New Life Residence

Type of visit: Required - 1 Year

LPA Audrey Jeung toured facility and grounds of this 1-level home, consisting of 6 client bedrooms--all with half bathrooms and exit doors--1 staff room, a common bathroom, shower room, kitchen and living/dining room. There is fenced patio and backyard. Washer and dryer are located in 2 car garage. No accessible bodies of water or fire safety hazards observed. PPE supply is inspected and food supplies are maintained. A comfortable temperature is maintained, lighting is sufficient for comfort and safety and hot water temperature tested at 120 degrees. Toilet and bathing facilities are equipped with grab bars and nonskid flooring material. Liquid soap is available at all sinks. First-aid kit is inspected and complete. A Disaster and Mass Casualty Plan is posted. There are 3 residents present and 2 staff. Criminal record clearances or exemptions for facility staff or other individuals who have client contact have been reviewed, as well as required staff records and proof of training. Client records are reviewed, including Centrally Stored Medication Records. Genny Flores is a RCFE administrator (x 1/27) that oversees facility operations. The following information/forms are requested to be submitted to CCLD BY 1/13/26: - Designation of Facility Responsibility LIC308) - Personnel Report (LIC500) - Proof of current liability insurance Deficiencies of the RCFE California Code of Regulations, Title 22, Division 6, Chapter 8 are observed and cited on following page.the state’s words, verbatim · CDSS document, Dec 30, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87464(h) · Plan of correction due date: Jan 13, 2026

REAPPRAISALS The licensee shall request that all residents receive an annual routine visit with a licensed medical professional once every 12 months, either in person or by video appointment. Documentation of the annual routine visit... shall be added to the resident's record. This requirement is not met, as MD reports for clients #2 & #3 are dated more than a year ago. Licensee failed to ensure that annual MD evaluations are maintained, which poses a potential health or safety risk to clients in care.the state’s words, verbatim · CDSS document, Dec 30, 2025

Plan of correction: MD reports for clients #2 and #3 will be updated, signed, and sent to CCLD BY DUE DATE

From the deficiency page — Deficiency type: Type B · Section cited: CCR87463(a) · Plan of correction due date: Jan 13, 2026

REAPPRAISALS The pre-admission appraisal... shall be updated in writing as frequently as necessary or once every 12 months, whichever occurs first, to note significant changes in condition... and to keep the appraisal accurate. This requirement is not met, as appraisal for client #3 is not maintained. Licensee failed to ensure that annual appraisals are maintained, which poses a potential health, safety or personal rights risk to clients in care.the state’s words, verbatim · CDSS document, Dec 30, 2025

Plan of correction: Updated signed appraisal for client #3 will be sent to CCLD BY DUE DATE

Type of visit: Case Management - Annual Continuation

LPA Jeung reviewed 3 clients' medications and issued additional citations based on observations made on 1/14/25 during annual inspection. Deficiencies of the California Code of Regulations, Title 22, are cited on following pages. See also Technical Advisory Note--1 page.the state’s words, verbatim · CDSS document, Jan 16, 2025

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.695(f)(2) · Plan of correction due date: Jan 24, 2025

HEALTH AND SAFETY CODE A facility shall have a set of keys available to facility staff on each shift for use during an evacuation that provides access to all occupied resident units, facility vehicles, all exit doors, all cabinets...or files that contain elements of the emergency disaster plan, including... food supplies & protective shelter supplies. This requirement was not met, as extra set of keys is not maintained in the event of an emergency. Licensee failed to maintain spare set of keys, which poses a potential health, safety or personal rights risk. This was discussed w/ administrator on 1/30/24.the state’s words, verbatim · CDSS document, Jan 16, 2025

Plan of correction: Spare set of emergency ksys will be maintained and separate from everyday use keys. Proof of correction to be sent to CCLD BY DUE DATE

From the deficiency page — Deficiency type: Type B · Section cited: CCR87609(b)(4)(B) · Plan of correction due date: Jan 24, 2025

