Carmel Village Memory Care

Type of visit: Required - 1 Year

On 8/6/2026, Licensing Program Analyst LPA J. Leffall arrived at the facility unannounced to conduct the Required Annual Inspection. LPA were greeted by receptionist, stated the purpose of the visit and met with Health Services Coordinator (HSC) Diana Gomez. Administrator (A1) Deanne Edwards joined in shortly after LPA’s arrival. LPA conducted tour of facility with HSC and A1. Residents were observed in activity room. The facility was observed to be at a comfortable temperature, clean, in good repair with no passageway obstructions or fire hazards. Fire extinguisher was observed with a service date of: 11/13/2025. Kitchen was toured. An adequate supply of perishable and non-perishable food was observed to be properly stored in freezer and refrigerator. Refrigerator temperature was observed maintained at 39 degrees F. and freezer was observed maintained at 0 degrees F. All chemicals were in locked storage. LPA toured a sample of resident bedrooms, activity room, dining room and enclosed patio area. Residents' rooms were toured and observed with adequately furnished bed, dresser, and adequate lighting. LPA observed securely fastened grab bars next to toilet and all tub/shower areas. 5 out of 5 residents rooms observed with non-skid shower strips. 5 out of 5 residents bathroom temperatures measured at a range of 107.9 to 110.5 degrees F. LPA completed a medication audit. Medications were stored in a locked medication room in a medication cart. MARs and medications were reviewed. Centrally Stored Medication Record observed. Samples of staff files were reviewed to have the required documents. Samples of resident’s files were reviewed to have all the required documents. No deficiencies issued during today's inspection. An exit interview was conducted with Administrator and Health Services Coordinator. A copy of this report was discussed and provided to Health Services Coordinator whose signature on this form confirms receipt of this document.the state’s words, verbatim · CDSS document, Aug 6, 2026

Type of visit: Case Management - Deficiencies

On 8/12/25, 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 7/28/25, in which R1’s medication order was delayed thus missed 2 doses of scheduled administering. LPA met with Administrator (A1) Linda Pope. On 8/7/25 the facility completed Med Aide training with staff and completion sheet submitted to CCLD. A citation is issued on the attached 809-D wtih appeal rights regarding medications not ordered timely.the state’s words, verbatim · CDSS document, Aug 12, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(4) · Plan of correction due date: Aug 13, 2025

a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following: (4) The licensee shall assist residents with self-administered medications as needed. Based on records reviewed and interviews conducted, R1’s medication orders were delayed, thus doses were missed, which poses an immediate Health & Safety risk to the residents.the state’s words, verbatim · CDSS document, Aug 12, 2025

Plan of correction: Licensee agrees to conduct in-service training and submit completion documents to CCLD by POC due date.

Type of visit: Required - 1 Year

On 8/12/2025, Licensing Program Analysts LPA J. Leffall arrived at the facility unannounced to conduct the Required Annual Inspection. LPAs were greeted by receptionist, stated the purpose of the visit and met with Administrator (A1) Linda Pope. LPA conducted tour of facility with A1. Residents were observed in activity room. The facility was observed to be at a comfortable temperature, clean, in good repair with no passageway obstructions or fire hazards. Fire extinguisher was observed with a service date of: 11/18/2024. Kitchen was toured. An adequate supply of perishable and non-perishable food was observed to be properly stored in freezer and refrigerator. Refrigerator temperature was observed maintained at 38 degrees F. and freezer was observed maintained at -2 degrees F. All chemicals were in locked storage. LPA toured a sample of resident bedrooms, activity room, dining room and enclosed patio area. Residents' rooms were toured and observed with adequately furnished bed, dresser, and adequate lighting. LPA observed securely fastened grab bars next to toilet and all tub/shower areas. 5 out of 5 residents rooms observed with non-skid shower strips. 5 out of 5 residents bathroom temperatures measured at a range of 106.7 to 107.2 degrees F. LPA completed a medication audit. Medications were stored in a locked medication room in a medication cart. MARs and medications were reviewed. Centrally Stored Medication Record observed. Samples of staff files were reviewed to have the required documents. Samples of resident’s files were reviewed to have all the required documents. No deficiencies issued during today's inspection. An exit interview was conducted with Licensee. A copy of this report was discussed and provided to Administrator whose signature on this form confirms receipt of this document.the state’s words, verbatim · CDSS document, Aug 12, 2025

Type of visit: Case Management - Other

On 4/11/25, 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 3/10/25, in which R1, and R2 was given medication of the incorrect dosage. LPA met with Administrator (A1) Linda Pope. A1 stated that the facility completed medication training with staff and completion sheet submitted to CCLD. A citation is issued on the attached 809-D regarding medications and R1 being given incorrectly.the state’s words, verbatim · CDSS document, Apr 11, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(4) · Plan of correction due date: Apr 12, 2025

(a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following: (4) The licensee shall assist residents with self-administered medications as needed. Based on records reviewed and interviews conducted, R1 and R2 was given the incorrect dosage of medications, which poses an immediate Health & Safety risk to the residents.the state’s words, verbatim · CDSS document, Apr 11, 2025

Plan of correction: Licensee agrees to conduct in-service training and submit completion documents to CCLD by POC due date.

