Beyond A Home

Type of visit: Required - 1 Year

On 10/1/2025 Licensing Program Analyst (LPA) Perchui Milena Khurshudyan arrived at this facility to conduct the required Annual Inspection. Upon arrival, LPA was greeted by the Caregiver Shela Ferencz, who granted access to the facility. LPA explained the reason for the visit. Facility Administrator Kesha Richardson arrived shortly after. LPA Khurshudyan reviewed the required postings on the hallway next to the entrance area and requested staff and residents’ rosters for review. The inspection tool was used to complete the visit. At 12:00pm LPA, with the help of the Caregiver, began a physical plant tour of the facility and the following was observed: This is a single-story building with seven (7) bedrooms, of which six (6) bedrooms are designated for residents’ private use, and one (1) office/staff room. There are three (3) bathrooms, a kitchen, common areas: living and dining rooms, and an outdoor area. Facility has an approved fire clearance for six (6) Non-ambulatory residents, of which one (1) can be bedridden in rooms #2,3,4, and a Hospice waiver approval for six (6) residents. Kitchen: LPA observed a seven-day supply of non-perishable food, and a two-day supply of perishable food properly stored and labeled. No expired food was observed. Facility stores knives and sharps inside the locked kitchen cabinet. Emergency supply of food / water was stored inside the pantry. Food storage and preparation areas are clean and inaccessible to pests. LPA observed two (2) fire extinguishers throughout the facility. The fire extinguishers were last serviced on 9/19/2024, LPA was informed that new service date is already scheduled for the following week. A weekly menu was also available for residents. The second refrigerator was also available in the garage for additional food supply. Dish soap and other chemicals were properly stored and locked inside separate closet located in the hallway. Continue on LIC809-C Bedrooms: There are seven (7) bedrooms in the facility. All bedrooms are for residents’ use. LPA observed bedrooms to be properly furnished with beds, linens, night stands, chairs, drawers, closets, and adequate lighting. All bedrooms appeared organized and clean. Residents have enough personal hygiene products. Common Areas: These include living and dining areas. LPA observed dining, living areas clean and clear of clutter. Furniture is generally new and in a good repair. Dining and living room furniture sits at the capacity of the facility. Walls, floors, windows, screens, and blinds were clean and in good repair. At 12:15pm, LPA measured the room temperature to be 78 degrees Fahrenheit. There is a linen closet with an adequate supply of fresh linens ready to use. No obstructions and or tripping hazards found throughout the facility. Facility has landline, LPA checked it was operational. There is a television, cabinet for activities, books, and art supplies available for clients’ use. Bathroom: There are three (3) bathrooms in the facility. The bathrooms contained hand soap, paper towels, toilet paper and trash bins with lids. The hot water temperature was measured at approximately 12:25pm to be 119.4 degrees Fahrenheit. The bathrooms were checked for cleanliness and proper operations. Towels and washcloths are not shared. Smoke and Carbon Monoxide Detectors: The smoke and carbon monoxide detectors were tested by staff at 12:35pm and were observed to be operational. Garage: The garage is currently being used for storage. Laundry Room: Functioning washer and dryer are located in a separate laundry room located in the hallway. Laundry detergents and other chemical supplies are locked and inaccessible to clients in care. Backyard: LPA observed sufficient yard space and fenced backyard. Appropriately covered shaded area available for clients to rest. There is outdoor furniture under the shaded area. LPA discussed the importance of maintaining care and supervision to meet the needs of clients. All exit doors were unlocked; no obstructions were observed around the emergency exit area. There is no body of water in the property. Staff/Client File review: Facility records are kept inside the locked commercial cabinets located in the office/staff room. Between 10:35am -11:55am LPA conducted records review of five (5) staff files and six (6) residents’ records. Files were complete and updated. Continue on LIC809C Medications: At approximately 12:35pm. LPA reviewed Centrally Stored Medication Destruction Records for proper