Elaine's Place

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Angela Barutyan arrived at the facility unannounced to conduct a required annual visit at 11:22AM. LPA met with staff and Administrator Elaine Bote who arrived shortly thereafter. Entrance interview conducted. Beginning at 11:27AM, the LPA, along with staff and Administrator, toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that facility is in compliance with Title 22 Regulations. The following was observed: KITCHEN: At 11:27AM, LPA inspected the kitchen/food service area. Kitchen appliances appeared clean and were in operable condition at the time of the visit. The facility had a sufficient supply of perishable and non-perishable food. Knives, sharps, cleaning supplies, and disinfectants are stored inaccessible in a locked cabinet. BEDROOMS: There are six (6) single-occupancy resident bedrooms. All resident bedrooms were observed to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. BATHROOMS: There are three (3) bathrooms, two (2) are in the hallway and one (1) is attached to Bedroom #3. LPA observed bathrooms to be clean, sanitary, and in operating condition with slip-resistant surfaces and grab bars. Hot water temperatures were measured in bathrooms and were between 114.3-117.7 degrees F, which is within the required range. Report Continued on LIC 809-C. COMMON AREAS: These include the living room and dining area. Common areas were appropriately furnished and in good condition. Smoke detectors and carbon monoxide detector were tested at 11:51AM and were operable. LPA observed two (2) fire extinguishers, one (1) by the laundry room which was fully charged and last serviced 09/10/2025 and one (1) in the kitchen area which was fully charged. Required posters were displayed throughout the common areas. OUTDOOR AREA: The backyard has patio furniture and a covered area. No obstructions observed in the passageways. No bodies of water were observed. There is an outdoor storage area which contained additional supplies and a staff break area. LPA observed a staff member sleeping in the storage area however interviews stated that staff have their own room and only utilize the storage area for breaks. MEDICATIONS: Medications review began at 11:54AM; medications are centrally stored and kept inaccessible in a locked kitchen cabinet. LPA reviewed medications for two (2) residents. At 12:15PM, LPA observed Trazadone 50mg for Resident #1 (R1) with four (4) pills unaccounted for. The centrally stored medication and destruction record (CSMDR) had the medication logged with a start date of 09/12/2025 and a quantity of 90 pills with directions to administer one (1) pill a day, however, a total of sixty-eight (68) pills were observed during the visit on 09/30/2025 instead of seventy-two (72) pills. Staff stated that the medication may have been incorrectly filled by the pharmacy and the quantity received may have been off, however, no documentation could be provided. RECORD REVIEW: LPA began record review at 12:55PM. LPA reviewed six (6) out of six (6) resident files for documents including, but not limited to: appraisals, medical records, admissions agreement, and consent forms. Four (4) out of six (6) resident files were missing updated appraisals. Administrator completed the reappraisals during the visit. LPA reviewed three (3) personnel files for documents including, but not limited to: personnel record (LIC 501), health assessments/screening (LIC 503), TB test, criminal record clearances, active first aid/CPR training, and appropriate training. LPA observed two (2) out of three (3) staff missing criminal record clearance, LIC501, and LIC503. During the visit, staff left to obtain criminal record clearance and Administrator stated that the two (2) staff will not resume work until receiving background clearance. Administrator stated that facility will have staff coverage. Report Continued on LIC 809-C. INFECTION CONTROL/EMERGENCY DISASTER PLANNING: During today’s visit, the LPA reviewed the facility's infection control practices. The facility’s policies and procedures as it pertains to infection control are adequate. Emergency disaster plan is updated annually as required. Emergency disaster drill was conducted on 09/01/2025. The following deficiencies were observed (See LIC 809-D) and cited from the California Code of Regulations, Title 22 and/or California Health and Safety Code. Civil penalty was issued in the amount of $1000 for criminal record clearance. Administrator was informed that failure to correct deficiencies may result in additional civil penalties. Exit interview conducted. The report was reviewed during the visit. A copy of the appeal rights and report were provided via email and postal mail on 10/01/2025 for signatures due to technical difficulties during the visit.the state’s words, verbatim · CDSS document, Sep 30, 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.