California Mentor-Marineview Home

Type of visit: Case Management - Incident

On 8/10/2026 at 1:30 pm, Licensing Program Analyst (LPA) Y. Brown arrived unannounced to conduct a case management visit in regards to a self reported incident report. LPA met with Administrator, Precious Yepez and explained the purpose of the visit. Based on the incident report, on 7/25/2026 resident (R1) was not given their 8:00 am medication. S1 stated that on 7/26/2026, S4 noticed that R1's 8:00 am morning medication of 1 dose of Phenobarbital 60 mg and 1 dose of Phenobarbital 15 mg was missed on 7/25/2026 while S4 observed R1's bubble pack. S1 stated that S4 called S5 and reported that S2 did not give R1 their morning medication. S1 stated R1's responsible party and doctor were notified. S1 stated that staff initiated a 7-day monitoring period to observed R1 of any potential adverse side effects related to the missed medication. The deficiency is cited per Title 22 California Code of Regulations and listed on LIC809D. Failure to submit proof of corrections (POC) by plan of correction due date and/or any repeat deficiencies within a 12-month period may result in civil penalties. *An Immediate civil penalty of $250 assessed for repeat violation* Exit interview conduct. A copy of this report, appeal rights, and LIC421FC provided.the state’s words, verbatim · CDSS document, Aug 10, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(4) · Plan of correction due date: Aug 11, 2026

(a) A plan for incidental medical and dental care shall be developed by each facility... (4) The licensee shall assist residents with self-administered medications as needed. This requirement is not met as evidenced by: Based on interview and record review the Licensee did not comply with the section cited above in that R1's morning medications were not given which poses an immediate health risk to person in care.the state’s words, verbatim · CDSS document, Aug 10, 2026

Plan of correction: By POC date, the Administrator agrees to implement a plan to make sure medication is being administered and submit plan to CCLD.

Type of visit: Case Management - Incident

On 5/20/2026 at 1:00 pm, Licensing Program Analyst (LPA) Y. Brown conducted an unannounced Case Management visit regarding an incident that was reported to CCLD on 5/14/2026. LPA met with Tahmeya Stover, Program Supervisor and explained the purpose of the visit. Tahmeya phoned Precious Yepez, Administrator (ADM) and the ADM arrived shortly after. LPA received a self-reported incident report from the facility that indicated that on 5/13/2025, at around 9:30 pm, Resident 1 (R1) eloped from the facility. Interview with staff (S1), S2 and S3 revealed that R1 eloped by exiting through the back gate of the facility. Interview with S2 revealed that S3 offered R1 an alternative beverage and R1 got frustrated and began hitting their room door and cursing at staff. S2 and S3 stated that they were able to calm R1 down and R1 went to sit on the couch in the living room. S2 and S3 stated that R1 got up from the couch and walked towards the backyard and went outside. S2 stated that they tried to redirect R1 to come back inside but R1 grabbed a stick and aimed it at staff in an aggressive manner. S2 stated that R1 then ran towards the gate to exit the facility. S3 stated that S2 came to tell them that R1 had ran out of the facility but by the time staff went to look outside for R1, R1 had left the facility unassisted. S3 stated that they contacted the police. S2 stated that they drove around the neighborhood but could not find R1 so they returned back to the facility. S1 and S2 stated that R1 returned to the facility around 9:50 pm. S1 and S2 stated that after the incident occurred, staff completed a full body check on R1 and found no injuries. Continue on LIC809-C. Continued from LIC809. During record review, LPA observed R1's physician report dated 04/22/2026 indicates that R1 is unable to leave the facility unsupervised. LPA observed R1's Individual Behavioral Support plan dated 3/13/2026 indicates that staff are too maintain vigilant supervision of R1 while in the common areas of the facility, particularly when R1 is near exits. The following deficiency was observed (see LIC 809D) and cited from the California Code of Regulations, Title 22. Failure to correct the deficiency and/or repeat deficiency within a 12-month period may result in civil penalty. Exit interview conducted with Precious. Appeal Rights and a copy of this report provided.the state’s words, verbatim · CDSS document, May 20, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.2(a)(4) · Plan of correction due date: Jun 3, 2026

(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: (4) To care, supervision.. This requirement was not met as evidence by: Based on record review and interview, the licensee did not comply with the section cited above by R1 leaving the facility unassisted which posed a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, May 20, 2026

Plan of correction: By POC date, The Administrator agrees to review resident's physician's report, creating a plan on increasing safety checks with residents with elopement or wandering, and conducting an in-service training with staff regarding supervision and elopement and send a copy of the training to CCLD.