documentation. The facility also maintains Medical Administration Records (MAR). LPA observed centrally stored medications locked inside the medication closet and inaccessible to residents in care. Complete First-aid kit is also available and placed in the common area. No potentially dangerous items were found in the facility. The facility operates with three (3) shifts and has two to three (2-3) staff members for each shift. LPA conducted an interview with an Administrator, one (1) caregiver and two (2) out of six (6) residents who were able to communicate. Facility plan/sketch is posted on the wall along with other posting requirements. LPA collected LIC500, LIC9020, and a copy of Certificate of Liability Insurance. Liability Insurance - Exp 12/21/2025 The Administrator's certificate - Exp date is 9/30/2026. No Citations issued during today’s visit. Exit interview conducted. Copy of this report provided.the state’s words, verbatim · CDSS document, Oct 1, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Evelin Rios arrived at the facility above to conduct an annual required visit. LPA was greeted and granted access by staff #1 (S1). S1 contacted the administrator Kesha Richardson and informed them LPA was at the facility. LPA spoke with the Administrator via telephone and explained the reason for the visit. Administrator met LPA at approximately 12:10 p.m. The facility has an approved fire clearance for six (6) non ambulatory residents of which one (1) may be bedridden. Facility has a Hospice waiver for six (6). Administrator could not stay until the end of todays visit and designated Lakesha Mackey, caregiver lead to sign todays report. At 11:45 a.m. LPA conducted a tour of the physical plant of the facility inside and out and the following was observed: Common Areas: These include two (2) sitting areas and a dining area. Areas were observed clean and clear of clutter. There is a fire place in one of the sitting areas that was adequately screened. The dining table sits the capacity of the facility. There are two fire extinguisher observed fully charged with service date 09/04/2024. Kitchen: The kitchen was observed clean and clear of clutter with a sufficient supply of two-day perishable and seven-day non-perishable foods; properly stored. LPA observed the knives and sharp objects located in a locked kitchen drawer inaccessible to residents in care. Bathrooms: LPA toured two (2) resident bathrooms. All bathrooms were observed with non-skid matts, grab bars, toilet paper, paper towels and hand soap. Hot water was tested at 3:08 p.m. and measured between 117.4 to 119.4 degrees Fahrenheit, within regulation. (Continued to LIC809-C) Bedrooms: LPA toured six (6) resident bedrooms. LPA observed rooms to have appropriate bedding and lighting. There is a night stand and sufficient storage. LPA tested the auditory alarms on the exit doors in the bedrooms and they were observed operational. Outside: LPA toured the outside area of the facility and observed appropriate outdoor furniture, with a covered shaded area for residents. LPA observed a locked shed used for storage. No bodies of water on the premises. LPA observed smoke detectors through out the facility. Smoke detectors are hard wired and interconnected. At 2:35 p.m. Lakesha tested a smoke detector. Smoke detectors were observed functioning properly. Lakesha tested a carbon monoxide detector located by the kitchen at 2:37 p.m. and it was observed operational. Resident and Staff Files: From approximately 12:35 p.m. to 2:30 p.m. LPA reviewed resident and staff files. LPA conducted a file review of six (6) out of six (6) resident records to insure compliance of licensing forms. LPA also conducted a file review of three (3) staff records to insure forms and training are up to date and in compliance with licensing forms. LPA reviewed certificate of liability insurance, emergency disaster training, LIC 500 and the facility program. Medications: At approximately 2:45 p.m. LPA reviewed Medication and Medication Records. LPA observed centrally stored medications locked in a closet by the kitchen. Medications were reviewed for proper storage and documentation. Facility also uses a Medication Administration Record (MAR). LPA also observed a complete first aid kit with manual. Pursuant to Title 22 Division 6 Chapter 8 of the CA Code of Regulations, there were no deficiencies observed during today's visit. Exit interview conducted. Copy of the report provided.the state’s words, verbatim · CDSS document, Oct 22, 2024

