George Anne Home

Health screening and fitness requirements

PERSONNEL REQUIREMENTS... verified by a health screening, including a chest x-ray or an intradermal test, performed by a physician not more than 6 months prior to or 7 days after employment or licensure. A report shall be made of each screening, signed by the examining physician. This requirement is not met, as health screening for staff #6 was not maintained and not submitted after citations issued on 9/3/24 and 8/27/25. Licensee failed to ensure that health screenings are maintained for all staff, which poses a potential health, safety or personal rights risk.

PERSONAL RIGHTSResidents in all RCFEs shall have the personal right to have access to individual storage space for private use. This requirement is not met, as facility records are stored in client room #4. Licensee failed to ensure that client's room is for client's personal use and not used by staff. This poses a potential health, safety or personal rights risk to clients in care.This was cited on 8/5/25 and 8/27/25 and not corrected.Clients' rooms will be reserved for clients' belongings only, and not for storage of facility equipment or supplies.

Signed rights acknowledgement in resident record

ADMINISTRATOR QUALIFICATIONS & DUTIESThe administrator shall have the qualifications specified in Sections 87405(d)(1) through (7)... Knowledge of and ability to conform to the applicable laws, rules and regulations. This requirement is not met, as demonstrated by repeated non-compliance of licensing requirements. Licensee failed to ensure that facility administrator possesses the ability to oversee facility operations in conformity with Title 22 requirements, which poses a potential health, safety or personal rights risk to clients in care.

Licensee must supervise facility operations

ACCOUNTABILITY OF LICENSEE GOVERNING BODYThe licensee, whether an individual or other entity, shall exercise general supervision over the affairs of the licensed facility and establish policies concerning its operation in conformance with these regulations and the welfare of the individuals it serves. This requirement is not met, as Mr. Gong stated emphatically that he "does not work there" at facility. Licensee failed to exercise general supervision over facility operations, which poses a potential health, safety or personal rights risk to clients in care.

RESUBMISSION OF APPLICATIONA new application shall be made whenever there is any change in conditions or limitations described on the current license, including, but not limited to any change in the licensee. This requirement was not met, as Articles of Organization were filed with the CA Secretary of State on 11/16/2016, but the Dept. was not notified of the change, and a new application was not made.Licensee failed to apply for licensure as an LLC, which poses a potential health, safety or personal rights risk to clients in care.

Store centrally held medications in locked secure place

INCIDENTAL MEDICAL CARECentrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. This requirement is not met, as plastic 7-day pill dispenser is observed in unlocked kitchen drawer, which is accessible to clients. Licensee failed to ensure that medications are inaccessible to residents, which poses an immediate health or safety risk to clients in care.

GENL REQUIREMNTS HEALTH COND.The licensee shall complete & maintain a current, written record of care... that includes, but is not limited to... Documentation from the physician of... Stability of the medical condition, Medical condition which requires incidental medical services, Method of intervention...skilled professional...who will perform the procedure if the resident needs assistance; names...phone number of...skilled professionals providing services, Emergency contacts. Client #4 has gall bladder stoma & there is no info about care or condition. This was cited on 7/31/25.

HEALTH AND SAFETY CODE...employee shall complete 10 hours of initial training...consist of 6 hours of hands-on shadowing training...prior to assisting with the self-administration of medications, & 4 hours of other training or instruction, as described in subdivision (f)...be completed within the first 2 weeks of employment. This requirement is not met, as training records are not available for review. Licensee failed to maintain documentation that staff have received medication training, which poses a potential health, safety or personal rights risk. This was cited on 9/3/24 & 8/5/25.

HEALTH & SAFETY CODEA facility shall provide training on the plan to each staff member upon hire and annually thereafter. The training shall include staff responsibilities during an emergency or disaster. This requirement is not met, as there is no documentation that staff received training on responding to emergencies, which poses a potential health, safety or personal rights risk to clients in care.This deficiency was cited on 9/3/24 and 7/31/25, and proof of correction was not submitted.

HEALTH AND SAFETY CODEAll RCFEs shall provide training to direct care staff on postural supports, restricted conditions or health services, and hospice care as a component of the training requirements specified in Section 1569.625. This requirement is not met, as training records are not available for review. Licensee failed to maintain documentation that staff have received this training, which poses a potential health, safety or personall rights risk. This was cited on 9/3/24 and 8/5/25 and not corrected.

