OUR HOME LLC

Official classification

Type A

Official code

87309(a)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care (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 not met by licensee as evidenced by: Based on LPA and Admin observation, pre-poured medication present on kitchen island counter, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

Facility to submit LIC9098 self certifying they will immediately cease pre-pouring medications.

Deadline recorded: Sep 10, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87633(b)

Regulation authority

CCR

What the official deficiency says

87633 Hospice Care of Terminally Ill Residents (b) A current and complete hospice care plan shall be maintained in the facility for each hospice resident and include the following: This requirement not met by licensee as evidenced by: Based on LPA and Admin obsevation, hospice care plan not on file for R1, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Facility to submit hospice care plan with feeding schedule for R1 to CCL by plan of correction due date.

Deadline recorded: Sep 23, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.2(a)(1)

Regulation authority

CCR

What the official deficiency says

87468.2 Additional Personal Rights of Residents in Privately Operated Facilities (a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights:(1) To have a reasonable level of personal privacy in accommodations, medical treatment, personal care and assistance, visits, communications, telephone conversations, use of the Internet, and meetings of resident and family groups. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA and licensee observation and interview, the licensee did not comply with the section cited above in that video survelliance with audio was found in the common areas inside and outside the facility, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/27/2025 Plan of Correction Facility immediately removed all cameras from inside and outside of facility, except for ring camera on front door. Licensee agrees to disable audio from front door ring camera. Facility to submit written notification to all residents and responsible parties disclosing the use of common area video surveillance Facility ti submit copies of notifcation to CCL by plan of correction du date. Facility to submit LIC9098 ensuring all video surveillance does not include audio, by plan of correction due date.

Official classification

Type A

Official code

87465(a)(4)

Regulation authority

CCR

What the official deficiency says

(4) The licensee shall assist residents with self-administered medications as needed. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA and licensee observation and record review, the licensee did not comply with the section cited above in that count of Quetiapine for R1 did not match Centrally Stored Medication Log, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/21/2025 Plan of Correction Licensee to submit plan to train all employees that administrering medication. Medication training must include medication test as required per Health and Safety Code 1569.69. Training to be conducted no later than 9/3/25 and training log and/or certificates of completion to be submitted to CCL no later than 9/2/25. LPA will return at later date to perform meication check.

Official classification

Type B

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 LPA and licensee observation, the licensee did not comply with the section cited above in that water temperature in sink accessible to residents in care measured at 94.5 in bathroom between rooms #4 and #5 and 102.9 degrees F in bedroom #3, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/03/2025 Plan of Correction Licensee to consult with professional plumber as to how best to regulate water temperature so that water comes up to a hot tempertaure within regulation within a timely manner. Licensee to report to LPA recommedations and what oprtion they will choose in order to regulate temperature. LPA will return to measure water temperature once repair/replacement has been compelted.

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 and licensee observation, the licensee did not comply with the section cited above in that licensee and LPA observed butcher knife left unattended on kitchen island with residents present less than 2 feet away at dining table which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/27/2025 Plan of Correction Licensee immeidately locked up butcher knife while LPA present. Deficiency cleared.

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 interview with Admin and LPA record review, the licensee did not comply with the section cited above in that S1 did not have fingerprint clearance. Per Guardian, the fingerprint clearance status of S1 is " in process, " but not yet showing a determination of eligible clearance which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/05/2024 Plan of Correction Facility to submit LIC 9098 self-certifying that S1 will not be present at or working in the facility, whether training or working, until fingerprint clearance is obtained and Guardian shows S1 with a clearance determination of eligible.

Official classification

Type B

Official code

1569.626(a)

Regulation authority

HSC

What the official deficiency says

(a) All residential care facilities for the elderly shall meet the following training requirements, as described in Section 1569.625, for all direct care staff: This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA and Admin record review, the licensee did not comply with the section cited above in that S2 did not have current training completed, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/16/2024 Plan of Correction Facility to submit to CCL training log for S2 showing all 20 hours of required training completed by plan of correction due date.

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 LPA, caregiver, and Admin observation, the licensee did not comply with the section cited above in that refrigerator drawer of radishes were covered in black substance and spots. Refrigerator drawer liner covered with black spots of a black substance and contained wilted and browning celery with brown liquid, and lemon and orange with white and blue fuzzy substance, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/05/2024 Plan of Correction Facility threw away all identified items and removed drawer liner with LPA present. Deficiency cleared.

Official classification

Type B

Official code

87705(c)(5)

Regulation authority

CCR

What the official deficiency says

(c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following: (5) Each resident with dementia shall have an annual medical assessment as specified in Section 87458, Medical Assessment, and a reappraisal done at least annually, both of which shall include a reassessment of the resident's dementia care needs. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA and Admin observation and record review, the licensee did not comply with the section cited above in that R1 has diagnosis of dementia, but most recent physician's report dated 5/15/2023 did not have all pages present, last page with doctor signature line not present, the next most current physician's report dated 2020. R1's most recent appraisal dated 5/5/2023, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/16/2024 Plan of Correction Facility to submit pictures to CCL of current physician's report with all pages present and doctor's signature present by plan of correction due date. Facility to submit to CCL current appraisal for R1 by plan of correction due date

Official classification

Type B

Official code

87705(f)(2)

Regulation authority

CCR

What the official deficiency says

(f) 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 and caregiver observation, the licensee did not comply with the section cited above in that one [1] of two [2] main bathrooms had cabinet containing toxins not locked but had locking function, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/16/2024 Plan of Correction Facility to train all staff on proper storage of toxins and disinfectants and submit to CCL copy of training log by plan of correction 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 LPAs record review, the licensee did not comply with the section cited above in [2] out of [5] staff CPR/training records were not updated, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/12/2023 Plan of Correction Licensee agreed to provide staff training records within 3 weeks. POC due date is 10/12/2023

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 LPA record review, the licensee did not comply with the section cited above in [3] out of [6] care plan for residents (R1, R2 & R3) which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/12/2023 Plan of Correction Licensee agreed to provide signed copies of residents' Appraisal Needs and Services Plans within 3 weeks. POC due date is 10/12/2023.

Official classification

Type B

Official code

87465(h)(4)

Regulation authority

CCR

What the official deficiency says

(h) The following requirements shall apply to medications which are centrally stored: (4) All centrally stored medications shall be labeled and maintained in compliance with state and federal laws. No persons other than the dispensing pharmacist shall alter a prescription label. This requirement is not met as evidenced by: Deficient Practice Statement A spot check of medications revealed that centrally stored medications log has discrepancies and one omission of dates filled and prescription numbers.

Official plan of correction

POC Due Date: 10/12/2023 Plan of Correction Licensee agreed to review the centrally stored medication log and maintain an accurate log going forward. Also, licensee will submit a written statement plan of how they plan to prevent this in the future. POC due date is 10/12/2023

Official classification

Type B

Official code

87203

Regulation authority

CCR

What the official deficiency says

87203 Fire Safety - All facilities shall be maintained in conformity with the regulations adopted by the State Fire Marshal for the protection of life and property against fire and panic. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA observation the licensee did not comply with the section cited above in [2] out of [3] fire extinguishers which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/12/2023 Plan of Correction Licensee needs to provide proof of serviced fire extinguishers by plan of correction due date, POC due date is 10/12/2023