ABSOLUTE CARE HOME

Official classification

Type B

Official code

87204(a)

Regulation authority

CCR

What the official deficiency says

(a) A licensee shall not operate a facility beyond the conditions and limitations specified on the license, including specification of the maximum number of persons who may receive services at any one time. An exception may be made in the case of catastrophic emergency when the licensing agency may make temporary exceptions to the approved capacity. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and interview, the licensee did not comply with the section cited above in the Administrator's relative resided at the facility and shared a room with R1 which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/13/2025 Plan of Correction The Licensee will admit their relative to the facility and provide CCLD their file by POC due date.

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 requirement is not met as evidenced by: Deficient Practice Statement Based on observation and interview, the licensee did not comply with the section cited above in knives were not secured and cleaning supplies in the garage were accessible which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/29/2025 Plan of Correction The Administrator secured the knives and garage during the visit. POC Cleared.

Official classification

Type B

Official code

87555(b)(28)

Regulation authority

CCR

What the official deficiency says

(b) The following food service requirements shall apply: (28) All food shall be protected against contamination. Contaminated food shall be discarded immediately upon discovery. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and interview, the licensee did not comply with the section cited above in emergency non-perishable food was expired which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/13/2025 Plan of Correction The Licensee will review/update the food supply and discard of expired food. The Licensee will send CCLD proof and a statement of understanding by POC due date.

Official classification

Type B

Official code

87465(h)(4)

Regulation authority

CCR

What the official deficiency says

(h) The following requirements shall apply to medications which are centrally stored: (4) All centrally stored medications shall be labeled and maintained in compliance with state and federal laws. No persons other than the dispensing pharmacist shall alter a prescription label. This requirement is not met as evidenced by: Deficient Practice Statement Based on interview and record review, the licensee did not comply with the section cited above in R1's medications were not properly documented which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/13/2025 Plan of Correction The Licensee will update R1's CSMDR and send to CCLD by POC due date.

Official classification

Type B

Official code

87465(e)

Regulation authority

CCR

What the official deficiency says

(e) For every prescription and nonprescription PRN medication for which the licensee provides assistance there shall be a signed, dated written order from a physician on a prescription blank, maintained in the resident's file, and a label on the medication. Both the physician's order and the label shall contain at least all of the following information. This requirement is not met as evidenced by: Deficient Practice Statement Based on interview and record review, the licensee did not comply with the section cited above in R1 did not have a PRN Authroization Letter which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/13/2025 Plan of Correction The Licensee will obtain R1's PRN Authorization Letter and provide it to CCLD by POC due date.

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 interview and record review, the licensee did not comply with the section cited above in the Licensee was unable to provide the LPA the emergency disaster plan which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/13/2025 Plan of Correction The Licensee will provide CCLD their emergency disaster plan by POC due date.

Official classification

Type B

Official code

1569.695(c)

Regulation authority

HSC

What the official deficiency says

(c) A facility shall conduct a drill at least quarterly for each shift ... Documentation of the drills shall include the date, the type of emergency covered by the drill, and the names of staff participating in the drill. This requirement is not met as evidenced by: Deficient Practice Statement Based on interview and record review, the licensee did not comply with the section cited above in the Licensee did not conduct quarterly emergency drills which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/13/2025 Plan of Correction The Licensee will create a schedule for emergency disaster drills, conduct them quarterly, and submit a statement of understanding by POC due date.

Official classification

Type B

Official code

87506(d)

Regulation authority

CCR

What the official deficiency says

Resident Records:87506(d)All resident records shall be available to the licensing agency to inspect, audit, and copy upon demand during normal business hours. Records may be removed if necessary for copying. Removal of records shall be subject to the following requirements: Based on interview and record review the licensee did not comply with the regulation above, records for R1 were not provided to LPA, which poses a potential personal rights risk to residents in care.

Official plan of correction

Licensee agrees to submit a self-certification letter that they understand the regulation and that they will ensure that all current and former resident's files are maintained for 3 yeas and made available to the Department for review. Provide the Department with a copy of Resident #1's file by 5/21/25. If cannot locate residents file will notify the Department. Amended to obtained signatures.

Deadline recorded: May 21, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87355(e)(2)

Regulation authority

CCR

What the official deficiency says

87355(e)(2) Criminal Record Clearance (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working (2) Request a transfer of a criminal record clearance as specified in Section 87355(c)… This requirement is not met as evidenced by: Deficient Practice Statement This requirement is not met as evidenced by: Based on record review and interview, the licensee did not comply with the section cited above as Interim Administrator is not associated to the facility which poses an immediate health and safety risk to residents in care. Civil Penalty Assessed.

