GEORGIA'S GUEST HOME

Official classification

Type A

Official code

87309(a)(1)

Regulation authority

CCR

What the official deficiency says

87309 Storage Space and Access (a) ...the licensee shall ensure that disinfectants, cleaning solutions...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: Based on observation and interview, Licensee did not comply with the section cited above, as staff left a bottle of bleach on a wooden hutch in the dining room, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

Licensee removed the bottle of bleach from the hutch and put it in locked storage.

Deadline recorded: Jun 11, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87411(c)(1)

Regulation authority

CCR

What the official deficiency says

87411 (c)(1) Staff providing care shall receive appropriate training in first aid. This requirement was not met as evidenced by: Based on file reviews, 2 of 4 files reviewed did not have documentation of 1st aid certification.

Official plan of correction

The administrator will audit all staff files for first aid documentation, have staff complete 1st aid renewal training where needed and add 1st aid cards to staff files. The administrator will send

Deadline recorded: Feb 28, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87412(a)

Regulation authority

CCR

What the official deficiency says

The licensee shall ensure that personnel records are maintained... Each personnel record shall contain the following information: (7) Past experience ...employers.(11) A health screening Based on file review, 1 of 4 files did not contain a health screening and 1 of 4 files did not have a job application or personnel record.

Official plan of correction

The administrator will participate in a Technical Support Program. The licensee will maike every effort to work with the TSP analyst at the facility. The POC will not be cleared until participation with TSP is complete and until the TSP analyst has made 1 or more visits to the facility as needed.

Deadline recorded: Apr 28, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87470(b)(2)

Regulation authority

CCR

What the official deficiency says

All staff and volunteers providing direct care to a resident who has a contagious disease shall wear appropriate Personal Protective Equipment (PPE) to prevent exposure to infectious agents.... This requirement is not met as evidenced by: Based on interview, staff were not wearing a mask or gloves while in the presence of residents in care. This poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

Licensee will read regulation 87470(b)(2), review and/or update the facility infection control plan as neede and submit a signed declaration of understanding to LPA by POC due date. Declaration to include understanding of mask requirement and signed by all staff.

Deadline recorded: Dec 20, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468(a)(2)

Regulation authority

CCR

What the official deficiency says

Personal Rights of Residents in all facilities. (a)Residents in all residential care facilities for the elderly shall have all other following personal rights: (2) To be accorded safe, healthful, and comfortable accommodations. This requirement is not met as evidenced by: Based on interviews, a client was allowed to wash dishes inadequately to the extent that staff had to wash dishes again to clean them.

Official plan of correction

Licensee will read regulation 87468(a)(2) and submit a signed declaration of understanding to LPA by POC due date and present a plan to redirect clients in regards to dishwashing by POC due date.

Deadline recorded: Dec 20, 2024. 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 All facilities shall have a qualified and currently certified administrator. This requirement is not met based as evidenced by Based on record reviews, there is not a qualified and certified administrator present at the facility. This poses an immediate Health, Safety or Personal Rights risk to persons in care.

Official plan of correction

The licensee will review the regulation cited and write a statement of understanding of the regulation cited. Statement will be emailed to LPA Campbell by POC date 08/14/2024 by POC date. The licensee has submitted their Administrative Certification renewal.

Deadline recorded: Aug 14, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

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 requiremet is not met as evidenced by: Based on observation, no smoke alarm was found in a client's bedroom which poses an immediate health, safety or personal rights riks to persons in care.

Official plan of correction

During visit, maintenance staff hung up the smoke detector.

Deadline recorded: Jul 30, 2024. 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 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. ... for the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by: Based on observation, roaches were observed on the floor, chemicals, debris and powertools were observe as accessible to clients and fire extinguishers were on the floor instead of being braced on the wall.

Official plan of correction

Facility will create a plan to maintain a clean, safe and sanitary facility in good repair at all times after completing work at the end of the day.

