Cypress Residence II

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Abeye Duguma met with Ray Sarmiento for a Required One (01) Year visit. LPA explained the reason for the visit. Administrator, Chery Monje-du, designated Ray Sarmiento to sign and accept this report. A tour of the physical plant was conducted at 09:30 AM and the following was noted: The facility has outdoor furniture with a covered shaded area for residents and visitors. The facility does not have a swimming pool/body of water. The garage is currently being used for storage and laundry. The facility has a total of four (04) bedrooms and two (02) bathrooms. The facility is fire cleared for six (06) non-ambulatory. The facility is currently occupying five (05) residents. The living and dining room are neat and clean. The residents' rooms are adequately furnished with appropriate lighting system. Hallways are well lit. Residents have enough personal hygiene product provided by the licensee. The bathroom was checked for cleanliness and proper operations. Towels and washcloths are not shared. There was enough clean linen available in the cabinets. Kitchen is sufficiently stocked with at least two (2) days perishable and seven (7) days non-perishable food. Frozen foods are wrapped and stored appropriately. Food storage and preparation areas are clean and inaccessible to pests. (continued on LIC 809-C) The facility maintains a comfortable temperature at 72°F. The smoke and carbon monoxide detectors are hardwired, interconnected and observed to be operational. Fire extinguisher is located near the kitchen, observed to be full and last inspected on 06/05/2025. Laundry detergents, cleaning agents and other toxins are locked away. Knives and sharps are observed to be locked and inaccessible to residents. The hot water temperature was measured at 118.5°F. LPA observed medication to be locked and inaccessible to residents. First aid kit available. No health and safety hazards noted during the visit. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Feb 13, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Abeye Duguma met with administrator, Chery Monje-Du, for a Required One (01) Year visit. LPA explained the reason for the visit. A tour of the physical plant was conducted at 09:30 AM and the following was noted: There is one entrance being utilized at the facility. The facility has a total of four (04) bedrooms and two (02) bathrooms. The facility is fire cleared for six (06) non-ambulatory. The facility is currently occupying six (06) residents. The facility has outdoor furniture with a covered shaded area for residents and visitors. The facility does not have a swimming pool/body of water. The garage is currently being used for storage and laundry. Laundry detergents, cleaning agents and other toxins are locked away. Kitchen is sufficiently stocked with at least two (2) days perishable and seven (7) days non-perishable food. Frozen foods are wrapped and stored appropriately. Food storage and preparation areas are clean and inaccessible to pests. Knives and sharps are observed to be locked and inaccessible to residents. The living and dining room are neat and clean. The facility maintains a comfortable temperature at 73°F. The smoke and carbon monoxide detectors are hardwired, interconnected and observed to be operational. Fire extinguisher is located near the kitchen, observed to be full and last inspected on 07/03/2024. (continued on LIC 809-C) The residents' rooms are adequately furnished with appropriate lighting system. Hallways are well lit. Residents have enough personal hygiene product provided by the licensee. The bathroom was checked for cleanliness and proper operations. The hot water temperature was measured at 116.2°F. Towels and washcloths are not shared. There was enough clean linen available in the cabinets. LPA observed medication and first aid kit to be locked and inaccessible to residents. No health and safety hazards noted during the visit. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Feb 28, 2025

Allegation investigated: Staff did not seek timely medical attention for resident. Resident sustained unexplained bruises while in care. Staff did not ensure resident’s care needs were being met.