Prohibit false or misleading facility statements

FALSE CLAIMSNo licensee, officer or employee of a licensee shall make or disseminate any false or misleading statement regarding the facility...This requirement was not met, as facility staff obtained personal and confidential information by falsely stating that the information was required by state licensing. Licensee failed to prevent staff from making false claims, which poses an immediate health, safety or personal rights risk to clients in care.This was cited on 8/14/25 and not addressed in plan of correction submitted on 8/18/25.

Health screening and fitness requirements

PERSONNEL REQUIREMENTS... verified by a health screening, including a chest x-ray or an intradermal test, performed by a physician not more than 6 months prior to or 7 days after employment or licensure. A report shall be made of each screening, signed by the examining physician. This requirement is not met, as 6 out of 6 staff files were missing health screenings and TB test results. Licensee failed to ensure that health screenings are maintained for all staff, which poses a potential health, safety or personal rights risk. This was cited on 9/3/24 and not corrected.

Complete admission suitability appraisal

PRE-ADMISSION APPRAISALPrior to admission a determination of the prospective resident's suitability for admission shall be completed and shall include an appraisal of their individual service needs in comparison with the admission criteria specified in Section 87455, Acceptance/Retention LimitS. This requirement is not met, as there is no signed appraisal on file for client #5, who was admitted 3 years ago. This poses a potential health, safety or personal rights risk to clients. This was cited on 9/3/24 and 7/31/25.

Update reappraisal at required intervals

REAPPRAISALSThe pre-admission appraisal... shall be updated in writing as frequently as necessary or once every 12 months, whichever occurs first, to note significant changes in condition... and to keep the appraisal accurate. This requirement is not met as reappraisals for ALL clients are missing or dated more than 12 months ago. Licensee failed to ensure that annual reappraisals are done, which poses a potential health, safety or personal rights risk to clients.This deficiency was observed on 9/3/24 & 7/31/25, & proof of correction was not submitted.

INCIDENTAL MEDICAL CAREFor every Rx and non Rx medication for which the licensee provides assistance there shall be a signed, dated written order from a physician, on a prescription blank, maintained in the residents file, and a label on the medication. Both the MD order & the label shall contain ...specific information. This requirement is not met, as MD orders are not maintained for C3 OTC Senna and C6 Senna Plus. Licensee failed to ensure that MD orders are maintained for OTC meds, which poses a potential health, safety or personal rights risk. This was cited 8/5/25.

INCIDENTAL MEDICAL CAREAll centrally stored medications shall be labeled and maintained in compliance with state and federal laws. No persons other than the dispensing pharmacist shall alter a prescription label. This requirement is not met, as staff write on RX labels. Licensee failed to ensure that staff do not write on Rx labels, which poses a potential health, safety or personal rights risk to clients in care.This was cited on 8/5/25 and not corrected.

INCIDENTAL MEDICAL CARERx medications which are not taken with the resident upon termination of services, not returned to the issuing pharmacy, nor retained in the facility as ordered by the resident’s physician & documented in the resident’s record nor disposed of... shall be destroyed in the facility by the facility administrator & another adult who is not a resident. Both shall sign a record, to be retained for at least 3 years, which lists... specific information. This requirement is not met, as Rx meds for former client observed in kitchen cabinet, which poses a potential health, safety or personal rights risk. This was cited 8/5/25.

Dignity in personal relationships

PERSONAL RIGHTSResidents in all RCFEs shall have... the ... personal right to be accorded safe, healthful &comfortable accommodations, furnishings & equipment. This requirement is not met, as client in room #5 is observed in bed with recliner chair & wheelchair placed next to bed, preventing her from getting out of bed. Licensee failed to ensure that clients are accorded safe & healthful accommodations, which poses an immediate health, safety or personal rights risk to clients in care.This was cited on 8/5/25, and "explanation" was submitted on 8/6/25, not correction.