Deadline recorded: Aug 9, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

1568.0822(c)(3)

Regulation authority

CCR

What the official deficiency says

1568.0822 (c)(3) The department shall assess an immediate civil penalty of five hundred dollars ($500) per violation... 3. Absence of supervision, as required by statute and regulation. This requirement is not met as evidenced by: Based on observation, the licensee did not ensure alert and awake staff were present in the facility which poses an immediate Health, Safety or Personal Rights risk to persons in care.

Official plan of correction

The licensee will write of statement of understanding that alert, awake staff are to be present in the facility continuously at all times. All staff will also sign a statement that they understand that they are not to leave the facility when on their shift at any time unless there is an emergency disaster requiring the evacuation of all residents or all residents are on an outing.. The documents are then to be provided to LPA Campbell via fax or email at renee.campbell@dss.ca.gov

Deadline recorded: Jun 17, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87412(g)

Regulation authority

CCR

What the official deficiency says

Personnel Records 87412(g) (g) All personnel records shall be maintained at the facility and shall be available to the licensing agency for review. This requirement is not met as evidenced by: Based on record review, none of the requested documents were present in the facility as required. This poses a potential health, safety and personal rights risk to persons in care.

Official plan of correction

Administrator will ensure that all required documents will be in individual files for each staff and resident and ready to review by 05/31/24.

Deadline recorded: May 31, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87468.2(4)

Regulation authority

CCR

What the official deficiency says

87468.2(4) Additional Personal Rights of Residents in Privately Operated Facilities...To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs... This requirement was not met as evidence by: Based on observation and interviews on 04/04/2024 care staff 1 left the facility and left residents alone for unknown time period. When LPA Martinez arrived at the facility there were no care staff. This posed an immediate health and safety risk to residents in care.

Official plan of correction

Licensee has implemented staffing plan. Licensee will email weekly staffing schedule to LPA Martinez by POC date 04/11/2024. Licensee provided staffing schedule to LPA Martinez during this visit. Licensee will email weekly staffing schedules until additional staff has been hired.

Deadline recorded: Apr 11, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87404(d)(2)

Regulation authority

CCR

What the official deficiency says

87404 Administrator – Qualifications and Duties (d)(2) The administrator shall have ... Knowledge of and ability to conform to the ...regulations. This requirement was not met as evidenced by Based on LPA Martinez’s interview , R1 stated he needs help with his activities for daily living. R1 needs a higher level of care than he is receiving at licensee’s unlicensed facility. Which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

The Administrator will require all future residents of the unlicensed facility to provide a physicians report that confirms a resident requires no assistance with medication or acivities of daily living by POC date. R1 will be moved to the licensed facility next door immediately by 4/05/2024

Deadline recorded: Apr 5, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87307(d)(2)

Regulation authority

CCR

What the official deficiency says

87307 (d)(2) The premises shall be maintained in a state of good repair and shall provide a safe and healthful environment. This requirement was not met as evidenced by: Based on observation, interviews and record reviews, the licensee has not begun improvements to ensure facility is clean safe, sanitary and in good repair. This poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Administrator states that by the next NCC meeting, significant process will have been made in the kitchen, bathroom, and for rugs/flooring.

Deadline recorded: Apr 30, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

1569.69

Regulation authority

HSC

What the official deficiency says

Employees assisting...with...medi- cation; training requirements (B) Two years...experience,.. as an administrator ...during which time the individual has acted in compliance with applicable regulations. This requirement was not met as evidenced by: Based on observa- tion, interviews and record review ,the licensee provided training to an employee while not in substan- tial compliance with applicable regulations.

Official plan of correction

Licensee will utilize training from vendor to mainting medication training requirements. Licensee wll provide a training plain with vendor names and class topics by POC date.

Deadline recorded: Apr 30, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

1533

Regulation authority

HSC

What the official deficiency says

Section 1533 ..any authorized ... employee,... State Department of Social Services may, enter ...any place providing ..care and .. services .. to prevent a violation of, any provision of this chapter. This requirement was not met as evidenced by: Based on obser- vation, licensee did not ensure the unlicensed facility was accessible to authorized employees of the State Dept of Social Services.

Official plan of correction

Licensee will replace the lock and obtain a new key for the unlicensed facility and be available within the hour to allow access by POC date.