Licensing Program Analyst (LPA) Abeye Duguma conducted a subsequent complaint visit to the facility to investigate the above allegations. LPA met with administrator, Chery Monje-du, and explained the reason for the visit. --- Staff did not seek timely medical attention for resident. It was alleged that resident was covered in a rash and had open wounds that were bleeding. To investigate the allegation, on 05/08/2024, LPA interviewed three (03) staff from around 12:30 PM to 1:30 PM and interviewed two (02) out of four (04) residents from around 1:30 PM to 2:15 PM. On 08/22/2024 at around 10:30 AM, LPA requested additional documents. During interviews with staff, all staff stated Resident #1 (R1) did not have any bleeding from open wounds but that they are aware of the rash. All staff stated the rash comes and goes. (CONT on LIC 9099-C) Unsubstantiated Staff added the rash was immediately treated with Calmoseptine to sooth and help promote healing. During interviews with residents, two (02) out of four (04) residents stated, if needed, that staff would seek medical attention timely. LPA was unable to interview the remaining two (02) residents. A review of R1’s most recent Kaiser Permanente hospital records do not indicate rash or open wound during the month in question. Based on interviews and record review, there is not enough information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time. --- Resident sustained unexplained bruises while in care. It was alleged that resident had bruises on their nose. To investigate the allegation, on 05/08/2024, LPA conducted a physical plant tour at around 11:30 AM, interviewed three (03) staff from around 12:30 PM to 1:30 PM and interviewed two (02) out of four (04) residents from around 1:30 PM to 2:15 PM. On 08/22/2024, LPA requested additional documents. During the physical plant tour, LPA did not observe any signs of abuse. During interviews with staff, all staff stated R1 did not have a bruise on the nose, rather it was redness from R1 continuously scratching their nose. Staff added antibiotic ointment was applied to the scratched area three times a day to sooth and help promote healing. A review of R1’s most recent Kaiser Permanente hospital records do not indicate that resident had any bruises or abrasions on their nose during the time in question. Based on observations, interviews and record review, there is not enough information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time. - Staff did not ensure resident’s care needs were being met. It was alleged that resident was not showered and repositioned in bed. To investigate the allegation, on 05/08/2024, LPA interviewed three (03) staff from around 12:30 PM to 1:30 PM and interviewed two (02) out of four (04) residents from around 1:30 PM to 2:15 PM. On 08/22/2024, LPA requested documents. During the physical plant tour, LPA did not experience any malodor and observed that all residents were clean and well groomed. (LIC9099-C) During interviews with staff, all staff stated facility residents are showered a minimum three times a week or more depending on their needs. Staff added R1 was not bedridden and did not require assistance with repositioning in bed but often reminded R1 to reposition anyway. During interviews with residents, two (02) out of four (04) residents stated they shower at least twice a week or more if they like, but do not require assistance with repositioning. A review of the resident’s Physician’s Report revealed that resident was not bedridden and did not require assistance with repositioning in bed. Based on observations, interviews and record review, there is not enough information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time. No health and safety hazards were noted during the visit. Exit interview conducted and a copy of the report was issued.the state’s words, verbatim · CDSS document, Aug 22, 2024 · control 31-AS-20240503164134

Allegation investigated: Staff did not ensure resident was adequately fed. Staff did not prevent resident from harming other residents.

Licensing Program Analyst (LPA) Abeye Duguma conducted an initial complaint visit to the facility to investigate the above allegation. LPA met with administrator, Chery Monje-du, and explained the reason for the visit. --- Staff did not ensure resident was adequately fed. It was alleged that staff are not feeding residents resulting in malnourishment and dehydration. To investigate the allegation, on 05/08/2024, LPA conducted a physical plant tour at around 11:30 AM, interviewed three (03) staff from around 12:30 PM to 1:30 PM and interviewed two (02) out of four (04) residents from around 1:30 PM to 2:15 PM. During the physical plant tour, LPA observed facility staff preparing and serving meals. LPA also observed more than seven (07) days perishable and two (02) days non-perishable foods. (CONT. on LIC 9099-C) Unsubstantiated During interviews with staff, all staff stated that residents are fed three (03) meals a day and offer snacks at least twice a day. During interviews with residents, two (02) out of four (04) residents stated that facility feeds them very well, offer three (03) meals a day and snacks. LPA was unable to interview the remaining two (02) residents. Based on observations and interviews, there is not enough information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time. --- Staff did not prevent resident from harming other residents. It was alleged that Resident #1 (R1) was being verbally and physically abused by other residents. To investigate the allegation, on 05/08/2024, LPA conducted a physical plant tour at around 11:30 AM, interviewed three (03) staff from around 12:30 PM to 1:30 PM and interviewed two (02) out of four (04) residents from around 1:30 PM to 2:15 PM. During the physical plant tour, LPA did not observe any signs of abuse and all residents were clean and well groomed. During interviews with staff, all staff stated they have never physically or verbally abused any residents or allowed residents to abuse other residents. During interviews with residents, two (02) out of four (04) residents stated staff have never physically or verbally harmed them and that they are all very kind, gentle and treat them with dignity and respect. Residents also added they have never been physically or verbally abused by other residents. LPA was unable to interview the remaining two (02) residents. Based on observations and interviews, there is not enough information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time. No health and safety hazards were noted during the visit. Exit interview conducted and a copy of the report was issued.the state’s words, verbatim · CDSS document, May 8, 2024 · control 31-AS-20240503164134

