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Inspection visit

Routine inspection

PACIFIC CARE HOME IIILicense 4156009334 citations on this visit
4 citations recorded

Inspector’s narrative

What the inspector wrote

On April 23, 2024 Licensing Program Analyst(LPA) Murial Han conducted an unannounced annual inspection. LPA was greeted by caregiver, Emily Soriano. LPA explained the purpose of the visit. Facility supervisor, Moddie Andaya arrived toward the end of the inspection and assisted with the rest of the inspection. LPA toured facility and grounds. No accessible bodies of water. LPA toured inside and outside including all of resident rooms, common areas, and kitchen area. The indoor and outdoor passageways were free of obstruction. Comfortable temperature is maintained and lighting is sufficient for comfort. LPA observed 5 resident rooms. Rooms were spacious and included all required furnishings. Bathrooms were observed to be clean; equipped with paper towels, soap, grab bars, and non-skid mats. Hot water temperature in the kitchen, and bathroom was measured at 107- 110 degrees F. 2 days for perishables and & 7 days non-perishable were observed to be present. During the tour of the garage, LPA observed chemicals were unlocked and accessible to residents. LPA also observed the garage was sectioned off in the middle; one side is for laundry, toxins and chemical storage, etc. and the other side consisted of: futon beds, clothing, plastic shoe storage unit, closet, toiletries, and a blue luggage. Medication cabinet, located in the kitchen area, was reviewed. Chemical was observed to be unlocked underneath the kitchen sink. Linen closet, located in the hallway, was observed to contain a sufficient supply of towels, blankets, and linens to meet the needs of the residents at this time. Facility was not able to provide documentation that emergency drills were conducted. Facility is equipped with smoke detectors and carbon monoxide detectors. Fire extinguisher was last inspected on 10/19/2023. A review of (4) facility resident records was conducted; A review of (2) facility staff records was conducted and 1 file was not available for review and according to the supervisor this staff just starting working at this facility yesterday and the file is still at one of the sister facilities. During today's inspection, there were 4 residents and 2 staff present. LPA requested these documents to be submitted by 4/24/2024: a copy of the administrator certification. Civil penalty is being assess today for repeat violation during the annual inspection on 10/14/2023. Based on observation, deficiency is cited under California Code of Regulations, Title, 22 cited on the LIC 809D. Failure to correct the deficiencies may result in civil penalties. This report is reviewed and discussed with administrator and supervisor. A copy is provided and the appeal rights

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.

  • 1569.695(c)Type A

    Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above as facility was not able to provide documents that emergency drill were conducted which poses an immediate health, safety or personal rights risk to persons in care.

  • 87305(a)Type A

    Requirement for building permit before construction

    Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above as LPA observed garage has livable items such as toiletries, futon beds, personal hygiene items, clothing, shoes, etc. which poses an immediate health, safety or personal rights risk to persons in care.

  • 87309(a)Type A

    Ensure hazardous items are locked and not unattended

    Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above as LPA observed chemicals in the kitchen area and in the garage are unlocked and accessible to residents which poses an immediate health, safety or personal rights risk to persons in care.

  • 87755(c)Type B

    Authority to audit and copy facility records

    Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above as 1 out of 3 staff personnel file was not available for review during the inspection which poses/posed a potential health, safety or personal rights risk to persons in care.

FAQ · About this visit

Common questions about this visit

What happened during the April 23, 2024 inspection of PACIFIC CARE HOME III?

This was an inspection of PACIFIC CARE HOME III on April 23, 2024. 4 citations were issued: 3 Type A (serious) and 1 Type B.

Were any citations issued to PACIFIC CARE HOME III on April 23, 2024?

Yes, 4 citations were issued (3 Type A, 1 Type B). The first citation was for: "Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above as facili..."

What type of inspection was this?

This was an inspection. Inspections are conducted by CCLD as part of their licensing oversight.

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