Community Care Licensing

Document Has Been Signed on 06/21/2023 02:37 PM - It Cannot Be Edited

FACILITY NAME:	CARING HANDS		FACILITY NUMBER:	019201041
ADMINISTRATOR:	MORALES, MERCEDES		FACILITY TYPE:	740
ADDRESS:	3536 MURPHY STREET		TELEPHONE:	(925) 330-5129
CITY:	LIVERMORE	STATE: CA	ZIP CODE:	94550
CAPACITY: 6		CENSUS: 4	DATE:	06/21/2023
TYPE OF VISIT:	Case Management - Annual Continuation	UNANNOUNCED	TIME BEGAN:	09:55 AM
MET WITH:	Juliano Montero, Caregiver Wilma Nacis, Caregiver		TIME COMPLETED:	02:55 PM

SUPERVISORS NAME: Harpreet Humpal LICENSING EVALUATOR NAME: Grace Luk LICENSING EVALUATOR SIGNATURE: DATE: 06/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/21/2023

Link to Parent Document Below:

FACILITY NAME: CARING HANDS	FACILITY NUMBER: 019201041
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/21/2023

Type B

Section Cited

CCR

87411(f)

(f) All personnel, including the licensee and administrator, shall be in good health, and physically and 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 six (6) months prior to or seven (7) days after employment or licensure.  A report shall be made of each screening, signed by the examining physician.  The report shall indicate whether the person is physically qualified to perform the duties to be assigned, and whether he/she has any health condition that would create a hazard to him/herself, other staff members or residents.  A signed statement shall be obtained from each volunteer affirming that he/she is in good health.  Personnel with evidence of physical illness or emotional instability that poses a significant threat to the well-being of residents shall be relieved of their duties. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above by not having health screening for S2 and chest x-ray for S1 which poses a potential health and safety risk to persons in care.
	POC Due Date: 07/12/2023
	Plan of Correction
1 2 3 4	Facility has agreed to obtain health screening for S2 and chest x-ray results for S1. Facility will submit the documents to CCLD by POC date.

SUPERVISOR'S NAME: Harpreet Humpal LICENSING EVALUATOR NAME: Grace Luk LICENSING EVALUATOR SIGNATURE: DATE: 06/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/21/2023

Link to Parent Document Below:

FACILITY NAME: CARING HANDS	FACILITY NUMBER: 019201041
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/21/2023

Type B

Section Cited

CCR

87458(b)(1)

(b) The medical assessment shall include, but not be limited to: (1) A physical examination of the resident indicating the physician's primary diagnosis and secondary diagnosis, if any and results of an examination for communicable tuberculosis, other contagious/infectious or contagious diseases or other medical conditions which would preclude care of the person by the facility. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above by not having medical assessments for R1 & R2 and chest x-ray for R3 & R4 which poses a potential health and safety risk to persons in care.
	POC Due Date: 07/12/2023
	Plan of Correction
1 2 3 4	Facility has agreed to obtain signed medical assessments for R1 & R2 and chest x-ray results for R3 & R4. Facility will submit the documents to CCLD by POC date.

Type B

Section Cited

CCR

87463(a)

(a) The pre-admission appraisal shall be updated, in writing as frequently as necessary to note significant changes and to keep the appraisal accurate. The reappraisals shall document changes in the resident's physical, medical, mental, and social condition. Significant changes shall include but not be limited to: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above by not having reappraisal/needs and service plans for all residents which poses a potential health and safety risk to persons in care.
	POC Due Date: 07/12/2023
	Plan of Correction
1 2 3 4	Facility has agreed to obtain reappraisal/needs and service plans for all residents and submit documents to CCLD by POC date.

SUPERVISOR'S NAME: Harpreet Humpal LICENSING EVALUATOR NAME: Grace Luk LICENSING EVALUATOR SIGNATURE: DATE: 06/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/21/2023

Link to Parent Document Below:

FACILITY NAME: CARING HANDS	FACILITY NUMBER: 019201041
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/21/2023

Type A

Section Cited

CCR

87465(h)(2)

(h) The following requirements shall apply to medications which are centrally stored: (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 by having unlocked eye drops and prescription ointment in refrigerator which poses an immediate health and safety risk to persons in care.
	POC Due Date: 06/22/2023
	Plan of Correction
1 2 3 4	Staff locked up the eye drops and prescription ointment during inspection. Deficiency cleared. Civil penalty of $250 is being assessed for a repeat violation.

Section Cited

	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

SUPERVISOR'S NAME: Harpreet Humpal LICENSING EVALUATOR NAME: Grace Luk LICENSING EVALUATOR SIGNATURE: DATE: 06/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/21/2023

Link to Parent Document Below:

FACILITY NAME: CARING HANDS	FACILITY NUMBER: 019201041
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/21/2023

Type B

Section Cited

CCR

87411(c)(1)

(c) All RCFE staff who assist residents with personal activities of daily living shall receive initial and annual training as specified in Health and Safety Code sections 1569.625 and 1569.69 (1) Staff providing care shall receive appropriate training in first aid from persons qualified by such agencies as the American Red Cross. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above by not having current first aid training for S2 and S3 which poses a potential health and safety risk to persons in care.
	POC Due Date: 07/12/2023
	Plan of Correction
1 2 3 4	Facility has agreed to obtain current first aid training for S2 and S3. Facility will submit first aid certificates to CCLD by POC date.

Section Cited

	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

SUPERVISOR'S NAME: Harpreet Humpal LICENSING EVALUATOR NAME: Grace Luk LICENSING EVALUATOR SIGNATURE: DATE: 06/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/21/2023