Community Care Licensing

SUPERVISOR'S NAME: Kristin Heffernan TELEPHONE: (818) 596-4493 LICENSING EVALUATOR NAME: Christine Yee TELEPHONE: (747) 230-3890 LICENSING EVALUATOR SIGNATURE: DATE: 01/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/11/2024

Document Has Been Signed on 01/11/2024 06:28 PM - It Cannot Be Edited

FACILITY NAME: CALA HOMES	FACILITY NUMBER: 195850295
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/11/2024

Type A

Section Cited

CCR

87411(f)

(f) All personnel, including the licensee and administrator, shall be in good health, and physically and mentally capable of performing assigned tasks. Good physical health shall be verified by a health screening, including a chest x-ray or an intradermal test, performed by a physician not more than six (6) months prior to or seven (7) days after employment or licensure. A report shall be made of each screening, signed by the examining physician. The report shall indicate whether the person is physically qualified to perform the duties to be assigned, and whether he/she has any health condition that would create a hazard to him/herself, other staff members or residents. A signed statement shall be obtained from each volunteer affirming that he/she is in good health.Personnel with evidence of physical illness or emotional instability that poses a significant threat to the well-being of residents shall be relieved of their duties. 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 per file review of Staff #3's Health Screen, staff was tested for tuberculosis and received positive results. However, there is no evidence that an x-ray was perfomed or another test was performed to rule out the presence of TB, which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 01/18/2024
	Plan of Correction
1 2 3 4	Licensee will ensure that all staff have the proper TB clearance before working at the facility. Licensee will obtain evidence from staff #3's doctor or re-submit to a TB test to get conclusive evidence that Staff #3 does not have TB by 1/18/24. A copy of the Result of the TB test will be submitted to the Department for review.

SUPERVISOR'S NAME: Kristin Heffernan TELEPHONE: (818) 596-4493 LICENSING EVALUATOR NAME: Christine Yee TELEPHONE: (747) 230-3890 LICENSING EVALUATOR SIGNATURE: DATE: 01/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/11/2024

Document Has Been Signed on 01/11/2024 06:28 PM - It Cannot Be Edited

FACILITY NAME: CALA HOMES	FACILITY NUMBER: 195850295
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/11/2024

Type A

Section Cited

CCR

87606(b)

(b) A facility shall notify the local fire jurisdiction within 48 hours of accepting or retaining any bedridden person, as specified in Health and Safety Code Section 1569.72(f). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview and file review, the licensee did not comply with the section cited above per information received from the Administrator, Resident #1, who is determined to be bedridden, requires repositioning, was admitted to the facility on 8/18/23 and the Administrator did not notify the local fire jurisdiction which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 01/12/2024
	Plan of Correction
1 2 3 4	Licensee will submit a written notice to the local fire jurisdication, notifying them of the presence of a bedridden resident residing at the home by 1/12/24

Section Cited

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

SUPERVISOR'S NAME: Kristin Heffernan TELEPHONE: (818) 596-4493 LICENSING EVALUATOR NAME: Christine Yee TELEPHONE: (747) 230-3890 LICENSING EVALUATOR SIGNATURE: DATE: 01/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/11/2024

Document Has Been Signed on 01/11/2024 06:28 PM - It Cannot Be Edited

FACILITY NAME: CALA HOMES	FACILITY NUMBER: 195850295
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/11/2024

Type B

Section Cited

CCR

87458(b)(5)

(b) The medical assessment shall include, but not be limited to: (5) The determination whether the person is ambulatory or nonambulatory as defined in Section 87101(a) or (n), or bedridden as defined in Section 87455(d). The assessment shall indicate whether nonambulatory status is based upon the resident's physical condition, mental condition or both. 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, as the Health Screen for Resident #2 does not indicaate if the resident is considered Ambulatory, Non-ambulatory or Bedridden, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 01/18/2024
	Plan of Correction
1 2 3 4	Licensee will contact Resident #2's physician to obtain an updated status of Resident #2's ability to ambulate and provide a copy of the determination to the Department by 1/18/24

Section Cited

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

SUPERVISOR'S NAME: Kristin Heffernan TELEPHONE: (818) 596-4493 LICENSING EVALUATOR NAME: Christine Yee TELEPHONE: (747) 230-3890 LICENSING EVALUATOR SIGNATURE: DATE: 01/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/11/2024