DUTCHOLLOW SUITES I

Official classification

Type A

Official code

87468.1(a)(6)

Regulation authority

CCR

What the official deficiency says

Personal Rights of Residents in All Facilities To leave or depart the facility at any time and to not be locked into any room, building, or on facility premises by day or night. This does not prohibit a licensee from establishing house rules, such as locking doors at night to protect residents, or barring windows against intruders, with permission from the Department. This facility was found to be deficient as evidenced by blocking in a resident in their bed with chairs and other furniture posing an immediate threat to the Health, Safety, and Personal Rights of all residents in care.

Official plan of correction

The facility designated Administrator stated that all residents should be afforded all of their personal rights at all times. A statement of correction, along with proof of updated staff training, for no less than (1) hour in duration, on the topic of residents personal rights will be completed and submitted into CCL by the due date for review by this LPA.

Deadline recorded: Jul 21, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87459(a)(4)

Regulation authority

CCR

What the official deficiency says

Functional Capabilities The facility shall assess the person's need for personal assistance and care by determining his/her ability to perform specified activities of daily living. Such activities shall include, but not be limited to: Transferring, including the need for assistance in moving in and out of a bed or chair. This facility was found to be deficient as evidenced by the inability of the current staff to provide adequate assistance in repositioning or transferring of residents which poses an immediate threat to the Health, Safety, and Personal Rights of all residents in care.

Official plan of correction

The facility designated Administrator stated that all residents' needs should be addressed and met by all facility staff at all times. A statement of correction, along with an updated LIC 500 for additional staff hires, will be updated and submitted into CCL by the due date for review by this LPA.

Deadline recorded: Jul 21, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87618(b)(1)

Regulation authority

CCR

What the official deficiency says

In addition to Section 87611(b), the licensee shall be responsible for the following: (1) Monitoring of the resident's ongoing ability to operate the equipment in accordance with the physician's orders. This facility was found to be deficient as evidenced by observations that a resident was unable to use and manipulate their oxygen machine to make sure that they were receiving it as prescribed by their licensed medical professional which posed a immediate threat to the Health, Safety, and Personal Rights to all residents in care.

Official plan of correction

The facility designated Administrator stated that all residents should be afforded all of their personal rights at all times. A statement of correction, along with proof of updated staff training, for no less than (1) hour in duration, on the topic of care and supervision related to resident oxygen use, will be completed and submitted into CCL by the due date for review by this LPA.

Deadline recorded: Jul 21, 2026. 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 the presence of bugs and insects at the front door and in the kitchen area as well which posed an immediate threat to the Health, Safety, and Personal Rights of all residents in care.

Official plan of correction

The facility designated Administrator stated that the kitchen area will be cleaned and kept clear of any old food items. A statement of correction, along with photos of the cleaned and cleared kitchen area, will be completed and submitted into CCL. In addition, a consultation will be made with the local pest control company to show that this facility is free of any pests or insects at that time. A statement of correction, along with updated consultation paperwork, will be completed and submitted into CCL by the due date for review by this LPA.

Deadline recorded: Jul 21, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87224(d)

Regulation authority

CCR

What the official deficiency says

The licensee shall set forth in the notice to quit the reasons relied upon for the eviction with specific facts to permit determination of the date, place, witnesses, and circumstances concerning those reasons. This facility was found to be deficient as evidenced by serving an eviction notice which did not have supporting information to note that a considerable change in behavior had occurred requring a higher level of care causing concern for harm to the resident and other residents in care. This posed an immediate threat to the health, safety, and personal rights to all residents in care.

Official plan of correction

The facility designated Administrator stated that all facility staff will undergo training, for no less than (1) hour in duration, on the topic of proper eviction procedures from a vendorized entity set forth on the CCLD website. A statement of correction, along with proof of updated training, will be completed and submitted into CCL for review by this LPA by the due date.

