Community Care Licensing

Document Has Been Signed on 09/11/2024 02:09 PM - It Cannot Be Edited

FACILITY NAME:	TLC HOME CARE 2		FACILITY NUMBER:	157209235
ADMINISTRATOR/ DIRECTOR:	ARRIETA JR, RODRIGO A.		FACILITY TYPE:	740
ADDRESS:	207 RIESLING VINES ST		TELEPHONE:	(661) 203-7565
CITY:	BAKERSFIELD	STATE: CA	ZIP CODE:	93314
CAPACITY: 6		CENSUS: 3	DATE:	09/11/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	10:30 AM
MET WITH:	Administrator, Rodrigo Arrieta		TIME VISIT/ INSPECTION COMPLETED:	02:23 PM

SUPERVISORS NAME: Melinda Hoffmann LICENSING EVALUATOR NAME: Alexandria Walton LICENSING EVALUATOR SIGNATURE: DATE: 09/11/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/11/2024

FACILITY NAME: TLC HOME CARE 2	FACILITY NUMBER: 157209235
	VISIT DATE: 09/11/2024

Link to Parent Document Below:

FACILITY NAME: TLC HOME CARE 2	FACILITY NUMBER: 157209235
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/11/2024

Type A

Section Cited

CCR

87309(a)

(a) Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above when sharps/knives were observed outdoors accessible to residents in care and disinfectant wipes were accessible to residents in care, which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 09/12/2024
	Plan of Correction
1 2 3 4	Licensee agrees to remove the sharp items and place them in a locked storage area and submit proof to the Fresno CCL office by the POC due date.

Section Cited

	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

SUPERVISOR'S NAME: Melinda Hoffmann LICENSING EVALUATOR NAME: Alexandria Walton LICENSING EVALUATOR SIGNATURE: DATE: 09/11/2024

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/11/2024

Link to Parent Document Below:

FACILITY NAME: TLC HOME CARE 2	FACILITY NUMBER: 157209235
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/11/2024

Type B

Section Cited

CCR

87303(c)

(c) All window screens shall be clean and maintained in good repair. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above when window screens in the living room area were in disrepair, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 09/30/2024
	Plan of Correction
1 2 3 4	Licensee agrees to repair or replace the window screens in the living room area and submit proof of repair or replacement to the Fresno CCL by the POC due date.

Type B

Section Cited

CCR

87307(d)(2)

(2) The premises shall be maintained in a state of good repair and shall provide a safe and healthful environment. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above when the outdoor lawn was observed to be in need of maintenance, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 09/30/2024
	Plan of Correction
1 2 3 4	Licensee agrees to have the lawn(s) maintenance and submit proof to the Fresno CCL office by the POC due date.

SUPERVISOR'S NAME: Melinda Hoffmann LICENSING EVALUATOR NAME: Alexandria Walton LICENSING EVALUATOR SIGNATURE: DATE: 09/11/2024

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/11/2024

Link to Parent Document Below:

FACILITY NAME: TLC HOME CARE 2	FACILITY NUMBER: 157209235
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/11/2024

Type B

Section Cited

HSC

1569.625(b)(2)

(2) In addition to paragraph (1), training requirements shall also include an additional 20 hours annually, eight hours of which shall be dementia care training, as required by subdivision (a) of Section 1569.626, and four hours of which shall be specific to postural supports, restricted health conditions, and hospice care, as required by subdivision (a) of Section 1569.696. This training shall be administered on the job, or in a classroom setting, or both, and may include online training. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above when documentation for staff training was not in the staff file, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 09/30/2024
	Plan of Correction
1 2 3 4	Licensee agrees to submit a written statement detailing the steps the facility will take to ensure the requirements for this section is met including a time frame when all staff will complete the above training to the Fresno CCL Office by the POC due date.

Type B

Section Cited

CCR

87412(h)

(h) All personnel records shall be retained for at least three (3) years following termination of employment. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview and record review, the licensee did not comply with the section cited above when Administrator was unable to provide a file for an employee who no longer worked for the facility which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 09/30/2024
	Plan of Correction
1 2 3 4	Licensee agrees to submit a written statement detailing the steps the facility will take to ensure the requirements for section 87412 are met to the Fresno CCL office.

