Inspection visit

Routine inspectionJune 27, 2023

ELISABETH CARE HOMELicense 07920038049 citations on this visit

49 citations recorded

Inspector’s narrative

What the inspector wrote

On 06/27/2023 at 11:10 AM, Licensing Program Analyst (LPA) L. Alexander arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Administrator, Obed D'Autruche and explained the purpose of the visit. The facility’s fire clearance was approved for 4 Non-Ambulatory. LPA toured facility with Obed including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 5 total bedrooms which 2 shared bedrooms are occupied by the residents and 3 bedrooms is occupied by staff. All outdoor and indoor passageways are kept free of obstruction except for side entry gate. There are no bodies of water observed. A comfortable temperature is maintained at 73 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathroom was measured at 130.6 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of one week supply of nonperishable and 2-day of perishable foods. Centrally stored medication and sharps were locked and inaccessible to residents. Smoke detectors and carbon monoxide detector were in operating condition during visit. Fire extinguisher was last serviced on 04/04/2023. Emergency Disaster Plan was last posted on 02/08/2018. First aid kit was observed to be complete. Emergency disaster drill have not been conducted. LPA reviewed 3 residents records. LPA reviewed 7 staff records and 1 of 7 have current first aid training and associated to the facility. LPA reviewed a sample of resident’s medications and it matched Medication Administration Record for R2. The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22 and/or Health and Safety Code Failure to correct deficiencies by POC date may result in additional Civil Penalties. At 11:20 AM LPA observed 3 pairs of scissors unlocked in kitchen drawers At 11:22 AM LPA observed 5 bottles of vitamins unlocked in kitchen cabinet At 11:25 AM LPA observed bleach, Ajax Cleaner, disinfectant wipes unlocked under kitchen sink At 11:28 AM LPA observed a pair of scissors and cutting knife on the floor in unlocked pantry At 11:35 AM LPA observed Fabuloso Multipurpose Cleaner, Clorox Bleach and Mr. Clean Freak Spray in Shared bathroom# 2 At 11:45 AM LPA observed shower chair and microwave outside on side of house At 1146 AM LPA observed Masters pad lock on outside entry side gate Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 07/04/2023: LIC 308 Designation of Administrative Responsibility LIC 309 Administrative Organization LIC 500 Personnel Report LIC 610E Emergency Disaster Plan Liability Insurance Current Administrator’s Certificate Exit interview conducted. Appeal Rights and a copy of this report provided.

Citations

49 citations recorded^*CCLD

What does Type A vs Type B mean?

Type A. Serious citation. Imminent or substantial risk to children. The regulator requires corrective action immediately and may impose a civil penalty.

Type B. Lower-severity citation. Corrective action required, no imminent risk. The regulator monitors compliance on the next visit.

