Deficiency Type
POC Due Date /
Section Number | DEFICIENCIES | PLAN OF CORRECTIONS(POCs) |
Type A
12/27/2021
Section Cited
CCR
87203
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2
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4
5
6
7 | 87203 Fire Safety - All facilities shall be maintained in conformity with the regulations adopted by the State Fire Marshal for the protection of life and property against fire and panic | 1
2
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5
6
7 | Administrator will purchase and replace missing smoke alarm by 12/27/2021. Licensee will submit a photograph as proof of compliance by due date. |
 | 8
9
10
11
12
13
14 | This was not met because the smoke alarm was missing from the a residents room #2. | 8
9
10
11
12
13
14 | |
Type A
12/23/2021
Section Cited
CCR87705(j)
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5
6
7 | Care of Persons with Dementia.
The licensee shall have an auditory device or other staff alert feature to monitor exits, if exiting presents a hazard to any resident. | 1
2
3
4
5
6
7 | The administrator will provide training on the proper care of persons with Dementia. |
| 8
9
10
11
12
13
14 | This was not met by; the facility failed to use the auditory alarm as designed. All auditory alarms had been turned off and doors were left ajar during visit. | 8
9
10
11
12
13
14 | |
Deficiency Type
POC Due Date /
Section Number | DEFICIENCIES | PLAN OF CORRECTIONS(POCs) |
Type A
12/24/2021
Section Cited
CCR
87465(H)(2)
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2
3
4
5
6
7 | Incidental Medical and Dental Care.The following requirements shall apply to medications which are centrally stored: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.
| 1
2
3
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5
6
7 | The administrator will be sure to have all medications secured inacessible to residents at all time. |
| 8
9
10
11
12
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14 | This was not met because medication were left unatended/ not locked on main floor accessible to dementia residents. | 8
9
10
11
12
13
14 | |
Type A
12/31/2021
Section Cited
CCR87465(6)(D)
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2
3
4
5
6
7 | Incidental Medical & Dental
Assistance with self-administration does not include forcing a resident to take medication, hiding or camouflaging medications in other substances without the resident's knowledge and consent, or otherwise infringing upon a resident's right to refuse to take a medication.
The licensee shall be responsible for assuring that a record of centrally stored prescription medications for each resident is maintained for at least one year and includes: | 1
2
3
4
5
6
7 | The facility will remove any pill crusher or cutter unless there is a physician authorization or precription. |
| 8
9
10
11
12
13
14 | The LPA observed a pill crusher inservices without perscription or authorization for use.
| 8
9
10
11
12
13
14 | |
Deficiency Type
POC Due Date /
Section Number | DEFICIENCIES | PLAN OF CORRECTIONS(POCs) |
Type A
12/31/2021
Section Cited
CCR
87303(a)
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2
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5
6
7 | Maintenance and Operation
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. | 1
2
3
4
5
6
7 | The administrator will repair or replace broken tiles through out the facility by 12/31/2021 |
| 8
9
10
11
12
13
14 | This was not met because, LPA observed several tiles that were broken near the kitchen. | 8
9
10
11
12
13
14 | |
Type A
12/31/2021
Section Cited
CCR87406(a)
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2
3
4
5
6
7 | Administrator - Qualifications and Duties.All facilities shall have a qualified and currently certified administrator. The licensee and the administrator may be one and the same person. The administrator shall have sufficient freedom from other responsibilities and shall be on the premises a sufficient number of hours to permit adequate attention to the management and administration of the facility as specified in this section. When the administrator is not in the facility, there shall be coverage by a designated substitute who shall have qualifications adequate to be responsible and accountable for management and administration of the facility as specified in this section. The Department may require that the administrator devote additional hours in the facility to fulfill his/her responsibilities when the need for such additional hours is substantiated by written documentation. | 1
2
3
4
5
6
7 | The administrator will submit proof of correction by due date 12/31/2021. |
| 8
9
10
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14 | This was not because LPA observed that the administrators certificate was expired during visit. | 8
9
10
11
12
13
14 | |
Deficiency Type
POC Due Date /
Section Number | DEFICIENCIES | PLAN OF CORRECTIONS(POCs) |
Type B
12/31/2021
Section Cited
CCR
87305(a)
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4
5
6
7 | Alterations to Existing Building or New Facilities. Prior to construction or alterations, all facilities shall obtain a building permit. | 1
2
3
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5
6
7 | Licensee will submit proof that rooms mentioned in garage were permitted by city code by due date 12/31/2021. |
| 8
9
10
11
12
13
14 | LPA observed additional rooms in the garage being used as living quarters. | 8
9
10
11
12
13
14 | |
Type B
12/31/2021
Section Cited
CCR87405(D)(1)
| 1
2
3
4
5
6
7 | Administrator - Qualifications and Duties
The administrator shall have the qualifications specified in Sections 87405(d)(1) through (7). If the licensee is also the administrator, all requirements for an administrator shall apply.
(1) Knowledge of the requirements for providing care and supervision appropriate to the residents. | 1
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5
6
7 | The licensee will remove or seek training for the equipment used for the residnets needs by due date. 12/31/2021 |
| 8
9
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13
14 | The LPA observed that the facility was using a hoyer lift without proper documented training or without proper instuction from a licensed proessional. | 8
9
10
11
12
13
14 | |