LIVE OAK REST HOME

Official classification

Type A

Official code

87466

Regulation authority

CCR

What the official deficiency says

87466 Observation of the Resident The licensee shall ensure that residents are regularly observed for changes in physical, mental, emotional & social functioning…When changes such as…deterioration of mental ability or a physical health condition are observed, the licensee shall ensure that such changes are documented & brought to the attention of the resident's physician and the resident's responsible person, if any…This requirement has not been met as evidenced by: Based on LPA’s records review and interviews with staff (S1, S2 & S3), the licensee noticed a significant change in R1’s mental condition, updated their care plan as of 3/1/26 but did not notify R1’s physician for further evaluation, which poses an immediate risk to the health & safety of the residents.

Official plan of correction

Licensee agrees to submit a written plan describing how the facility will ensure residents’ needs are met and the proper supervision is provided. Plan should address the re-appraisal process for changes in condition including inappropriate interactions with residents and staff. Written plan will be submitted to CCL by POC due date of 8/12/26. Licensee refused to sign the LIC809 and LIC809D forms acknowledging the findings. LPA printed forms and left them with the Licensee.

Deadline recorded: Aug 12, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87465(h)(5)

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. Based on interviews conducted with the licensee and staff (S1, S2 & S3), licensee is the designated person that pre pours medications to be given to the residents in care, which poses a potential risk to the health & safety of the residents.

Official plan of correction

Licensee agrees to stop pre-pouring medication greater than a 24 hr period. Licensee will train staff in medication management. Licensee will submit proof of training to CCL by 8/18/26. Licensee refused to sign the LIC809 and LIC809D forms acknowledging the findings. LPA printed forms and left them with the Licensee.

Deadline recorded: Aug 18, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87211(a)(1)(D)

Regulation authority

CCR

What the official deficiency says

87211 Reporting Requirements (1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within 7 days of the occurrence of any of the events specified in (A) through (D) below…This requirement has not been met as evidence by: Based on LPA’s/Licensee records review and interviews, the licensee failed to notify the department within 7 days of occurrence that R1 passed away on 5/5/26, which poses a potential risk to the health & safety of residents in care.

Official plan of correction

Licensee to ensure incidents are reported per regulation. Licensee agrees to review regulation 87211 and conduct training for all staff on reporting requirements. Evidence of completed training to be submitted to CCL by POC date of 06/05/2026..

Deadline recorded: Jun 5, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87303(a)(1)

Regulation authority

CCR

What the official deficiency says

87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary & in good repair at all times... (1) Floor surfaces in bath, laundry & kitchen areas shall be maintained in a clean, sanitary, and odorless condition. This requirement has not been met as evidence by: Based on LPAs/Licensee and interviews with Licensee, the licensee failed to ensure that the facility was sanitary & odor free. LPA observed a strong urine smell in the facility, which poses a potential risk to the health & safety of the residents.

Official plan of correction

Licensee to ensure that the facility is sanitary, clean & odorless at all times; Licensee to determine the way to control the odor & submit an LIC 9098 self certification that the facility is free of odor by POC due date 06/05/2026.

Deadline recorded: Jun 5, 2026. A deadline is not proof that correction was completed.

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 LPA/Licensee's observation, the licensee did not comply with the section cited above in two out of two faucets used by residents in care water measured 129.9 and 134.8 which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/11/2025 Plan of Correction Licensee adjusted water heater immediately. Licensee will submit pictures as proof that water is within compliance to CCL by POC due date.

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 documentation of a medical assessment, signed by a licensed medical professional acting within the scope of their practice and made within the last year, to be kept in the resident's record. 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 five resident's medical assessment 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: 06/27/2025 Plan of Correction Licensee agreed to obtain a current medical assessment for R1. Licensee will submit LIC9098 self-certification form to CCL ensuring their compliance with regulation by POC due date of 6/27/25.

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 LPA's/Licensee observation, interview and record review, the licensee did not comply with the section cited above in two out of five residents (R1 & R2) care plans needs to be updated which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/27/2025 Plan of Correction Licensee agreed to conduct an assessment with resident (R1 & R2). Licensee will submit LIC9098 self-certification form to CCL ensuring that they are in compliance with regulation by POC due date of 6/27/25.

Official classification

Type B

Official code

87507(a)(1)

Regulation authority

CCR

What the official deficiency says

(a) The licensee shall complete an individual written admission agreement, as defined in Section 87101(a), with each resident or the resident's representative, if any. (1) The text of the admission agreement, including any attachments and modifications, shall be: 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 resident's admission agreements indicating the use of video surveillance in common areas which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/27/2025 Plan of Correction Licensee agreed to elaborate an addendum to current admissions agreements of all five residents and have their responsible parties to sign it if they agree with it. Licensee will submit LIC9098 self-certification form to CCL ensuring their compliance with this regulation by POC due date of 6/27/25.

Official classification

Type B

Official code

87156(b)(1)(F)

Regulation authority

CCR

What the official deficiency says

87156(b)(1)(F) Licensing Fees. In addition to fee set forth in subdivision , the department shall charge the following.. licensee fails to pay the annual licensing fee on or before the due date as indicated by postmark on the payment. 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 as of 6/10/25 licensing/late fees equals to $247.50, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/27/2025 Plan of Correction The Licensee shall pay the outstanding fees and submit proof that they have paid them to CCL by POC due date of 6/27/25.

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 two out of three staff do not have additional 20 hours annually, which poses/posed 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 Licensee agrees to have staff complete training and send to CCL self-certification form (LIC9098) by POC due date to clear deficiency.