87506(b)(17)(A)Type B
Based on record review, the licensee did not comply with the section cited above in by not having Pre-Admission Appraisal which poses a potential health, safety or personal rights risk to persons in care.
87705(f)(1)Type A
Based on observation, the licensee did not comply with the section cited above in by not having knives inaccessible to residents which poses an immediate health, safety risk to persons in care.
87303(e)(5)Type B
Based on observation, the licensee did not comply with the section cited above in by having Non-skid mats in Shared Bathroom#2 which posesa pote ntial health and safety risk to persons in care.
87307(d)(6)Type B
Based on observation, the licensee did not comply with the section cited above in by having a Masters pad lock on entry gate and a piece of tree trunk wood placed on the outside side entry gate which poses a potential health, safety or personal rights risk to persons in care.
87457(c)(1)Type B
Based on record review, the licensee did not comply with the section cited above in by not having a Pre-Admission Appraisal for residents in care which poses a potential health, safety or personal rights risk to persons in care.
87458(a)Type B
Based on record review, the licensee did not comply with the section cited above in by not having signed Physicians Report for all residents in care which poses a potential health, safety or personal rights risk to persons in care.
87458(b)Type B
Based on record review, the licensee did not comply with the section cited above in by not having medical assessments for residents, R3 in care which poses a potential health, safety or personal rights risk to persons in care.
87458(b)(5)Type B
Based on record review, the licensee did not comply with the section cited above in by not having medical assessments of all residents in care which poses a potential health, safety or personal rights risk to persons in care.
87465(f)(1)Type B
Based on record review, the licensee did not comply with the section cited above in by not having name, addresses, telephone numbers of resident's physicians and dentists on file which poses a potential health, safety or personal rights risk to persons in care.
87467(a)Type B
Based on record review, the licensee did not comply with the section cited above in by not having meetings with residents and their reps which poses a potential health, safety or personal rights risk to persons in care.
87633(h)(5)Type B
Based on record review, the licensee did not comply with the section cited above in by not having R2's acknowledgement to receive hospi ce care and R3's agreement to shared living space which posesa potential health, safety or personal rights risk to persons in care.
87458(b)(1)Type B
Based on record review, the licensee did not comply with the section cited above in by not having full diagnosis information on residents in care which poses a potential health, safety or personal rights risk to persons in care.
1569.695(a)(1)Type B
Based on observation and record review, the licensee did not comply with the section cited above in by not having such plans available which poses a potential health, safety or personal rights risk to persons in care.
1569.695(c)Type B
Based on record review, the licensee did not comply with the section cited above in by not having fire drills completed which poses a potential health, safety or personal rights risk to persons in care.
1569.695(d)Type B
Based on record review, the licensee did not comply with the section cited above in by not reviewing plans annually. R2 has been at facility over a year and no review in file which posesa pote ntial health, safety or personal rights risk to persons in care.
1569.695(e)(1)Type B
Based on record review, the licensee did not comply with the section cited above in noy having resident roster's completed which posesa potential health, safety or personal rights risk to persons in care.
1569.695(e)(2)Type B
Based on record review, the licensee did not comply with the section cited above in by not having Appraisal Needs and Services Plans for residents which poses a potential health, safety or personal rights risk to persons in care.
87208(d)Type B
Based on record review, the licensee did not comply with the section cited above in by not having Bedridden for R2 and R3 included in their plan which can pose a potential health, safety or personal rights risk to persons in care.
87303(a)Type B
Based on observation, the licensee did not comply with the section cited above in by not having shower chair, microwave in outside back side yard accessible to residents in care which poses a potential health and safety risk to persons in care.
87303(e)(2)Type A
Based on observation, the licensee did not comply with the section cited above in by having water temp at 133.4F which poses an immediate health, safety or personal rights risk to persons in care.
87309(a)Type A
Based on observation, the licensee did not comply with the section cited above in by having scissors, viatmins, cleaning solutions inaccessible which poses an immediate health, safety or personal rights risk to persons in care.
87411(f)Type B
Based on record review, the licensee did not comply with the section cited above in by not having TB and Health Screenings for all staff which poses a potential health, safety or personal rights risk to persons in care.
87412(a)Type B
Based on record review, the licensee did not comply with the section cited above in by not having complete staff records maintained at the facility which poses a potential health, safety or personal rights risk to persons in care.
87456(a)(2)Type B
Based on record review, the licensee did not comply with the section cited above in by not having pre-admission appraisal for residents in care which poses a potential health, safety or personal rights risk to persons in care.
87457(c)Type B
Based on record review, the licensee did not comply with the section cited above in by not having on file an appraisal of individual service needs which poses a potential health, safety or personal rights risk to persons in care.
87467(a)(3)Type B
Based on record review, the licensee did not comply with the section cited above in by having meeting scheduled with residents and their reps which poses a potential health, safety or personal rights risk to persons in care.