Official plan of correction

POC Due Date: 09/18/2024 Plan of Correction Interim Administrator agrees to reach out to Administrator to get properly associated to the facility.

Official classification

Type B

Official code

87705(c)(5)

Regulation authority

CCR

What the official deficiency says

87705(c)(5) Care of Persons with Dementia: Each resident with dementia shall have an annual medical assessment as specified in Section 87458, Medical Assessment, and a reappraisal done at least annually, both of which shall include a reassessment of the resident’s dementia care needs. This requirement is not met as evidenced by: Deficient Practice Statement This requirement is not met as evidenced by: Based on record review and interview, the licensee did not comply with the section cited above as R2’s Physician’s Report (LIC602) is dated 4/21/2021 which poses a potential health and safety risk to residents in care.

Official plan of correction

POC Due Date: 09/25/2024 Plan of Correction Interim Administrator agrees to schedule an appointment to update R2's Physician's Report.

Official classification

Type B

Official code

87307(a)(2)(C)

Regulation authority

CCR

What the official deficiency says

87307(a)(2)(C): Personal Accommodations and Services. No bedroom of a resident shall be used as a passageway to another room, bath, or toilet. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review and interviews conducted, the licensee did not comply with the section cited above as R1 who resides in Bedroom 3 is being showered once a week in the private bathroom of Bedroom 5 where R2 currently resides which poses a potential health, safety, and resident’s rights risk to residents in care.

Official plan of correction

POC Due Date: 09/19/2024 Plan of Correction Interim Administrator agrees to ensure R1 is no longer showered in the private bathroom of Bedroom 5 where R2 currently resides.

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

87303(a) Maintenance and Operation: (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 and interviews conducted, the licensee did not comply with the section cited above as multiple items of debris and discarded items were observed outside on the northside of the facility.

Official plan of correction

POC Due Date: 10/04/2024 Plan of Correction Interim Administrator agrees to have debris items discarded no later than due date. Interim Administrator agrees to provide proof of clean up via photos directly to LPA via email.

Official classification

Type A

Official code

87355(e)(1)

Regulation authority

CCR

What the official deficiency says

87355(e)(1)Criminal Record Clearance (e) All individuals subject to a criminal record review...(b) shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance... This requirement is not met as evidenced by: Based on record review and interviews the licensee did not comply with the section cited above by not ensuring that I1 has a criminal record clearance and associated to the facility which poses an immediate health, safety and personal rights risk to persons in care.

Official plan of correction

POC has been met, I1 has obtained a criminal reord clearance and associated to the facility. Civil Penalties assessed in the amount of $500.

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

Official classification

Type A

Official code

87705(f)(2)

Regulation authority

CCR

What the official deficiency says

87705(f)(2)Care of Persons with Dementia (f)...inaccessible to residents with dementia: (2) Over-the-counter medication, nutritional supplements or vitamins, alcohol, cigarettes, and toxic substances... This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section above as medication was accessible in R1's room, which poses an immediate health and safety risk to persons in care.

Official plan of correction

Medication in R1's room was secured during today's visit. Plan of Correction met.

Deadline recorded: Mar 19, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87555(b)(8)

Regulation authority

CCR

What the official deficiency says

87555(b) General Food Service Requirements( 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 evidence by: Based on observation, the licensee failed to comply with the section cited above as the LPA observed expired food, food past the best by date, and food in unmarked containers with no dates which poses an immediate health and safety risk to residents in care.

Official plan of correction

The Administrator shall submit proof the refrigerator and pantry are cleaned and expired, unlabeled food, and food of not good quality are removed. Proof shall be submitted by 08/23/2022.

Deadline recorded: Aug 23, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87555(b)(27)

Regulation authority

CCR

What the official deficiency says

87555 General Food Service Requirements (b)(27) All kitchen areas shall be kept clean and free of litter, rodents, vermin and insects. This requirement is not met as evidence by: Based on observation, the LPA observed spiders and ants in the pantry and ants on the kitchen counters, and clutter on the counter's, and dining room/living room area which poses a potential health and safety risk to residents in care.

Official plan of correction

In addition to cleaning the pantry and refrigerator, the Administrator shall also clean the kitchen counters and surfaces and ensure there are no insects or clutter in the kitchen and dinning room and living room area.

Deadline recorded: Aug 23, 2022. A deadline is not proof that correction was completed.