Deadline recorded: Jun 27, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87468.2(a)(3)

Regulation authority

CCR

What the official deficiency says

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: To be encouraged and assisted in exercising their rights as citizens and as residents of the facility. Residents shall be free from interference, coercion, discrimination, and retaliation in exercising their rights. This facility was found to be deficient as evidenced by the execution of an eviction notice to a resident and their responsible party after a complaint was filed. This posed an immediate threat to the Health, Safety, and Personal Rights of all residents in care.

Official plan of correction

The facility designated Administrator stated that all facility staff will undergo training, for no less than (2) hours in duration, on the topic of Personal Rights from a vendorized entity set forth on the CCLD website. A statement of correction, along with proof of updated training, will be completed and submitted into CCL for review by this LPA by the due date.

Deadline recorded: Jun 27, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87219(a)(1)

Regulation authority

CCR

What the official deficiency says

Residents shall be encouraged to maintain and develop their quality of life through participation in a variety of planned activities. The activities made available shall include: Socialization to promote or enhance personal relationships. Activities may include, but are not limited, to: This facility was found to be deficient as evidenced by the lack of activities that were being offered and lack of involvement for the facility residents made by the facility staff. This posed an immediate threat to the Health, Safety, and Personal Rights to all residents in care.

Official plan of correction

The facility designated Administrator stated that all facility staff will undergo training, for no less than (1) hour in duration, on the topic of proper resident activities from a vendorized entity set forth on the CCLD website. A statement of correction, along with proof of updated training, will be completed and submitted into CCLD for review by this LPA by the due date.

Deadline recorded: Jun 27, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87465(h)(2)

Regulation authority

CCR

What the official deficiency says

(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 is not met as evidenced by: Based on interview and record review, the licensee did not ensure that medication was locked and made inaccessible to the residents in care. This poses an immediate health, safety, and personal rights risks to persons in care.

Official plan of correction

Medications were observed to be locked and made inaccessible at the time of this visit. Facility Administrator stated that a review of the section will be conducted. A statement of correction, along with proof of staff training from an outside vendor for no less than (1) hour in duration, for the cited section will be completed and submitted to the LPA's email at arielle.pascua@dss.ca.gov. by the due date. Information submitted must include attendees, trainers, and information discussed.

Deadline recorded: May 14, 2026. A deadline is not proof that correction was completed.

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 is not met as evidenced by: Based on observations, the licensee did not ensure that knives and hazardous materials were locked and made inaccessible to the residents in care. This poses an immediate health, safety, and personal rights risk to persons in care

Official plan of correction

Facility Administrator stated that a review of the section will be conducted. A statement of correction, along with proof of staff training from an outside vendor for no less than (1) hour in duration, for the cited section will be completed and submitted to the LPA's email at arielle.pascua@dss.ca.gov. by the due date. Information submitted must include attendees, trainers, and information discussed.

Deadline recorded: May 14, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

1569.312(e)

Regulation authority

HSC

What the official deficiency says

Monitoring the activities of the residents while they are under the supervision of the facility to ensure their general health, safety, and well-being. This is not met as evidenced by: Based on interview and record review, this Licensee did not ensure that S1 supervised the residents in care. It was stated through interviews that S1 was witnessed to be sleeping at the time of a family visit which was corroborated through a video recording. This poses an immediate health, safety, and personal rights risks to persons in care.

Official plan of correction

Facility Administrator stated that a review of the section will be conducted. A statement of correction, along with proof of staff training from an outside vendor for no less than (1) hour in duration, for the cited section will be completed and submitted to the LPA's email at arielle.pascua@dss.ca.gov. by the due date. Information submitted must include attendees, trainers, and information discussed.

Deadline recorded: Apr 15, 2026. 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

(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 is not met as evidenced by: Based on observations, the licensee did not ensure that the facility was in a clean manner. It was observed that that facility had clutter across multiple areas, including the kitchen, living spaces, and bedrooms. This poses a potential health, safety, and personal rights risks to persons in care.

Official plan of correction

Facility Administrator stated that a review of the section will be conducted. A statement of correction, along with proof of cleaning and cleaning schedule will sent to the LPA by POC date.

