Medication handling and storageType A
- Official classification
- Type A
- Official code
- 87465(c)(3)
- Regulation authority
- CCR
What the official deficiency says
(c) If the resident's physician has stated in writing that the resident is unable to determine his/her own need for nonprescription PRN medication, but can communicate his/her symptoms clearly, facility staff designated by the licensee shall be permitted to assist the resident with self-administration, provided all of the following requirements are met: (3) A record of each dose is maintained in the resident's record. The record shall include the date and time the PRN medication was taken, the dosage taken, and the resident's response. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview, record review, the licensee did not comply with the section cited above in 5 out of 5 medicationsAtrovastatin 20 mg tab. Take 1 tablet by mouth daily, Alprazolam .5 mg tab ever day, max daily 1 tablet, Amlodipine Besylate 10 mg tablet. Take 1 tablet by mouth daily Meloxicam 7.5 mg tablet. Take 1 by mouth daily, Melatonin 10 mg, take 1 tablet by mouth every night *All medications were not initialed for multiple dates which poses an immediate health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 08/11/2026 Plan of Correction Licensee agrees for staff to complete medication training and submit completion certificates to CCLD by POC due date.
Records and plan of operationType B
- Official classification
- Type B
- Official code
- 87506(b)(16)
- Regulation authority
- CCR
What the official deficiency says
(b) Each resident's record shall contain at least the following information: (16) Records of resident's cash resources as specified in Section 87217, Safeguards for Resident Cash, Personal Property, and Valuables. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview, record review, the licensee did not comply with the section cited above in 4 out of 5 residents did not contain the Safeguard for Property Values form in resident's file which poses/posed a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 08/24/2026 Plan of Correction Licensee agrees to submit the Safeguard for Property Values forms to CCLD by POC due date.
Admission, assessment, and evictionType B
- Official classification
- Type B
- Official code
- 87463(a)
- Regulation authority
- CCR
What the official deficiency says
(a) The pre-admission appraisal, as specified in Section 87457, Pre-Admission Appraisal, shall be updated, in writing as frequently as necessary or once every 12 months, whichever occurs first, to note significant changes in condition, as defined in Section 87101, Definitions, and to keep the appraisal accurate. For the purposes of this section, the updated pre-admission appraisal shall be referred to as the reappraisal. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview, record review, the licensee did not comply with the section cited above in 2 out of 5 residents did not contain the Appraisal Needs and Services form in resident file which poses/posed a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 08/24/2026 Plan of Correction Licensee agrees to submit the Appraisal Needs and Services forms to CCLD by POC due date.
Resident rightsType B
- Official classification
- Type B
- Official code
- 1569.39(b)
- Regulation authority
- HSC
What the official deficiency says
(b) A residential care facility for the elderly that accepts or retains residents with restricted health conditions, as defined by the department, shall ensure that residents receive medical care as prescribed by the resident’s physician and contained in the resident’s service plan by appropriately skilled professionals acting within their scope of practice. An appropriately skilled professional may not be required when the resident is providing self-care, as defined by the department, and there is documentation in the resident’s service plan that the resident is capable of providing self-care. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview, record review, the licensee did not comply with the section cited above in 3 out of 5 residents did not contain the LIC-602/TB test in resident's file which poses/posed a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 08/24/2026 Plan of Correction Licensee agrees to submit the LIC-602 forms to CCLD by POC due date.
Health conditions and treatmentsType B
- Official classification
- Type B
- Official code
- 87633(b)(1)
- Regulation authority
- CCR
What the official deficiency says
(b) A current and complete hospice care plan shall be maintained in the facility for each hospice resident and include the following: (1) The name, office address, business telephone number, and 24-hour emergency telephone number of the hospice agency and the resident's physician. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview, record review, the licensee did not comply with the section cited above in 4 out of 5 residents did not contain the LIC-601 in resident's file which poses/posed a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 08/24/2026 Plan of Correction Licensee agrees to submit the LIC-601 forms to CCLD by POC due date.