MELOS CARE HOME

Official classification

Type A

Official code

87309(a)

Regulation authority

CCR

What the official deficiency says

87309 Storage Space and Access (a) ... the licensee shall ensure that disinfectants, cleaning solutions, ... are in locked storage and are not left unattended if outside the locked storage. This requirement is not met as evidenced by: Based on observation the licensee did not comply with the section cited above as cleaning solutions were unsecured in an under-sink cabinet which poses an immediate health and safety risk to clients in care.

Official plan of correction

Administrator secured the chemicals at the time of the visit. POC cleared.

Deadline recorded: Jul 18, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468(b)(1)(A)

Regulation authority

CCR

What the official deficiency says

87468 Personal Rights (b)...a resident...shall be...given a copy... (1) The personal rights of residents... (A) ...the signed copy shall be included in the resident's record. This requirement is not met as evidenced by: Based on observation the licensee did not comply with the section cited above as two residents did not have signed copies of the personal rights of residents included in their files which poses a potential personal rights risk to clients in care.

Official plan of correction

Administrator agreed to obtained signed copies of the personal rights of residents for the identified residents no later than POC due date.

Deadline recorded: Aug 1, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87555(b)(24)

Regulation authority

CCR

What the official deficiency says

87555 General Food Service Requirements (b) The following...shall apply: (24)... toxic substances shall not be stored...where kitchen...utensils are stored. This requirement is not met as evidenced by: Based on observation the licensee did not comply with the section cited above as knives and other sharp objects were stored alongside toxins and cleaning chemicals in a locked under-sink storage cabinet located in the kitchen which poses an immediate health risk to clients in care.

Official plan of correction

Administrator agreed that licensee will relocate the chemicals to a seperate locked storage area no later than POC due date.

Deadline recorded: Jul 2, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87202(a)

Regulation authority

CCR

What the official deficiency says

87202 Fire Clearance (a) All facilities shall maintain a fire clearance... This requirement is not met as evidenced by: Based on observation the licensee did not comply with the section cited above as the facility's fire door failed to close during a test of the facility's smoke alarms which poses an immediate safety risk to clients in care.

Official plan of correction

The administrator agreed that licensee will ensure the fire door remains closed until appropriate repairs can be completed. Administrator agreed to submit proof of the fire door functioning properly to CCLD.

Deadline recorded: Jul 2, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87608(a)(5)(B)

Regulation authority

CCR

What the official deficiency says

(B) Bed rails that extend the entire length of the bed are prohibited except for residents who are currently receiving hospice care and have a hospice care plan that specifies the need for full bed rails. 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 2 residents (R1 & R2) were observed with full bedrails and R1 is not on hospice nor does R1 have a physician's orders for bedrails and R2 has 1 (one) full bedrail and a doctor's order for bedrails, but is not on hospice which poses a potential personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/04/2024 Plan of Correction Administrator agreed to remove the full bedrails from both R1 and R2's beds. Administrator will obtain a physician's order for half bedrails and will only utilize half bedrails for R1 and Administrator will switch R2's bed rail to a half bedrail and provide proof of correction to CCL by POC due date.

Official classification

Type B

Official code

87705(c)(5)

Regulation authority

CCR

What the official deficiency says

(c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following: (5) 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 Based on record review, the licensee did not comply with the section cited above in 2 residents (R3 and R4) both have a dementia diagnosis, but had medical assessments more than one year old, which poses a potential health risk to persons in care.

Official plan of correction

POC Due Date: 09/04/2024 Plan of Correction Administrator will obtain a current medical assessment for both R3 and R4 and will provide proof to CCL by POC due date.

Official classification

Type B

Official code

87506(b)

Regulation authority

CCR

What the official deficiency says

(b) Each resident's record shall contain at least the following information: This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, the licensee did not comply with the section cited aboveas in 4 out 4 residents were misisng the appropriate consent forms which pose a potential health, safety and personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/01/2023 Plan of Correction The adminsitrator agreed to the following: 1. Have all resident files updated to show completed consent forms. Provide proof ro CCL no later than 9/1/2023.