Allegation investigated: Staff did not accompany resident to the ER

On 2/13/2026 at 10:30 AM, Licensing Program Analyst (LPA) Y. Brown arrived unannounced to conduct a complaint investigation and deliver findings in regards to the allegation above. LPA met with Precious Yepez, Program Director and informed her the reason for visit. During the course of investigation, LPA interviewed four (4) staff members and the Reporting Party (RP). LPA reviewed documents such as (incident reports, Maintenance invoice: heater, LIC602- Medical Assessment, and IPP for R1.) Continued on LIC9099-C. Substantiated Continued from LIC9099. Allegation: Staff did not ensure the heater was not in disrepair Finding: Unsubstantiated Interview with staff revealed that the heater was working on and off around 12/4/2025 but the staff provided residents with space heaters. Interview with staff revealed that the breaker got fixed on 12/7/2025. LPA observed that the heater was functional and working during visit. Allegation: Staff did not ensure the shower had hot water Finding: Unsubstantiated Interview with staff revealed that the facility has two showers. S1 stated that the second shower has warm water but it takes time to warm up. S1's interview revealed that the residents use the first shower since the water does not take long to warm up but both showers have warm water. Interview with staff revealed that no residents missed any of their shower times. Allegation: Staff did not ensure they were not without electricity Finding: Unsubstantiated Interview with staff revealed that the facility's electricity went out for about an hour and a half on 12/6/2025. LPA observed that the facility has a generator. Interviews with staff revealed that the entire neighborhood's electricity shut off that day. LPA observed that the facility has emergency flashlights. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did occur, therefore the allegation is UNSUBSTANTIATED. No deficiencies are being cited on this date. Exit interview conducted with Precious and a copy of this report provided. Allegation: Staff did not accompany resident to the ER Finding: Substantiated RP stated that R1 did not have a staff to accompany them to the ER and R1 is unable to advocate for themselves. A review of R1's IPP (Individual Program Plan) indicated that R1 would need direct assistance in an emergency, as R1 is Deaf and nonverbal. R1's IPP also states that R1 would not be able to communicate with emergency personnel on their own. Interview with staff revealed that there was not adequate staff available to go with R1 to the hospital at the time. Based on LPAs information obtained during investigation, the preponderance of evidence standard has been met, therefore, the above allegations are found to be SUBSTANTIATED. California Code of Regulations (Title 22, Division 6, Chapter 8), are being cited on the attached LIC9099D. Exit interview was conducted with Precious and Appeal Rights was provided.the state’s words, verbatim · CDSS document, Feb 13, 2026 · control 15-AS-20251217090546

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87411(a) · Plan of correction due date: Feb 20, 2026

87411 Personnel Requirements - General (a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs... This requirement was not met as evidence by: Based on interview the Licensee did not comply with the section cited above in that the facility did ensure that there was staff sufficient in numbers to accommodate R1's emergency needs which poses a potential safety risk to persons in care.the state’s words, verbatim · CDSS document, Feb 13, 2026

Plan of correction: By POC date, the administrator agrees to implement a plan that ensures there are enough staff on shift in case of an emergency and send the plan to CCLD.

Type of visit: Case Management - Incident

On 2/13/2026 at 12:30 PM, Licensing Program Analyst (LPA) Y. Brown conducted an unannounced Case Management visit regarding an incident that was reported to CCLD on 1/6/2026. LPA met with Precious Yepez, Program Director and explained the purpose of the visit. The incident of missed medication occurred on 1/5/2026. Program Director (PD) stated that they were the only staff that was able to pass out medication since the other two staff on shift were registry staff. PD stated that they don't remember why the medication was missed and might have been busy with other tasks. The deficiency is cited per Title 22 California Code of Regulations and listed on LIC809D. Failure to submit proof of corrections (POC) by plan of correction due date and/or any repeat deficiencies within a 12-month period may result in civil penalties. Exit interview conducted with Precious. A copy of the appeal rights and this report was provided.the state’s words, verbatim · CDSS document, Feb 13, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(4) · Plan of correction due date: Feb 14, 2026

87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility [...](4) The licensee shall assist residents with self-administered medications as needed. This requirement is not met as evidenced by: Based on interview and record review the Licensee did not comply with the section cited above in that R1's afternoon medication was not given which poses an immediate health risk to person in care.the state’s words, verbatim · CDSS document, Feb 13, 2026

Plan of correction: By POC date, the Administrator agrees to implement a plan to make sure medication is being administered and submit plan to CCLD.

