Deficiency Type
POC Due Date /
Section Number | DEFICIENCIES | PLAN OF CORRECTIONS(POCs) |
Type A
08/15/2024
Section Cited
CCR
87202(a)
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2
3
4
5
6
7 | All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department, or district providing fire protection services, or the State Fire Marshal. Prior to accepting or retaining any of the following types of persons, the applicant or licensee shall notify the licensing agency and obtain an appropriate fire clearance approved by the city, county, or city and county fire department, or district providing fire protection services, or the State Fire Marshal | 1
2
3
4
5
6
7 | Administrator removed the locks on the front door and side gates during inspection. In addition, Administrator agrees to send into CCL a statement of understanding concerning regulation. |
 | 8
9
10
11
12
13
14 | This requirement is not met as evidenced by: Based on observation and interview the license did not keep fire exits clear which poses an immediate health and safety risk to residents in care. | 8
9
10
11
12
13
14 | Statement to be sent into CCL by 8/15/24. Administrator agrees to out in new batteries for the carbon monoxide detector. |
Type A
08/23/2024
Section Cited
CCR87465(a)(4)
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2
3
4
5
6
7 | 87465 Incidental Medical and Dental Care. (a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following: (4) The licensee shall assist residents with self-administered medications as needed. | 1
2
3
4
5
6
7 | Administrator agrees to obtain all new medication lists signed by physician. Administrator to obtain all medications listed on new medication list. New medication lists to be sent into CCL by 8/23/24. |
| 8
9
10
11
12
13
14 | This requirement is not met as evidenced by: Based on observation licensee did not have all medications or orders available to clients which poses an immediate health and safety risk to residents in care. | 8
9
10
11
12
13
14 | |
Deficiency Type
POC Due Date /
Section Number | DEFICIENCIES | PLAN OF CORRECTIONS(POCs) |
Type B
08/23/2024
Section Cited
CCR
87355(e)(2)
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2
3
4
5
6
7 | 87355 Criminal Record Clearance (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (2) Request a transfer of a criminal record clearance as specified in Section 87355(c) | 1
2
3
4
5
6
7 | LPA transferred S1 fingerprints to the facility during facility visit. Administrator to complete a statement of understanding of criminal record clearance regulation. Statement to be sent into CCL by 8/23/24. |
| 8
9
10
11
12
13
14 | This requirement is not met as evidenced by: Based on record review the licensee did not have S1 associated to the facility prior to working at the home which poses a potential health and safety risk to residents in care. | 8
9
10
11
12
13
14 | |
Type B
08/23/2024
Section Cited
CCR87468.1(a)(3)
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2
3
4
5
6
7 | 87468.1 Personal Rights of Residents in All Facilities. (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (3) (3) To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature, such as withholding residents’ money or interfering with daily living functions such as eating, sleeping, or elimination. | 1
2
3
4
5
6
7 | Administrator agrees to remove the lock on the pantry. Administrator to send LPA a picture of the removal of the lock by 8/23/24. |
| 8
9
10
11
12
13
14 | This requirement is not met as evidenced by: Based on observation and interview licensee kept food cabinet locked at night which poses a potential health and safety risk to residents in care. | 8
9
10
11
12
13
14 | |
Deficiency Type
POC Due Date /
Section Number | DEFICIENCIES | PLAN OF CORRECTIONS(POCs) |
Type B
08/23/2024
Section Cited
CCR
87307(a)
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2
3
4
5
6
7 | 87307 Personal Accommodations and Services. (a) Living accommodations and grounds shall be related to the facility's function. The facility shall be large enough to provide comfortable living accommodations and privacy for the residents, staff, and others who may reside in the facility. | 1
2
3
4
5
6
7 | Administrator agrees that staff will no longer sleep in the common areas of facility. Administrator to send into LPA a updated LIC500 that identifies awake staff to ensure residents with AWOL behaviors do not leave the |
| 8
9
10
11
12
13
14 | This requirement is not met as evidenced by: Based on observation staff are sleeping in the common living room which poses potential health and safety risk to residents in care. | 8
9
10
11
12
13
14 | facility unassisted. LIC500 to be sent into CCL by 8/23/24. |
Type B
08/30/2024
Section Cited
CCR87705(c)(5)
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2
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4
5
6
7 | (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. | 1
2
3
4
5
6
7 | Administrator to obtain an updated LIC602 for R1. Documentation to be sent into CCL by 08/30/24. |
| 8
9
10
11
12
13
14 | This requirement is not met as evidenced by: Based on record review, the licensee did not comply with the section cited above in 1 out of 5 residents which poses/posed a potential health, safety or personal rights risk to persons in care. | 8
9
10
11
12
13
14 | |
Deficiency Type
POC Due Date /
Section Number | DEFICIENCIES | PLAN OF CORRECTIONS(POCs) |
Type A
08/30/2024
Section Cited
CCR
87309(a)
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5
6
7 | (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. | 1
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3
4
5
6
7 | Administrator removed medications immediately and locked medications up in the medication room. Administrator agrees to obtain training on medication management, copy of training to be sent into CCL |
| 8
9
10
11
12
13
14 | This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above and LPA observed medications unlocked in the R2 bedroom and outside which poses an immediate health, safety or personal rights risk to persons in care. | 8
9
10
11
12
13
14 | by 8/30/24. |
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4
5
6
7 | | 1
2
3
4
5
6
7 | |
| 1
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4
5
6
7 | | 1
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7 | |