The state marks this report as 3 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Abeye Duguma met with administrator, Chery Monje-Du, for a Required One (01) Year visit. LPA explained the reason for the visit. A tour of the physical plant was conducted at 01:00 PM and the following was noted: There is one entrance being utilized at the facility. The facility has a total of four (04) bedrooms and two (02) bathrooms. The facility is fire cleared for six (06) non-ambulatory. The facility is currently occupying six (06) residents. The facility has outdoor furniture with a covered shaded area for residents and visitors. The facility does not have a swimming pool/body of water. The garage is currently being used for storage and laundry. Laundry detergents, cleaning agents and other toxins are locked away. Kitchen is sufficiently stocked with at least two (2) days perishable and seven (7) days non-perishable food. Frozen foods are wrapped and stored appropriately. Food storage and preparation areas are clean and inaccessible to pests. Knives and sharps are observed to be locked and inaccessible to residents. The living and dining room are neat and clean. The facility maintains a comfortable temperature at 70°F. The smoke and carbon monoxide detectors are hardwired, interconnected and observed to be operational. Fire extinguisher is located near the kitchen, observed to be full and last inspected on 06/05/2023. (continued on LIC 809-C) The residents' rooms are adequately furnished with appropriate lighting system. Hallways are well lit. Residents have enough personal hygiene product provided by the licensee. The bathroom was checked for cleanliness and proper operations. The hot water temperature was measured at 114.9°F. Towels and washcloths are not shared. There was enough clean linen available in the cabinets. LPA observed medication and first aid kit to be locked and inaccessible to residents. No health and safety hazards noted during the visit. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Feb 17, 2024

Allegation investigated: Staff did not keep toxins inaccessible to persons other than employees.

Licensing Program Analyst (LPA) Abeye Duguma conducted an unannounced initial complaint visit to the facility. LPA met with Licensee, Chery Monje-Du, and explained the reason for the visit. --- Staff did not keep toxins inaccessible to persons other than employees. It was alleged that staff left magnet key that stores toxins accessible to residents in the main restroom on a paper towel. To investigate this allegation, on 12/06/2023, LPA made observations at around 12:30 PM and interviewed three (03) staff from around 1:00 PM – 2:30 PM. LPA observed cleaning supply storage cabinet to be locked and keys in possession of staff. During interviews, Staff #1 stated that they only heard about the incident, Staff #2 stated that they did not know anything about the incident and Staff #3 stated they are aware of the incident and took steps to immediatley train and remind staff not leave the magnetic key in a places accessible to residents. (CONT. LIC 9099-C) Substantiated Based on interviews, there is enough information to verify the allegation, therefore, the allegation is SUBSTANTIATED at this time, however a plan of correction was not implemented as the Licensee took immediate steps to train and meet with staff to review regulation. No health and safety hazards noted during the visit. Exit interview was conducted and a copy of report was issued.the state’s words, verbatim · CDSS document, Dec 6, 2023 · control 31-AS-20231130154148

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87705(f)(2) · Plan of correction due date: Dec 6, 2023

87705 Care of Persons with Dementia (f) The following shall be stored inaccessible to residents with dementia: (2) …. toxic substances such as certain plants, gardening supplies, cleaning supplies and disinfectants. This requirement is not met as evidenced by: Based on interviews, the licensee did not ensure that toxins were inaccessible to residents in care which poses a potential Health, Safety, or Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Dec 6, 2023

Plan of correction: A POC was not issued as the Licensee provide immediate training and met with staff to review regulation. A copy of the Service Meeeting was provided.