Skip to main content
ReadyRule homepageReadyRule

Inspection visit

Follow-up on corrections

HUMBLE HAVEN RCFE IILicense 1976100084 citations on this visit
4 citations recorded

Inspector’s narrative

What the inspector wrote

Licensing Program Analyst (LPA) Melissa Spaeth conducted an unannounced case management visit and was greeted by the caregiver. An Informal Meeting was conducted at the Woodland Hills Office on 9/17/2024 with the Licensee, Nicole De Las Alas. LPM Troy Agard discussed the deficiencies cited at the facility during an annual visit conducted on 08/07/2024. LPA Spaeth reviewed the deficiencies with the Licensee and informed the Licensee the deficiencies must be cleared by Tuesday, 9/24/2024. Upon arrival, LPA explained the purpose of the visit was to review the residents' files and receive a copy of a staff member’s (S2) CPR/First Aid training certificate. LPA Spaeth received a copy during the visit LPA toured the facility at 10:20 am until 10:55 am. At 10:45 am, LPA observed a bedridden resident was not in the designated bedridden room. At 11:00 am, LPA observed the auditory device on the front door and the exit doors to Rooms 2 and 5 were not working. LPA Spaeth reviewed the resident's files at 11:15 am until 12:00 pm. LPA observed five out of five residents' files were missing the I.D & Emergency Information form (LIC 601) and Personal Rights form. LPA also observed four out of the five residents are on hospice care. However the facility has an approved hospice waiver for three residents. Pursuant to Title 22 Division 6 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D). Exit interview conducted, Appeal Rights discussed, and a copy of the signed report was given.

Citations

4 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)(2)Type A

    87202(a)(2) All facilities shall maintain a fire clearance approved by fire dept... Prior to accepting any of the following types of persons, licensee shall obtain an appropriate fire clearance approved by fire dept, (2) Bedridden persons. This requirement is not met as evidenced by The Licensee failed to follow Title 22 Regulations regarding approved fire clearance, by placing bedridden resident R1 to the room that had no bedridden fire clearance. This poses an immediate health and safety risk to residents in care.

  • 87506(b)(8)Type B

    87506 Resident Records (b) each resident’s record shall contain….(8) names, address, & telephone numbers of resident’s representative….. This is evidenced by: LPA Spaeth observed the five residents' files did not contain a completed LIC 605 I.D. & Emergency Information and LIC 613C Personal Rights documents

  • 87632(a)(1)Type B

    87632 Hospice Care Waiver (a) In order to accept or retain terminally ill residents & permit them to receive care from a hospice agency, the licensee shall have obtained a facility hospice waiver …(1) Specification of the maximum number of terminally ill resident which the facility wants to have…. This is evidenced by: The facility has an approved hospice waiver for three residents. However, LPA observed there are four out of five residents who are on hospice.

  • 87705(j)Type A

    87705 Care of Persons with Dementia (j) The licensee shall have an auditory device…to monitor exits, if exiting presents a hazard to any resident. This requirement is not met as evidenced by: Due to LPA's observations, the Licensee failed to ensure the auditory devices were working at the front door and exit doors in Rooms 2 and 5

FAQ · About this visit

Common questions about this visit

What happened during the September 25, 2024 inspection of HUMBLE HAVEN RCFE II?

This was a other inspection of HUMBLE HAVEN RCFE II on September 25, 2024. 4 citations were issued: 2 Type A (serious) and 2 Type B.

Were any citations issued to HUMBLE HAVEN RCFE II on September 25, 2024?

Yes, 4 citations were issued (2 Type A, 2 Type B). The first citation was for: "87202(a)(2) All facilities shall maintain a fire clearance approved by fire dept... Prior to accepting any of the follow..."

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

Share this reportEmail

Next steps

If this is your facility,claim this pageand correct anything the record gets wrong. Free.

Researching this visit professionally?Book a 15-minute calland we will walk through what we have on file.

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