PERSONAL RIGHTSResidents in all RCFEs shall have the personal right to have access to individual storage space for private use. This requirement is not met, as facility records are stored in client room #4. Licensee failed to ensure that client's room is for client's personal use and not used by staff. This poses a potential health, safety or personal rights risk to clients in care.This was cited on 8/5/25 and not corrected

HEALTH AND SAFETY CODERCFEs shall meet...training requirements, as described in Section 1569.625, for all direct care staff...12 hours of dementia care training, 6 of which...completed before...working independently with residents, and the remaining 6 hours of which shall be completed within the first 4 weeks of employment. This requirement is not met, as training records are not available for review. Licensee failed to maintain documentation that staff have received dementia training, which poses a potential health, safety or personall rights risk. This was cited on 9/3/24 and 8/5/25.

Prohibit false or misleading facility statements

FALSE CLAIMSNo licensee, officer or employee of a licensee shall make or disseminate any false or misleading statement regarding the facility...This requirement was not met, as facility staff obtained personal and confidential information by falsely stating that the information was required by state licensing. Licensee failed to prevent staff from making false claims, which poses an immediate health, safety or personal rights risk to clients in care.

Licensee responsibility for records confidentiality

RESIDENT RECORDSAll information & records obtained from or regarding residents shall be confidential. The licensee shall be responsible for storing...records & for safeguarding the confidentiality of their contents. The licensee & all employees shall reveal or make available confidential information only upon the resident's written consent or... designated representative. This requirement was not met, as staff shared unsolicited personal and confidential client information via text to another client's responsible party. Licensee failed to ensure the confidentiality of client information, which poses an immediate health, safety or personal rights risk to clients in care.

Health screening and fitness requirements

PERSONNEL REQUIREMENTS... verified by a health screening, including a chest x-ray or an intradermal test, performed by a physician not more than 6 months prior to or 7 days after employment or licensure. A report shall be made of each screening, signed by the examining physician. This requirement is not met, as 6 out of 6 staff files were missing health screenings and TB test results. Licensee failed to ensure that health screenings are maintained for all staff, which poses a potential health, safety or personal rights risk. This was cited on 9/3/24 and not corrected.

INCIDENTAL MEDICAL CAREFor every Rx and non Rx medication for which the licensee provides assistance there shall be a signed, dated written order from a physician, on a prescription blank, maintained in the residents file, and a label on the medication. Both the physician's order and the label shall contain ...specific information. This requirement is not met, as MD orders are not maintained for C3 OTC Senna and C6 Senna Plus. Licensee failed to ensure that MD orders are maintained for OTC meds, which poses a potential health, safety or personal rights risk

HEALTH AND SAFETY CODEAll RCFEs shall provide training to direct care staff on postural supports, restricted conditions or health services, and hospice care as a component of the training requirements specified in Section 1569.625. This requirement is not met, as training records are not available for review. Licensee failed to maintain documentation that staff have received this training, which poses a potential health, safety or personall rights risk. This was cited on 9/3/24 and not corrected, as staff #6 did not have proof of training on hospice care, restricted health conditions.

HEALTH AND SAFETY CODERCFEs shall meet...training requirements, as described in Section 1569.625, for all direct care staff...12 hours of dementia care training, 6 of which...completed before...working independently with residents, and the remaining 6 hours of which shall be completed within the first 4 weeks of employment. This requirement is not met, as training records are not available for review. Licensee failed to maintain documentation that staff have received dementia training, which poses a potential health, safety or personall rights risk. This was cited on 9/3/24, as staff #6 did not have dementia training.

Dignity in personal relationships

PERSONAL RIGHTSResidents in all RCFEs shall have... the ... personal right to be accorded safe, healthful &comfortable accommodations, furnishings & equipment. This requirement is not met, as client in room #5 is observed in bed with recliner chair and wheelchair placed next to bed, preventing her from getting out of bed. Licensee failed to ensure that clients are accorded safe & healthful accommodations, which poses an immediate health, safety or personal rights risk to clients in care.

INCIDENTAL MEDICAL CAREAll centrally stored medications shall be labeled and maintained in compliance with state and federal laws. No persons other than the dispensing pharmacist shall alter a prescription label. This requirement is not met, as staff write on RX labels. Licensee failed to ensure that staff do not write on Rx labels, which poses a potential health, safety or personal rights risk to clients in care.

