JORDETH SENIOR CARE HOME

Official classification

Type B

Official code

87211(a)(1)

Regulation authority

CCR

What the official deficiency says

(1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below. This report shall include the resident's name, age, sex and date of admission; date and nature of event; attending physician's name, findings, and treatment, if any; and disposition of the case. 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. Upon arrival at the facility LPA observed work being done on the facility roof. Hammering and drilling observed from inside the faciilty with 2 of 3 residents being present. Work started on 7/23/26. CCL was not notified of the wor being completed. This poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/07/2026 Plan of Correction Licensee stated they will do training for reporting requirements and provide in-service sign in sheet and training material to CCL by POC date.

Official classification

Type B

Official code

1569.625(b)(1)

Regulation authority

HSC

What the official deficiency says

(1) The department shall adopt regulations to require staff members of residential care facilities for the elderly who assist residents with personal activities of daily living to receive appropriate training. This training shall consist of 40 hours of training. A staff member shall complete 20 hours, including six hours specific to dementia care, as required by subdivision (a) of Section 1569.626 and four hours specific to postural supports, restricted health conditions, and hospice care, as required by subdivision (a) of Section 1569.696, before working independently with residents. The remaining 20 hours shall include six hours specific to dementia care and shall be completed within the first four weeks of employment. The training coursework may utilize various methods of instruction, including, but not limited to, lectures, instructional videos, and interactive online courses. The additional 16 hours shall be hands-on training. This requirement is not met as evidenced by: Deficient Practice Statement Based on records reviewed, the licensee did not comply with the section cited above. 1 of 1 staff file reviewed did not have the required annual training completed. This poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/07/2026 Plan of Correction Licensee stated they will search for initial training records and send to CCL as proof of correction. If unable to locate, staff will complete all training and a copy of transcripts/certificates will be provided to CCL as proof of correction.

Official classification

Type B

Official code

1569.695(a)

Regulation authority

HSC

What the official deficiency says

(a)In addition to any other requirement of this chapter, a residential care facility for the elderly shall have an emergency and disaster plan that shall include, but not be limited to, all of the following: This requirement is not met as evidenced by: Deficient Practice Statement Based on records reviewed, the licensee did not comply with the section cited above. Facility sketch does not identify assembly points/points. Transportation needs and evacuation proceedures are not appropriately reflected. Process for communicating with others is not listed. Annual training on plan is not completed. This poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/07/2026 Plan of Correction Licensee stated they will update the emergency and disaster plan (LIC 610E) and submit to CCL by POC date as proof of correction.

Official classification

Type A

Official code

87202(a)

Regulation authority

CCR

What the official deficiency says

(a) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, or the State Fire Marshal. Prior to accepting or retaining any of the following types of persons, the applicant or licensee shall notify the licensing agency and obtain an appropriate fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, or the State Fire Marshal: 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 the door to the staff bedroom that leads to the garage fire exit was unable to be opened due to the staff bed being in the way of opening the door, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/03/2025 Plan of Correction Licensee agrees to remove or adjust the bed so it is not blocking the door from opening. Licensee agrees to submit a photo by POC due date 08/03/25. Licensee agrees to submit photo of new bed by 8/8/25.

Official classification

Type B

Official code

87633(b)

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: 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 2 resident records did not have Hospice Care Plans, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/08/2025 Plan of Correction Licensee agrees to submit hospice care plans for R1, R2 and R3 by POC due date 8/8/25.

Official classification

Type B

Official code

87468.1(a)(6)

Regulation authority

CCR

What the official deficiency says

87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (6) 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 requirement is not met as evidenced by: LPA found that facility staff confined resident to their room. LIC stated a plastic door knob cover was placed on the inside door knob of R1's bedroom to prevent R1 from leaving the facility after R1 AWOL'd the second time from the facility. This poses a potential safety or personal rights risk to residents in care.

Official plan of correction

Licensee will submit proof of written statement about non-use of door knob covers, to CCL by POC due date.

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