Deadline recorded: Apr 19, 2024. 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. This requirement is not met as evidenced by: Based on observation, interviews, and record review, the licensee did not maintain the facility in a clean and sanitary condition. The facility currently has evidence of bedbugs. This poses a potential health and safety risk to residents in care.

Official plan of correction

The licensee shall have a certified pest control company conduct a facility-wide bedbug treatment. The licensee shall send proof/invoice of bedbug inspection/treatment to LPA via email by 12/15/2023 The licensee shall create a schedule of routine pest control inspections and treatment to minimize the incidents. The licensee shall maintain proof/invoices of pest control inspectionsk and provide to Licensing upon request.

Deadline recorded: Dec 15, 2023. 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

All facilities shall have a qualified and currently certified administrator. The licensee and the administrator may be one and the same person. The administrator shall have sufficient freedom from other responsibilities and shall be on the premises a sufficient number of hours to permit adequate attention to the management and administration of the facility as specified in this section. This facility was found to be deficient as evidenced by not having a certified administrator on file at this time. This presented an immediate threat to the Health, Safety, and Personal Rights of the residents in care.

Deadline recorded: Sep 15, 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 facility was found to be deficient as evidenced by having worn out, torn, and missing carpet throughout this facility. This presented an immediate threat to the Health, Safety, and Personal Rights of the residents in care.

Deadline recorded: Sep 29, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87303(e)(6)

Regulation authority

CCR

What the official deficiency says

Water supplies and plumbing fixtures shall be maintained as follows: (6) Toilet, hand washing and bathing facilities shall be maintained in operating condition. Additional equipment shall be provided in facilities accommodating physically handicapped and/or non ambulatory residents, based on the residents' needs. This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above in that there were holes in the walls, issues with the plumbing fixtures, and toilets that needed to be repaired/replaced which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Citations were already issued on annual visit dated 03/09/2023 and POC already completed. No additional POC required at this time.

Deadline recorded: May 4, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87303(f)(2)

Regulation authority

CCR

What the official deficiency says

(f) Solid waste shall be stored and disposed of as follows: (2) Syringes and needles are disposed of in accordance with the California Code of Regulations, Title 8, Section 5193 concerning bloodborne pathogens. 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 syringes and lancets were left out in a kitchen cabinet that was unable to be secured making them accessible to all facility staff and residents alike which posed an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/10/2023 Plan of Correction Facility designated Administrator stated that all syringes and lancets will be stored and maintained in a locked cabinet at all times to make them inaccessible to all facility residents at all times. A statement of correction, along with photo taken as proof of removed syringes and lancets, will be completed and submitted into CCL by the due date of 03/10/2023.

Official classification

Type A

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 record review, the licensee did not comply with the section cited above in [2] out of [5] facility resident files did not have the required TB clearance which posed immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/10/2023 Plan of Correction Facility designated Administrator stated that all facility staff will be properly cleared for TB with the corresponding document, LIC 503, to be updated and completed. A statement of correction, along with copies of the updated LIC 503 will be completed and submitted into CCL by the due date of 03/10/2023 for review by this LPA.

Official classification

Type A

Official code

1569.618(b)

Regulation authority

HSC

What the official deficiency says

(b) At least one administrator, facility manager, or designated substitute who is at least 21 years of age and has qualifications adequate to be responsible and accountable for the management and administration of the facility pursuant to Title 22 of the California Code of Regulations shall be on the premises 24 hours per day. The designated substitute may be a direct care staff member who shall not be required to meet the educational, certification, or training requirements of an administrator. The designated substitute shall meet qualifications that include, but are not limited to, all of the following: 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 [2] out of [2] facility designated Administrators' certificates were expired and no proof of updated certificates were made available for review at the time of this visit which posed an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/10/2023 Plan of Correction Facility designated Administrator stated that the most updated information pertaining to this facility designated Administrator will be updated and submitted into CCL for review by this LPA along with a statement of correction.

