ST MARY'S HOME

Official classification

Type A

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above in that the flooring in the common areas and some resident bedrooms were in need of being repaired/replaced since the planks were starting to slide and separate which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

The facility designated Administrator stated that a bid will be obtained in order to determine the severity of the damage and overall cost to repair/replace the facility flooring in the common areas and resident bedrooms. A statement of correction, along with proof of contracted bid for the flooring services to repair/replace, will be completed and submitted into CCL for review by this LPA.

Deadline recorded: Apr 17, 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

(a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above in that the flooring in the common areas and some resident bedrooms were in need of being repaired/replaced since the planks were starting to slide and separate which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/12/2026 Plan of Correction The facility designated Administrator stated that a bid will be obtained in order to determine the severity of the damage and overall cost to repair/replace the facility flooring in the common areas and resident bedrooms. A statement of correction, along with proof of contracted bid for the flooring services to repair/replace, will be completed and submitted into CCL for review by this LPA.

Official classification

Type A

Official code

87303(e)(2)

Regulation authority

CCR

What the official deficiency says

(2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degrees C) and not more than 120 degree F (49 degrees C). This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above in that the hot water measured in a resident restroom faucet was found to be at 124.2 degrees which was above the allowed range which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/12/2026 Plan of Correction The facility designated Administrator stated the hot water heater will be turned down and the hot water dispensed will be measured for the next (3) days at various times of the day (AM, PM, and NOC shift) in order to make sure that the temperatures are all within the allowed range of 105-120 degrees at all times. A statement of correction, along with documented proof of the hot water temperatures taken over the next (3) days, will be completed and submitted into CCL.

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 that [2] out of [4] facility staff files did not contain updated TB clearance on their health screenings which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/12/2026 Plan of Correction The facility designated Administrator stated that an audit of all of the facility staff files will be conducted to make sure that the medical assessments are complete and up to date. A statement of correction, along with copies of the updated medical assessments with clearance for TB for the facility staff will be completed and submitted into CCL for review by this LPA by the due date.

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 [1] out of [4] facility staff did not have updated first aid training certification which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/12/2026 Plan of Correction The facility designated Administrator stated that an audit of all of the facility staff files will be conducted to make sure that the first aid training is complete and up to date for all staff. A statement of correction, along with copies of the updated first aid training for the facility staff will be completed and submitted into CCL for review by this LPA by the due date.

Official classification

Type A

Official code

87555(b)(26)

Regulation authority

CCR

What the official deficiency says

(26) Supplies of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days shall be maintained on the premises. 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 pantry area was reviewed and there was not a sufficient supply of non perishable food items to satisfy the 7-day quantities on hand at all times which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/12/2026 Plan of Correction The facility designated Administrator stated that a review of the current non perishable food supply will be conducted and additional food items will be purchased to make sure that this facility maintains, and has on hand at all times, a sufficient supply of 7-day non perishable food items. A statement of correction, along with a receipt of the updated food purchase for non perishable food items, will be completed and submitted into CCL for review by this LPA by the due date.

Official classification

Type A

Official code

87506(b)(10)

Regulation authority

CCR

What the official deficiency says

(b) Each resident's record shall contain at least the following information: (10) Reports of the medical assessment specified in Section 87458 Medical Assessment, and of any special problems or precautions. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, the licensee did not comply with the section cited above in that [2] out of [6] facility resident files did not have a complete and updated medical assessment which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/12/2026 Plan of Correction The facility designated Administrator stated that an audit of all of the facility resident files will be conducted to make sure that the medical assessments are complete and up to date. A statement of correction, along with copies of the updated medical assessments for the facility residents will be completed and submitted into CCL for review by this LPA by the due date.

Official classification

Type A

Official code

87458(c)(1)(A)

Regulation authority

CCR

What the official deficiency says

(c) The medical assessment shall include, but not be limited to: (1) A physical examination of the resident indicating the licensed medical professional's diagnosis or diagnoses and results of an examination for all of the following: (A) Communicable tuberculosis. 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 [6] facility resident files did not have updated and proper TB clearance which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/12/2026 Plan of Correction The facility designated Administrator stated that an audit of all of the facility resident files will be conducted to make sure that the medical assessments are complete and up to date. A statement of correction, along with copies of the updated medical assessments with clearance for TB for the facility residents will be completed and submitted into CCL for review by this LPA by the due date.

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 that several window screens and sliding glass door screens were in need of repair/replacement containing holes, tears, and rips in them. Some sliding glass door screens were offline and needed to be realigned which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/18/2026 Plan of Correction The facility designated Administrator stated that an audit of all window screens and sliding glass door screens will be reviewed to make sure that they do not have any holes, rips, or tears in them. Also any misaligned sliding glass door screens will be repaired and realigned to make sure that they are able to be used and handled by the facility residents in opening/closing them. A statement of correction, along with contracted work for the repairs/replacements of the screens will be completed and submitted into CCL for review by this LPA by the due date.

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 [1] out of [4] facility staff did not have updated training hours which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/18/2026 Plan of Correction The facility designated Administrator stated that an audit of all facility personnel files will be conducted to make sure that all associated facility staff providing care and supervision to the residents in care and adequately trained and updated for annual training hours at all times. A statement of correction, along with updated hours of annual training, will be completed and submitted into CCL for review by this LPA by the due date.

Official classification

Type A

Official code

87411(f)

Regulation authority

CCR

What the official deficiency says

87411(f) Personnel Requirements - General. All personnel ...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. 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 of 4 personnel files reviewed, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/14/2025 Plan of Correction Administrator will review regulation 87411 and present a statement of understanding to LPA Campbell via email. Provide proof of negative TB tests for S1 and S2. Audit all files to ensure they were completed in full by POC 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 LPA Jensen's review of the Centrally Stored Medication and Destruction Record in comparison to medication on hand, the licensee did not comply with the section cited above in 1 of 1 count which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/01/2024 Plan of Correction Licensee agrees to document Centrally Stored Medication and Destruction Record with all Medications noting the date they are filled and started.

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

Maintenance and Operation 87303(a) The facility shall be 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 in when the LPA observed ants on the bed and floor of a residents's bedroom where there were crumbs attracting the insects. This poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/04/2023 Plan of Correction Licensee will have pest control visit the facility and provide a treatment by the above due date and will submit proof of treatment to kimberly.viarella@dss.ca.gov. The Licensee will also have someone repair the switch plate and kickplate to the door off of that room in order to prevent insects entry.

Official classification

Type B

Official code

87555(b)

Regulation authority

CCR

What the official deficiency says

Food Storage (b) The following food service requirements shall apply: (8) All food shall be of good quality. Commercial foods shall be approved by appropriate federal, state and local authorities. Food in damaged containers shall not be accepted, used or retained. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above when 1 out of 3 items pulled from the refrigerator were expired and 4 out of 4 items that were wrapped in plastic or were in storage containers were not labeld and dated. This poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/04/2023 Plan of Correction Licensee will develop a monthly schedule for cleaning the refridgerator so that expired goods will be disposed of immediately. This schedule will be submitted to kimberly.viarella@dss.ca.gov. by 08/04/2023.