Deadline recorded: May 14, 2026. A deadline is not proof that correction was completed.

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 of food in the kitchen, the licensee did not comply with the section cited above, as there were food items that were expired in the refrigerator and pantry, and there were open food items that required refrigeration after opening that were stored in the pantry unrefrigerated, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/09/2025 Plan of Correction The Administrator began conducting an inventory of the food supply and discarding expired and unrefrigerated food. The Licensee agrees to conduct a monthly audit of the food supply to identify and discard all and unrefrigerated expired food. The Administrator will send LPA an email when inventory and discard is complete.

Official classification

Type B

Official code

87555(b)(25)

Regulation authority

CCR

What the official deficiency says

(b) The following food service requirements shall apply: (25) Soaps, detergents, cleaning compounds or similar substances shall be stored in areas separate from food supplies. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation of items in kitchen cabinets, the licensee did not comply with the section cited above, as ant and roach killer and leather cleaner were observed stored with food items in the cabinets, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/09/2025 Plan of Correction The Administrator will remove cleaners and pesticides from food storage areas and put them in a locked cabinet separate food. The Administrator will email LPA when this is complete.

Official classification

Type B

Official code

87458(a)

Regulation authority

CCR

What the official deficiency says

(a) Prior to a person's acceptance as a resident, the licensee shall obtain and keep on file, documentation of a medical assessment, signed by a physician, made within the last year. The licensee shall be permitted to use the form LIC 602 (Rev. 9/89), Physician's Report, to obtain the medical assessment. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA Jensen's record review, the licensee did not comply with the section cited above in 1 out of 3 residents files which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/16/2024 Plan of Correction

Official classification

Type A

Official code

87466

Regulation authority

CCR

What the official deficiency says

Observation of the Resident The licensee shall ensure that residents are regularly observed for changes... and that appropriate assistance is provided when such observation reveals unmet needs. When changes ... are observed, the licensee shall ensure that such changes are documented and brought to the attention of the resident's physician ... This requirement was not met as evidenced by Based on an interview with the Administrator and a review of facility records, medical records and photographs, R1 developed a wound while under facility care that was not reported to R1’s physician. This poses an immediate risk to the health, safety and personal rights of residents in care.

Official plan of correction

The Licensee has already completed the plan of correction under compliant number 27-AS-20231213133955. No further plan of correction required.

Deadline recorded: May 10, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87464(f)(1)

Regulation authority

CCR

What the official deficiency says

Basic Services Basic services shall at a minimum include: (1) Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). This requirement was not met as evidenced by: Based on interviews conducted, facility records, medical records and photographs taken by the Administrator, R1 did not receive the care and supervision needed to prevent a wound which endangered their physical health. This poses an immediate risk to the health, safety and personal rights of residents in care.

Official plan of correction

R1 no longer resides at the facility. The facility has conducted additional training on wound care and personal rights. The facility has also increased resident observation and documentation. No further plan of correction is required.

Deadline recorded: Mar 13, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

1569.884

Regulation authority

HSC

What the official deficiency says

Contents of Residential Care Facility Admission Agreements The admission agreement shall include all of the following: (a) A comprehensive description of any items and services provided under a single fee, , such as a monthly fee for room, board... the resident shall receive a monthly statement itemizing all separate charges incurred by the resident. This requirement was not met as evidenced by Licensee's admission that file receipts were inaccurate and no other receipts were generated. This poses a potential risk to the health, safety and personal rights of residnets in care.

Official plan of correction

The Licensee agrees to send monthly receipts to the payee effective immediately and retain those receipts in the file.

Deadline recorded: Jan 25, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87464(f)(4)

Regulation authority

CCR

What the official deficiency says

Basic Services Basic services shall at a minimum include: ...assistance with taking prescribed medications...This requirement was not met as evidenced by: Based on LPA Jensen's review of the MAR, R2 did not receive a prescribed medication from 1/11/24 through 1/15/24. This poses an immediate risk to the health, safety and personal rights of residents in care.

