Community Care Licensing

Document Has Been Signed on 01/31/2022 07:34 PM - It Cannot Be Edited

FACILITY NAME:	TLC HOME CARE 1		FACILITY NUMBER:	157209106
ADMINISTRATOR:	ARRIETA, RODRIGO A. JR.		FACILITY TYPE:	740
ADDRESS:	5801 COCHRAN DRIVE		TELEPHONE:	(661) 558-4499
CITY:	BAKERSFIELD	STATE: CA	ZIP CODE:	93309
CAPACITY: 6		CENSUS: 6	DATE:	01/31/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Rodrigo Arrieta, Licensee/Administrator		TIME COMPLETED:	11:30 AM

SUPERVISORS NAME: Andy Xiong LICENSING EVALUATOR NAME: Malia Thao LICENSING EVALUATOR SIGNATURE: DATE: 01/31/2022

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

FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/31/2022

Link to Parent Document Below:

FACILITY NAME: TLC HOME CARE 1	FACILITY NUMBER: 157209106
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/31/2022

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 observations, interview, records review, the licensee did not comply with the section cited above in two out of two staff not having current health assessments, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 02/14/2022
	Plan of Correction
1 2 3 4	Licensee will submit proof of health screenings for S1 and S2 to CCL by POC due date.

SUPERVISOR'S NAME: Andy Xiong LICENSING EVALUATOR NAME: Malia Thao LICENSING EVALUATOR SIGNATURE: DATE: 01/31/2022

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

FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/31/2022

Link to Parent Document Below:

FACILITY NAME: TLC HOME CARE 1	FACILITY NUMBER: 157209106
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/31/2022

Type B

Section Cited

CCR

87303(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. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observations and interview, the licensee did not comply with the section cited above. LPA observed the complete grass area in backyard to be covered in dog feces and observed there were 3 dogs present on the facility premises, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 02/14/2022
	Plan of Correction
1 2 3 4	Licensee will submit proof of receipt of service to clean dog feces from backyard from landscaper to CCL by POC due date.

Section Cited

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

SUPERVISOR'S NAME: Andy Xiong LICENSING EVALUATOR NAME: Malia Thao LICENSING EVALUATOR SIGNATURE: DATE: 01/31/2022

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

FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/31/2022

Link to Parent Document Below:

FACILITY NAME: TLC HOME CARE 1	FACILITY NUMBER: 157209106
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/31/2022

Type B

Section Cited

HSC

1569.625(b)(1)

(1) The department shall adopt regulations to require staff members of residential care facilities for the elderly who assist residents with personal activities of daily living to receive appropriate training. This training shall consist of 40 hours of training. A staff member shall complete 20 hours, including six hours specific to dementia care, as required by subdivision (a) of Section 1569.626 and four hours specific to postural supports, restricted health conditions, and hospice care, as required by subdivision (a) of Section 1569.696, before working independently with residents. The remaining 20 hours shall include six hours specific to dementia care and shall be completed within the first four weeks of employment. The training coursework may utilize various methods of instruction, including, but not limited to, lectures, instructional videos, and interactive online courses. The additional 16 hours shall be hands-on training. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview and records review, the licensee did not comply with the section cited above in two out of two staff. S1 and S2 started working on 1/1/22 and have only received 10.5 training hours, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 02/14/2022
	Plan of Correction
1 2 3 4	Licensee will submit proof of a total of 40 hours of initial training for S1 and S2 to CCL by POC due date.

SUPERVISOR'S NAME: Andy Xiong LICENSING EVALUATOR NAME: Malia Thao LICENSING EVALUATOR SIGNATURE: DATE: 01/31/2022

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

FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/31/2022

Link to Parent Document Below:

FACILITY NAME: TLC HOME CARE 1	FACILITY NUMBER: 157209106
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/31/2022

Type B

Section Cited

CCR

87608(a)(5)(B)

(B) Bed rails that extend the entire length of the bed are prohibited except for residents who are currently receiving hospice care and have a hospice care plan that specifies the need for full bed rails. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview, and records review, the licensee did not comply with the section cited above. R1 has full length bed rails, but R1 is not on hospice and facility does not have an approved exception on file for R1, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 02/14/2022
	Plan of Correction
1 2 3 4	Licensee will submit an exception request for approval of full length bed rails for R1 by POC due date.

Section Cited

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

SUPERVISOR'S NAME: Andy Xiong LICENSING EVALUATOR NAME: Malia Thao LICENSING EVALUATOR SIGNATURE: DATE: 01/31/2022

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

FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/31/2022

Link to Parent Document Below:

FACILITY NAME: TLC HOME CARE 1	FACILITY NUMBER: 157209106
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/31/2022

Type A

Section Cited

CCR

87303(e)(2)

87303 Maintenance and Operation (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 degree C) and not more than 120 degree F (49 degree C). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observations, the licensee did not comply with the section cited above. LPA measured the hall bathroom hot water at 130.1 degrees F, which poses an immediate safety risk to persons in care.
	POC Due Date: 02/01/2022
	Plan of Correction
1 2 3 4	Licensee will submit proof of hall bathroom hot water to measure within regulation to CCL by POC due date.

Section Cited

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

SUPERVISOR'S NAME: Andy Xiong LICENSING EVALUATOR NAME: Malia Thao LICENSING EVALUATOR SIGNATURE: DATE: 01/31/2022

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

FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/31/2022