Catuira Home II

Type of visit: Case Management - Annual Continuation

On 8/27/26 Licensing Program Analyst (LPA) J. Leffall arrived unannounced to conduct an Annual Inspection. LPA introduced self, stated the purpose of the visit, and was greeted by Administrator (A1) Camala Kopacz. LPA was granted entry. 4 residents were present during inspection and the other 2 attended Day Program. LPA toured facility with A1. The facility was observed to be at a comfortable temperature, clean, in good repair, and no passageway obstructions or fire hazards were observed inside. An adequate supply of perishable and non-perishable food was observed. Freezer temperature was maintained at 0 degrees F and refrigerator temperature was maintained at 38 degrees F. Fire extinguisher was observed with a purchase date of: 7/6/26. Fire drill last completed on 7/7/26. Washer and dryer observed operational during visit. Carbon monoxide and smoke detectors were tested and observed to be operational. Residents' bedrooms were toured and observed to be adequately furnished with bed, dresser, and adequate lighting. All bathrooms are toured and observed to be operational. Hot water temperature was tested at a temperature range of 117.8 to 119.4 in 2 bathrooms. Non-skid mat and grab bars observed in bathrooms. Outside of facility toured. Side gate was self-closing and self-latching. Outside was observed with adequate outdoor seatings available for residents. A sample of medications were checked and observed kept locked in the hall closet. Residents’ MARS was reviewed. First aide kit observed with all of the required items. Samples of residents and a sample of staff files reviewed to have all the required documents. No deficiencies issued during this inspection. Exit Interview conducted. LPA is requesting the following documents be submitted to the Fresno CCL office by 9/10/26: Current copy of Administrator Certificate, Designation of Facility Responsibility (LIC308), Administrator Organization LIC 309, Affidavit regarding Client/Resident Cash Resources LIC 400, Liability Insurance-RCFE, Emergency and Disaster Plan LIC 610E, Personnel Report LIC500, Register of Facility Clients/Residents for LIC9020A A copy of this report was distributed to Administrator whose signature confirms receipt of this report.the state’s words, verbatim · CDSS document, Aug 27, 2026

Type of visit: Case Management - Deficiencies

On 8/27/26, Licensing Program Analyst (LPA) J. Leffall conducted a case management visit to follow up and confirm details of an incident report that was received by the Department. The incident occurred on 8/3/26, in which some of R1, R2, and R3’s medication was given but S1 did not initial on multiple dates. LPA met with Administrator Camalah Kopacz. S1’s employment has been terminated as a result of the multiple medication errors. A citation and civil penalty are being issued on the attached 809-D and 421FC regarding medication errors. A copy of this report with Appeal Rights were issued to Staff Oscar Aninon because Administrator had to leave. Staff's signature confirms receipt of this report.the state’s words, verbatim · CDSS document, Aug 27, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(c)(3) · Plan of correction due date: Aug 27, 2026

(c) If the resident's physician has stated in writing that the resident is unable to determine his/her own need for nonprescription PRN medication, but can communicate his/her symptoms clearly, facility staff designated by the licensee shall be permitted to assist the resident with self-administration, provided all of the following requirements are met: (3) A record of each dose is maintained in the resident's record. The record shall include the date and time the PRN medication was taken, the dosage taken, and the resident's response. This requirement is not met as evidenced by: Based on observation, interview, record review, the licensee did not comply with the section cited above in multiple medications for R1, R2 and R3 were administered but not signed/initialed on the correct dates which poses an immediate health, safety or personal rights to persons in care. POCthe state’s words, verbatim · CDSS document, Aug 27, 2026

Plan of correction: On 8/14/26 Staff completed medication training.

Allegation investigated: Facility is not meeting resident's dietary needs. Facility is not meeting resident's hygiene needs. Facility staff is not answering the facility phone.