ALLOWABLE HEALTH CONDITIONS/ USE OF HOME HEALTH AGENCIES ..Written agreement shall include day and evening contact information for the HH agency...method of communication between the agency & facility, which may include verbal contact, electronic mail, or logbook. This requirement was not met, as there are no progress notes maintained from home health providers whenever they visit a resident. Licensee failed to ensure maintenance of HH notes from visiting providers, which poses a potential health, safety or personal rights risk. This was discussed with administrator on 1/30/24.the state’s words, verbatim · CDSS document, Jan 16, 2025

Plan of correction: Administrator to ensure that home health visiting nurses document each visit. Plan/proof of correction to be sent to CCLD BY DUE DATE

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.69(b) · Plan of correction due date: Jan 24, 2025

HEALTH AND SAFETY CODE Each employee who received training, passed the examination required in paragraph (5) of subdivision (a), who continues to assist with the self-administration of medicines, shall also complete 8 hours of training on med -related issues in each succeeding 12- month period. This requirement was not met, as S1 & S ____ who manage and administer clients' medications, have not received annual medication training for 2024. Licensee failed to ensure that staff who handle medications receive required training, which poses a potential health, safety or personal rights risk. S1 received 1 hour of med training in 2024 & there is no record that S __ received any medication training in 2024.the state’s words, verbatim · CDSS document, Jan 16, 2025

Plan of correction: Staff who handle and administer clients' medications will receive annual required medications training. Proof of corrction to be sent to CCLD BY DUE DATE.

From the deficiency page — Deficiency type: Type B · Section cited: HSC1569.626(a)(2) · Plan of correction due date: Jan 24, 2025

HEALTH AND SAFETY CODE All RCFEs shall meet the following training requirements, as described in Section 1569.625, for all direct care staff: 8 hours of in-service training per year on the subject of serving residents with dementia. This requirement was not met, as there is no record that staff #3 and #4 received ANY training in 2024. Licensee failed to ensure that staff received required training, which poses a potential health, safety or personal rights risk to clients in care.the state’s words, verbatim · CDSS document, Jan 16, 2025

Plan of correction: Staff #3 and #4 will receive required annual dementia training. Proof of correction to be sent to CCLD BY DUE DATE.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(h)(6) · Plan of correction due date: Jan 24, 2025

iNCIDENTAL MEDICAL CARE A record of centrally stored prescription medications for each resident shall be maintained and include names of the resident for whom prescribed, prescribing physician and pharmacist, drug name, strength and quantity, dates filled, started & expiration, prescription number and instructions. This requirement is not met, as 2 OTC meds for client #2, OTC Senna and Rx Vit D3 for C5, & medications received but not yet started, are not recorded on CSMR. This poses a potential health, safety or personal rights risk to clients in care.the state’s words, verbatim · CDSS document, Jan 16, 2025

Plan of correction: Medications will be recorded on Centrally Stored Medications Records upon RECEIPT. Proof/plan of correction will be sent to CCLD BY DUE DATE

Type of visit: Required - 1 Year

LPA Audrey Jeung toured facility and grounds of this 1-level home, consisting of 6 client bedrooms--all with half bathrooms and exit doors--1 staff room, a common bathroom, shower room, kitchen and living/dining room. There is an enclosed patio and backyard. Washer and dryer are located in 2 car garage. No accessible bodies of water or fire safety hazards observed. PPE supply is inspected. Food supplies are maintained. A comfortable temperature is maintained, lighting is sufficient for comfort and safety and hot water temperature tested at 118 degrees. Toilet and bathing facilities are equipped with grab bars and nonskid flooring material. Liquid soap is available at all sinks. First-aid kit is inspected and complete. A Disaster and Mass Casualty Plan is posted. There are 5 residents present and 2 staff. Two residents receive hospice services. Criminal record clearances or exemptions for facility staff or other individuals who have client contact have been reviewed, including current first aid training and health screenings. Genny Flores is a RCFE administrator (x 1/25) that has submitted education certificates in October 2024 for renewal of administrator certificate. The following information/forms are requested to be submitted to CCLD BY 1/21/25: - Facility Floor Plan (LIC999 including all bathrooms) - Proof of current liability insurance Deficiencies of the RCFE California Code of Regulations, Title 22, Division 6, Chapter 8 are observed and cited on following pages.the state’s words, verbatim · CDSS document, Jan 14, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(h)(2) · Plan of correction due date: Jan 14, 2025

