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Inspection visit

Follow-up on corrections

BLESSED HOMECARE 3License 3459200623 citations on this visit
3 citations recorded

Inspector’s narrative

What the inspector wrote

Licensing Program Analyst (LPA) Cassie Yang arrived unannounced at the facility and observed the following deficiencies. LPA met with S1 and Licensee and explained the purpose of the visit. At entrance, S1 opened the door for LPA. When asked how long has S1 been working at the facility S1 stated "about two months". Based on LIC 500 provided on October 31, 2024 dated October 29, 2024, it listed S1 as a caregiver. Based on LPA's file review of Guardian, S1 does not have a criminal clearance association to the facility. Based on file review of LPA's emails, it revealed Licensee had sent an email to CDSS CCL SAC ACS TRANSFER REQUEST corresponding LPA on September 6, 2024, Licensee sent a photo of S1's DOJ Applicant Fingerprint Response. File review observed on September 9, 2024 LPA responded "Please send all the required documents in order for the regional office to assist with the association." File review, there was no additional response from Licensee. Criminal Clearance Transfer Request LIC 9182 and S1's driver license/proof of identification for S1 has not been received by the Department. Note: facility has been cited for Criminal Record Clearance violation during LPA's visits conducted on 7/18/2024 and 8/20/2024. LPA provid ed a copy of the following Title 22 regulations for Licensee to review: CCR 87355 Criminal Record Clearance CCR 87458 Medical Assessment CCR 87506 Resident Records Please continue report on LIC 809-C. LIC 809-C Additionally, during file review of resident files, facility did not have LIC 602 and/or any medical assessment conducted for R1. When asked, Licensee provided LPA a copy of R1's Skilled Nursing Discharge form. Licensee stated "this is all that they gave me when he came here." LPA and Licensee discussed that prior to admission for residents in care, LIC 602 is required in order for needs and service to be assessed. Licensee stated she did not know it was not the LIC 602. The following form did not have physician's primary diagnosis and secondary diagnosis, Documentation of prior medical services and history and current medical status including, but not limited to height, weight, and blood pressure, Identification of physical limitations of the person to determine his/her capability, determination whether the person is ambulatory or nonambulatory and Information applicable to the pre-admission appraisal. As a result of the inspection, deficiencies were observed and cited. Please see LIC 809-D, additionally, civil penalties accessed. Exit interview conducted and a copy of report and appeal rights provided. Due to Licensee no longer being at the facility, S1 has signed the following report, signature on this form acknowledges receipt.

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.

  • 87405(d)(3)Type B

    87405 Administrator - Qualifications and Duties (d) The administrator shall have the qualifications specified in Sections 87405(d)(1) through (7). If the licensee is also the administrator, all requirements for an administrator shall apply. (3) Ability to maintain or supervise the maintenance of financial and other records. This requirement is not met as evidenced by: Based on file review and interview, Licensee did not comply as R1's skilled nursing facility discharge paperwork was mistaken for LIC 602 which R1 has no current LIC 602 on file, which poses a potential risk for residents in care.

  • 87458(a)Type B

    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. The licensee shall be permitted to use the form LIC 602 (Rev. 9/89), Physician's Report, to obtain the medical assessment. This requirement is not met as evidenced by: Based on file review, Licensee did not comply as R1 did not have a LIC 602 / Medical Assessment present on file which poses a potential risk for residents in care.

  • 1569.312(e)Type A

    §1569.312 Basic services requirements Every facility required to be licensed under this chapter shall provide at least the following basic services: (e) Monitoring the activities of the residents while they are under the supervision of the facility to ensure their general health, safety, and well-being. This requirement is not met as evidenced by: Based on file review of the incident report and interview, Licensee did not comply as R1 left the facility through the front door without staff seeing which poses an immediate health and saftey risk.

  • 87555aType B

    87555 General Food Service Requirements (a) The total daily diet shall be of the quality and in the quantity necessary to meet the needs of the residents and shall meet the Recommended Dietary Allowances of the Food and Nutrition Board of the National Research Council. All food shall be selected, stored, prepared and served in a safe and healthful manner.This requirement is not met as evidenced by: Based on LPA and S1's food inspection, Licensee did not comply as there was a jar of instant coffee in the pantry with expiration date of August 31, 2024, which poses a potential risk for residents in care.

  • 87355(c)Type A

    87355 Criminal Record Clearance(c) A licensee or applicant for a license may request a transfer of a criminal record clearance from one state licensed facility to another, or from Trust Line to a state licensed facility by providing the following documents to the Department:This requirement is not met as evidenced by: Based on observation, file review and interview, the licensee did not comply with the section cited above as S1 was observed to be working but are not associated to the facility roster which poses an immediate health, safety or personal rights risk to persons in care.

FAQ · About this visit

Common questions about this visit

What happened during the November 5, 2024 inspection of BLESSED HOMECARE 3?

This was a other inspection of BLESSED HOMECARE 3 on November 5, 2024. 3 citations were issued: 1 Type A (serious) and 2 Type B.

Were any citations issued to BLESSED HOMECARE 3 on November 5, 2024?

Yes, 3 citations were issued (1 Type A, 2 Type B). The first citation was for: "87405 Administrator - Qualifications and Duties (d) The administrator shall have the qualifications specified in Section..."

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.