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Angela Barutyan arrived at the facility unannounced to conduct a required annual visit at 09:22AM. LPA met with Caregiver Norma Gregorio and reason for the visit was explained. Entrance interview conducted. Staff contacted Administrator Elaine Bote who arrived at 10:25AM. Beginning at 09:24AM, the LPA, along with the caregiver toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that facility is in compliance with Title 22 Regulations. The following was observed: BEDROOMS: There are six (6) single-occupancy resident bedrooms. At 09:27AM, LPA observed Bedroom #1 with two (2) out of four (4) light bulbs not working. Staff replaced the light bulbs during the visit. All client bedrooms were observed to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. BATHROOMS: There are three (3) bathrooms, two (2) are in the hallway and one (1) is attached to Bedroom #3. All bathrooms were supplied with appropriate soap and paper towels. Between 09:30AM – 09:42AM, water temperatures were measured in bathrooms and measured within 128.2 degrees F – 138.7 degrees F, which is outside of the required range of 105 degrees F – 120 degrees F. Staff lowered water heater. At 12:01PM, LPA measured water temperature in bathroom #1 which measured at 135.0 degrees F. Administrator installed warning signs to label and properly identify hot water until the water heater can be repaired. KITCHEN: At 10AM, LPA inspected the kitchen/food service area. Kitchen appliances appeared clean and were in operable condition at the time of the visit. The facility has a sufficient supply of perishable and non-perishable food. At 10:09AM, LPA observed a spoiled cucumber, vegetable produce stored without bags or containers, a dented can of tomatoes, and opened and unrefrigerated jars of relish and jam. Staff discarded all items immediately and stored vegetable produce in bags. Knives, sharps, cleaning supplies, and disinfectants are stored inaccessible in a locked cabinet. Report Continued on LIC 809-C COMMON AREAS: These include the living room and dining area. Common areas were appropriately furnished and in good condition. Carbon monoxide detector was tested at 10:58AM and was operable. Smoke detectors were tested at 10:59AM. LPA observed the smoke detector in the living room not working. Staff attempted to fix the detector during the visit. Staff purchased and installed a new smoke detector which was tested at 03:09PM and was operable. LPA observed two (2) fire doors, one (1) to the hallway leading to resident bedrooms and the other one (1) to bedroom #6. Fire doors were not functioning properly as they had a door stopper by use of a rubber band on the handle which prevented the doors from closing when smoke detectors were tested. Administrator purchased a fire door holder that keeps the doors open during the day and is kept closed at night. Two (2) fire extinguishers were observed on a wall by the laundry room and in the kitchen area which were fully charged and last purchased 05/06/2024. Required posters were displayed throughout the common areas. OUTDOOR AREA: The backyard has patio furniture and a covered area. No obstructions observed in the passageways. No bodies of water were observed. MEDICATIONS: Medications review began at 10:17AM; medications are centrally stored and kept inaccessible in a locked kitchen cabinet. LPA reviewed medications for three (3) residents. LPA observed three (3) medications which were not logged on the centrally stored medication and destruction record. Staff immediately logged the medications. RECORD REVIEW: LPA began record review at 11:06AM. LPA reviewed five (5) out of six (6) client files for documents including, but not limited to: appraisals, medical records, admissions agreement, and consent forms. One (1) out of five (5) residents had an initialed but not signed and dated Admissions Agreement. Resident reviewed and signed the Admission Agreement at the time of the visit. LPA reviewed three (3) personnel files for documents including, but not limited to: personnel record (LIC 501), health assessments/screening (LIC 503), criminal record clearances (LIC 508), active first aid/CPR training, and appropriate training. LPA observed two (2) out of three (3) staff to have CPR but no First Aid training. First aid training was completed during the time of the visit. Report Continued on LIC 809-C INFECTION CONTROL/EMERGENCY DISASTER PLANNING: During today’s visit, the LPA reviewed the facility's infection control practices. The facility’s policies and procedures as it pertains to infection control are adequate. LPA was unable to review the emergency disaster plan and emergency disaster drills as the requested files were not kept on site. INTERVIEWS: During today’s visit, LPA interviewed three (3) residents and three (3) staff. The following deficiencies were observed (See LIC 809-D) and cited from the California Code of Regulations, Title 22 and/or California Health and Safety Code. Civil penalty was issued in the amount of $500. Administrator was informed that failure to correct deficiencies may result in additional civil penalties. Exit interview conducted. The report was reviewed, and a copy of the appeal rights and report were provided.the state’s words, verbatim · CDSS document, Oct 17, 2024

The state marks this report as 11 pages; the online copy we transcribed has 6. You can request the full file from the county licensing office.