Official classification

Type B

Official code

87457(c)(1)

Regulation authority

CCR

What the official deficiency says

(c) Prior to admission a determination of the prospective resident's suitability for admission shall be completed and shall include an appraisal of his/her individual service needs in comparison with the admission criteria specified in Section 87455, Acceptance and Retention Limitations. (1) The appraisal shall include, at a minimum, an evaluation of the prospective resident's functional capabilities, mental condition and an evaluation of social factors as specified in Sections 87459, Functional Capabilities and 87462, Social Factors. 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 1 out of 4 residents were missing the appropriate preadmission appraisal which poses a potential health, safety and personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/01/2023 Plan of Correction The adminsitrator agreed to the following: 1. Have all resident files updated to show completed preappraisal and needs and services plans. Provide proof ro CCL no later than 9/1/2023.

Official classification

Type A

Official code

87355(e)

Regulation authority

CCR

What the official deficiency says

(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: 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 3 out of 4 staff were not cleared or associated to the facility (S1, S2, S3) which poses an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 08/10/2023 Plan of Correction Adminsitrator agreed to the following: 1. Associate all working staff to the facility and notify CCL no later than 8/10/2023. Civil Penalties Assessed.

Official classification

Type A

Official code

87705(f)

Regulation authority

CCR

What the official deficiency says

(f) The following shall be stored inaccessible to residents with dementia: 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 knives, sharps and cleaning supplies were observed to be unlocked under the kitchen sink and and over the counter supplements accesssible on dining room table chair which poses an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 08/10/2023 Plan of Correction Administrator agreed to the following: 1. Replace lock to cabinet or relocate and lock accessible items and lock up accessible over the counter supplements. Notify CCL no later than 8/10/2023.

Official classification

Type B

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: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above the resident bathroom in the hallway was unkempt which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 08/10/2023 Plan of Correction Adminsitrator agreed to the following: 1. Clean resident bathroom and fix toilet paper holder and provide proof to CCL no later than 8/10/2023.

Official classification

Type B

Official code

87412(a)

Regulation authority

CCR

What the official deficiency says

(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: 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 2 out 4 staff files were incomplete (S3, S4) and 2 out 4 staff files were missing (S1, S2) which poses a potential health, safety and personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/18/2023 Plan of Correction Adminstrator agreed to the following: 1. Ensure that each staff has a completed staff file containing all documents required per Title 22 regualtions. Provide proof to CCL no later than 8/18/2023.

Official classification

Type A

Official code

87303(e)(2)

Regulation authority

CCR

What the official deficiency says

87303(e)(2) Water supplies and plumbing fixtures shall be maintained as follows: (2) Faucets used by residents for personal care... temperature of not less than 105-degree F and not more than 120-degree F. This requirement is not met as evidenced by: Based on LPAs observation, the licensee did not comply with the section cited above as two (2) out of two (2) facility restroom faucets delivers hot water measured at 102.2 and 100.6 degrees Fahrenheit, which poses an immediate health and safety risk to persons in care.

Official plan of correction

The Licensee adjusted the thermostat during time of visit and has agreed to submit a hot water temperature log for five (5) days to show that the hot water is being maintained between temperatures 105- and 120-degrees Fahrenheit.

Deadline recorded: Aug 29, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87202(a)

Regulation authority

CCR

What the official deficiency says

87202(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… county fire department or district providing fire protection services, or the State Fire Marshal. This requirement is not met as evidenced by: Based on LPA observation, the licensee did not comply with the section cited above as fire extinguisher was served over a year ago, which poses a potential health and safety risk to persons in care.

Official plan of correction

The Licensee has agreed to have fire extinguisher serviced or purchase new fire extinguisher and show proof to CCL by 9/02/2022.

Deadline recorded: Sep 2, 2022. A deadline is not proof that correction was completed.