INCIDENTAL MEDICAL CARE 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 was not met, as 2 bottles of Vit D3 stored in common bathroom,and acetaminophen and Vit C stored in kitchen cabinet, where items are accessible to residents. Licensee failed to ensure that medications are stored where inaccessible to clients, which poses an immediate health, safety or personal rights risk to clients in care.the state’s words, verbatim · CDSS document, Jan 14, 2025

Plan of correction: Vitamin D3, acetaminophen and Vit C relocated to inaccessible storage area in LPA's presence. Deficiency corrected and cleared

From the deficiency page — Deficiency type: Type A · Section cited: CCR87309(a) · Plan of correction due date: Jan 14, 2025

STORAGE SPACE AND ACCESS The licensee shall ensure that disinfectants, cleaning solutions, poisonous substances... and other similar items which could pose a danger to residents are in locked storage and are not left unattended... This requirement is not met, as Windex is stored in common bathroom cabinet, accessible to clients. Licensee failed to ensure that cleaning solutions are secured, which poses an immediate health, safety or personal rights risk to clients in care.the state’s words, verbatim · CDSS document, Jan 14, 2025

Plan of correction: Bottle of Windex was removed from common bathroom in LPA's presence and secured. Deficiency corrected and cleared in LPA's presence.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(13) · Plan of correction due date: Jan 21, 2025

PERSONAL RIGHTS Residents in all RCFEs shall have the personal right to have access to individual storage space for private use. This requirement is not met, as personal items belonging to staff are stored in closet in client room #3. Licensee failed to ensure that residents' closets are limited to residents' personal items, and not used by staff. This poses a potential health, safety or personal rights risk to clients in care.the state’s words, verbatim · CDSS document, Jan 14, 2025

Plan of correction: Personal belongings of staff will be removed from clients' rooms and proof of correction to be sent to CCLD BY DUE DATE

From the deficiency page — Deficiency type: Type B · Section cited: CCR87633(b) · Plan of correction due date: Jan 21, 2025

HOSPICE CARE OF TERMINALLY ILL A current and complete hospice care plan shall be maintained in the facility for each hospice resident and include specific information. This requirement is not met, as there is no hospice care plan maintained for client #3, including use of half bed rails. Licensee failed to ensure that hospice care plan is maintained for all hospice clients, which poses a potential health, safety or personal rights risk to clients in care.the state’s words, verbatim · CDSS document, Jan 14, 2025

Plan of correction: Hospice care plan for client #3 will be sent to CCLD BY DUE DATE, and shall include order for use of half bed rails.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Jan 21, 2025

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. This requirement is not met, as discarded furnishings are observed in backyard--table, chairs, bed frame, 2 bicycles, scooters, shelf--and pipe and insulation are exposed in room #6 as a 3' x 18" section of ceiling is missing. This poses a potential health, safety or personal rights risk to clients in care.the state’s words, verbatim · CDSS document, Jan 14, 2025

Plan of correction: Ceiling was temporarily covered in LPA's presence. Discarded items will be removed from premises and proof of correction to be sent to CCLD BY DUE DATE

From the deficiency page — Deficiency type: Type B · Section cited: CCR87457(c) · Plan of correction due date: Jan 21, 2025

PREADMISSION APPRAISAL Prior to admission a determination of the prospective resident's suitability for admission shall be completed & shall include an appraisal of their individual service needs... This requirment is not met, as appraisals for clients #2, #3, #4, #5 are missing or incomplete. Licensee failed to ensure that all residents have completed, signed and dated appraisals on file, which poses a potential health, safety or personal rights risk to clients in care.the state’s words, verbatim · CDSS document, Jan 14, 2025