Allegation investigated: Resident sustained severe pressure injury due to staff neglect Facility staff did not meet resident's incontinence needs

Licensing Program Analysts (LPAs) Kelly Dulek and Valeria Conway conducted a subsequent complaint investigation for the allegations listed above. LPAs arrived at the facility at 10:54AM and initially met with facility staff Norma Gregorio. Licensee/Administrator was contacted via telephone and arrived at 11:15AM. Entrance interview conducted. During today's visit, LPAs toured the facility with Licensee/Administrator at 11:24AM. No immediate health and safety concerns were identified during today's visit. During an initial visit conducted on 01/10/2024, LPA Dulek interviewed staff at 10:28AM and toured the facility with staff at 10:43AM. LPA also reviewed and obtained copies of documents pertinent to the investigation, interviewed residents at 11:05AM and 11:55AM, and interviewed Administrator at 11:32AM. Throughout the course of the investigation, LPA reviewed all pertinent documents. The following was then determined: Report Continued on LIC 9099-C Unsubstantiated Allegation: Resident sustained severe pressure injury due to staff neglect: The complaint alleges that Resident #1 (R1) sustained a severe pressure injury while residing at the facility due to staff neglecting R1’s needs. Interview revealed that R1 was admitted to the facility on 12/23/2023, following a brief stay at a Skilled Nursing Facility. Record review revealed that R1 had a sacral pressure injury prior to moving into the facility. R1’s physician’s report dated 12/22/2023 is marked “yes” under history of skin condition or breakdown, with the comment “sacral unstageable wound.” Physician’s report also indicates that R1 is receiving hospice care upon discharge from the skilled nursing facility. R1’s Appraisal Needs and Service Plan also indicates R1 is “currently receiving care through hospice agency” and indicates that R1 has a “unstageable pressure ulcer on sacrum and redness to right hip and buttocks area.” LPA reviewed R1’s hospice documents, which indicate R1 was receiving wound care three times per week while at the facility. Additional documentation reviewed indicates facility staff attempted to reposition R1 every two (2) hours even throughout the night. However, sometimes R1 refused and staff documented the refusal. Based on interview and record review, there is insufficient evidence to support the allegation or that a violation occurred, therefore, the allegation that “resident sustained severe pressure injury due to staff neglect” is deemed UNSUBSTANTIATED at this time. Allegation: Facility staff did not meet resident’s incontinence needs: The complaint alleges that R1 was left lying in urine for 12-14 hours all night. Physician’s report indicates R1 had a “right side nephrostomy tube attached to drainage bag” to output R1’s urine, due to urinary retention. As R1 was admitted to hospice, effective 12/22/2023, prior to moving into the facility, interview revealed that hospice nurses were responsible for the care of R1’s nephrostomy tube/bag. Additionally, a staff interview revealed that prior to the complaint, R1 had multiple loose bowel movements, requiring additional incontinence care. Documentation reviewed revealed that R1 was changed additional times, due to the loose bowel movements. Staff interviewed indicated incontinent residents are checked every two hours throughout the day, as well as upon the residents’ request. LPA observed that each resident has a bell in their room to ring for additional assistance. Resident interviews revealed that their incontinence needs are regularly met and residents can call for additional assistance any time of the day or night. Staff conduct rounds during the overnight shift and rest in a common area where they can quickly respond to residents’ calls for assistance. Based on interview and record review, although the allegation may be valid, at this time there is insufficient evidence to support the allegation or that a violation occurred, therefore, the allegation that “facility staff did not meet resident’s incontinence needs” is deemed UNSUBSTANTIATED at this time. No citations issued. Exit interview conducted. A copy of the report was provided.the state’s words, verbatim · CDSS document, Jan 23, 2024 · control 29-AS-20240108173850