Type of visit: Case Management - Deficiencies

On 2/13/2026 at 11:30 AM, Licensing Program Analyst (LPA) Y. Brown arrived unannounced to conduct a Case Management visit. LPA met with Precious Yepez, Program Director and explained the purpose of the visit. While LPA Y. Brown was conducting a complaint investigation (15-AS-20251217090546) on 12/17/2025 during file review and interview LPA discovered: 1. The facility did not submit any incident reports in regards to the facility not having electricity and the heater not working. The deficiency was observed (see LIC809D) and cited from the California Code of Regulation, Title 22. Failure to correct the deficiencies may result in civil penalties. Exit interview conducted with Precious and a copy of this report and appeal rights provided.the state’s words, verbatim · CDSS document, Feb 13, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a) · Plan of correction due date: Feb 20, 2026

87211 Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including... This requirement is not met as evidenced by: Based on interview the Licensee did not comply with the section cited above in that the facility did not report to licensing about the facility being without electricity and the heater breaking which poses a potential safety risk to persons in care.the state’s words, verbatim · CDSS document, Feb 13, 2026

Plan of correction: By POC date, the Administrator agrees conduct an in-service training with staff that goes over the regulation 87211 and send proof of the in-service to CCLD.

Allegation investigated: Staff is violating resident's personal rights

On 2/3/2026 at 1:30 PM, Licensing Program Analyst (LPA) Y. Brown arrived unannounced to conduct a complaint investigation and deliver findings in regards to the allegation above. LPA explained the purpose of the visit with Program Director Precious . During the complaint visit, LPA reviewed and obtained the LIC 500 (Personnel report), LIC9020 (client roster) and interviewed R1, S1, S2 and W2. LPA also reviewed and obtained R1's LIC 602 (Physicians reports), case manager contact information and updated Individual Program Plan (IPP). Continue on LIC9099-C. Unsubstantiated Continued from LIC9099. Allegation: Staff is violating resident's personal rights Finding: Unsubstantiated Interview with the reporting party (RP) revealed that R1 has never requested only a women staff to help them with their ADLS (activities of daily living) but they are concerned that R1 only prefers certain staff members. RP stated that it depends on R1's mood on how they react to certain staff members. W1 stated that R1 has expressive behaviors towards different staff but has no issue with the specific gender of staff to help them. W2 stated that R1 has never talked to them about wanting only a women staff. Interview with S1 and S2 revealed that R1 has never requested or asked for a specific gender to help them but R1 has behaviors towards different staff members depending on their mood. LPA reviewed R1's IPP and LIC602 and there were no indications or orders that stated that R1 needs to only be helped by a specific gender. Based on interviews and record review during visit, the allegation that staff at the facility are not monitoring resident's blood pressure was found to be unsubstantiated. A finding that a complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. No deficiency cited. Exit Interview conducted with Precious and copy of this report provided.the state’s words, verbatim · CDSS document, Feb 3, 2026 · control 15-AS-20251107121710

Type of visit: Case Management - Incident

On 1/16/2026 at 3:00 pm, Licensing Program Analyst (LPA) Y. Brown conducted an unannounced Case Management visit regarding an incident that was reported to CCLD on 1/15/2026. LPA met with Renny Manansala, Administrator and explained the purpose of the visit. S2 submitted an incident report that stated R1 alleges S5 has been sexually abusing R1 to the department on 1/15/2026. The incident report states that the incident happened on 1/13/2026. LPA interviewed Staff (S1) and Resident (R1) during visit. S1 stated that the incident has been reported to Adult Protective Services (APS) and the Local Police Department was contacted. S1 stated that the police have started their own investigation and told the facility to hold off on their internal investigation at this time. S1 stated that S5 has been put on administrative leave. LPA was unable to interview S5 at this time. During Visit, LPA obtained the following resident records: R1's LIC 602 (Medical Assessment), Hospice Care Plan, ID &Emergency form, Face Sheet, IPP, IBSP and incident report. LPA also collected the Adult Protective Services (APS) report. Continue on LIC809C. Continued from LIC809. No deficiencies cited during the visit. LPA will conduct further investigation and will return if needed. Exit interview conducted with Renny and a copy of this report provided.the state’s words, verbatim · CDSS document, Jan 16, 2026