Official plan of correction

The Licensee agrees to document all communications with resident physicians and the pharmacy effective immediately and reconcile the MAR with the Centrally Stored Medication and Destruction Record.

Deadline recorded: Jan 26, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87467(a)(3)

Regulation authority

CCR

What the official deficiency says

Resident Participation in Decision Making The licensee shall arrange a meeting with the resident and appropriate individuals identified in Section 87467(a)(1) to review and revise the written record as specified, when there is a significant change in the resident’s condition, or once every 12 months, whichever occurs first. Significant changes shall include, but not be limited to occurrences specified in Section 87463, Reappraisals. This requirement was not met as evidenced by LPA Jensen's review of R2's file which contained a Needs and Service Plan conducted in 2018. This poses a potential risk to the health, safety and personal rights of residents in care.

Official plan of correction

The Licensee agrees to submit updated Needs and Service Plans that fully comply with this regulation by the POC due date.

Deadline recorded: Feb 22, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87555(a)

Regulation authority

CCR

What the official deficiency says

General Food Service Requirements ...All food shall be selected, stored, prepared and served in a safe and healthful manner. This requirement was not met as evidenced by: Based on LPA Jensen's observation of expired food in the pantry and refrigerator and food items requiring refrigeration being stored in the pantry. This poses a potential risk to the health, safety and personal rights of residents in care.

Official plan of correction

The facility staff began conducting an inventory of the food supply and discarding expired food. The Licensee agrees to conduct a monthly audit of the food supply to identify and discard of all expired food.

Deadline recorded: Nov 1, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

1569.655(a)

Regulation authority

HSC

What the official deficiency says

If a licensee of a residential care facility for the elderly increases the rates of fees for residents or makes increases in any of its rate structures for services, the licensee shall provide no less than 60 days' prior written notice to the residents or the residents' representatives. This requirement was not met as evidenced by: Based on LPA Jensen's review of 3 of 3 resident files that indicate rate increases may be made after 30 days. This poses a potential risk to the health, safety and personal rights of residents in care.

Official plan of correction

The Licensee agrees to establish new admission agreements signed by the resident or responsible party if applicable that are in compliance with the HSC. The Licensee will send the admission agreement to LPA Jensen by the Plan of Correction due date.

Deadline recorded: Dec 8, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87608(a)(3)

Regulation authority

CCR

What the official deficiency says

Postural Supports A written order from a physician indicating the need for the postural support shall be maintained in the resident’s record. The licensing agency shall be authorized to require other additional documentation if needed to verify the order. This requirement was not met as evidenced by: Based on LPA Jensen's observation of R1's bed being blocked by various items effectively restricting R1's mobility without a physician's order. This poses an immediate risk to the health, safety and personal rights of residents in care.

Official plan of correction

The facility staff called the Primary Care Physician requesting authorization for postural supports for R1 during the course of this visit and in the presence of the LPA. The facility staff will either remove the postural supports or send confirmation that the physician has given approval by 11/6/23.

Deadline recorded: Nov 1, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87307(d)(6)

Regulation authority

CCR

What the official deficiency says

Personal Accommodations and Services All outdoor and indoor passageways and stairways shall be kept free of obstruction. This requirement was not met as evidenced by: Based on LPA Jensen's observation of a bedroom sliding door and bedroom door blocked by equipment or furniture. This poses a potential threat to the health, safety and personal rights of residents in care.

Official plan of correction

The Licensee removed the obstructions during the course of the visit. No further plan of correction is required.

Deadline recorded: Oct 18, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87208(a)(7)(A)

Regulation authority

CCR

What the official deficiency says

Plan of Operation Each facility shall have and maintain a current, written definitive plan of operation...The plan and related materials shall contain the following: Sketches...including a floor plan that describes the capacities of the buildings for the uses intended and a designation of the rooms to be used for nonambulatory residents and for bedridden residents. This requirement was not met as evidenced by LPA Jensen's observation that a client room had been converted in to a staff room. This poses a potential threat to the health, safety and personal rights of residents in care.