Official classification

Type A

Official code

87412(a)(11)

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: (11) A health screening as specified in Section 87411, Personnel Requirements - General. 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 [2] out of [5] facility resident files did not have the required health screening documents which posed immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/10/2023 Plan of Correction Facility designated Administrator stated that all facility staff will be properly cleared for their health screening, LIC 503, to be updated and completed. A statement of correction, along with copies of the updated LIC 503 will be completed and submitted into CCL by the due date of 03/10/2023 for review by this LPA.

Official classification

Type A

Official code

87411(c)(1)

Regulation authority

CCR

What the official deficiency says

(1) Staff providing care shall receive appropriate training in first aid from persons qualified by such agencies as the American Red Cross. 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 [4] out of [5] facility resident files did not have the required current First Aid training which posed immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/16/2023 Plan of Correction Facility designated Administrator stated that all facility staff will be properly trained in First Aid with updated and completed certificates. A statement of correction, along with copies of the updated First Aid certificates will be completed and submitted into CCL by the due date of 03/16/2023 for review by this LPA.

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 licensee did not comply with the section cited above since there were several window and door screens that were in need of repair/replacement due to having holes, rips, or tears in them which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/16/2023 Plan of Correction Facility designated Administrator stated that all window and door screens will be reviewed and any of them that contained any holes, rips, or tears will be repaired/replaced as necessary. A statement of correction will be completed, along with photos of the updated window and door screens, to be submitted into CCL by the due date.

Official classification

Type B

Official code

87303(e)(6)

Regulation authority

CCR

What the official deficiency says

(e) Water supplies and plumbing fixtures shall be maintained as follows: (6) Toilet, handwashing and bathing facilities shall be maintained in operating condition. Additional equipment shall be provided in facilities accommodating physically handicapped and/or nonambulatory residents, based on the residents' needs. 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 holes in the walls and items that needed to be repaired/replaced which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/16/2023 Plan of Correction Facility designated Administrator stated that all restroom walls will be repaired to remove all holes and physical plant issues within them. A statement of correction, along with photos of the repairs that were completed, will be completed and submitted into CCL for review by this LPA.

Official classification

Type B

Official code

1569.618(c)(4)

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: (4) Ensure that the facility is clean, safe, sanitary, and in good repair at all times. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above since resident bedroom furniture and furnishings were in need of repair. Drawers were missing handles, of off the rails and closet doors were off the rails or very difficult to slide open when needed which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/16/2023 Plan of Correction Facility designated Administrator stated that the resident bedroom furniture and furnishings will be reviewed and repaired/replaced as necessary to make sure that they are in good repair at all times. A statement of correction, along with photos of the repaired/replaced furniture/furnishings, will be completed and submitted into CCL by the due date of 03/16/2023.

Official classification

Type B

Official code

87411(d)

Regulation authority

CCR

What the official deficiency says

(d) All personnel shall be given on the job training or have related experience in the job assigned to them. This training and/or related experience shall provide knowledge of and skill in the following, 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 record review, the licensee did not comply with the section cited above in [5] out of [5] staff files did have contain the required updated annual training which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/16/2023 Plan of Correction Facility designated Administrator stated that all facility staff providing care and supervision to the residents will receive the required updated Annual training, with corresponding number of hours, and have proof of training within the facility staff records. A statement of correction, along with copies of staff training topics and hours, will be completed and submitted into CCL by the due date.

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 in that kitchen cabinets, drawers, and storage units were in need of repair/replacement which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/16/2023 Plan of Correction Facility designated Administrator stated that all kitchen cabinets and drawers will be reviewed and any that needed to be repaired/replaced will be corrected and brought into good repair. A statement of correction, along with photos of updated kitchen cabinetry, will be completed and submitted into CCL by the due date.

Official classification

Type B

Official code

87555(b)(29)

Regulation authority

CCR

What the official deficiency says

(b) The following food service requirements shall apply: (29) All equipment, fixed or mobile, and dishes, shall be kept clean and maintained in good repair and free of breaks, open seams, cracks or chips. 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 kitchen dishes, cookware, and utensils needed to be cleaned and maintained in a sanitary condition at all times which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/16/2023 Plan of Correction Facility designated Administrator stated that all kitchen dishes, cookware, and utensils will be reviewed and any that needed to be repaired/replaced will be corrected, cleaned, and sanitized. A statement of correction, along with photos of updated kitchen dishes, cookware and utensils will be completed and submitted into CCL by the due date.

