Aaa Residential Elderly Retreat #3

Type of visit: Required - 1 Year

On 6/30/26 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 Staff (S1) Alexis Bell. LPA was granted entry. 2 residents were present during inspection. 1 resident was attending day program. Administrator (A1) Sheila Dillard arrived shortly after LPA’s arrival. LPA toured facility with S1. 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. Samples of resident’s medications were checked and observed locked in kitchen cabinet. Clients’ MARS was reviewed. Fire extinguisher reviewed with a purchase date of: 10/30/25. Fire drill completed on 6/1/26. Clients' bedrooms were toured and reviewed. Cleaning chemicals were observed stored and locked in kitchen cabinet. Resident’s bedrooms 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 117.6 degrees in 1 bathroom. Outside of facility toured. Outside observed free of debris. Side gate was self-closing and self-latching. Outside was observed with adequate outdoor seatings available for clients. Freezer temperature observed at 5 degrees F and refrigerator temperature maintained at 25 degrees F. Smoke detectors and carbon monoxide were tested and observed to be operational. All client’s and samples of staff files reviewed to have all the required documents. The following deficiencies is being cited on the attached 809D in accordance with California Code of Regulations, Title 22, Division 6. Exit Interview conducted. LPA is requesting the following documents be submitted to the Fresno CCL office by 7/14/26: Current copy of Administrator Certificate, Designation of Facility Responsibility (LIC308), Administrator Organization (LIC 309), Affidavit regarding Client/Resident Cash Resources (LIC 400), Liability Insurance, Emergency and Disaster Plan (LIC 610E), Personnel Report (LIC500), Register of Facility Clients/Residents for (LIC9020A) A copy of this report with Appeal Rights were provided to A1, whose signature on this form confirms receipt of this report.the state’s words, verbatim · CDSS document, Jun 30, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Rachel Bruce arrived announced to conduct the Annual inspection. LPA met with Administrator Sheila Dillard (AD) and explained the purpose of the visit. Facility was toured with AD. Currently there are two residents living in this home, one was present and one was at day program. During this visit, LPA toured the facility inside & out. Facility has 3 Resident bedrooms and two bathrooms. Facility observed to be clean, odor free and at a comfortable temperature. Common areas were furnished well with adequate seating and lighting available. Living room has sufficient seating for 6 residents. Fireplace observed clean and properly covered with glass covering. AD explained that it is inoperable and is not being used. Dining room has dining table and chairs sufficient for 6. LPA observed an adequate supply of linen in hallway closet. Combo Alarm for Carbon Monoxide and smoke detection in the entryway and bedrooms tested and found to be operational. Resident bathroom is properly equipped with securely fastened grab bars in toilet and tub/shower areas, non-skid mat, paper towels were observed. Hot water measured 105.7 degrees F. Bedrooms appeared clean and contained mattresses and bedding in good condition. Lighting was appropriate. All bedrooms are set up to be shared by two residents. At the time of the inspection two bedrooms had only one bed to potentially accommodate a hospital bed should an incoming resident have one. Smoke detectors in bedrooms were tested and found to be operational. Windows are operable with screens in good condition. Bathroom in Bedroom 3 is allocated for staff. This bathroom does not have grab bars in toilet or shower/tub areas. Extra resident hygiene supplies are stored in entry way closet. This closet is kept locked and also contains cleaning supplies and will store resident medications. AD has individual bins allocated for residents and a small locked box for refrigerated medications. Knives are stored in this closet. First aid kit reviewed and found to contain required items. LPA observed that the kitchen was well maintained, with working lights and well maintained appliances. The kitchen counters and sink are free from debris. LPA observed a trash bin with the lid in cabinet. LPA observed refrigerator/freezer are well maintained and clean. LPA observed a 2 day perishable food supply. The kitchen pantry was clean, organized, and had 7 days of non-perishable food. A fire extinguisher is mounted on the wall with the correct pressure gauge as indicated on the meter. Receipt of purchase accessible and checked by LPA. LPA observed that the backyard is well maintained, bushes and grass in good condition. Facility has covered patio with table and chairs for 6. Doors and passageways are unobstructed throughout the facility including outdoors. Self latching gate on the side of the yard was found to be in need of adjustment. LPA conducted staff file and resident file reviews. Required documentation present and organized. No citations issued at today's visit. An exit interview was conducted. A copy of this report provided to AD, whose signature on this form confirms receipt of these documents.the state’s words, verbatim · CDSS document, Jun 5, 2025

Allegation investigated: Staff did not transport resident to medical appointment in a timely manner.

