Deficiency Type
POC Due Date /
Section Number | DEFICIENCIES | PLAN OF CORRECTIONS(POCs) |
Type B
03/07/2025
Section Cited
CCR
87555(b)(26)
| 1
2
3
4
5
6
7 | GENERAL FOOD SERVICE
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 there are no canned fruits maintained and minimal fresh | 1
2
3
4
5
6
7 | Proof of correction to be sent to CCLD BY DUE DATE |
 | 8
9
10
11
12
13
14 | vegetables for 2 day supply. Licensee failed to maintain 7-day supply of canned food and 2-day supply of fresh vegetables, which poses a potential health and safety risk to clients in care. Minimal amount of broccoli crowns and lettuce and frozen mixed vegetables observed. | 8
9
10
11
12
13
14 | |
Type B
03/07/2025
Section Cited
CCR87458(a)
| 1
2
3
4
5
6
7 | MEDICAL ASSESSMENT
Prior to a person's acceptance as a resident, the licensee shall obtain documentation of a MD assessment, signed by a licensed medical professional... and made within the last year, to be kept in the resident's record.
| 1
2
3
4
5
6
7 | Copies of MD reports and/or TB test results for clients #1, #3, #5 to be sent to CCLD BY DUE DATE. |
| 8
9
10
11
12
13
14 | This requirement is not met, as there are no MD reports and/or TB test results on file for 3 out of 5 clients. Licensee failed to ensure that MD reports and/or TB test results are maintained for all clients, which poses a potential health, safety or personal rights risk. No MD report/TB test results for C1, C3,C5. | 8
9
10
11
12
13
14 | |
Deficiency Type
POC Due Date /
Section Number | DEFICIENCIES | PLAN OF CORRECTIONS(POCs) |
Type B
03/07/2025
Section Cited
CCR
87506(a)
| 1
2
3
4
5
6
7 | RESIDENT RECORDS
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.
This requirement was not met, as 1 out of 5 | 1
2
3
4
5
6
7 | Plan of correction to be sent to CCLD BY DUE DATE. |
| 8
9
10
11
12
13
14 | client file is not available for review. Licensee failed to ensure that all client records are made available for licensing agency review, which poses a potential health, safety or personal rights risk to clients in care.
File for client #5 is not available. | 8
9
10
11
12
13
14 | |
Type B
03/07/2025
Section Cited
CCR87463
| 1
2
3
4
5
6
7 | REAPPRAISALS
The pre-admission appraisal, as specified in Section 87457... shall be updated in writing as frequently as necessary or once every 12 months, whichever occurs first, to note significant changes in condition, as defined in Section 87101, Definitions, and to keep the appraisal accurate. | 1
2
3
4
5
6
7 | Current IPP or reappraisal for client #4 to be sent to CCLD BY DUE DATE |
| 8
9
10
11
12
13
14 | This requirement is not met, as there is no current appraisal or IPP for client #4, who was admitted 8/2022. Licensee failed to ensure that updated appraisals are maintained for cll clients, which poses a potential health, safety or personal rights risk to client in care | 8
9
10
11
12
13
14 | |
Deficiency Type
POC Due Date /
Section Number | DEFICIENCIES | PLAN OF CORRECTIONS(POCs) |
Type B
03/07/2025
Section Cited
HSC
1569.625(b)(1)
| 1
2
3
4
5
6
7 | HEALTH AND SAFETY CODE
(Initial) training shall consist of 40 hours... 20 hours, including 6 hours specific to dementia care...and 4 hours specific to postural supports, restricted health conditions, and hospice care... before working independently with residents. The remaining 20 hours shall | 1
2
3
4
5
6
7 | Proof of correction that staff #2 and #7 received required 40 hours of initial training to be sent to CCLD BY DUE DATE |
| 8
9
10
11
12
13
14 | include 6 hours specific to dementia care and shall be completed within the first 4 weeks of employment. This requirement is not met, as there is no evidence that 2 out 5 new staff received initial training, which poses a potential health, safety or personal rights risk to clients in care. No info on training for staff #2 and #7 | 8
9
10
11
12
13
14 | |
Type B
03/07/2025
Section Cited
HSC1569.625(b)(2)
| 1
2
3
4
5
6
7 | HEALTH AND SAFETY CODE
Training requirements shall...include an additional 20 hours annually, 8 hours of which shall be dementia care training, as required by subdivision (a) of HSC 1569.626, & 4 hours of which shall be specific to postural supports, restricted health conditions, and | 1
2
3
4
5
6
7 | Proof of correction that staff #5 and #6 received required 20 hours of annual training to be sent to CCLD BY DUE DATE |
| 8
9
10
11
12
13
14 | hospice care, as required by subdivision (a) of Section 1569.696. This requirement is not met, as there is no evidence that 2 staff received annual continuing training in 2024, which poses a potential health, safety or personal rights risk to clients in care.
No annual training for staff #5 and #6. | 8
9
10
11
12
13
14 | |
Deficiency Type
POC Due Date /
Section Number | DEFICIENCIES | PLAN OF CORRECTIONS(POCs) |
Type B
04/04/2025
Section Cited
HSC
1569.69(b)
| 1
2
3
4
5
6
7 | HEALTH AND SAFETY CODE
Each employee who ...continues to assist with the self-administration of medicines, shall also complete 8 hours of in-service training on medication-related issues in each succeeding 12-month period.