Official classification

Type B

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 record review, the licensee did not comply with the section cited above in [5] out of [5] resident files which did not have an updated and completed Medication Administration Record which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/16/2023 Plan of Correction Facility designated Administrator stated all resident files, with accompanying Medication Administration Record (MAR), should be updated and completed at all times. A statement of correction, along with copies of the updated Medication Administration Record (MAR), will be completed and submitted into CCL for review by this LPA by the due date.

Official classification

Type B

Official code

87555(b)(27)

Regulation authority

CCR

What the official deficiency says

General Food Service Requirements The following...requirements shall apply: All...areas shall be kept clean and free of litter, rodents, vermin and insects. This requirement is not met as evidenced by: Administrator did not ensure facility exterior and interior was free of litter and insects. Based on observations the team observed flies in the kitchen area as well as roach filled traps. This violation poses a potential health, and safety risk to residents in care.

Official plan of correction

Licensee shall remove all litter from inside and outide of the facility, remove filled roach sticky traps regularly, ensure facility is free of flies. Please fax a letter of completion by POC due date.

Deadline recorded: Oct 26, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.1(a)(2)

Regulation authority

CCR

What the official deficiency says

Personal Rights of Residents in All Facilities Residents in all residential care facilities for the elderly shall have all of the following personal rights: To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This requirement is not met as evidenced by: Administrator did not ensure facility interior was safe and healthful for resident use. Based on observations the team observed bed bugs on the residents bedding. This violation poses a potential health, and safety risk to residents in care.

Official plan of correction

Licensee shall replace bed bug covering for residents beds and/or mattress. Licensee shall also submit a statement that staff and visitors are to wear masks as a part of infection control. Please fax to office by POC due date.

Deadline recorded: Oct 26, 2022. 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

Maintenance and Operation 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 facility was found deficient as evidenced by the presence of flies throughout this facility in the common areas, resident bedrooms, and restrooms. This posed a potential threat to the overall health, safety, and personal rights of all residents in care.

Official plan of correction

The facility representative stated that a pest control plan will be completed and submitted into CCL detailing the type of service that will be contracted and actual service date. A statement of correction will be completed and submitted into CCL by the due date of 03/28/2022.

Deadline recorded: Mar 28, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87464(f)(4)

Regulation authority

CCR

What the official deficiency says

Basic Services Basic services shall at a minimum include: Personal assistance and care as needed by the resident and as indicated in the pre-admission appraisal, with those activities of daily living such as dressing, eating, bathing and assistance with taking prescribed medications, as specified in Section 87608. This facility was found deficient as evidenced by the staff not maintaining and making sure that the bedrooms were kept clean and free of any debris and pests. It was observed that bedding needed to be changed out with a need for housekeeping as well. This posed a potential threat to the overall health, safety, and personal rights of all residents in care.

Official plan of correction

The facility representative stated that a housekeeping schedule will be completed and submitted into CCL for all residents and their service needs along with a statement of correction by the due date of 03/28/2022.

Deadline recorded: Mar 28, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87303(a)(1)

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. (1) Floor surfaces in bath, laundry and kitchen areas shall be maintained in a clean, sanitary, and odorless condition. 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 carpet in the common areas, as well as in the resident bedrooms were in need of replacement since they were ripped and worn. in addition, these areas carried urine and other unwanted odors which posed an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/09/2022 Plan of Correction Facility designated Administrator stated that a plan for replacement for the common rooms, replaced with laminate flooring, and resident bedrooms, replaced with new carpet, will be completed and submitted into CCL by the due date. A plan of the start date and end date will be submitted into CCL with receipt of all flooring materials included as well.

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 licensee did not comply with the section cited above in a review of the facility window screens which were torn and contained rips which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/09/2022 Plan of Correction The facility designated Administrator stated that all window screens will be reviewed and if any are ripped or torn, in any way, will be replaced/repaired with proof of correction submitted into CCL by the due date.