Community Care Licensing

SUPERVISOR'S NAME: Alisa Ortiz TELEPHONE: (714) 703-4084 LICENSING EVALUATOR NAME: Andrea Mendivil TELEPHONE: 714-703-2738 LICENSING EVALUATOR SIGNATURE: DATE: 05/16/2022

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

FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/16/2022

Document Has Been Signed on 05/19/2022 10:12 AM - It Cannot Be Edited

FACILITY NAME: LOVING CARE FACILITY FOR THE ELDERLY	FACILITY NUMBER: 306005581
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/16/2022

Type A

Section Cited

CCR

87465(h)(2)

Centrally stored medicines shall be 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. 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. LPA observed unsecured medication in the kitchen which poses an immediate health and safety risk to persons in care.
	POC Due Date: 05/17/2022
	Plan of Correction
1 2 3 4	Licensee to correct issue and forward proof to LPA by POC due date.

Type A

Section Cited

CCR

87705(f)(2)

The following shall be stored inaccessible to residents with dementia: (2) Over-the-counter medication, nutritional supplements or vitamins, alcohol, cigarettes, and toxic substances such as certain plants, gardening supplies, cleaning supplies and disinfectants. 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. LPA observed unsecured clearning supplies which poses an immediate health and safety risk to persons in care.
	POC Due Date: 05/17/2022
	Plan of Correction
1 2 3 4	Licensee corrected during visit.

SUPERVISOR'S NAME: Alisa Ortiz TELEPHONE: (714) 703-4084 LICENSING EVALUATOR NAME: Andrea Mendivil TELEPHONE: 714-703-2738 LICENSING EVALUATOR SIGNATURE: DATE: 05/16/2022

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

FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/16/2022

Document Has Been Signed on 05/19/2022 10:12 AM - It Cannot Be Edited

FACILITY NAME: LOVING CARE FACILITY FOR THE ELDERLY	FACILITY NUMBER: 306005581
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/16/2022

Type B

Section Cited

CCR

87468(a)(1)

(a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (1) To have a reasonable level of personal privacy in accommodations, medical treatment, personal care and assistance, visits, communications, telephone conversations, use of the Internet, and meetings of resident and family groups 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 in 2 out of 4 resident bedrooms.LPA observed survilence cameras in 2 out of 4 bedrooms which poses an immediate personal rights risk to persons in care.
	POC Due Date: 05/17/2022
	Plan of Correction
1 2 3 4	Licensee to remove cameras and forward proof to LPA by POC due date.

Type B

Section Cited

CCR

87608(a)(3)

Postural Support(a)Based on the individual's preadmission appraisal, and subsequent changes to that appraisal... Postural supports may be used...(3)A written order from a physician indicating the need for 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 in 2 out of 4 beds. LPA observed partial bed rails without physician's orders which poses a potential health and safety risk to persons in care.
	POC Due Date: 05/17/2022
	Plan of Correction
1 2 3 4	Licensee to remove rails and forward proof to LPA by POC due date.

SUPERVISOR'S NAME: Alisa Ortiz TELEPHONE: (714) 703-4084 LICENSING EVALUATOR NAME: Andrea Mendivil TELEPHONE: 714-703-2738 LICENSING EVALUATOR SIGNATURE: DATE: 05/16/2022

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

FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/16/2022

Document Has Been Signed on 05/19/2022 10:12 AM - It Cannot Be Edited

FACILITY NAME: LOVING CARE FACILITY FOR THE ELDERLY	FACILITY NUMBER: 306005581
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/16/2022

Type A

Section Cited

CCR

87203

All facilities shall be maintained in conformity with the regulations adopted by the State Fire Marshal for the protection of life and property against fire and panic. 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 in 2 out of 2 exit gates. LPA observed 2 out of 2 exit gates in backyard were locked which poses an immediate health and safety risk to persons in care.
	POC Due Date: 05/17/2022
	Plan of Correction
1 2 3 4	Licensee to unlock gates and forward proof to LPA by 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: Alisa Ortiz TELEPHONE: (714) 703-4084 LICENSING EVALUATOR NAME: Andrea Mendivil TELEPHONE: 714-703-2738 LICENSING EVALUATOR SIGNATURE: DATE: 05/16/2022

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

FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/16/2022