Official plan of correction

The Licensee will submit a sketch that accurately depict the usage of each room or sign an attestation that the current sketch is accurate.

Deadline recorded: Oct 24, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

80087(a)

Regulation authority

CCR

What the official deficiency says

Buildings and Grounds The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors. This requirement was not met as evidenced by: Based on LPA Jensen's observation of toxins, tools, sharp objects and insects. This poses an immediate risk to the health, safety and personal rights of residents in care.

Official plan of correction

The Licensee removed all hazardous items and made them inaccessible during the course of the visit. No further plan of correction required.

Deadline recorded: Oct 18, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(h)(2)

Regulation authority

CCR

What the official deficiency says

Incidental Medical and Dental Care 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 Jensen's observation upon arrival of medication in the kicthen that was accessible to residents in care. This poses an immediate risk to the health, safety and personal rights of residdents in care.

Official plan of correction

The Licensee agrees to conduct a daily walk through to ensure all medications are inaccessible to residents in care. The Licensee will email an attestation that daily walk throughs will be conducted.

Deadline recorded: Oct 18, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87507(5)(g)(c)

Regulation authority

CCR

What the official deficiency says

Refund conditions. Facility policy concerning refunds, including the conditions under which a refund for advanced monthly fees will be returned in the event of a resident’s death, pursuant to Health and Safety Code section 1569.652. dmission agreements shall specify the following: (1) Basic services, as defined in Section 87101(b), to be made available. (2) Additional items and services which are available. (3) Payment provisions A refund of any fees paid in advance covering the time after the resident’s personal property has been removed from the facility shall be issued to the individual, individuals, or entity contractually responsible for the fees or, if the deceased resident paid the fees, to the resident’s estate, within 15 days after the personal property is removed. Based on records review and interviews with R1 and the ombudsmen (ON) LPA reviewed the admissions agreement , the licensee did not comply with the section cited. After a review of resident records LPA found that the admissions agreement only had N/A under refunds and no other information which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Provided a refund to R1 with in 3 days. LPA provided the licensee with the phone number where R1 could be reached as discussed with R1. Licensee will also update all admissions agreements with required information for all residents and provide a copy to the department via the LPA by 7/24/2023. updates can be emailed to LPA Lewis at Kesha.Lewis@dss.ca.gov Copies are now due by 08/11/2023.

Deadline recorded: Aug 11, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87507(5)(g)(c)

Regulation authority

CCR

What the official deficiency says

Refund conditions. Facility policy concerning refunds, including the conditions under which a refund for advanced monthly fees will be returned in the event of a resident’s death, pursuant to Health and Safety Code section 1569.652. dmission agreements shall specify the following: (1) Basic services, as defined in Section 87101(b), to be made available. (2) Additional items and services which are available. (3) Payment provisions A refund of any fees paid in advance covering the time after the resident’s personal property has been removed from the facility shall be issued to the individual, individuals, or entity contractually responsible for the fees or, if the deceased resident paid the fees, to the resident’s estate, within 15 days after the personal property is removed. Based on records review and interviews with R1 and the ombudsmen (ON) LPA reviewed the admissions agreement , the licensee did not comply with the section cited. After a review of resident records LPA found that the admissions agreement only had N/A under refunds and no other information which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Provided a refund to R1 with in 3 days. LPA provided the licensee with the phone number where R1 could be reached as discussed with R1. Licensee will also update all admissions agreements with required information for all residents and provide a copy to the department via the LPA by 7/24/2023. updates can be emailed to LPA Lewis at Kesha.Lewis@dss.ca.gov

Deadline recorded: Jul 15, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87307(e)

Regulation authority

CCR

What the official deficiency says

Personal Accommodations(e) Facilities providing services to residents who have physical or mental disabilities shall assure the inaccessibility of fishponds, wading pools, hot tubs, swimming pools, or similar bodies of water, when not in active use by residents, through fencing, covering or other means.The following requirement has not been met as evidenced by: LPA Hurt observed a large empty in ground swimming pool in facility backyard to be unlocked and accessible to facility residents which poses an immediate, health safety or personal rights risk to residents in care.

