Hepzebah House

Requirements: (a) Each licensee shall furnish to the licensing agency such reports... (1) A written report shall be submitted to the licensing agency and to the person... ... any of the events specified in (A), (B) & (D)...This requirement is not met as evidenced by: Based on interviews and record reviews conducted by LPA, the licensee did not comply with the section cited above by failing to notify CCLD regarding R1's hospitalization on 05/03/26, which poses a potential health and safety risk to persons in care.

Obtain required California clearance or exemption

Criminal Record Clearance: (d) All individuals subject to criminal record review shall be fingerprinted and sign a Criminal Record Statement under penalty of perjury.This requirement is not met as evidenced by: Based on LPA interview and record review, licensee did not comply with the section cited above by failing to obtain S1's fingerprint clearance prior to employement. This poses an immediate health, safety or personal rights risk to persons in care.

Basic Services: (a) The services... shall be conducted so as to continue and promote, to the extent possible, independence and self-direction for all persons accepted for care...This requirement is not met as evidenced by: Based on the credible witnesses visit conducted on 05/03/26, the licensee did not comply with the section cited above by not changing R1's soiled incontinence brief, which posed a potential health, safety, and personal rights risk to persons in care.

Incidental Medical...: Emergency care requirements shall include the following: (1) The name, address, telephone number of each resident's physician... shall be readily available to... and facility staff.This requirement is not met as evidenced by: Based on credible witnesses visit conducted on 05/03/26, licensee did not comply with the section cited above by failing to provide R1's emergency record during 911 visit. This poses a potential health, safety, and personal rights risk to persons in care.

Passageways and stairways kept clear

Personal Accommodations and Services:(d) The following space and safety provisions shall apply to all facilities: (6) All outdoor and indoor passageways and stairways shall be kept free of obstruction.This requirement is not met as evidenced by: Based on LPAs observation, licensee did not comply with the section cited above by not ensuring that the outside (front) hose is away from the ramp and properly placed/rolled on a hook. This poses a potential health, safety, and personal rights risk to persons in care.

Based on interview, the licensee did not comply with the section cited above by failing to obtain/maintain liability insurance as required, which poses a potential health, safety, and personal rights risk to persons in care.

Maintain separate complete record for each resident

Based on record review, the licensee did not comply with the section cited above. Resident records were incomplete and or missing documents, which poses/posed a potential health, safety or personal rights risk to persons in care.

Maintain required personnel records for staff

Based on record review, the licensee did not comply with the section cited above. Upon LPA's request Licensee/Administrator was unable to provide S1's facility records. LPA was informed that S1 got hired on 01/15/2024 and no file was completed. This poses/posed a potential health, safety or personal rights risk to persons in care.

Based on observation, interview, and record review, the licensee did not comply with the section cited above in two out of two incidents reports for R4 were not submitted to the department which poses/posed a potential health, safety or personal rights risk to persons in care.

Based on interview, the licensee did not comply with the section cited above by failing to obtain/maintain liability insurance as required which poses a potential health, safety, and personal rights risk to persons in care.

Based on interviews, the licensee failed to ensure that the administrator had knowledge of licensing rules and regulations which poses an immediate health and safety risk to the residents in care.

Based on interview and record review, the licensee did not comply with the section cited above to ensure that CSMDR were properly documented for accountability. R1’s medication was not documented properly. This poses an immediate health and safety risk to residents in care.

Maintain separate complete record for each resident

87506 Resident Records: (a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident...This requirement is not met as evidenced by: Based on record review, the licensee did not comply with the section cited above. Resident records were incomplete and or missing documents, which poses/posed a potential health, safety or personal rights risk to persons in care.

Maintain required personnel records for staff

87412 Personnel Records: (a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information:This requirement is not met as evidenced by: Based on record review, the licensee did not comply with the section cited above. Upon LPA's request Licensee/Administrator was unable to provide S1's facility records. LPA was informed that S1 got hired in Fabruary 2023 and no file was completed. This poses/posed a potential health, safety or personal rights risk to persons in care.

Maintain separate complete record for each resident

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 was not met as evidenced by: Based on record review and interviews, the licensee did not comply with the section ctied above in at least 1 resident which poses a potential Health, Safety, or Personal Rights risk to persons in care.

Complete admission suitability appraisal

87457 Pre-Admission Appraisal - General (c) Prior to admission a determination of the prospective resident's suitability for admission shall be completed and shall include an appraisal of his/her individual service needsThis requirement was not met as evidenced by: Based on record review and interviews, the licensee did not comply with the section ctied above in 1 out of 5 residents which poses a potential Health, Safety, or Personal Rights risk to persons in care.

Obtain baseline medical assessment before resident admission

87458 Medical Assessment (a) Prior to a person's acceptance as a resident, the licensee shall obtain and keep on file, documentation of a medical assessment, signed by a physician, made within the last year.This requirement is not met as evidence by: Based on records review, R1, R2, and R3 did not have Physician Reports or medical assesments in their facility files. This poses a potential health and safety risk to residents in care.

Document behavioral expression and related causes

87463 Reappraisals (c) The licensee shall arrange a meeting with the resident... when there is significant change in the resident’s condition, or once every 12 months, whichever occurs first.This requirement is not met as evidenced by: Based on records review, R1, R2, and R3 did not have reappraisails in their facility files.This poses a potential health and safety risk to residents in care.

87355 Criminal Record Clearance (a) The Department shall conduct a criminal record review of all individuals... and shall have the authority to approve or deny a facility license, or employment, residence, or presence in the facility, based upon the results of such review.This requirement is not met as evidence by: Based on LPA observations and interviews, the individual providing supervision to residents in care did not submit a criminal background clearance to the department. This poses an immediate health and safety risk to residents in care.