Inspection visit

Routine inspection (multi-day)March 16, 2022

DEVONSHIRE ELDERLY CARELicense 1976095003 citations on this visit

3 citations recorded

Inspector’s narrative

What the inspector wrote

On 03/16/2022 Licensing Program Analyst (LPAs) Joscelyn Martinez, Melissa Ruiz and Long-Term Care Ombudsman Velvet Tabb arrived at the facility mentioned above for an unannounced annual continuation. Upon arrival LPAs and Ombudsman were greeted by staff Maria Bangash. This continued annual is focused on physical plant and health and safety. A physical tour was conducted at 9:45 a.m and observed the following: Infection control: Covid-19 infection control signage were observed outside of the facility. Proper signage was also observed inside in the common areas. Upon entrance, staff took LPAs’ temperature and was asked to sign-in the visitor’s log. Food Inspection/Kitchen: LPAs observed there to be sufficient stock of one-week non-perishable foods and two-day perishable foods. Food storage and preparation areas were dirty and need immediate cleaning. All three (3) refrigerators in the facility were observed to have food stains, crumbs, and old liquid spills from frozen meats. Kitchen cabinets are in disrepair. LPAs observer water damage underneath the sink. Garbage cans did not have a tight-fitting lid in the kitchen. Sharps and some medications were centrally stored in a locked area. LPAs observed two plastic containers of medication accessible to residents inside the kitchen cabinet. Smoke detectors/carbon monoxide are located throughout the facility and are hardwired. Fire alarm and carbon monoxide alarm were tested at 12:07 p.m and appear to be functional. Fire extinguishers was observed in the facility with a purchase date of 02/22/22. Continue on 809-C Common Areas: All common areas were observed to be cleaned and properly furnished. Facility maintains a comfortable temperature of 71.0 F. The facility does not have a working telephone. LPA Martinez attempted using the phone, but the phone indicated “no line”. LPA Martinez observed cleaning chemical in the living room closet and accessible to residents. Facility has many cracks throughout the walls which need repair. Resident room s: There are eight (8) rooms which of three (3) are designated for staff use. All bedrooms were toured and were properly furnished and have appropriate bedding and linens. One of the shared bedrooms had a strong urine smell. This same bedroom also had an outlet with no cover and an exposed wire. Bathrooms: There are five and a half (5 1/2) bathrooms which of three (3) are for residents. The hot water temperature measured at 142.7 degrees Fahrenheit. One of the bathrooms did not have a trash can with a tight-fitting lid and did not contain a non-skid mat. Cleaning solution was observed inside the bathroom drawer and accessible to residents. This same restroom has a broken screen on the window that leads to the front of the house. Outside areas: LPAs toured the outside area of the facility. There is a separate unit which contains three (3) different rooms. These rooms are being used for Airbnb. The Airbnb guest have access to the house and the shared laundry area. There is an additional storage that contains the washer and dryer along with tools and chemicals. This unit is not locked and accessible to residents. LPAs observed appropriate outdoor furniture, with a covered shaded area for residents. There is an empty jacuzzi on the side of the house that is not being used. Currently there is only one staff available to work in the facility. Staff members Maria stated that all of the other staff members are out of the country and do not have a current return date. LPAs reminded Maria that if she is the only staff available, she cannot leave the facility and needs to hire additional staff immediately. Citations will be addressed in a complaint visit done concurrently with today’s annual report. Per California code Title 22 regulations issued. See 809Ds attached to this report. Report signed and delivered. Exit interview conducted. Appeal Right Issued.

Citations

10 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.

87303(e)(2)Type A
Based on water temperature measurement, the licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care.
87311Type A
Based on observation the licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care.
87204(a)Type A
87204(a) Limitations-Capacity and Ambulatory Status. A licensee shall not operate a facility beyond the conditions and limitations specified on the license including the maximum number of persons who may receive services at any one time.This requirement is not met as evidenced by: Based on LPAs observation on an annual visit on 3/10/22, the licensee did not comply with the section cited above as 7 residents were living at this facility which poses an immediate health, safety or personal rights risk to persons in care.
87303(a)Type B
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.This requirement is not met as evidenced by: Based on LPA observation during the annual conducted concurrently today, bathrooms were observed to be unsanitary, one bedroom had a strong urine smell, and the refrigerators were contaminated with old food spills including old packaged meat liquids.This poses a potential health, safety or personal rights risk to persons in care.
87307(d)(2)Type B
87307 Personal Accommodations and Services (d) (2) The premises shall be maintained in a state of good repair and shall provide a safe and healthful environment.This requirement is not met as evidenced by: Based on LPA observation during the annual conducted concurrently today, two window screens are in disrepair, facility has large cracks in walls, kitchen cabinets are in disrepair, one fire alarm detector is in disrepair, staff bedroom door is broken, staff bedroom wall has a hole, and outlet covers are missing and have exposed wires in one of the bedrooms. This poses a potential health, safety or personal rights risk to persons in care.
87411(a)Type A
87411(a) Personnel Requirements-General. Personnel shall at all times be sufficient in numbers and competent to provide the services necessary to meet resident needs.This requirement is not met as evidenced by: Based on LPA observation and interviews, the licensee failed to provide sufficient staff for residents in care. There was one (1) staff member for six (6) residents in care.
87506(a)Type B
87506 Resident Records a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff.This requirement is not met as evidenced by: Based on observation, interview and record review, the Administrator failed to provide two (2) out of sixe (6) resident records. This poses a potential health, safety or personal rights risk to persons in care.
87506(c)(1)Type B
78506(c) All information and records obtained from or regarding residents shall be confidential. (1) The licensee shall be responsible for storing active and inactive records and for safeguarding the confidentiality of their contents. The licensee and all employees shall reveal or make available confidential information only upon the resident's written consent or that of his designated representative.This requirement is not met as evidenced by: Based on observation, the Administrator did not ensure that resident records remain confidential as they were located in a shared bookshelf in one of the bedrooms. This poses a potential health, safety or personal rights risk to persons in care.
87303(e)(5)Type B
Based on observation, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.
87705(f)(1)(2)Type A
87705 (f)(1)(2) The following shall be stored inaccessible to residents with dementia: (1) Knives, matches, firearms, tools and other items that could constitute a danger to the resident(s). (2) Over-the-counter medication, nutritional supplements or vitamins, alcohol, cigarettes, and toxic substances such as certain plants, gardening supplies, cleaning supplies and disinfectants.This requirement is not met as evidenced by: Based on LPAs observations, the Administrator did not ensure that medications, tools, and cleaning supplies were inaccesible to residents in care. This poses an immediate health, safety or personal rights risk to persons in care due to dementia residents in care.

FAQ · About this visit

Common questions about this visit

What happened during the March 16, 2022 inspection of DEVONSHIRE ELDERLY CARE?

This was a other inspection of DEVONSHIRE ELDERLY CARE on March 16, 2022. 3 citations were issued: 2 Type A (serious) and 1 Type B.

Were any citations issued to DEVONSHIRE ELDERLY CARE on March 16, 2022?

Yes, 3 citations were issued (2 Type A, 1 Type B). The first citation was for: "Based on water temperature measurement, the licensee did not comply with the section cited above which poses an immediat..."

What type of inspection was this?

This was a other inspection. other 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 (multi-day)·March 16, 2022