Deficiency Type
POC Due Date /
Section Number | DEFICIENCIES | PLAN OF CORRECTIONS(POCs) |
Type A
03/18/2025
Section Cited
CCR
87412(d)
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5
6
7 | PERSONNEL RECORDS
The licensee shall maintain documentation that an administrator has met the certification requirements specified in Section 87406 or the recertification requirements in Section 87407. This requirement is not met, as proof of recertification of RCFE administrator | 1
2
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5
6
7 | Proof that application for RCFE administrator certification was submitted to CCLD with required training and payment will be sent to CCLD BY DUE DATE.
If available, RCFE administrator certification status will be submitted to CCLD |
 | 8
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13
14 | was not received. Licensee failed to ensure that there is a certified RCFE administrator managing facility, which poses a potential health, safety or personal rights risk to clients in care. On 12/2/24, confirmatiion that Ms. Patalot registered for 40 hour RCFE administrator classes was submitted to CCLD | 8
9
10
11
12
13
14 | |
Type B
03/18/2025
Section Cited
CCR87412(a)(11)
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7 | PERSONNEL RECORDS
The licensee shall ensure that personnel records are maintained on ... each employee. Each personnel record shall contain ...a health screening as specified in Section 87411, Personnel Requirements - General.
This requirement was not met, as health | 1
2
3
4
5
6
7 | Current health screening and/or TB test result for staff #4 to be sent to CCLD BY DUE DATE |
| 8
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14 | screening and/or TB test results are not maintained for Staff #4, which poses a potential health, safety or personal rights risk to clients in care. | 8
9
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11
12
13
14 | |
Deficiency Type
POC Due Date /
Section Number | DEFICIENCIES | PLAN OF CORRECTIONS(POCs) |
Type B
03/18/2025
Section Cited
CCR
87608(a)(3)
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4
5
6
7 | POSTURAL SUPPORTS
A written order from a physician indicating the need for the postural support shall be maintained in the resident’s record. The licensing agency shall be authorized to require other additional documentation if needed to verify the order. | 1
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7 | Written MD orders of half bed rails for clients #1 and #2 will be sent to CCLD BY DUE DATE |
| 8
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14 | This requirement is not met, as MD orders for half bed rails for clients #1 and #2 are not maintained. Licensee failed to ensure that MD orders are maintained for those who have half bed rails, which poses a potential health, safety or personal rights risk to clients in care. | 8
9
10
11
12
13
14 | |
Type B
03/18/2025
Section Cited
HSC1569.695(c)
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7 | HEALTH AND SAFETY CODE
A facility shall conduct a drill at least quarterly... type of emergency covered in a drill shall vary from quarter to quarter, taking into account different emergency scenarios. An actual evacuation of residents is not required during a drill... Documentation of | 1
2
3
4
5
6
7 | Disaster drill documentation shall be revised and submitted to CCLD BY DUE DATE. |
| 8
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14 | the drills shall include the date, the type of emergency covered by the drill, and the names of staff participating in the drill.
This requirement is not met, as record of disaster drills is incomplete. This poses a potential health, safety or personal rights risk to clients in care. | 8
9
10
11
12
13
14 | |
Deficiency Type
POC Due Date /
Section Number | DEFICIENCIES | PLAN OF CORRECTIONS(POCs) |
Type B
03/18/2025
Section Cited
HSC
1569.695(e)(1-4)
| 1
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3
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5
6
7 | HEALTH AND SAFETY CODE
A facility shall have all of the following information readily available to facility staff during an emergency:
A resident roster with the date of birth for each resident; An appraisal of resident needs and services plan for each resident; | 1
2
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4
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6
7 | Proof that the required information is available to staff at all times will be sent to CCLD BY DUE DATE |
| 8
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14 | A resident medication list for residents with centrally stored medications; Contact information for the responsible party and physician for each resident. This requirement was not met, as there was no documentation available to staff for 3 residents in the event of an emergency. | 8
9
10
11
12
13
14 | |
Type B
03/18/2025
Section Cited
HSC1569.625(b)(2)
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7 | HEALTH AND SAFETY CODE
... training requirements shall also include an additional 20 hours annually, 8 hours of which shall be dementia care training, as required by subdivision (a) of Section 1569.626, and 4 hours of which shall be specific to postural supports, restricted health conditions, and hospice care, as | 1
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5
6
7 | Proof of required training for staff #6 will be sent to CCLD BY DUE DATE |
| 8
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14 | required by subdivision (a) of Section 1569.696. This requirement was not met, as there is no proof that staff #6 received 8 hours of dementia training & 4 hours of postural supports, restricted health conditions & hospice care training, which poses a potential health, safety or personal rights risk to clients. | 8
9
10
11
12
13
14 | |
Deficiency Type
POC Due Date /
Section Number | DEFICIENCIES | PLAN OF CORRECTIONS(POCs) |
Type B
03/18/2025
Section Cited
CCR
87411(c)
| 1
2
3
4
5
6
7 | PERSONNEL REQUIREMENTS
Staff providing care shall receive appropriate training in first aid from persons qualified by such agencies as the American Red Cross.
This requirement was not met, as proof of current first aid training for staff #6 was not received nor maintained. Licensee failed to | 1
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5
6
7 | Proof of current first aid training for staff #6 to be sent to CCLD BY DUE DATE |
| 8
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14 | ensure that all caregivers have current first aid training, which poses a potential health, safety or personal rights risk to clients in care. | 8
9
10
11
12
13
14 | |
| 1
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6
7 | | 1
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5
6
7 | |
| 1
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4
5
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7 | | 1
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7 | |