window screen on room #3 needs to be replaced. All garbage cans do need to have a lid cover. which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/03/2024 Plan of Correction Licensee/acting administrator agreed to submit pictures as proof of repairs needed were resolved to CCL by POC due date to clear the citation.

Official classification

Type A

Official code

87405(d)

Regulation authority

CCR

What the official deficiency says

(d) 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. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA's/acting administrator observation, records review and interview, the licensee did not comply with the section cited above by not obtaining a valid administrator certification after informal meeting conducted on 6/28/23 with the Department or appointing an individual who had a valid administrator certificate, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/03/2024 Plan of Correction Acting administrator and Licensee agreed to submit supporting documentation of training hours completed as of today to CCL by POC due date to clear the citation. The Department will be reviewing the information obtained to determine if further actions are needed.

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/acting administrator observation, interview and record review, the licensee did not comply with the section cited above in three out of five residents (R1, R2 & R3) 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: 07/16/2024 Plan of Correction Acting Administrator 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

87309(a)

Regulation authority

CCR

What the official deficiency says

87309 Storage Space (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: Based on record review, the licensee did not comply with the section cited above by a knife being accessible to a resident in care who was able to store item and eventually physically threaten a staff with it. This is an immediate risk to the health, safety and personal rights of residents in care.

Official 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, 9/22/2023.

Deadline recorded: Sep 23, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

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 observation, the licensee did not comply with the section cited above because areas of the facility were visibly dirty, smelled of urine along with debris being stored in the backyard which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/10/2023 Plan of Correction Facilty staff cleaned the bathroom during LPA inspection. Facility agrees to clean doorways and walls that are visibly dirty and to remove all debris, including but not limited to mattresses, by POC due date 5/10/2023. LPA will return to facility to confirm completion.

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 observation, the licensee did not comply with the section cited above by having the water in temperature in the resident's bathroom being above the range allowed per regulation which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/10/2023 Plan of Correction Facility staff turned down water heater during inspection. Facility will test water to ensure it is within regulation no later than POC due date 5/10/2023. LPA will return to facility to confirm completion.

Official classification

Type A

Official code

87465(h)(2)

Regulation authority

CCR

What the official deficiency says

(h) The following requirements shall apply to medications which are centrally stored: (2) 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 Based on observation, the licensee did not comply with the section cited above by not locking the medication cart when left unsupervised, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/10/2023 Plan of Correction Facility staff locked cart per LPA's instruction and confirmed that cart will be locked when left unsupervised. Deficiency is cleared.

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 observation, the licensee did not comply with the section cited above in 2 out of 2 staff not having proof of a First Aid and CPR Certificate, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/12/2023 Plan of Correction Facility agrees to maintain staff files in this facility including proof of First Aid and CPR Certificates by POC due date, 5/12/2023. LPA will return to review files.

Official classification

Type B

Official code

87412(a)

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: This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above in 2 out of 2 staff not having staff files available at this facility, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/12/2023 Plan of Correction Facility agrees to maintain staff files in this facility by POC due date, 5/12/2023. LPA will return to review files.

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 record review, the licensee did not comply with the section cited above by not having proof that Administrator has an active Administrator Certificate which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/12/2023 Plan of Correction Facility agrees to provide an update regarding the status of the Administrator's certification by 5/12/2023.

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 record review, the licensee did not comply with the section cited above in 9 out of 10 residents not having an updated reappraisal which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/12/2023 Plan of Correction Administrator to complete reappraisals for noted residents by POC due date, 5/12/2023. LPA will return to confirm completion.

Official classification

Type B

Official code

87507(c)

Regulation authority

CCR

What the official deficiency says

(c) Admission agreements shall be signed and dated, acknowledging the contents of the document, by the resident or the resident's representative, if any, and the licensee or the licensee's designated representative no later than seven days following admission. Attachments to the agreement may be utilized as long as they are also signed and dated as prescribed above. 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 1 out of 10 residents not having a signed Admission Agreement which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/12/2023 Plan of Correction Administrator must sign Admission Agreement and have resident or their responsible party sign agreement no later than 5/12/2023. LPA will return to confirm completion.

Official classification

Type B

Official code

87555(b)(8)

Regulation authority

CCR

What the official deficiency says

(b) The following food service requirements shall apply: (8) All food shall be of good quality. Commercial foods shall be approved by appropriate federal, state and local authorities. Food in damaged containers shall not be accepted, used or retained. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above in not having all perishable food being of good quality which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/12/2023 Plan of Correction Facility agrees to go through all refrigerators and remove any and all foods that do not meet regulation by POC due date, 5/12/2023. LPA will return to confirm completion.

Official classification

Type B

Official code

87555(b)(23)

Regulation authority

CCR

What the official deficiency says

(b) The following food service requirements shall apply: (23) All readily perishable foods or beverages capable of supporting rapid and progressive growth of micro-organisms which can cause food infections or food intoxications shall be stored in covered containers at appropriate temperatures. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above by having food not labeled and stored per regulation including but not limited to food being stored in foil and not completely covered, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/12/2023 Plan of Correction Facility agrees to go through all refrigerators and repackage foods and label them per regulation by POC due date, 5/12/2023. LPA will return to confirm completion.

Official classification

Type B

Official code

87555(b)(27)

Regulation authority

CCR

What the official deficiency says

(b) The following food service requirements shall apply: (27) All kitchen areas shall be kept clean and free of litter, rodents, vermin and insects. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above by a refrigerator that stores perishable foods appeared dirty and unsanitary which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/12/2023 Plan of Correction Facility agrees to clean refrigerators by POC due date, 5/12/2023. LPA will return to confirm completion.

Official classification

Type B

Official code

87465(h)(5)

Regulation authority

CCR

What the official deficiency says

(h) The following requirements shall apply to medications which are centrally stored: (5) Each resident's medication shall be stored in its originally received container. No medications shall be transferred between containers. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above by having the evening medications already poured and being stored in a separate container, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/12/2023 Plan of Correction Facility will stop pre-pouring medications immediately and submit self-certification that medication will be stored in it's original container per regulation by POC due date 5/12/2023.

Official classification

Type B

Official code

87465(h)(6)

Regulation authority

CCR

What the official deficiency says

87465 (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: (A) The name of the resident for whom prescribed. (B) The name of the prescribing physician. (C) The drug name, strength and quantity. (D) The date filled. (E) The prescription number and the name of the issuing pharmacy. 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 by not maintaining a Centrally Stored Medication Log which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/12/2023 Plan of Correction Facility to find or complete the Centrally Stored Medication Log by POC due date, 5/12/2023. LPA will return to review.