On 11/13/25 at 1:00pm Licensing Program Analyst (LPA) J. Leffall conducted an initial complaint visit to open and to deliver findings on above allegations. LPA met with Administrator (A1) Camalah Kopacz. The Department conducted interviews with staff, residents and reviewed facility and resident records. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did occur, therefore the allegation is Unsubstantiated. No deficiencies were issued. Exit interview conducted. A copy of this report was distributed to Staff Ann Marie Bushay which confirms signature of this report. Unsubstantiatedthe state’s words, verbatim · CDSS document, Nov 13, 2025 · control 24-AS-20251106163018

Type of visit: Required - 1 Year

On 9/3/25 Licensing Program Analyst (LPA) J. Leffall arrived unannounced to conduct an Annual Inspection. LPA introduced self, stated the purpose of the visit, and was greeted by Staff (S1) Oscar Aninon. Administrator Camala Kopacz did not attend visit as she is out of the country. LPA was granted entry. 4 residents were present during inspection and the other 2 attended Day Program. Staff (S2) Ann Marie Bushay was present during the visit as well. LPA toured facility with S2. The facility was observed to be at a comfortable temperature, clean, in good repair, and no passageway obstructions or fire hazards were observed inside. An adequate supply of perishable and non-perishable food was observed. Freezer temperature was maintained at -0 degrees F and refrigerator temperature was maintained at 38 degrees F. Fire extinguisher was observed with a purchase date of: 5/20/25. Fire drill last completed on 7/11/24. Washer and dryer observed operational during visit. Carbon monoxide and smoke detectors were tested and observed to be operational. Residents' bedrooms were toured and observed to be adequately furnished with bed, dresser, and adequate lighting. All bathrooms are toured and observed to be operational. Hot water temperature was tested at a temperature of 107.2 degrees in bathroom 1 and 1112.8 degrees F. in bathroom 2. Non-skid mat and grab bars observed in bathrooms. Outside of facility toured. Side gate was self-closing and self-latching. Outside was observed with adequate outdoor seatings available for residents. A sample of medications were checked and observed kept locked in the hall closet. Residents’ MARS was reviewed. 2 medications were observed to be signed/initialed on the wrong dates. First aide kit observed with all of the required items. All residents and a sample of staff files reviewed to have all the required documents. The following deficiency is being cited on the attached 809D in accordance with California Code of Regulations, Title 22, Division 6. Exit Interview conducted. The following documents requested to be updated and submitted to Fresno CCL by 09/17/25: Lic 308, Lic 500, Lic 610E, Current Liability Insurance and current Administrator’s certificate. A copy of this report was provided to S2, whose signature on this form confirms receipt of these report.the state’s words, verbatim · CDSS document, Sep 3, 2025

Type of visit: Required - 1 Year

On 9/6/24 Licensing Program Analysts (LPA) J. Leffall and R. Bruce arrived unannounced to conduct an Annual Inspection. LPAs introduced selves, stated the purpose of the visit, and was greeted by Administrator (A1) Camala Kopacz. LPAs were granted entry. 4 residents were present during inspection and the other 2 attended Day Program. LPAs toured facility with A1. The facility was observed to be at a comfortable temperature, clean, in good repair, and no passageway obstructions or fire hazards were observed inside. An adequate supply of perishable and non-perishable food was observed. Freezer temperature was maintained at -8 degrees F and refrigerator temperature was maintained at 39 degrees F. Fire extinguisher was observed with a purchase date of: 5/16/24. Fire drill last completed on 7/11/24. Washer and dryer observed operational during visit. Carbon monoxide and smoke detectors were tested and observed to be operational. Residents' bedrooms were toured and observed to be adequately furnished with bed, dresser, and adequate lighting. All bathrooms are toured and observed to be operational. Hot water temperature was tested at a temperature of 108 degrees in bathroom 1 and 108 degrees F. in bathroom 2. Non-skid mat and grab bars observed in bathrooms. Outside of facility toured. Side gate was self-closing and self-latching. Outside was observed with adequate outdoor seatings available for residents. A sample of medications were checked and observed kept locked in kitchen cabinet. Residents’ MARS was reviewed. First aide kit observed with all of the required items. All residents and a sample of staff files reviewed to have all the required documents. No deficiencies issued during this inspection. Exit Interview conducted. The following documents requested to be updated and submitted to Fresno CCL by 09/20/24: Lic 308, Lic 500, Lic 610E, Current Liability Insurance and current Administrator’s certificate. A copy of this report was provided to Designee, whose signature on this form confirms receipt of these report.the state’s words, verbatim · CDSS document, Sep 6, 2024