Community Care Licensing

Document Has Been Signed on 02/26/2025 05:39 PM - It Cannot Be Edited

FACILITY NAME:	CARRIAGE CARE		FACILITY NUMBER:	075601035
ADMINISTRATOR/ DIRECTOR:	TUAZON, GABRIEL & ERLINDA		FACILITY TYPE:	740
ADDRESS:	1959 CARRIAGE DRIVE		TELEPHONE:	(925) 977-9678
CITY:	WALNUT CREEK	STATE: CA	ZIP CODE:	94598
CAPACITY: 6		CENSUS: 5	DATE:	02/26/2025
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	01:00 PM
MET WITH:	Administrators Gabriel and Erlinda Tuazon		TIME VISIT/ INSPECTION COMPLETED:	06:00 PM

SUPERVISORS NAME: Harpreet Humpal LICENSING EVALUATOR NAME: James Sampair LICENSING EVALUATOR SIGNATURE: DATE: 02/26/2025

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

FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/26/2025

Link to Parent Document Below:

FACILITY NAME: CARRIAGE CARE	FACILITY NUMBER: 075601035
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/26/2025

Type A

Section Cited

CCR

87303(e)(2)

(e) Water supplies and plumbing fixtures shall be maintained as follows: (2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degrees C) and not more than 120 degree F (49 degrees C). 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 1 out of 1 places it was tested at 122.3 degrees Fahrenheit, which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 02/27/2025
	Plan of Correction
1 2 3 4	Licensee reduced temperature during the visit and cleard the deficiency.

Type A

Section Cited

CCR

87309(a)

(a) Except as specified in subsection (b), the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances, knives, matches, tools, sharp objects, and other similar items which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage. 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. The storage room that contained cleaning solutions and poisonous substances had an unlocked door, which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 02/27/2025
	Plan of Correction
1 2 3 4	Licensee locked the storage room door, clearing the deficiency during the inspection.

SUPERVISOR'S NAME: Harpreet Humpal LICENSING EVALUATOR NAME: James Sampair LICENSING EVALUATOR SIGNATURE: DATE: 02/26/2025

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

FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/26/2025

Link to Parent Document Below:

FACILITY NAME: CARRIAGE CARE	FACILITY NUMBER: 075601035
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/26/2025

Type B

Section Cited

HSC

1569.625(b)(2)

(2) In addition to paragraph (1), training requirements shall also include an additional 20 hours annually, eight hours of which shall be dementia care training, as required by subdivision (a) of Section 1569.626, and four hours of which shall be specific to postural supports, restricted health conditions, and hospice care, as required by subdivision (a) of Section 1569.696. This training shall be administered on the job, or in a classroom setting, or both, and may include online training. 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 in 2 of the 5 staff files that contained no proof of staff completing the required training during the past 12 months which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 03/05/2025
	Plan of Correction
1 2 3 4	On or before the due date, the Licensee will send LPA message stating that proof of training is in the staff members' file for 2024 training.

Type B

Section Cited

CCR

87463(i)

(i) When there is significant change in condition, as defined in Section 87101, Definitions, or once every 12 months, whichever occurs first, the licensee shall arrange an in-person or virtual meeting or conference call to share the reappraisal with the resident, the resident's representative, if applicable, and appropriate facility staff, as specified in Section 87467, Resident Participation in Decision Making. 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 in the Appraisal / Needs and Services and annual physical (Physician's Report) that was missing for 2 of the 5 residents, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 03/05/2025
	Plan of Correction
1 2 3 4	On or before the due date, the Licensee will send LPA message stating that appointments have been set for the residents and that a new Appraisal / Needs and Services will be completed after the visit for those 2 residents based on what she knows and what the Physician's Report states.

SUPERVISOR'S NAME: Harpreet Humpal LICENSING EVALUATOR NAME: James Sampair LICENSING EVALUATOR SIGNATURE: DATE: 02/26/2025

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

FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/26/2025