Allegation investigated: Staff does not ensure facility is kept free of mal odors

On 12/26/2025 at 9:30 AM, Licensing Program Analyst (LPA) Y. Brown arrived unannounced to conduct a complaint visit. LPA explained the purpose of the visit with Care staff Donise Lewis. Program Supervisor Tahmeya Stover arrived to the facility around 11:40 AM. During the complaint visit, LPA attempted to interview Clients, reviewed the LIC 500 (Personnel report), LIC9020 (client roster) and client records. Allegation: Staff does not ensure facility is kept free of mal odors During review of the complaint submitted the complainant stated that the facility has a strong odor smell from a staff member but the complainant denies the staff being under the influence while working. Continued to LIC9099-C. Unsubstantiated Continued from LIC9099. The interview with the RP/Complainant revealed that the smell coming from the staff member does not interfere with work or with the clients. The interview with S1/ADM revealed that they have never smelled an odor at the facility and it revealed that there were no concerns with a smell coming from a staff member at the facility. The interview with S2 revealed that there weren't any smells coming from a staff member that was hindering the safety of clients. The interview with S3 revealed that they have never smelled any odor coming from staff members and has worked all shift times. The interview with S4 revealed that they have never smelled any odor coming from a staff member that would interfere with work. LPA attempted to interview clients but was unable to due to clients being non-verbal. Based on interviews with staff and clients and observations during visit, the allegation that staff does not ensure facility is kept free of mal odors was found to be unsubstantiated. A finding that a complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. No deficiency cited. Exit Interview conducted with Tahmeya and copy of this report provided.the state’s words, verbatim · CDSS document, Dec 26, 2025 · control 15-AS-20251216100733

Type of visit: Case Management - Deficiencies

On 12/26/2025 at 11:45 AM, Licensing Program Analyst (LPA) Y. Brown arrived unannounced to conduct a case management visit. LPA met with Program Supervisor Tahmeya Stover. During the course of investigation for complaint (#15-AS-20251216100733), the following deficiency was observed: 1) LPA reviewed Guardian and observed S1 was not fingerprint cleared or associated to the facility. Civil penalty of $500 is being assessed on today's visit. The deficiency was observed (see LIC 809D) and cited from the California Code of Regulations, Title 22. Failure to correct deficiencies may result in civil penalties. Exit interview conducted with Tahmeya and a copy of this report, civil penalty, and appeal rights provided.the state’s words, verbatim · CDSS document, Dec 26, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 80019(e)(3) · Plan of correction due date: Dec 29, 2025

80019 Criminal Record Clearance (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1522 shall prior to working [...] (3) Request a transfer of a criminal record clearance as specified in Section 80019(f) or.. This requirement was not met as evidence by: Based on record review the Licensee did not comply with the section cited above in not having S1 fingerprint cleared and associated to the facility which poses an immediate health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Dec 26, 2025

Plan of correction: By POC date, the Administrator agreed to fingeprint and associate S1 to the facility and send proof to CCLD. *Civil Penalty of $500 is being assessed on today's date*

Type of visit: Case Management - Other

On 11/14/2025 at 10:45 AM, Licensing Program Analysts (LPAs) Y. Brown and K. Nguyen arrived unannounced to conduct a Case Management visit. LPA met with Precious Yepez, Program Director. While LPAs were conducting a complaint investigation (#15-AS-20251107121710) on 11/14/2025, During interview, S1 stated that the facility is short staffed however, management has been conducting interviews and hiring regarding the short-staffing. LPAs requested the following document: Staff schedule and updates on any new hires on staffing submitted to CCLD by 11/21/2025. LPAs discussed with S1 that all times on the staff schedule that are empty needs to be indicated with a staff member. Exit interview conducted with Precious Yepez and a copy of this report provided.the state’s words, verbatim · CDSS document, Nov 14, 2025

