Golden Star Home

Based on LPA and admin observation, the licensee did not comply with the section cited above in that sharp knives in kitchen unlocked and not secure accessible to resident in care including chemicals in laundry room not locked which posed an immediate health, safety or personal rights risk to persons in care.

Based on LPA and admin observation licensee did not comply with the section cited above in that vermin and/or rodent droppings found throughout garage and kitchen floor of facility which posed a potential health, safety or personal rights risk to persons in care.

Based on LPA and admin observation and record review, the licensee did not comply with the section cited above facility Unable to provide proof of disaster drills being conducted which poses a potential health, safety or personal rights risk to persons in care.

Reporting Requirements 87211(a)(1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below. [....] This requirement is not met as evidenced by: LPA obtained “Narrative Charting” notes for R1 which state that R1 was sent to the hospital via 911 twice in September 2023, the resident was admitted, and facility did not submit incident reports, which poses a potential health, safety, and/or personal rights violation to residents in care.

Based on LPA and admin observation the licensee did not comply with the section cited above in that Rodent droppings found in storage room and staff room in garage and bathtub faucet/spiket is broken and hanging down, which posed a potential health, safety or personal rights risk to persons in care.

Based on LPA and admin observation and interview, the licensee did not comply with the section cited above in that Monoxide detectors located throughout the facility were not operational as the actual detector was removed and not connected to the wires in the ceiling have batteries which posed an immediate health, safety or personal rights risk to persons in care.

Based on LPA and admin observation and record review, the licensee did not comply with the section cited above in that S1 is a part time employee. Training for S1 not present or on file which poses a potential health, safety or personal rights risk to persons in care.

Based on LPA and admin observation and interview the licensee did not comply with the section cited above in that Backyard is not accessible to residents as many trenches are open, exposing pipes and presenting tripping hazards. Additionally, pavers present but scattered and stacked among mounds of dirt which poses/posed a potential health, safety or personal rights risk to persons in care.

Based on LPA and admin observation, the licensee did not comply with the section cited above in that sharp knife found in kitchen drawer unlocked. Sharps container found in kitchen counter accessible to residents, which posed an immediate health, safety or personal rights risk to persons in care.

Based on LPA and admin observation and record review the licensee did not comply with the section cited above in that medications found accessible to residents which poses an immediate health, safety or personal rights risk to persons in care.

Based on LPA and Admin observation and record review the licensee did not comply with the section cited above in that CSML not completed for all residents requiring medication administration which poses an immediate health, safety or personal rights risk to persons in care.

Based on LPA and admin observation the licensee did not comply with the section cited above in that Frozen chilis found opened and uncovered in freezer expired from October 2024. Frozen mushrooms found with black and brown substance unwrapped. Head of lettuce found in overflow refrigerator with black and brown substance with pooling liquid in wrapping. Bread packages found expired from March 2025. Rice found with bugs and rodent droppings which posed a potential health, safety or personal rights risk to persons in care.

Based on LPA and admin observation the licensee did not comply with the section cited above in that R2 bedroom, room #2 has noticable dor of incontinence which poses a potential health, safety or personal rights risk to persons in care

87411 Personnel Requirements - General(c) All RCFE staff who assist residents with personal activities of daily living shall receive initial and annual training as specified in Health and Safety Code sections 1569.625 and 1569.69This requirement is not met as evidenced by: Licensee was unable to provide LPA proof of completed annual training and medication training hours for both S1 and S2.

§1569.5 Regulations authorizing temporary respite care for frail elderly persons...(a)...may require screening of persons to determine the level of care required, a physical history completed by the person’s personal physician....This requirement is not met as evidenced by: I1 observed in facility receiving respite care without any documentation, including but not limited to: a contract, centrally stored medication destruction log, physician's medical assessment, proof of negative TB results, a care plan, consent for emergency medical treatment, etc.

87411Personnel Requirements - General (g) Prior to ... initial presence in the facility, all employees...shall:...Request a transfer of a criminal record clearance as specified in Section 87355(c).This requirement is not met as evidenced by: S2 was not associated to the facility on the Guardian roster.

87412 Personnel Records(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee.This requirement is not met as evidenced by: Licensee was unable to provide LPA proof of required personnel documentation for S2.

Based on observation, the licensee did not comply with the section cited above because the front door has a latch that is attached to the door frame and extends over the door and has key that requires it to be opened. The front and back door both have a latch that is attached to the door frame and when pushed up is able to cover part of the front door and then pushed down which locks it in place but does not require a lock. Both prevents residents from exiting which poses an immediate health, safety or personal rights risk to persons in care.

Based on observation, the licensee did not comply with the section cited above because the front door's audio alarm is turned off which poses an immediate health, safety or personal rights risk to persons in care.

Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in [count] out of [total count] [(objects) (persons)] [identifiers] which poses/posed a potential health, safety or personal rights risk to persons in care.

cited in error

Based on interviews with both staff members, LPA learned that the licensee did not comply with the section cited above due to the facility not conducting an Emergency Disaster Drill this year. This regulation poses/posed a potential health, safety or personal rights risk to persons in care.

Based on records review and interviews R1 missed two dosages of medication which poses an immediate risk to the health and safety of residents in care.

Based on today's inspection and review of The Guardian, the licensee did not comply with the section cited above in 2 out of 2 individuals residing in the home did not have the proper fingerprint transfer association to this facility which poses/posed a potential health, safety or personal rights risk to persons in care.

80072 Personal Rights (a)... residential facilities, each client shall have personal rights which include, but are not limited to, the following: (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs. This requirement has not been met as evidence by: Based on observation, Licensee did not ensure the personal rights of persons in care a safe & health accomodations. R1 body covered in ants and feces. which poses/posed an immediate health, safety or personal rights risk to persons in care.

87555(b)(8) General Food Service Requirements:(b) The following food service requirements shall apply: (8) All food shall be of good quality.This requirement was not met as evidenced by: Based on observations, Administrator did not ensure the regulation above due to uncovered food, expired fresh food, and canned foods. This a potential health & safety risk to residents in care.

87464 Basic Services Basic services shall at a minimum include: (1) Care & supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). This requirement is not met as evidenced by: Based on observation and interviews, the licensee did not provide care and supervision for R2.which posed an immediate risk to health and safety.