ASHLEY'S MANOR I

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 as side gate had a metal wire obstructing the lach preventing the gate from opening which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/12/2026 Plan of Correction Caregiver and designee immediately removed the metal wire from the gate latch. Staff verbalized understanding the importance of not obstructing emergency exits. POC Cleared

Official classification

Type A

Official code

87615(a)(5)

Regulation authority

CCR

What the official deficiency says

(a) Persons who require health services for or have a health condition including, but not limited to, those specified below shall not be admitted or retained in a residential care facility for the elderly: (5) Residents who depend on others to perform all activities of daily living for them as set forth in Section 87459, Functional Capabilities. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and record review, the licensee did not comply with the section cited above as two residents who has no capacity for self-care and no record of an exception on file, which poses an immediate health and safety risk to residents in care.which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/13/2026 Plan of Correction Licensee will read regulation cited and write a statement of understanding. Also, licensee will ask POA to contact a hospice agency to assess residents. If they do not qualify for hospice services, licensee will apply for an exception with CCL.

Official classification

Type B

Official code

87463(i)

Regulation authority

CCR

What the official deficiency says

(i) When there is significant change in condition, as defined in Section 87101, Definitions, or once every 12 months, whichever occurs first, the licensee shall arrange an in-person or virtual meeting or conference call to share the reappraisal with the resident, the resident's representative, if applicable, and appropriate facility staff, as specified in Section 87467, Resident Participation in Decision Making. 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 as four out of five resident's needs and service plan were missing signatures which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/27/2026 Plan of Correction Licensee wll collect signatures and submit proof to LPA before POC due date.

Official classification

Type A

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 observation, interview and record review, the licensee did not comply with the section cited above by not having an accurate count of medication for Resident #1 which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/31/2025 Plan of Correction Provide training to staff authorized to complete the Centrally Stored Log on how to manage, store and administer medication. Also, complete frequent medication audits.

Official classification

Type B

Official code

87705(h)

Regulation authority

CCR

What the official deficiency says

(h) Outdoor facility space used for resident recreation and leisure shall be completely enclosed by a fence with self-closing latches and gates, or walls, to protect the safety of residents. 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 2 (two) gates were observed to be not self-closing nor self-latching which poses a potential safety risk to persons in care.

Official plan of correction

POC Due Date: 03/27/2024 Plan of Correction Licensee agreed to make adjustments to both side gates and to ensure that both are self-latching and self closing. Licensee with send photos or video to CCL by POC due date.

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

87303 (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include...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 and interview, the facility has had rodents observed in both the garage area as well as near a resident room and has evidence of rodent infestation in the attic, which poses a potential health and safety hazard to residents in care.

Official plan of correction

Licensee indicated pest control services will be provided tomorrow and upon completion, Licensee will provide proof to CCL by POC due date.

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

Official classification

Type A

Official code

87303(e)(2)

Regulation authority

CCR

What the official deficiency says

(e) Water supplies and plumbing fixtures shall be maintained as follows: (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, as water temperature measured at 125.6 degrees Fahrenheit at 01:27PM, which poses an immediate safety risk to persons in care.

Official plan of correction

POC Due Date: 02/01/2023 Plan of Correction During today's visit, Licensee adjusted the hot water heater and prior to LPA leaving the facility, water temperature measured within the required range. Licensee will also log water temperature readings for one week and send a copy of the log to LPA by POC due date.