Type of visit: Required - 1 Year

On 09/19/2025 at 11:30 AM, Licensing Program Analyst (LPA) Y. Brown conducted an unannounced annual 1-year required inspection. LPA met with LVN/ Care Staff Ruth Duffy and explained the purpose of the visit. Ruth phoned the Program Director (PD) Precious Yepez. PD arrived to the facility at around 12:00 PM. The facility’s fire clearance was approved for four (4) residents, four (4) may be non-ambulatory. LPA toured the facility including but not limited to bedrooms, bathrooms, kitchen, common area, garage, and back yard. The facility consists of four (4) bedrooms and two (2) bathrooms. All indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature for residents is maintained at 73 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the resident. All toilets, hand washing, and bathing are safe, sanitary and in operating condition. The supply of extra hygiene was available for residents. Smoke detectors and carbon monoxide combination were in operating condition during visit. Fire extinguisher was last purchased on 8/4/2025. First aid kit was observed to be complete. LPA reviewed five (5) staff and three (3) resident records. LPA reviewed a sample of medication. Continued on LIC809C. (Continued from LIC809...) LPA observed that the Emergency Disaster Plan was last reviewed on 7/26/2025. The following forms will be updated and submitted to CCLD by 9/26/2025: LIC610D: Emergency disaster plan LIC500: (Personnel Record) THE FOLLOWING DEFICIENCIES WERE OBSERVED DURING VISIT: At 3:00 pm, LPA observed missing 20 hours of annual training from 0/5 staff members. At 3:15 pm, LPA observed missing first aid certifications from 3/5 staff members. At 3:30 pm, LPA observed no current administrator at the facility. At 3:35 pm, LPA observed that 2/5 staff members were not fingerprint cleared or associated to the facility. At 4:30 pm, LPA observed that there wasn't an updated quarterly fire drill conducted. At 5:00 pm, LPA observed that the hot water temperature in the shared resident restroom was measured at 139.4 degrees Fahrenheit. *An immediate civil penalty of $1250.00 will be assessed on today's date. Deficiencies are cited per Title 22 California Code of Regulations and listed on LIC809D. Failure to submit proof of corrections (POC) by plan of correction due date and/or any repeat deficiencies within a 12-month period may result in civil penalties. Exit interview conducted. A copy of the appeal rights, LIC421FC, LIC421BG and this report provided.the state’s words, verbatim · CDSS document, Sep 19, 2025

The state marks this report as 8 pages; the online copy we transcribed has 7. You can request the full file from the county licensing office.

Allegation investigated: Staff are not properly maintaining laundry devices.

On 4/22/2025, at 9:00 AM, Licensing Program Analysts (LPAs) James Sampair and Yasamin Brown arrived unannounced at the facility to investigate the allegation above. Upon entry into the facility, the LPAs identified themselves and stated the purpose of the visit to Nurse Ruth Duffy. Administrator Maehellena Harlan arrived at approximately 9:30 AM. The complaint alleges that staff are not properly maintaining laundry devices. The LPAs inspected the clothes washer and verified that mold was growing on the drum and on the rubber washer. The presence of mold verified the validity of the allegation. The preponderance of the evidence standard has been met, and the allegation is SUBSTANTIATED. Deficiency is cited under the California Code of Regulations listed on LIC 9099-D. Failure to submit proof of correction (POC) by plan of correction due date and/or any repeat deficiencies within a 12-month period may result in civil penalties. Exit interview conducted with Administrator. Appeal Rights and a copy of this report provided. Substantiated ... Continued from LIC 9099 The complaint alleges that staff do not properly clean the home. The LPAs inspected the facility and found that the home was properly cleaned. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove them; therefore, the allegation is UNSUBSTANTIATED. Exit interview conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Apr 22, 2025 · control 15-AS-20250414141712

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87303(g)(1) · Plan of correction due date: Apr 23, 2025

87303 Maintenance and Operation (g) Facilities which have machines and do their own laundry shall: (1) Have ... equipment maintained in good repair. This requirement was not met as evidenced by: LPAs observed that mold was growing on the drum and on the rubber gasket of the upright clothes washer, which poses an immediate health risk to persons in care.the state’s words, verbatim · CDSS document, Apr 22, 2025

Plan of correction: The administrator agreed to replace the clothes washer on or before the due date.