Type of visit: Case Management - Incident

On 2/6/25, 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 1/22/25, in which Resident’s personal rights were violated during meal time at facility. An internal investigation was conducted and it was concluded that Staff (S1) and (S2) were adjusting resident’s meals. Per LIC-624 the facility completed a termination of S1 and S2. The document with Plan of Correction (POC), Mandated Reporting protocol (AB-1417 (2023), Resident Rights in Assisted Living, and Managing Malnutrition and Dehydration forms were submitted to CCLD. A citation is issued on the attached 809-D regarding client’s Personal Rights.the state’s words, verbatim · CDSS document, Feb 6, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.2 · Plan of correction due date: Feb 7, 2025

87468.2 Additional Personal Rights of Residents in Privately Operated Facilities (a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (5) To be served food of the quality and quantity necessary to meet their nutritional needs. This requirement was not met as evidenced by the facility’s report and investigation that 2 staff scrapped food off resident’s plate prior to serving them, which poses a potential health, safety, and personal rights risk.the state’s words, verbatim · CDSS document, Feb 6, 2025

Plan of correction: Licensee agrees to terminate the 2 Caregiver employees for violating residents’ personal rights. Notify resident’s RP’s who reside on South Hallway who were potentially impacted by the violation incident. Conduct Inservice training that includes: -Generations MC Dining Room Policy and Procedures -Resident Personal Rights -Mandated Reporter Expectations -Managing Mealtime with Dementia Enroll all MC Caregivers and MC med aides in the following Relias Courses. They include: -Abuse, Neglect, and Exploitation in the Elder Care Setting -Resident Rights in Assisted Living -Managing Malnutrition and Dehydration Continue to monitor and document the monthly weight of all residents. Notify MD per policy of weight changes month-over-month. Supervisor(s) will randomly monitor dining room activity; goal is to validate training is now a BEST PRACTICE(S)

Type of visit: Required - 1 Year

On 9/4/2024, Licensing Program Analysts (LPAs) J. Leffall and K.Kaur arrived at the facility unannounced to conduct the Required Annual Inspection. LPAs were greeted by receptionist, stated the purpose of the visit and met with Administrator (A1) Linda Pope. LPA’s conducted tour of facility with A1. Residents were observed, dining area and activity room. The facility was observed to be at a comfortable temperature, clean, in good repair with no passageway obstructions or fire hazards. Fire extinguisher was observed with a service date of: 11/21/2023. Kitchen was toured. An adequate supply of perishable and non-perishable food was observed to be properly stored in freezer and refrigerator. Refrigerator temperature was observed maintained at 35 degrees F. and freezer was observed maintained at 0 degrees F. Ice machine was observed with yellow discoloring and half of the mechanism had black spots over the yellow discoloration. All chemicals were in locked storage. LPAs toured a sample of resident bedrooms, activity room, dining room and enclosed patio area. Residents' rooms were toured and observed with adequately furnished bed, dresser, and adequate lighting. LPAs observed securely fastened grab bars next to toilet and all tub/shower areas. 6 out of 6 residents rooms observed with non-skid shower strips. 6 out of 6 residents bathroom temperatures measured at 107.4, 106.3, 108.7, 109.3, 105.9, and 106.9 degrees. LPAs completed a medication audit. Medications were stored in a locked medication room in a medication cart. MARs and medications were reviewed. Review of Centrally Stored Medication Record revealed R1’s medication log was incomplete. Based on record review LPAs observed 1 out of 1 residents medication count was over the required amount. A sample of staff files were reviewed to have the required documents. A sample of resident’s files were reviewed to have all the required documents. Deficiencies are being cited on the attached 809D in accordance with California Code of Regulations, Title 22,Division 6. An exit interview was conducted with Licensee. Report signed on-site; a copy of this report, 809D with appeal rights was provided.the state’s words, verbatim · CDSS document, Sep 4, 2024