Community Care Licensing

Document Has Been Signed on 03/14/2023 01:18 PM - It Cannot Be Edited

FACILITY NAME:	LAURENCE RESIDENTIAL CARE		FACILITY NUMBER:	300607404
ADMINISTRATOR:	LAURENCE, VERNELL		FACILITY TYPE:	735
ADDRESS:	3722 S. ROSS ST.		TELEPHONE:	(714) 662-7771
CITY:	SANTA ANA	STATE: CA	ZIP CODE:	92707
CAPACITY: 6		CENSUS: 5	DATE:	03/14/2023
TYPE OF VISIT:	Case Management - Deficiencies	UNANNOUNCED	TIME BEGAN:	11:33 AM
MET WITH:	Facility Administrator - Vernell Laurence		TIME COMPLETED:	01:30 PM

SUPERVISORS NAME: Luz Adams LICENSING EVALUATOR NAME: Celine DePerio LICENSING EVALUATOR SIGNATURE: DATE: 03/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/14/2023

Link to Parent Document Below:

FACILITY NAME: LAURENCE RESIDENTIAL CARE	FACILITY NUMBER: 300607404
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/14/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 03/14/2023 Section Cited CCR 80087(g)	1 2 3 4 5 6 7	80087 Buildings and Grounds (g) Disinfectants, cleaning solutions, poisons, firearms and other items that could pose a danger...shall be stored where inaccessible to clients. This requirement was not met as evidence by:	1 2 3 4 5 6 7	As plan of correction (POC) licensee agrees to ensure that all disinfectants, cleaning solutions, poisons, firearms and other items that could pose a danger is made inaccessible to clients in care and will provide proof of understanding to Community Care Licensing on the regulation cited on or by 3/15/23.
	8 9 10 11 12 13 14	Based on observation, and interviews, the facility failed to ensure that disinfectants, cleaning solutions, poisons, firearms and other items that could pose a danger... were unlocked. LPA observed multiple bottles of disinfectant sprays, and bleach located in an unlocked kitchen cabinet under the sink. This poses an immediate health and safety risk to clients in care.	8 9 10 11 12 13 14
Type A 03/14/2023 Section Cited CCR80075(k)(1)	1 2 3 4 5 6 7	80075 Health Related Services (k) The following requirements shall apply... (1) Medication shall be kept in a safe and locked place that is not accessible to persons other than employees responsible... This requirement was not met as evidence by:	1 2 3 4 5 6 7	As plan of correction (POC) licensee agrees to ensure that all medications are made inaccessible to clients in care. Licensee will provide proof of understanding to Community Care Licensing on the regulation cited on or by 3/15/23.
	8 9 10 11 12 13 14	Based on observation, interview and file review, the facility failed to ensure that medications were kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. LPA observed a bottle of Losartan 50mg with over 10 pills in an unlocked kitchen cabinet. This poses an immediate health and safety risk to clients in care.	8 9 10 11 12 13 14

SUPERVISOR'S NAME: Luz Adams LICENSING EVALUATOR NAME: Celine DePerio LICENSING EVALUATOR SIGNATURE: DATE: 03/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/14/2023

Link to Parent Document Below:

FACILITY NAME: LAURENCE RESIDENTIAL CARE	FACILITY NUMBER: 300607404
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/14/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 03/14/2023 Section Cited CCR 85068.5(e)	1 2 3 4 5 6 7	85068.5 Eviction Procedures (e) A written report of any eviction processed in accordance with (a) above shall be sent to the licensing agency within five days of the eviction. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	As plan of correction (POC) licensee agrees to ensure that 30-day eviction notices is in compliance with section 80068.5 and will notify the licensing agency. Licensee will provide proof of understanding to Community Care Licensing on the regulation cited on or by 3/24/23.
	8 9 10 11 12 13 14	Based on observation, interview and file review, the facility failed to inform the licensing agency within five days of the eviction. Licensee issued a 30-day eviction on 2/28/23, and only notified Regional Center. This poses a potential health and safety risk to clients in care.	8 9 10 11 12 13 14
Type B 03/14/2023 Section Cited CCR80077.4(b)(4)	1 2 3 4 5 6 7	80077.4 Care for Clients with Incontinence (b) If a licensee accepts or retains a client who has bowel and/or bladder incontinence, the licensee is responsible for all of the following: (4) Ensuring that clients with incontinence are kept clean and dry, and that the facility remains free of odors. This requirement was not met as evidence by:	1 2 3 4 5 6 7	As plan of correction (POC) licensee agrees to ensure that facility remains free of odors. Licensee will provide proof of understanding to Community Care Licensing on the regulation cited on or by 3/24/23.
	8 9 10 11 12 13 14	Based on observation, interview and file review, the facility failed to ensure that facility remains free of odors. During the tour of the interior portion of the facility, LPA observed a strong urine odor in the shared bedroom of client 1 and client 2. This poses a potential health and safety risk to clients in care.	8 9 10 11 12 13 14

SUPERVISOR'S NAME: Luz Adams LICENSING EVALUATOR NAME: Celine DePerio LICENSING EVALUATOR SIGNATURE: DATE: 03/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/14/2023