87506(a)Type B
Based on record review, the licensee did not comply with the section cited above in by not having each resident's records available, e.g., R3 which poses a potential health, safety or personal rights risk to persons in care.
87506(b)(11)Type B
Based on record review, the licensee did not comply with the section cited above in by not having health condition for R3 which poses a potential health, safety or personal rights risk to persons in care.
87506(b)(15)Type B
Based on record review, the licensee did not comply with the section cited above in by not having the appraisals completed for residents which poses a potential health, safety or personal rights risk to persons in care.
87506(b)(17)(B)Type B
Based on record review, the licensee did not comply with the section cited above in by not having Functional Capabilities on file for residents in care which poses a potential health, safety or personal rights risk to persons in care.
87506(b)(17)(C)Type B
Based on record review, the licensee did not comply with the section cited above in by not having Mental Conditions for residents in care which posesa potent ial health, safety or personal rights risk to persons in care.
87506(b)(17)(E)Type B
Based on record review, the licensee did not comply with the section cited above in Reappraisals for residents in care which poses a potential health, safety or personal rights risk to persons in care.
87506(b)(9)Type B
Based on record review, the licensee did not comply with the section cited above in by not having resident's records with physician's telephone numbers which poses a potential health, safety or personal rights risk to persons in care.
87508(a)(1)Type B
Based on record review, the licensee did not comply with the section cited above in by not having R3's Medical Assessment on file which poses a potential health, safety or personal rights risk to persons in care.
87508(a)(2)Type B
Based on record review, the licensee did not comply with the section cited above in by not having R3's Medical Assessment which poses a potential health, safety or personal rights risk to persons in care.
87508(a)(3)Type B
Based on record review, the licensee did not comply with the section cited above in by not having R3's information on file which poses a potential health, safety or personal rights risk to persons in care.
87508(b)Type B
Based on record review, the licensee did not comply with the section cited above in by not having resident registry roster completed and on file which poses a potential health, safety or personal rights risk to persons in care.
87508(c)(1)Type B
Based on record review, the licensee did not comply with the section cited above in by not having registry information of all residents which poses a potential health, safety or personal rights risk to persons in care.
87632(d)(2)Type B
Based on record review, the licensee did not comply with the section cited above in by notifying CCL of R2's hospice care which poses a potential health, safety or personal rights risk to persons in care.
87633(b)Type B
Based on record review, the licensee did not comply with the section cited above in by not having hospice care plan for R2 in their file which poses a potential health, safety or personal rights risk to persons in care.
87633(b)(1)Type B
Based on record review, the licensee did not comply with the section cited above in by not having a complete hospice care plan for R2 which poses a potential health, safety or personal rights risk to persons in care.
87633(b)(4)Type B
Based on record review, the licensee did not comply with the section cited above in by not having a hospice care plan for R2's file which poses a potential health, safety or personal rights risk to persons in care.
87633(b)(4)(A)Type B
Based on record review, the licensee did not comply with the section cited above in by not having a complete hospice care plan for R2 which poses a potential health, safety or personal rights risk to persons in care.
87633(h)(1)Type B
Based on record review, the licensee did not comply with the section cited above in by not having in the resident's files an advanced directive which poses a potential health, safety or personal rights risk to persons in care.
87705(f)(2)Type A
Based on observation, the licensee did not comply with the section cited above in by having vitamins unlocked which poses an immediate health, safety or personal rights risk to persons in care.
87303(e)(3)Type A
Based on observation, the licensee did not comply with the section cited above in by having water temp 133.4 which poses an immediate health, safety or personal rights risk to persons in care.
87705(c)(6)Type B
Based on record review, the licensee did not comply with the section cited above in by not having R2's appraisals/reappraisals completed which poses a potential health, safety or personal rights risk to persons in care.
87463(a)Type B
Based on record review, the licensee did not comply with the section cited above in by having reappraisals for residents which poses a potential health, safety or personal rights risk to persons in care.
87507(e)(2)Type B
Based on record review, the licensee did not comply with the section cited above in by not having a copy of Admission Agreement which poses a potential health, safety or personal rights risk to persons in care.

FAQ · About this visit

Common questions about this visit

What happened during the June 27, 2023 inspection of ELISABETH CARE HOME?

This was a inspection inspection of ELISABETH CARE HOME on June 27, 2023. 49 citations were issued: 5 Type A (serious) and 44 Type B.

Were any citations issued to ELISABETH CARE HOME on June 27, 2023?

Yes, 49 citations were issued (5 Type A, 44 Type B). The first citation was for: "Based on record review, the licensee did not comply with the section cited above in by not having Pre-Admission Appraisa..."

What type of inspection was this?

This was a inspection inspection. inspection inspections are conducted by CCLD as part of their licensing oversight.

SourceView on CCLD View original report

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Data from CCLD public records. Last updated May 25, 2026. If you believe any information is inaccurate, report it here.

Routine inspection·June 27, 2023