SUPERVISOR'S NAME: Melinda Hoffmann LICENSING EVALUATOR NAME: Alexandria Walton LICENSING EVALUATOR SIGNATURE: DATE: 09/11/2024

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/11/2024

Link to Parent Document Below:

FACILITY NAME: TLC HOME CARE 2	FACILITY NUMBER: 157209235
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/11/2024

Type B

Section Cited

CCR

87468(c)(2)(A)

(c) Licensees shall prominently post personal rights, nondiscrimination notice, and complaint information in areas accessible to residents, representatives, and the public. (2) Information on the appropriate reporting agency in case of a complaint or emergency, including procedures for filing confidential complaints, shall be posted as follows: (A) Licensees may use the Residential Care Facility for the Elderly (RCFE) Complaint Poster (PUB 475) or may develop their own poster as provided in this section. A poster developed by the licensee shall contain the same content as the PUB 475. The poster that is posted shall be 20” x 26” in size and be posted in the main entryway of the facility. PUB 475 may be accessed, downloaded, and printed from the www.ccld.ca.gov website. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above when complaint poster (PUB 475) was not observed in the facility, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 09/30/2024
	Plan of Correction
1 2 3 4	Licensee agrees to obtain a complaint poster and post the poster in the facility as discussed in the above regulation and submit proof the poster was placed in the facility to the Fresno CCL office by the POC due date.

SUPERVISOR'S NAME: Melinda Hoffmann LICENSING EVALUATOR NAME: Alexandria Walton LICENSING EVALUATOR SIGNATURE: DATE: 09/11/2024

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/11/2024

Link to Parent Document Below:

FACILITY NAME: TLC HOME CARE 2	FACILITY NUMBER: 157209235
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/11/2024

Type B

Section Cited

HSC

1569.695(c)

(c) A facility shall conduct a drill at least quarterly for each shift. The type of emergency covered in a drill shall vary from quarter to quarter, taking into account different emergency scenarios. An actual evacuation of residents is not required during a drill. While a facility may provide an opportunity for residents to participate in a drill, it shall not require any resident participation. 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
1 2 3 4	Based on observation, the licensee did not comply with the section cited above when the facility did not conduct a disaster drill which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 09/30/2024
	Plan of Correction
1 2 3 4	Licensee agrees to conduct a disaster drill and submit documentation to the Fresno CCL office by the POC due date.

Type B

Section Cited

CCR

87608(a)(5)(B)

(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
1 2 3 4	Based on observation, the licensee did not comply with the section cited above when bed rails were placed on R3's bed without a physician's order, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 09/30/2024
	Plan of Correction
1 2 3 4	Licensee agrees to remove the bed rails and obtain a phsycian's order if bed rails are needed. Proof bed rails have been removed or a copy of the physician's order for bed rails will be submitted to the Fresno CCL office by the POC due date.

SUPERVISOR'S NAME: Melinda Hoffmann LICENSING EVALUATOR NAME: Alexandria Walton LICENSING EVALUATOR SIGNATURE: DATE: 09/11/2024

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/11/2024

Link to Parent Document Below:

FACILITY NAME: TLC HOME CARE 2	FACILITY NUMBER: 157209235
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/11/2024

Type B

Section Cited

CCR

87609(b)(4)

(b) Incidental medical care may be provided to residents through a licensed home health agency provided the following conditions are met: (4) The licensee and home health agency agree in writing on the responsibilities of the home health agency, and those of the licensee in caring for the resident's medical condition(s). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above when R1 did not have a written agreement on file, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 09/30/2024
	Plan of Correction
1 2 3 4	Licensee agrees to obtain a written agreement with the home health agency and submit a copy to the Fresno CCL office by the POC due date.

Type B

Section Cited

CCR

87705(c)(5)

(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
1 2 3 4	Based on record review, the licensee did not comply with the section cited above when R2 did not have an updated medical assessment on file which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 09/30/2024
	Plan of Correction
1 2 3 4	Licensee agrees to obtain a medical assessment for R2 and submit a copy to the Fresno CCL office by the POC due date.

SUPERVISOR'S NAME: Melinda Hoffmann LICENSING EVALUATOR NAME: Alexandria Walton LICENSING EVALUATOR SIGNATURE: DATE: 09/11/2024

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/11/2024