Licensing Program Analysts (LPA)'s Shawna Doucette conducted an unannounced complaint visit and was granted entry by Administrator Sheila Dillard. LPA's explained the purpose of the visit. LPA conducted interviews and reviewed records. Based on interviews, LPA is unable to determine if there was a time staff refused to take a resident to a medical appointment. Based on record reviews and interviews, Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. An exit interview was conducted and a copy of this report was provided. Unsubstantiated Based on the Departments interviews and record review, this agency has investigated the complaint alleging, Questionable Death,Staff did not inform resident's responsible party of resident's change in condition and Staff did not address resident's change in condition We have found that the complaint was UNFOUNDED, which means it could not have happened, and/or is without a reasonable basis, therefore we have dismissed the complaint. An exit interview was conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Nov 8, 2024 · control 24-AS-20240708092417

Type of visit: Case Management - Incident

On 10/15/2024, Licensing Program Analyst (LPA) R Bruce conducted a Case Management visit. This visit was conducted at the AAA Residential Elderly Retreat on Monitor Ave as LPA was meeting with Administrator and conducted inspection. LPA explained the purpose of the case management was to discuss recent Incident Reports (IR) submitted to CCL. LPA reviewed and discussed IR dated 9/27/24 regarding a decline in health for resident R1. An updated incident report will be submitted informing CCL that the resident has returned home. He has been provided a hospital bed and a request for home health services. Staff will continue to monitor. LPA reviewed and discussed IR dated 9/22/24 regarding Resident R2. R2 had been to the hospital to be treated for an infection on his arms and legs. LPA was told that the Resident has very poor hygiene and as a result of that his extremities had become infected. Staff continues to encourage him regarding hygiene practices. No deficiencies cited during visit.the state’s words, verbatim · CDSS document, Oct 15, 2024

Type of visit: Case Management - Other

On 10/03/2024, Licensing Program Analysts (LPAs) M. Medina and R. Bruce conducted an unannounced Case Management visit. LPAs introduced self, stated purpose of visit, and allowed entrance by Licensee, Sheila Dillard. LPAs conducted visit to follow up on incident reports that were submitted to this department. An incident report for R1 which occurred on 9/19/24 for R2 which occurred on 9/24/24. LPAs reviewed resident files and requested the following documents for both R1 and R2: Physician's report and Appraisal/Needs and Services Plan and hospital discharge paperwork. No deficiencies cited during visit.the state’s words, verbatim · CDSS document, Oct 3, 2024

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Lissett Padgett arrived announced to conduct the Annual inspection. LPA met with Administrator Sheila Dillard (AD) and explained the purpose of the visit. Facility was toured with AD. Currently there are no residents living in this home. During this visit, LPA toured the facility inside & out. Facility has 3 Resident bedrooms and two bathrooms. Facility observed to be clean, odor free and at a comfortable temperature, 70 degrees per hallway thermostat. Common areas were furnished well with adequate seating and lighting available. Living room has sectional, with sufficient seating for 6 residents. Fireplace observed clean and AD explained that it is inoperable and will not be used. Dining room has dining table and chairs sufficient for 6. LPA observed an adequate supply of linen in hallway closet. Combo Alarm for Carbon Monoxide and smoke detection in the entryway tested and found to be operational. Resident bathroom is properly equipped with securely fastened grab bars in toilet and tub/shower areas, non-skid mat, paper towels were observed. Hot water measured 116.6 degrees F. Bedrooms appeared clean and contained mattresses and bedding in good condition. Lighting was appropriate. All bedrooms are set up to be shared by two residents. Smoke detectors in bedrooms were tested and found to be operational. Windows are operable with screens in good condition. Bathroom in Bedroom 3 is allocated for staff. This bathroom does not have grab bars in toilet or shower/tub areas. Hot water measured 118.8 degrees F. Extra resident hygiene supplies are stored in entry way closet. This closet is kept locked and also contains cleaning supplies and will store resident medications. AD has individual bins allocated for residents and a small locked box for refrigerated medications. Knives are stored in this closet. First aid kit reviewed and found to contain required items. LPA observed that the kitchen was well maintained, with working lights and well maintained appliances. The kitchen counters and sink are free from debris. LPA observed a trash bin with the lid in cabinet. LPA observed refrigerator/freezer are well maintained and clean. LPA observed a 2 day perishable food supply. The kitchen pantry was clean, organized, and had 7 days of non-perishable food. A fire extinguisher is mounted on the wall with the correct pressure gauge as indicated on the meter. LPA observed required paper products. LPA, observed that the backyard is well maintained, bushes and grass in good condition. Facility has covered patio with table and chairs for 6. Doors and passageways are unobstructed throughout the facility including outdoors. Self latching gate on the side of the yard was found to be in working order. Smoke and Carbon Monoxide detectors tested and found to be functioning. LPA conducted staff file reviews. Administrator’s re-certification was confirmed to be in active status and was received by the Department as required. An exit interview was conducted. A copy of this report provided to AD, whose signature on this form confirms receipt of these documents.the state’s words, verbatim · CDSS document, May 2, 2024