Deficiency Type
POC Due Date /
Section Number | DEFICIENCIES | PLAN OF CORRECTIONS(POCs) |
Type B
11/10/2022
Section Cited
CCR
87555(b)(26)
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7 | 87555 General Food Service Requirements (b) The following food service requirements shall apply (26) Supplies of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days shall be maintained on the premises. This requirement is not met as evidenced by: | 1
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7 | Administrator will provide the required supply of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days. |
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14 | Observations made during the tour of the facility on 11/03/2022 revealed licensee does not have a sufficient 2-day supply of perishable food & a 7-day supply of non-perishal foods which is a potential health risk to residents in care. | 8
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Type B
11/10/2022
Section Cited
CCR80087(a)
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7 | 80087(a) Buildings and Grounds. The facility shall be kept clean, sanitary and in good repair at all times. This requirement is not met as evidenced by: | 1
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7 | Administrator will replace the flind in the staff room and clean the entire facility. |
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14 | During visit LPA observed the following: 1. blind broken in staff room. 2. Dog feces throughout the facility 3. Living room furniture was dirty (4) Administrator office smelled of dog urine and dog feces which is a potential health and safety risk to residents in care. | 8
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14 | |
Deficiency Type
POC Due Date /
Section Number | DEFICIENCIES | PLAN OF CORRECTIONS(POCs) |
Type A
11/10/2022
Section Cited
CCR
87464(f)(3)
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7 | 87464 Basic Services (f) Basic services shall at a minimum include: (1) Care & supervision as defined in Section 87101(c)(3) & Health and Safety Code section 1569.2(c). This requirement is not met as evidenced by: | 1
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7 | Administrator will ensure new staff members will be provided to the facility. |
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14 | During LPA's visit, LPA observed there were no staff members present to provide care and assistance to the residents, which is a potential personal rights risk to residents in care | 8
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14 | This is a zero tolerance violation therefore civil penalty in the amount of $500 has been issued. |
Type B
11/10/2022
Section Cited
CCR87506(a)
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7 | 87506 Resident Records (a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff. | 1
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7 | Administrator will send copies of Resident records to LPA via email. |
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14 | Based on record review the licensee did not comply with the section cited above by not maintaining complete facility files for three out of the four residents which poses a potential health, safety or personal rights risk to persons in care. | 8
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14 | |
Deficiency Type
POC Due Date /
Section Number | DEFICIENCIES | PLAN OF CORRECTIONS(POCs) |
Type A
11/10/2022
Section Cited
CCR
87468.2(a)(4)&5
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7 | 87468.2(a)(4) &5 Personal Rights: In addition to the rights listed in Section 87468.1…residents…shall have all of the following personal rights: To care, supervision, & services that meet their individual needs.. delivered by staff that are sufficient in numbers, … and to be served food of the quality and quantity…. | 1
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7 | Administrator will hire new staff members to cover all shifts at the facility. |
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14 | These requirements are not met as evidenced by: During LPA's visit 2:30 PM until 10:30 PM, LPA observed there were no staff present to provide care & assistance to the residents; staff were not available to prepare the meals. R4 walked to KFC to purchase his dinner; R3 went to a supermarket to purchase food, R1 prepared frozen food for R1 & R2 which poses an immediate personal rights risk to the residents in care. | 8
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14 | Absence of supervision is a serious violation as stated in H&S Code 1569.49 (c )(3), an immediate civil penalty of $500 is issued for 11/3/2022. The department may impose $100 of continued civil penalty for each day after the citation is issued until it is corrected. |
Type A
11/10/2022
Section Cited
CCR87413a)(1)
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7 | 87413a)(1) Personnel-Operations: In each facility, when regular staff members are absent, there shall be coverage by personnel with qualifications adequate to perform the assigned tasks. | 1
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7 | Administrator will hire new staff members to cover all shifts at the facility. |
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14 | This requirement is not met as evidenced by: During LPA's visit between 2:30 PM to 10:30 PM, the administrator who was also acting as the only caregiver, left the facility and did not find other staff to perform the task as the house manager or caregiver. | 8
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14 | |
Deficiency Type
POC Due Date /
Section Number | DEFICIENCIES | PLAN OF CORRECTIONS(POCs) |
Type A
11/10/2022
Section Cited
CCR
87405(h)(1)
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7 | 87405(h)(1) Administrator - Qualifications and Duties: The administrator shall have the responsibility to:(1) Administer the facility in accordance with these regulations, program and budget. | 1
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7 | Administrator will ensure there are qualified staff members to cover all shifts. Also, Administrator will conduct a weekly food inventory to ensure there is an adequate supply of food and will clean the facility each day. |
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14 | This requirement is not met as evidenced by: During LPA's visit at 2:30 PM until 10:30 PM, the Administrator failed to follow regulations to provide staffing, meet the food requirements, ensure cleanliness at the facility & maintain resident records.
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7 | | 1
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