Official classification

Type B

Official code

87468.1(a)

Regulation authority

CCR

What the official deficiency says

(a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: This requirement is not met as evidenced by: Deficient Practice Statement Based on LPAs interview and observation the facility failed to ensure R1 & R2's personal rights are protected due to the camera with visual placed in shared R1's & R2's room which poses a potential health and safety risk to residents in care.

Official plan of correction

POC Due Date: 08/16/2024 Plan of Correction Licensee agrees to contact responsible party to remove or sign letter requesting use of cameras on R1's & R2's bedroom. Licensee will submit exception request or LIC9098 self-certifying that cameras won't be installed in shared bedroom to CCL by POC due date 8/16/2024.

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 LPA/Licensee observation and interview, Licensee did not comply with the section cited above in two out of two bathrooms used by residents in care water temperature was not within regulation, posing an immediate health, safety and personal rights risk to residents in care.

Official plan of correction

POC Due Date: 07/01/2023 Plan of Correction Licensee to ensure water temperature is within regulatory guidelines. Licensee will adjust water temperature within regulation. Licensee agrees to send self - certfication that water temperature will be monitored for one week to CCL by POC date.

Official classification

Type A

Official code

87465(a)(6)

Regulation authority

CCR

What the official deficiency says

(6) When requested by the prescribing physician or the Department, a record of dosages of medications which are centrally stored shall be maintained by the facility. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA/Licensee observation, interview and record review, the licensee did not comply with the section cited above in two out of five residents in care which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/01/2023 Plan of Correction Licensee agreed to review medication records for all residents and will conduct medication training with staff. Licensee will submit a self-certification LIC9098 form along with training dates for staff to CCL by POC due date.

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 LPA's/Licensee observation, interview and record review, the licensee did not comply with the section cited above. Last disaster drill was conducted at least every quarter which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/21/2023 Plan of Correction Licensee agreed to conduct a quarterly disaster drill. Licensee will submit a current disaster drill conducted within the las quarter to clear the citation by POC due date.

Official classification

Type B

Official code

87705(c)(3)

Regulation authority

CCR

What the official deficiency says

(c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following: (3) In addition to the on-the-job training requirements in Section 87411(d), staff who provide direct care to residents with dementia shall receive the following training as appropriate for the job assigned and as evidenced by safe and effective job performance: This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA's/Licensee observation, interview and record review of staff files, the licensee did not comply with the section cited above in one out of two staff did not have 20 hours additional training, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/21/2023 Plan of Correction Licensee agreed to have staff take 20 hours of training and will send in proof of staff required training to LPA by POC due date.

Official classification

Type B

Official code

87705(c)(4)

Regulation authority

CCR

What the official deficiency says

(c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following: (4) There is an adequate number of direct care staff to support each resident's physical, social, emotional, safety and health care needs as identified in his/her current appraisal. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPAs observation and record review the facility failed to ensure adequate staffing to meet residents care needs which poses a potential health and safety risk to residents in care.

Official plan of correction

POC Due Date: 07/21/2023 Plan of Correction Licensee agrees to hire, train and submit a staffing schedule to ensure staffing is adequate to meet residents needs and there is not a lack of supervision, submit staff schedule to CCL by POC due date.

Official classification

Type A

Official code

87468.1(a)(2)

Regulation authority

CCR

What the official deficiency says

(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 is not met as evidenced by: Deficient Practice Statement Based on LPA’s observation, record review and interviews with Licensee did not ensure that staff was wearing a mask and staff daily screening results are documented as reflected in facility's mitigation plan and current CCL requirements. This poses an immediate risk to the health, safety and personal rights to the residents in care.

Official plan of correction

POC Due Date: 05/28/2022 Plan of Correction Licensee will ensure Personal Rights of residents are maintained. Licensee agrees to submit self-certification (LIC9098) as a proof that all staff has been reminded about mask requirement to CCL by POC due date.

Official classification

Type A

Official code

87411(a)

Regulation authority

CCR

What the official deficiency says

Type A 87411 Personnel Requirements (a) Facility personnel shall at all times be sufficient in numbers & competent to provide the services necessary to meet resident needs…This requirement has not been met as evidence by: Deficient Practice Statement Based on observations, records review and interviews with Licensee did not ensure that staff on duty was sufficient to meet the needs of residents in care. Per Licensee, there are only two staff including him to provide services to residents in care which poses an immediate risk to the health and safety of residents in care.

Official plan of correction

POC Due Date: 05/28/2022 Plan of Correction Licensee agreed to submit a written plan in how the facility will ensure that resident’s needs are being met daily and Personnel Report (LIC500) to CCL by POC due date.

Official classification

Type B

Official code

87211(a)(1)

Regulation authority

CCR

What the official deficiency says

Type B 87211 Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports as the Department may require…(1) A written report shall be submitted to the licensing agency & person responsible for the resident within 7 days of the occurrence of any of the events…This requirement has not been met as evidence by: Deficient Practice Statement Based on LPA’s records review and interviews conducted with Administrator did not ensure that CCL was notified of one out of two bathrooms used by residents in care were being remodel which poses a potential health & safety risk to residents in care.

Official plan of correction

POC Due Date: 06/03/2022 Plan of Correction Licensee to ensure all incidents that threaten the health & safety of residents are reported to CCL per regulation. Licensee to review regulation and will submit LIC90998 self-certification that the regulation was reviewed by POC due date.