Type of visit: Case Management - Deficiencies

On 04/22/2025, at 9:00 AM, Licensing Program Analysts (LPAs) Y. Brown and J. Sampair arrived unannounced to conduct an investigation of complaint 15-AS-20250414141712. The LPAs met with Administrator Maehellena Harlan and informed her of the reason for the visit. LPA Brown observed the following: -At 10:15 AM, hot water temperate in the kitchen was measured at 150.3 Degrees Fahrenheit. -At 10:35 AM, during record review it was discovered that the proper documentation for change of administrator has not submitted to the Department. Deficiency is cited from Title 22 California Code of Regulations, and listed on 809-D. Failure to submit proof of correction by plan of correction due date and any repeat violation may result in civil penalty. Deficiency and plan and proof of correction were discussed with the administrator. Exit interview conducted. Appeal Rights and copy of this report provided.the state’s words, verbatim · CDSS document, Apr 22, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87303(e)(2) · Plan of correction due date: Apr 23, 2025

Maintenance and Operation (e) Water supplies and plumbing fixtures shall be maintained as follows: (2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degree C) and not more than 120 degree F (49 degree C). This requirement is not met as evidenced by: -Based on observation, the licensee did not comply with the section above. Hot water temperature was measured at 150.3 degrees in the kitchen and 146.6 degrees Fahrenheit in the restroom which poses immediate safety risk to persons in care.the state’s words, verbatim · CDSS document, Apr 22, 2025

Plan of correction: Administrator agreed to adjust hot water temperature and submit a picture to CCLD by POC date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87407(k) · Plan of correction due date: Apr 29, 2025

Administrator Recertification Requirements (k) Whenever a certified administrator assumes or relinquishes responsibility for administering a residential care facility for the elderly, he or she shall provide written notice, within thirty (30) days, to: This requirement is not met as evidenced by: -Based on observation, the Administrator is not listed as the current administrator of the facility.the state’s words, verbatim · CDSS document, Apr 22, 2025

Plan of correction: Administrator agreed to submit documents required for the administrator switch and submit proof of the documents to CCLD by POC date.

Allegation investigated: Resident was not supervised while on an outing with staff.

On this day, 12/20/24, at 1:30 pm, Licensing Program Analyst (LPA) Delmundo arrived unannounced to deliver the findings for the above allegation. LPA met with Area Director Rosemary Maurillo and informed the purpose of visit. LPA called and spoke on the phone with Maehellena Harlan, administrator. It was alleged that S1 took resident, R1, to a community outing on 3/08/22 and when they returned the other staff discovered a piece of paper with several transactions on it indicating that S1 had been doing DoorDash while R1 was with S1. ....continued on LIC9099C Unsubstantiated During the course of investigation, LPA obtained copies of staff schedule, lists of facility residents and staff, and reviewed residents' records. LPA obtained copies of residents' including but not limited to the following documents: LIC601 Identification and Emergency Information; LIC602A Physician's Report; Annual Review. LPA also obtained copy of Community Outings Record, LIC501 Personnel Record and LIC500 Personnel Report. LPA interviewed resident on 3/16/22 and staff (S1, S2, S3, S4, S5, S6 and interim administrator) on 3/16/22, 12/19/24 and 12/20/24. S1 stated he could have drove the van and taken the resident out for community outings but denied the allegation and stated not working for DoorDash. Three of the staff stated not working on 3/08/22 while the other staff stated seeing the paper. Another staff also stated seeing the paper with S1's name on it but would not say it's a receipt but the paper appeared to be a computer print out. The interim administrator (ID) stated that the paper was given to her on 3/10/22 and that the paper does not have a letter head so she was not sure if it's a blank statement but it has S1's name, date and time, and DoorDash transaction in it. The ID stated she conducted an internal investigation and that S1 denied the allegation. The ID further stated it's unknown if S1 was just transferring money to S1's account. LPA interviewed one resident who stated not knowing R1 and S1. Due to medical diagnosis, LPA was not able to obtain information from the other 3 residents. Review of Community Outing showed R1 went for an outing on 3/08/22; however, the paper with DoorDash transaction was dated 3/04/22. Based on information gathered and LPA unable to obtain information from 3 residents due to medical diagnosis, the allegation is closed a unsubstantiated. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. No deficiency cited. Exit interview conducted and copy of this report provided.the state’s words, verbatim · CDSS document, Dec 20, 2024 · control 15-AS-20220309160459