Allegation investigated: Staff not provided medications as prescribed. Staff not provided medications as prescribed. Residents not being provided adequate food service. Resident(s) not being provided with activities.

On 03/28/2024 Licensing Program Analyst (LPA) Melissa Spaeth conducted a subsequent complaint investigation at the above facility to address the following allegation(s). LPA met with the caregiver. LPA explained the purpose of this visit was to deliver the findings for this complaint. The investigation consisted of the following: On 08/05/2022, then, LPA Ruiz conducted a physical plant tour and collected resident documentation. During the 3/27/2024 visit, interviews were attempted with all five (5) residents of which one resident was interviewed at 11:15 am. The other four (4) residents were unable to participate due to their cognitive function. LPA Spaeth interviewed a staff member (S1) working at the facility at 11:15 am until 11:40 am. LPA reviewed the residents’ medications at 11:50 am until 12:15 pm. LPA received copies of residents' records and the facility menu. LPA Spaeth interviewed two staff members as of today, 3/28/2024 at 9:30 am and at 10:00 am via phone call. LPA reviewed resident documentation at 10:20 am until 11:00 am. Cont. on 9099C Unsubstantiated The investigation revealed the following: Regarding the allegation: Staff not provided medications as prescribed. It is being alleged that a resident’s medications were not being provided in a timely manner as prescribed. LPA Spaeth interviewed one (1) out of five (5) residents who stated they received medications in a timely manner as prescribed by their physician. Three (3) out of the five (5) staff members unanimously confirmed medications are distributed in a timely manner as prescribed by the physician. Two staff members were unavailable for interviews. LPA also reviewed the medication logs for two (2) out of the five (5) residents at 10:20 am until 11:00 am and there were no errors. LPA reviewed a previous resident’s medication logs and did not observe any issues. Regarding the allegation: Residents being left in soiled diapers. It’s being alleged a resident is left in their bed all day in their soiled diaper and developed pressure sores. The three (3) out of five (5) staff members interviewed unanimously stated a resident is never left in their soiled diaper for an entire day. All three (3) staff members confirmed they check diapered residents every two hours. During LPA’s tour of the facility, LPA checked each room and did not observe a soiled resident laying in their bed. LPA also reviewed a previous resident’s hospice records which did not state the resident had bed sores. Regarding the allegation: Residents not being provided adequate food service. It’s being alleged that a resident was not provided enough food during lunch and asked for additional food because they were still hungry. One (1) resident out of the five (5) residents confirmed they receive enough food to eat at each meal. The resident also confirmed staff will give an additional helping if requested. All three (3) staff members out of five (5) confidently confirmed residents are provided enough food at each meal. All three stated there is never a shortage of food. During LPA’s visit on 3/27/2024, LPA observed the lunch meal consisted of ham sandwich, salad, and fruit. LPA also observed a two-day supply of perishable food and a seven-day supply of non-perishable food available at the facility. Regarding the allegation: Resident(s) not being provided with activities. During LPA’s visit on 3/27/2024, LPA observed two residents participating in a coloring and word search activity. LPA Spaeth also observed a staff member was providing an exercise instruction to a resident. One (1) resident confirmed activities are provided every day and the three (3) out of the five (5) staff members stated various activities are provided each day. Based on records reviewed, interviews, and LPA’s observations, the four allegations indicated above are unsubstantiated. Exit interview conducted and a copy of the report was given.the state’s words, verbatim · CDSS document, Mar 28, 2024 · control 31-AS-20220803130850

Allegation investigated: Resident sustained pressure injuries while in care Staff mismanaged resident's medication

On 03/27/2024 Licensing Program Manager (LPM) Troy Agard and Licensing Program Analyst (LPA) Melissa Spaeth conducted a subsequent complaint investigation at the above facility to address the following allegation(s). LPA and LPM met with Administrator and Licensee, Kesha Richardson. LPA explained the purpose of this visit was to gather information, conduct interviews and deliver findings for this complaint. The investigation consisted of the following: on 05/24/2022, then, LPA Ruiz investigated and unsubstantiated six (6) of the eight (8) allegations. On 03/27/2024 from 9:45am- 10:15am LPA conducted a facility tour and interviews. LPM Agard reviewed records from 10:15am -11:01am. LPA and LPM collected R1’s Hospice records, Medication Administration Record (MAR), Needs and Services Plan, Physician Report, Staff and Resident Roster. Cont. on 9099C Unsubstantiated The investigation revealed the following: Regarding the allegation: Resident sustained pressure injuries while in care. It’s being alleged a resident had a stage 2 bed sore. During interviews, LPA interviewed two (2) out of two (2) staff. S1 confirmed R1 came to the facility with a stage 2 bed sore which was being treated via hospice services. S1 denied any additional wound development. During a record review, a nursing summary from Bristol Hospice dated 02/17/2022 indicated R1 was receiving care for a stage 2 bed sore which completely healed. S2 was unable to confirm the allegation due to not knowing R1. R1 was unavailable for an interview due to passing away. Regarding the allegation: Staff mismanaged resident's medication. It’s being alleged R1 is not receiving morphine pain medication for extreme pain. Rather, R1 was given Tylenol. During an interview with S1, they stated R1 never reported being in extreme pain, therefore Morphine was not administered. During a record review, LPA observed that extra strength Tylenol is an approved pro re nata (prn) for R1, making the facility compliant with R1’s Medication Administration Records. Interviews were attempted with all five (5) residents of which one (1) reported no issues with their medication. The other four (4) residents were unable to participate due to their cognitive function. Based on records reviewed and interviews, both above allegations are unsubstantiated. Exit interview conducted and a copy of the report was given.the state’s words, verbatim · CDSS document, Mar 27, 2024 · control 31-AS-20220516115132