Deficiency Type
POC Due Date /
Section Number | DEFICIENCIES | PLAN OF CORRECTIONS(POCs) |
Type B
01/20/2025
Section Cited
CCR
87309(a)
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7 | 87309 Storage Space and Access
(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. | 1
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7 | Administrator stated items were removed from the bathroom and placed in locked cabinets. Storage area will a locking device added. The storage shed will have a pad lock added. Administrator stated they will provide CCL with pictures for proof of correction by POC date. |
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14 | This requirement was not met as evidence by: LPA observation of chemicals/items posing a danger on bathroom #3 countertop, in storage area in back yard and in storage shed all unlocked and accessible to residents in care. This poses a potential health, safety and or personal rights risk to residents in care. | 8
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Type B
01/20/2025
Section Cited
CCR87555(b)(9)
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7 | 87555 General Food Service Requirements (b) The following food service requirements shall apply: (9) Procedures which protect the safety, acceptability and nutritive values of food shall be observed in food storage, preparation and service.
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7 | Adminstrator provided training to staff. Items that have been open will be dated. Pictures will be sent to CCL for verification. In-service sign in sheet will be provided to CCL by POC date. |
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14 | This requirement was not met as evidence by: LPA observation of food in refrigerator was not properly stored/dated. This poses a potential health, safety and or personal rights risk to residents in care. | 8
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14 | |
Deficiency Type
POC Due Date /
Section Number | DEFICIENCIES | PLAN OF CORRECTIONS(POCs) |
Type B
01/20/2025
Section Cited
CCR
87555(b)(21)
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7 | 87555 General Food Service Requirements (b) The following food service requirements shall apply: (21) Freezers of adequate size shall be maintained at a temperature of 0 degrees F (-17.7 degrees C), and refrigerators of adequate size shall maintain a maximum temperature of 40 degrees F (4 degrees C). They shall be kept clean and food stored to enable adequate air circulation to maintain the above temperatures.
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7 | Administrator will rearrange freezer to allow proper air circulation. In-service training sheet with training material will be provided to CCL by POC date. |
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14 | This requirement was not met as evidence by: LPA observation of freezer being packed and not having adequate air circulation to maintain temperature. This poses a potential health, safety and or personal rights risk to residents in care. | 8
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11
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14 | |
Type B
01/20/2025
Section Cited
CCR87307(2)(C)
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7 | 87307 Personal Accommodations and Services (2) Resident bedrooms shall be provided which meet, at a minimum, the following requirements: (C) No bedroom of a resident shall be used as a passageway to another room, bath or toilet.
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7 | Administrator stated they will remove all of the facility items out of the storage area in R6's bedroom. Administrator stated they will provide a picture that items have been removed as proof of correction by POC date. |
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14 | This requirement was not met as evidence by: LPA observation of storage area accessible through R6’s bedroom. This poses a potential health, safety and or personal rights risk to residents in care. | 8
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11
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14 | |
Deficiency Type
POC Due Date /
Section Number | DEFICIENCIES | PLAN OF CORRECTIONS(POCs) |
Type B
01/20/2025
Section Cited
CCR
87307(d)(4)
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7 | 87307 Personal Accommodations and Services (d) The following space and safety provisions shall apply to all facilities: (4) Stairways, inclines, ramps and open porches and areas of potential hazard to residents with poor balance or eyesight shall be made inaccessible to residents unless equipped with sturdy hand railings and unless well-lighted.
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7 | Administrator will get a bid for railing and ramp on the open porch area. Administrator will submit the quote and completion date by POC date in writting. |
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14 | This requirement was not met as evidence by: LPA observation of open patio on back of facility without hand railings or lighting. This poses a potential health, safety and or personal rights risk to residents in care. | 8
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Type B
01/20/2025
Section Cited
CCR87307(a)(3)(C)
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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. The following provisions shall apply: (3) Equipment and supplies necessary for personal care and maintenance of adequate hygiene practice shall be readily available to each resident. The resident may provide the following items; however, if the resident is unable or chooses not to provide them, the licensee shall assure provision of:
(C) Clean linen, including blankets, bedspreads, top bed sheets, bottom bed sheets, pillow cases, mattress pads, bath towels, hand towels and wash cloths. The quantity shall be sufficient to permit changing at least once per week or more often when indicated to ensure that clean linen is in use by residents at all times. The linen shall be in good repair. The use of common wash cloths and towels shall be prohibited.
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7 | Adminitrator stated they have purchased 10 new towels. WIll put inside of cupboard. Administrator will provide a picture of additional items for resident nand submit to CCL by POC date. |
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14 | This requirement was not met as evidence by: LPA observation of linen. The facility has 7 towels for 5 residents in care. This poses a potential health, safety and or personal rights risk to residents in care. | 8
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Deficiency Type
POC Due Date /
Section Number | DEFICIENCIES | PLAN OF CORRECTIONS(POCs) |
Type B
01/20/2025
Section Cited
CCR
87608(a)(3)
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7 | 87608 Postural Supports (a) Based on the individual's preadmission appraisal, and subsequent changes to that appraisal, the facility shall provide assistance and care for the resident in those activities of daily living which the resident is unable to do for himself/herself. Postural supports may be used under the following conditions. (3) 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.
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7 | Administrator stated they will be seeking prescriptions for bed railing from the residents physicians. Order will be provided to CCL as proof of verification. |
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14 | This requirement was not met as evidence by: LPA observation of residents beds with hand railing. A written order for this postural support was not observed in resident files reviewed. This poses a potential health, safety and or personal rights risk to residents in care. | 8
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Type B
01/20/2025
Section Cited
CCR87303(a)
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7 | 87303 Maintenance and Operation
(a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors.
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7 | Administrator stated items will be corrected. Pictures/video will be provided as proof of correction by POC date. |
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14 | This requirement was not met as evidence by: LPA observation of: attic space door observed dirty and in need of painting. Vent in hallway near office observed hanging and in need of cleaning. AC/heating vents in facility observed dirty and in need of cleaning. Doorway from living room to sitting area observed in need of touch up paint. Gates on right and left side of facility not self-latching. This poses a potential health safety and or personal rights risk to residents in care. | 8
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