Type of visit: Case Management - Deficiencies

While at the facility for other reason, Licensing Program Analyst (LPA) Delmundo learned from Area Director (AD) Rosemary Maurillo that the facility has a new administrator (ADM), Maehellena Harlan, who started sometime in November 2023. However, upon checking the roster from Guardian Portal, ADM is not on the list of employees associated to this facility. Guardian Portal showed ADM is fingerprint cleared. Deficiency is cited from Title 22 California Code of Regulations and listed on 809D. Failure to submit proof of correction by plan of correction due date and any repeat violation within 12 month period may result in civil penalty. Deficiency and plan and proof of correction were discussed with AD and over the phone with ADM. Exit interview conducted. Appeal Rights, LIC9098 Proof of Correction form and copy of this report provided.the state’s words, verbatim · CDSS document, Dec 20, 2024

From the deficiency page — Deficiency type: Type B · Section cited: CCR 80019(e)(3) · Plan of correction due date: Jan 3, 2025

80019 Criminal Record Clearance: (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1522 shall prior to working, residing or volunteering in a licensed facility:(3) Request a transfer of a criminal record clearance as specified in Section 80019(f) -This requirement is not met as evidenced by: -Based on interview and record review, the licensee did not comply with the section above in administrator not associated to this facility which poses a potential safety and/or personal rights risks to persons in care.the state’s words, verbatim · CDSS document, Dec 20, 2024

Plan of correction: Area Director stated she'll have the ADM associated. Proof to be submitted by 1/03/25.

Type of visit: Required - 1 Year

On 10/07/2024 at 08:30 AM, Licensing Program Analysts (LPAs) David Doidge and James Sampair arrived unannounced to conduct the Required Annual Inspection. Upon entry, LPAs stated the purpose of the visit to Nena Gibson Program Supervisor and Area Director Rosemary Maurilio arrived at 10:00 AM. LPAs toured the facility including but not limited to bedrooms, bathrooms, dining area, activity rooms, kitchen, common areas, and outdoor area. Smoke detectors and carbon monoxide detectors were fully functional. Fire extinguishers were observed to be full and last serviced on 08/28/2024. Temperature in the facility was measured at 72.0 degrees Fahrenheit at 08:53 AM and facility cited for hot water measured at 127.7 degrees Fahrenheit at 8:53 AM. The LPAs observed required postings in the facility, including the Complaint Poster, Ombudsman and Personal Rights posters, and the Theft and Loss Policy. Grab bars for each toilet and shower were installed. Non-skid mats were observed. There were adequate lights in each room. Resident rooms were observed to be cleaned and fully furnished. Indoor and outdoor passages were free of obstruction. One week of nonperishable and 2 days of perishable food supplies were available. 1 A-Type citation issued and 1 B-Type citation issued. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Oct 7, 2024

Allegation investigated: Staff did not properly report incidents involving a resident Staff did not seek timely medical attention for the residents Staff did not address the residents change in medical condition

On 5/3/2024 at 11:05 AM, Licensing Program Analysts (LPAs) J. Clancy-Czuleger arrived unannounced to deliver findings for the above allegations. LPA explained the purpose of the visit with Program Supervisor Nena Gibson. On the allegation facility staff did not properly report incidents involving a resident. Based on record review and interviews the facility the staff did not report the positive skin test because the client has a history of having false positive TB skin tests since the 1980s. The care staff were waiting on reporting it to CCLD until they were able to get the more accurate chest X-ray. On the allegation facility Staff did not address the residents change in medical condition. Based on record review and interviews the facility was getting the client retested for TB with a different kind of test. They had already made two attempts to get the chest X-ray with no success as the client was not sitting still for the scan. Continued on LIC 9099C... Unsubstantiated ...Continued from LIC 9099 On the allegation facility staff did not seek timely medical attention for the residents. Based on record review and interviews the facility did schedule medical visits for both R1 and R2 when they got their respiratory infections along with follow up visits when the infections were not clearing up. Although the allegations may have happened or are valid, there are not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, May 3, 2024 · control 15-AS-20231116135451