OXYGEN ADMINISTRATION..."No Smoking-Oxygen in Use" signs shall be posted in the appropriate areas.This requirement was not met, as there were no oxygen in use signs posted on 7/31/25 during initial annual inspection, which poses a potential health, safety or personal rights risk.

INCIDENTAL MEDICAL CARERx medications which are not taken with the resident upon termination of services, not returned to the issuing pharmacy, nor retained in the facility as ordered by the resident’s physician & documented in the resident’s record nor disposed of... shall be destroyed in the facility by the facility administrator & another adult who is not a resident. Both shall sign a record, to be retained for at least 3 years, which lists... specific information. This requirement is not met, as Rx meds for former client observed in kitchen cabinet, which poses a potential health, safety or personal rights risk.

HEALTH AND SAFETY CODE...employee shall complete 10 hours of initial training...consist of 6 hours of hands-on shadowing training...prior to assisting with the self-administration of medications, & 4 hours of other training or instruction, as described in subdivision (f)...be completed within the first 2 weeks of employment. This requirement is not met, as training records are not available for review. Licensee failed to maintain documentation that staff have received medication training, which poses a potential health, safety or personal rights risk. This was cited on 9/3/24, as staff #6 did not have medication training.

PERSONAL RIGHTSResidents in all RCFEs shall have the personal right to have access to individual storage space for private use. This requirement is not met, as facility records are stored in client room #4. Licensee failed to ensure that client's room is for client's personal use and not used by staff. This poses a potential health, safety or personal rights risk to clients in care.

GENL REQUIREMNTS HEALTH COND.The licensee shall complete & maintain a current, written record of care... that includes, but is not limited to... Documentation from the physician of... Stability of the medical condition, Medical condition which requires incidental medical services, Method of intervention...skilled professional...who will perform the procedure if the resident needs assistance; names...phone number of...skilled professionals providing services, Emergency contacts. Client #4 has gall bladder stoma & there is no information about care or condition.

HEALTH & SAFETY CODEA facility shall provide training on the plan to each staff member upon hire and annually thereafter. The training shall include staff responsibilities during an emergency or disaster. This requirement is not met, as there is no documentation that staff received training on responding to emergencies, which poses a potential health, safety or personal rights risk to clients in care.This deficiency was cited on 9/3/24 and proof of correction was not submitted.

HEALTH & SAFETY CODEA facility shall conduct a drill at least quarterly for each shift...type of emergency... shall vary. An actual evacuation...is not required... Documentation... shall include the date, the type of emergency covered...names of staff participating in the drill. This requirement is not met, as documentation of emergency drills does not clearly indicate what was done, which poses a potential health, safety or personal rights risk to clients in care.This deficiency was cited on 9/3/24 and proof of correction was not submitted.

Limit operations to licensed capacity

LIMITATIONS - CAPACITY & AMBULATORY STATUSA licensee shall not operate a facility beyond the conditions and limitations specified on the license, including specification of the maximum number of persons who may receive services at any one time. This requirement is not met, as client #1 is determined by MD to be bedridden, but facility is not licensed for bedridden clients. Licensee failed to ensure operation within limits of license, which poses a potential health, safety or personal rights risk to clients in care.

Certified administrator requirements and substitute coverage

ADMIN QUALIFICATIONS DUTIESAll facilities shall have a qualified and currently certified administrator. This requirement is not met, as proof of a certified RCFE administrator is not available. Licensee failed to ensure there is a certified RCFE administrator, which poses a potential health, safety or personal rights risk to clients in care.

First aid training requirements

PERSONNEL REQUIREMENTSStaff providing care shall receive appropriate training in first aid from persons qualified by such agencies as the American Red Cross. This requirement is not met, as 5 out of 6 staff do not have proof of current first aid training, which poses a potential health, safety or personal rights risk to clients in care.

PERSONNEL RECORDSThe licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain specific information. This requirement is not met, as staff records for 6 out of 6 files reviewed are missing job applications, health screenings, including TB test results, criminal record statements. Licensee failed to ensure required staff records are maintained, which poses a potential health, safety or personal rights risk to clients.This was observed on 9/3/24 and not corrected.