Official plan of correction

Licensee will ensure the gate to empty swimming pool is locked and send proof to LPA by POC date of 10/12/2022.

Deadline recorded: Oct 12, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(h)(2)

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: (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: LPA observed the facility has medications in the kitchen, and living room areas unlocked and accessible to residents which poses an immediate health, safety, or personal rights risk to residents in care.

Official plan of correction

Licensee will ensure all medications are locked and inaccesible to residents by 10/12/2022 POC date.

Deadline recorded: Oct 12, 2022. A deadline is not proof that correction was completed.

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: The following requirement has not been met as evidenced by: LPA observed toxins, and cleaning supplies unlocked and accesible to residents in several rooms including the garage, kitchen and backyard area of the facility which poses an immediate health, safety or personal rights risk to residents in care.

Official plan of correction

Licensee shall ensure all toxins and chemicals are locked away and send proof to LPA by 10/12/2022 POC date.

Deadline recorded: Oct 12, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(h)(2)

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: (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 LPA observed medications on facility kitchen table, and in an unlocked drawer inside a residents room which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/20/2022 Plan of Correction Licensee will lock away all medications, conduct training on medication handling, and send proof to LPA by 09/20/2022 POC date.

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: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above in LPA observed cleaning supplies unlocked and accessible on the back porch, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/20/2022 Plan of Correction Licensee will lock away all toxins immediately, and send proof to LPA by 09/20/2022 POC date.

Official classification

Type B

Official code

87555(b)(9)

Regulation authority

CCR

What the official deficiency says

87555 General Food Service Requirements (a) The total daily diet shall be of the quality and in the quantity necessary to meet the needs of the residents and shall meet the Recommended Dietary Allowances of the Food and Nutrition Board of the National Research Council. All food shall be selected, stored, prepared and served in a safe and healthful manner. (b) The following food service requirements shall apply: (9) Procedures which protect the safety, acceptability and nutritive values of food shall be observed in food storage, preparation and service. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above as LPA observed several tupperwares inside the refrigerator did not have labels or dates, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/05/2022 Plan of Correction Licensee will clean the refrigerator and ensure all intems are dated and labeled by 10/05/2022 POC date.

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. 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 LPA observed the facility to be cluttered, and not clean which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/05/2022 Plan of Correction Licensee will clean the facility by 10/05/2022 POC date. LPA will conduct POC date to confirm facility is clean.

Official classification

Type A

Official code

87887(h)(1)

Regulation authority

CCR

What the official deficiency says

BUILDINGS AND GROUNDS (h)Disinfectants, cleaning solutions, poisons, firearms, and other items which could pose a danger if readily available to residents shall be stored where inaccesible to residents. 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. LPA observed disinfectants on the back patio unlocked and accesible to residents. This poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/11/2021 Plan of Correction Licensee removed cleaning solutions from back patio. Licensee will clean back patio and send photos to LPA.

Official classification

Type A

Official code

87303(A)

Regulation authority

CCR

What the official deficiency says

Maintenance and Operations (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. LPA observed clutter all over the entire home. The entire home was filled with belongings from a storage unit outside. The kitchen area was not usable as it had items scattered all over the counters which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/11/2021 Plan of Correction Licensee will clean entire kitchen and living room area and sent photo proof to LPA by POC date.

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 lcoked place that is not accesible to persons other than employees responsible for the supervision of the cetnrally stored medications. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above. LPA observed several over the counter medications out on the kitchen table upon the entering the facility which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/12/2021 Plan of Correction Facility staff will be trained on the medication regulation along with licensee. Licensee will send proof of training to LPA. Licensee will review the regulation section and provide a statement of understanding.