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Inspection visit

Follow-up on corrections

DEVONSHIRE ELDERLY CARELicense 1976095005 citations on this visit
5 citations recorded

Inspector’s narrative

What the inspector wrote

On 09/17/24, Licensing Program Analyst (LPAs) Gina Saucedo and Angelica Segovia conducted unannounced, initial visit to this facility in conjunction with a complaint control #31-AS-20240911090516 LPA met with the Caregiver, Farrah Siddiqui and explained the reason for the visit. During the physical tour, LPA conducted a review of records and no incident report-Unusual Incident/Injury Report was sent to Community Care Licensing Department-(CCLD) for any of the residents that have recently gone to a hospital and incidents in the house that involved police activity. Furthermore, there has been changes to the original facility sketch. There was a removal of a garage that was originally in the facility sketch. It is now converted to a three (3) unit living area and has a white gate surrounded the area. The original facility sketch had a clearance for a garage. In addition, there is an individual living in one (1) of the three (3) living areas that is not background cleared. Per the California Code of Regulations, Title 22, Division 6, Chapter 8, deficiencies are cited and noted on LIC 809D. Exit interview conducted, appeal rights and copy of report signed and delivered to the Assistant Administrator.

Citations

5 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.

  • 87202(a)Type A

    (a) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, or the State Fire Marshal. Prior to accepting or retaining any of the following types of persons, the applicant or licensee shall notify the licensing agency and obtain an appropriate fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, or the State Fire Marshal:This requirement is not met as evidenced by: Based on the observation and record review, the licensee did not comply with the section cited above in regards to the garage being converted into three (3) living areas which poses an immediate health, safety or personal rights risk to persons in care.

  • 87208(a)Type A

    (a) Each facility shall have and maintain a current, written definitive plan of operation. The plan and related materials shall be on file in the facility and shall be submitted to the licensing agency with the license application. Any significant changes in the plan of operation which would affect the services to residents shall be submitted to the licensing agency for approval. The plan and related materials shall contain the following:This requirement is not met as evidenced by: Based on the observation, interview and record review, the licensee did not comply with the section cited above in submitting an application for the conversion of the garage into three (3) separate living units which poses/posed an immediate health, safety or personal rights risk to persons in care.

  • 87211(a)1(A)Type A

    87211 (a)(1)(A)Reporting Requirements: (a) Each licensee shall furnish to the licensing agency such reports... including, but not limited to, the following:(1)A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below... This requirement is not met as evidenced by: Based on the LPA observation and interviews the licensee/administrator did not ensure resident reports to be submitted to CCLD from the above facility involving multiple incidents which poses an Immediate Health, Safety or Personal Rights risks to persons in care.

  • 87305(a)Type A

    Prior to construction or alterations, all facilities shall obtain a building permit.This requirement is not met as evidenced by: Based on the observation and record review the licensee did not comply with the section cited above in one out of one area of contruction-removal of a garage and new construction which poses an immediate health, safety or personal rights risk to persons in care.

  • 87355(e)(1)Type A

    Criminal Clearance 87355(e)(1) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (1)Obtain a California clearance or a criminal record exemption as required by the Department This requirement is not met as evidenced by: Licensee failed to obtain criminal clearance/background for the individual that is living in one (1) of the three (3) living areas attached to the above facility which poses an Immediate Health, Safety or Personal Rights risks to persons in care.

FAQ · About this visit

Common questions about this visit

What happened during the September 17, 2024 inspection of DEVONSHIRE ELDERLY CARE?

This was a other inspection of DEVONSHIRE ELDERLY CARE on September 17, 2024. 5 citations were issued: 5 Type A (serious).

Were any citations issued to DEVONSHIRE ELDERLY CARE on September 17, 2024?

Yes, 5 citations were issued (5 Type A, 0 Type B). The first citation was for: "(a) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department or d..."

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 CCLDView original report

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