This requirement is not met, as there is no | 1
2
3
4
5
6
7 | Proof of correction that staff #5 and #6 received required 8 hours of annual medication training to be sent to CCLD BY DUE DATE |
| 8
9
10
11
12
13
14 | evidence of medications training in 2024 for 2 staff. Licensee failed to ensure that staff who handle medications received annual continuing medications training, which poses a potential health, safety or personal rights risk to clients in care. No medication training in 2024 for Staff #5 and #6. | 8
9
10
11
12
13
14 | |
Type B
03/07/2025
Section Cited
CCR87411(f)
| 1
2
3
4
5
6
7 | PERSONNEL REQUIREMENTS
All personnel...shall be in good health, & physically & mentally capable of performing assigned tasks. Good physical health shall be verified by a health screening, including a chest x-ray or an intradermal test, performed by a physician not more than 6 months prior to | 1
2
3
4
5
6
7 | Current health screenings and/or TB test results for S2, S3, S6, S7 will be sent to CCLD BY DUE DATE |
| 8
9
10
11
12
13
14 | or 7 days after employment or licensure. A report shall be... signed by the examining physician...whether the person is physically qualified to perform the duties to be assigned... has any health condition that would create a hazard... No health screening/ TB test results for S2, S3, S6, S7 | 8
9
10
11
12
13
14 | |
Deficiency Type
POC Due Date /
Section Number | DEFICIENCIES | PLAN OF CORRECTIONS(POCs) |
Type B
03/07/2025
Section Cited
CCR
87412(a)(1-8)
| 1
2
3
4
5
6
7 | PERSONNEL RECORDS
The licensee shall ensure that personnel records are maintained on...each employee.... contain the following info:
Employee's full name, Social Security #, date of employment, written verification that the employee is at least 18 years of age...home address and phone number,
| 1
2
3
4
5
6
7 | Copies of job applications for staff #4 and #7 to be sent to CCLD BY DUE DATE. |
| 8
9
10
11
12
13
14 | educational background, past experience, including types of employment and former employers, type of position for which employed. This requirment was not met, as job applications are not maintained for 2 out of 7 staff, which poses a potential health or safety risk. No job applications for S4 & S7. | 8
9
10
11
12
13
14 | |
| 1
2
3
4
5
6
7 | | 1
2
3
4
5
6
7 | |
| 1
2
3
4
5
6
7 | | 1
2
3
4
5
6
7 | |
Deficiency Type
POC Due Date /
Section Number | DEFICIENCIES | PLAN OF CORRECTIONS(POCs) |
Type A
02/27/2025
Section Cited
CCR
87465(h)(6)
| 1
2
3
4
5
6
7 | INCIDENTAL MEDICAL CARE
A record of centrally stored Rx medications for each resident shall be maintained and include names of the resident for whom prescribed, prescribing physician and pharmacist, drug name, strength and quantity, dates filled, started & expiration, | 1
2
3
4
5
6
7 | Clients' medications were recorded on Centrally Stored Medications Records in LPA's presence
Deficiency corrected and cleared. |
| 8
9
10
11
12
13
14 | prescription number and instructions.
This requirement was not met, as meds for client #3 and Senna 12/14/24 for client #2 are not recorded on Centrally Stored Medication Record, which poses a potential health, safety or personal rights risk. | 8
9
10
11
12
13
14 | |
Type A
02/28/2025
Section Cited
CCR87217(g)(1)
| 1
2
3
4
5
6
7 | SAFEGUARDS FOR RESIDENT CASH
Each licensee shall maintain adequate safeguards and accurate records of cash resources & valuables entrusted to his care, including....records of residents' cash resources maintained as a drawing account shall include a ledger accounting (columns | 1
2
3
4
5
6
7 | Recordkeeping of clients' P & I monies will be modified to reflect CURRENT and ACCURATE cash on hand. Transaction records will be maintained BY MONTH, with cash balances carried forward.
Proof/plan of correction to be sent to CCLD BY DUE DATE |
| 8
9
10
11
12
13
14 | for income, disbursements and balance) for each resident, and supporting receipts filed in chronological order. Each accounting shall be kept current. This requirement is not met, as P & I records & cash for C2 and C5 are not accurate& staff were unable to describe cash handling procedure & recordkeeping. | 8
9
10
11
12
13
14 | |
Deficiency Type
POC Due Date /
Section Number | DEFICIENCIES | PLAN OF CORRECTIONS(POCs) |
Type A
02/28/2025
Section Cited
HSC
1569.695
| 1
2
3
4
5
6
7 | HEALTH & SAFETY CODE
A facility shall conduct a drill at least quarterly for each shift. The 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.... shall not require any | 1
2
3
4
5
6
7 | Emergency disaster drills shall be conducted quarterly and documented.
Plan/proof of correction to be sent to CCLD BY DUE DATE, and documentation of emergency drill to be sent to CCLD when conducted. |
| 8
9
10
11
12
13
14 | resident participation. Documentation of 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 there is no record of any disaster drills preformed, which poses an immediate health and safety risk to clients. | 8
9
10
11
12
13
14 | |
| 1
2
3
4
5
6
7 | | 1
2
3
4
5
6
7 | |
| 1
2
3
4
5
6
7 | | 1
2
3
4
5
6
7 | |