Plan of correction: Appraisals shall be completed, signed and dated for 4 clients, and copies will be sent to CCLD BY DUE DATE

From the deficiency page — Deficiency type: Type A · Section cited: HSC 1569.185(e) · Plan of correction due date: Jan 15, 2025

HEALTH AND SAFETY CODE The failure of an applicant for licensure or a licensee to pay all applicable and accrued fees and civil penalties shall constitute grounds for denial or forfeiture of a license. This requirement is not met, as licensee has failed to pay annual licensing renewal fees for 2023, 2024 and 2025, which poses an immediate health, safety or personal rights risk to clients in care. Licensee was reminded to pay licensing fee on 1/30/24 during annual visit.the state’s words, verbatim · CDSS document, Jan 14, 2025

Plan of correction: Annual licensing fees and late charges totalling $1979 will be paid BY DUE DUE DATE. Proof of payment/correction to be sent to CCLD BY DUE DATE.

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.69(b) · Plan of correction due date: Jan 21, 2025

HEALTH AND SAFETY CODE Each employee who received training and passed the exam required in paragraph (5) of subdivision (a)... who continues to assist with the self-administration of medicines, shall also complete 4 hours of in-service training on medication-related issues in each succeeding 12-month period. This requirement is not met, as all staff have not received 4 hours of continuing medication training, which poses a potential health, safety or personal rights risk to clients in care.the state’s words, verbatim · CDSS document, Jan 14, 2025

Plan of correction: Staff who handle clients' medications will receive at least 4 hours of annual medication training. Proof/plan of correction to be sent to CCLD BY DUE DATE.

From the deficiency page — Deficiency type: Type B · Section cited: HSC1569.696 · Plan of correction due date: Jan 21, 2025

HEALTH AND SAFETY CODE All RCFEs shall provide training to direct care staff on postural supports, restricted conditions or health services, & hospice care as a component of the training requirements specified in Section 1569.625. The training shall include... 4 hours of training thereafter of in-service training per year on the subject of serving those residents. This requirement was not met, as staff #3 and #4 have not received this training for 2024. Licensee failed to ensure that all staff receive required training, which poses a potential health, safety or personal rights risk to clients in care.the state’s words, verbatim · CDSS document, Jan 14, 2025

Plan of correction: Staff #3 and #4 will received required training on postural supports, restricted health conditions and hospice care. Proof of training to be sent to CCLD BY DUE DATE.

Type of visit: Required - 1 Year

LPA Audrey Jeung toured facility and grounds of this 1-level home, consisting of 6 client bedrooms--all with half bathrooms and exit doors--1 staff room, a common bathroom, shower room, kitchen and living/dining room. There is an enclosed patio and backyard. Washer and dryer are located in 2 car garage. No accessible bodies of water or fire safety hazards observed. PPE supply is inspected. Food supplies are adequate. Medications, toxins and sharps are stored appropriately and inaccessible to clients, a comfortable temperature is maintained, and lighting is sufficient for comfort and safety. Toilet and bathing facilities are equipped with grab bars and nonskid flooring material. Liquid soap is available at all sinks. First-aid kit is inspected and complete. A Disaster and Mass Casualty Plan is posted. There are 6 residents present and 2 staff. LPA interviewed 2 residents. One resident is receiving hospice services. Criminal record clearances or exemptions for facility staff or other individuals who have client contact have been reviewed, including current first aid training and health screenings. Tina Camaclang and Genny Flores are certified RCFE administrators (x 2/24 and 1/25) that oversee facility operations. The following information/forms are requested to be submitted to CCLD BY 2/13/24: - Designation of Facility Responsibility (LIC308) - Personnel Report (LIC500) - Emergency Disaster Plan (LIC610E) - Facility Floor Plan (LIC999 including all bathrooms) - Proof of current liability insurance - Annual licensing fees due $1237 or proof of payment Deficiencies of the RCFE California Code of Regulations, Title 22, Division 6, Chapter 8 are observed and cited on following pages. Technical Violations are issued--see 7 pages.the state’s words, verbatim · CDSS document, Jan 30, 2024