PRE-ADMISSION APPRAISALPrior to admission a determination of the prospective resident's suitability for admission shall be completed and shall include an appraisal of their individual service needs in comparison with the admission criteria specified in Section 87455, Acceptance/Retention LimitS. This requirement is not met, as there is no signed appraisal on file for client #5, who was admitted 3 years ago. This poses a potential health, safety or personal rights risk to clients. This was cited on 9/3/24.

Update reappraisal at required intervals

REAPPRAISALSThe pre-admission appraisal... shall be updated in writing as frequently as necessary or once every 12 months, whichever occurs first, to note significant changes in condition... and to keep the appraisal accurate. This requirement is not met as reappraisals for ALL clients are missing or dated more than 12 months ago. Licensee failed to ensure that annual reappraisals are done, which poses a potential health, safety or personal rights risk to clients.This deficiency was observed on 9/3/24 and proof of correction was not submitted.

REAPPRAISALSThe licensee shall request that all residents receive an annual routine visit with a licensed medical professional... every 12 months...Documentation.. shall be added to the resident's record...of a resident's refusal...shall be added to the resident's record. This requirement is not met, as MD assessments for 3 out of 6 client were done over 3 years ago or not maintained. Licensee failed to ensure annual MD assessments, which poses a potential health, safety or personal rights risk. NO MD report for C2, MD reports for C5 & C6 dated 2022. This deficiency observed 9/3/24.

Maintain an approved first aid kit on-site

INCIDENTAL MEDICAL CARE... a complete first aid kit shall be maintained and be readily available in a specific location in the facility. The kit shall be...approved by the American Red Cross, or shall contain at least... current edition of a first aid manual approved by the American Red Cross, the American Medical Association or a state or federal health agency. This requirement is not met, as there is no first-aid manual available, which poses a potential health, safety or personal rights risk to clients in care.

Maintain separate complete record for each resident

RESIDENT RECORDSEach resident’s record shall contain…Resident's legal name…Social Security number, Date of admission…Last known address, Birthdate, Religious preference, if any…Names, address, and telephone numbers of the resident’s representative … to be notified in case of emergency, Name, address, phone number of physician and dentist to be called in an emergency. This requirement is not met, as there is no emergency informatiion maintained for 3 out of 6 clients, which poses a potential health, safety or personal rights risk. No emergency info for C1, C2, C4

Maintain physician order documentation in resident record

POSTURAL SUPPORTSA written order from a physician indicating the need for the postural support shall be maintained in the resident’s record.This requirement is not met, as there are no MD orders maintained for 4 out of 6 clients who have half bed rails. Licensee failed to maintain MD orders for use of half bed rails, which poses a potential health, safety or personal rights risk to clients in care.This deficiency was cited on 9/3/24 and proof of correction was not submitted.

Based on observation, the licensee did not comply with the section cited above, as there are discarded walkers, mattresses, furniture and 13 oxygen tanks in backyard, which poses a potential health, safety or personal rights risk to persons in care.

Provide resident hot water for personal care

Based on observation, the licensee did not comply with the section cited above, as hot water temperature tested at 128 degrees in rear common bathroom. This poses an immediate health, safety or personal rights risk to persons in care.

Ensure hazardous items are locked and not unattended

Based on observation, the licensee did not comply with the section cited above, as cleaning liquids are stored where accessible to clients. In bathroom in room #1 and common bathroom, purple liquid Fabuloso is stored. Pine Sol, degreaser, and other cleaning liquids are stored in unlocked cabinet under kitchen sink, and gallon of Clorox bleach observed in backyard in gazebo.This poses an immediate health, safety or personal rights risk to persons in care.

Health screening and fitness requirements

Based on staff records review, the licensee did not comply with the section cited above in 3 out of 6 staff files reviewed, which poses a potential health, safety or personal rights risk to persons in care.There is no health screening and TB test result for staff #2 and #3. Staff #1 has no health screening on file.

Complete admission suitability appraisal

Based on client records review, the licensee did not comply with the section cited above in 1 out of 6 client files reviewed, which poses a potential health, safety or personal rights risk to persons in care.There is no appraisal on file for client #5, who was admitted over 2 years ago.

