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Inspection visit

Routine inspection

PACIFIC CARE HOME VLicense 4156010813 citations on this visit
3 citations recorded

Inspector’s narrative

What the inspector wrote

LPA Audrey Jeung toured facility and grounds. There are 6 private client rooms--2 of which have private bathrooms--a staff room, 2 common bathrooms, living/dining area, kitchen, and 2-car garage, where the washer and dryer are located. There is a daybed in the garage which is used by staff on breaks. No accessible bodies of water or fire safety hazards observed. PPE supply is adequate. Toxins and sharps are stored appropriately and inaccessible to clients, a comfortable temperature is maintained, and lighting is sufficient for comfort and safety. Toilet and bathing facilities are equipped with grab bars and nonskid flooring material. Soap and paper towels--or cloth towels in private bathrooms--are available at all sinks. First-aid kit is inspected and complete. A Disaster and Mass Casualty Plan is posted. There are 6 residents present, and 3 staff. Criminal record clearances or exemptions for facility staff or other individuals who have client contact have been reviewed, as well as staff records. Moddie Andaya and Billy Ick (x 3/24 ) are certified RCFE administrators that oversee facility operations. Client records, including medications are reviewed. The following updated forms are requested to be submitted to CCLD BY 5/17/24: • LIC 308 Designation of Administrative Responsibility • LIC 500 Personnel Report (including specific hours when administrators are present in facility) • LIC 309 Administrative Organization Proof of current liability insurance is given to LPA today. Deficiencies of the RCFE California Code of Regulations, Title 22, Division 6, Chapter 8 are observed and cited on a following page. See also Advisory Notes--4 pages.

Citations

3 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.

  • 87355(e)(2)Type A

    Obtain required California clearance or exemption

    CRIMINAL BACKGROUND CLEARANCEAll individuals subject to a criminal record review pursuant to HSC 1569.17(b) shall prior to working, residing or volunteering in a licensed facility, request a transfer of a criminal record clearance as specified in Section 87355(c). This requirement was not met, as staff #1 does not have criminal record clearance associated to this facility. Licensee failed to ensure that all staff have criminal record clearance associated to facility, which poses an immediate health and safety risk to clients in care.

  • 87411(c)(1)Type B

    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 was not met, as staff #1 and #2 do not have current first aid training. Licensee failed to ensure that caregivers have current first-aid training, which poses a potential health, safety, or personal rights risk to clients in care.

  • 87465(h)(2)Type A

    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 hall cabinet where medications are secured is unlocked upon LPA's arrival. Also, Clearlas for client 2 & Miralax for client 5 are stored in unlocked kitchen cabinet.Licensee failed to ensure that medications are inaccessible to clients, which poses an immediate health and safety risk to clients in care.

FAQ · About this visit

Common questions about this visit

What happened during the May 3, 2024 inspection of PACIFIC CARE HOME V?

This was an inspection of PACIFIC CARE HOME V on May 3, 2024. 3 citations were issued: 2 Type A (serious) and 1 Type B.

Were any citations issued to PACIFIC CARE HOME V on May 3, 2024?

Yes, 3 citations were issued (2 Type A, 1 Type B). The first citation was for: "CRIMINAL BACKGROUND CLEARANCEAll individuals subject to a criminal record review pursuant to HSC 1569.17(b) shall prior ..."

What type of inspection was this?

This was an inspection. 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.