Store centrally held medications in locked secure place

Based on observation, the licensee did not comply with the section cited above, as clients' medications are stored in unlocked cabinets in hallway and kitchen, which poses an immediate health, safety or personal rights risk to persons in care.

Right to personal privacy in daily care

Based on observation, the licensee did not comply with the section cited above, as there is a chair used to weigh all clients stored in room #4 for lack of a common storage area for the chair.This poses a potential health, safety or personal rights risk to persons in care.

Signed rights acknowledgement in resident record

Based on client records review, the licensee did not comply with the section cited above in 2 out of 6 client files reviewd, which poses a potential health, safety or personal rights risk to persons in care.Personal rights forms are incomplete or missing for clients #1 and #2.

Maintain physician order documentation in resident record

Based on client records review, the licensee did not comply with the section cited above in 6 out of 6 client files reviewed, which poses a potential health, safety or personal rights risk to persons in care.All clients have half bed rails on bed, but there are no MD orders on file.

Based on review of staff training records, the licensee did not comply with the section cited above, as there is no evidence that staff have received required dementia training.This poses a potential health, safety or personal rights risk to persons in care.

Based on review of client records, the licensee did not comply with the section cited above in 4out of 6 client files reviewed, which poses a potential health, safety or personal rights risk to persons in care.Clients #1, #3, #4, #6 are diagnosed with dementia, but MD reports and appraisals are dated more than 12 months ago.

Based on staff records review, the licensee did not comply with the section cited above, as there is no documentation that staff received 4 hours of training on postural supports, restricted health conditions, and hospice care.This poses a potential health, safety or personal rights risk to persons in care.

Based on absence of documentation and confirmation from staff, the licensee did not comply with the section cited above, as there is no documentation that of emergency drills.This poses a potential health, safety or personal rights risk to persons in care.

Based on staff records review, the licensee did not comply with the section cited above, as staff have not received training on responding to emergencies. This poses a potential health, safety or personal rights risk to persons in care.

Based on staff records review, the licensee did not comply with the section cited above, as there is no documentation that staff who handle or manage medications have received required medications training.This poses a potential health, safety or personal rights risk to persons in care.

Citation deleted

Right to personal privacy in daily care

Based on observation, there is a chair used to weigh all clients stored in room #4 for lack of a common storage area for the chair. Licensee failed to ensure client's right to personal accommodations by storing facility equipment in client's room. This poses a potential health, safety or personal rights risk to persons in care.

Right to confidential records and approved disclosure

ADDITIONAL PERSONAL RIGHTSIn addition to the rights listed in 87468.1, residents in privately operated RCFEs shall have the personal right to have their records and personal information remain confidential and to approve their release, except as authorized by law. This requirement was not met, as a video recording was made by staff and sent to client's NP without consent of client or responsible party. Licensee failed to protect confidentiality of client's personal information, which posed a potential personal rights risk to clients in care.

Store centrally held medications in locked secure place

Based on observation, clients' medications that are refrigerated are stored in unlocked small refrigerator in hallway, and excess medications are stored in unlocked drawer in hallway. Licensee failed to ensure that medications are inaccessible to clients, which poses an immediate health, safety or personal rights risk to persons in care.

Provide resident hot water for personal care

Based on observation, the licensee did not comply with the section cited above, as hot water temperature tested at 125 degrees F in middle common bathroom, which poses an immediate health, safety or personal rights risk to persons in care.

Address and clearance obligations before facility work

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, obtain a California clearance or a criminal record exemption as required by the Department. Based on presence of staff J.G.who does not have criminal record clearance, the licensee did not comply with the section cited above, which poses an immediate health, safety or personal rights risk to persons in care. Staff J.G. completed the application to obtain a criminal record clearance, but clearance has not yet bee granted. Civil penalty of $500 is assessed today--$100/day for maximum 5 days.

Ensure hazardous items are locked and not unattended

Based on observation with administrator,two cans of paint and lighter fluid are stored in unlocked rear storage shed with sliding door and general cleaning supplies and chemicals are stored in another unlocked storage shed with double doors. The licensee did not comply with the section cited above, as toxins were stored where items are accessible to clients, which poses an immediate health, safety or personal rights risk to persons in care.