Anna's Home & Paradise

Type of visit: Required - 1 Year

At approximately 9:00 a.m. on 09/30/26, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced annual inspection. LPA met with staff and later the licensee disclosed the reason for the visit. The facility was last visited on 08/19/25 for an annual visit. It is a single story building with five (05) bedrooms, two (02) bathrooms, kitchen, garage, common areas, and outdoor areas. It has an approved fire clearance for six (06) nonambulatory residents, of which one (01) may be bedridden in Bedroom #5. The facility serves residents with dementia. Approved hospice waivers for six (06). At the main entrance, LPA observed a screening station for infectious diseases which contained hand sanitizer, a digital thermometer, masks, and a visitor sign-in sheet. Postings were observed at the front for the infection control plan, emergency disaster plan, personal rights, house rules, rights of resident councils, theft and loss policy, ombudsman contacts, confidential complaint contacts, facility sketch with emergency exit routes clearly labelled, administrator certificate, facility license, and COVID postings. Walls, floors, windows, screens, and blinds were clean and in good repair. The living room at the front contained furniture in good repair, television, reading material, and a covered fireplace. LPA called out from the telephone at approximately 9:15 a.m. It was deemed operational. The dining room contained a piano, board games, television, and furniture in good repair. Two (02) residents were observed watching television a the dining room table. Surveillance cameras were used in common areas. A sufficient supply of linens and towels were located in the hallway closet. At approximately 9:30 a.m. LPA observed fully charged fire extinguishers in the kitchen and patio area. The kitchen extinguisher was last checked on 03/13/26 and had a tag attached. Confidential files were locked in the office area. The garage was locked and contained medications, an extra refrigerator, cleaning supplies, medications, and other resident supplies. At 9:45 a.m. LPA measured the room temperature to be 74 degrees Fahrenheit. Four (04) out of four (04) auditory alarms were turned on and functioning during today's visit. The facility has five (05) private bedrooms. All bedrooms contained a lamp, a chair, nightstand, and a bed with adequate bedding. All furnishings were clean and in good condition. All hospital-style beds had wheels in the locked positions. The facility has two (02) bathrooms. One (01) bathroom is private to Bedroom #1, and one (01) is shared. All bathrooms contained liquid soap, paper towels, handwashing instruction sign, trash can with a tight-fitting lid, grab bars near the toilet and shower, and a non-skid mat in the shower. At approximately 10:20 a.m. LPA measured the water temperature in the private bathroom to be 105 degrees Fahrenheit. LPA observed an adequate supply of perishable and non-perishable foods in the kitchen and garage. The stove hood was clean. Appliances were in good condition. Sharps were locked below the counter top. Cleaning solutions were locked below the sink. At 10:30 a.m. LPA observed the refrigerator and freezer temperatures to be 40 and -1 degrees Fahrenheit, respectively. A washing machine and dryer were located near the kitchen. Both were in working order. LPA observed a covered patio area in the rear of the facility. The patio contained furniture in good condition. At approximately 10:40 a.m., smoke and carbon monoxide detectors were tested and operational. Detectors were hard-wired and operated simultaneously. Two (02) out of two (02) fire doors closed when the detectors were tested. All emergency exit paths were free from obstructions. The exit gate was unlocked. Evacuation routes were posted. At approximately 11:15 a.m. LPA conducted a record review of resident and personnel files. All files were complete and available for audit. Facility liability insurance is valid through 07/22/27. During today’s inspection, no immediate health or safety concerns were observed. Exit interview conducted. Copy of report provided.the state’s words, verbatim · CDSS document, Sep 30, 2026

Allegation investigated: Facility staff improperly providing medication assistance Facility staff do not follow modified diets

At approximately 8:45 a.m. on 09/05/25 Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced complaint visit. LPA met with staff and disclosed the reason for the visit. To investigate the allegations above, LPA conducted an initial visit on 06/17/25 and interviewed staff and residents between 9:15 a.m. and 1:30 p.m., toured the facility at 9:30 a.m., and conducted a record review of pertinent records at 10:30 a.m. Today, LPA toured the facility at 9:00 a.m. and conducted a medication review at 9:45 a.m. Regarding the allegation "Facility staff improperly providing medication assistance" it was alleged staff did not provide proper medication assistance to Resident #1 (R1). Medication review today revealed residents were properly provided assistance with medication. Medications were stored in the correct quantities as well. Interviews with five (05) out of six (06) residents revealed they had no issues with staff’s medication procedures. Interviews with two (02) staff and the administrator revealed all physician orders are followed. Unsubstantiated Interview with Staff #1 (S1) at 9:15 a.m. on 06/17/25 revealed that after each of R1’s hospitalizations, doctors wrote new orders. They changed one capsule medication to a liquid then changed it back to a capsule days later. Interview with the administrator at 1:20 p.m. on 06/17/25 revealed that despite R1’s frequent hospitalizations and subsequent medication changes, staff always followed all physician orders and updates. Record review of R1’s medication list revealed medication changes on 06/02/25 and 06/10/25. Record review provided no other pertinent information about R1’s medication procedures. Staff training records indicated all staff received training for R1’s special health care needs. Based on interviews and record review, facility staff properly provided medication assistance. Therefore, the allegation is deemed UNSUBSTANTIATED at this time. Regarding the allegation "Facility staff do not follow modified diets " it was alleged staff served all residents the same food and did not follow modified diets. Record review of residents’ medical assessments revealed that zero (00) out of six (06) residents had modified diets prescribed by a physician. Review of R1’s medical records revealed R1 “states that [they have] dysphagia, but [they don’t. They] passed swallow evaluation”. Additionally, R1’s records indicated normal Gastrointestinal functioning. Interviews with five (05) out of six (06) residents revealed they enjoyed the food served in the facility. Interviews with two (02) staff and the administrator confirmed no residents have modified diets. Staff and the administrator confirmed that all physician orders are followed. Staff noted all residents are served three (03) meals a day and snacks. LPA observed breakfast service today at 9:00 a.m. and lunch service at approximately 12:00 p.m. on 08/19/25. Meals served to residents contained a nutritious variety of fruits, grains, proteins, and liquids. Food was served in a safe and healthful manner. Based on observations, interviews, and record review, staff serve appropriate meals to residents. Therefore, the allegation is deemed UNSUBSTANTIATED at this time. No immediate health or safety concerns were observed during today’s visit. Exit interview conducted. Copy of report provided.the state’s words, verbatim · CDSS document, Sep 5, 2025 · control 31-AS-20250616164325

Allegation investigated: Staff do not treat resident with respect Staff hit resident

At approximately 10:00 a.m. on 08/19/25 Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced complaint visit. LPA met with staff and disclosed the reason for the visit. To investigate the allegations above, LPA toured the facility inside and out at 10:00 a.m., interviewed staff and residents between 10:15 a.m. and 3:00 p.m. today, and conducted a record review of pertinent records, including but not limited to an admission agreement, medical assessment, and care plan at 11:15 a.m. Regarding the allegation "Staff do not treat resident with respect" it was alleged Staff #1 (S1) screamed and cursed at Resident #1 (R1). Interviews with four (04) out of five (05) residents today confirmed that S1 and other staff have not yelled at them or any other residents. Interview with R1 confirmed that S1 and another staff, Staff #2 (S2) yell at them. Interview with the administrator at approximately 11:00 a.m. today revealed no staff have yelled at residents. Unsubstantiated Interview with S1 at approximately 12:00 p.m. today revealed they have not yelled at any residents. S1 noted that they occasionally speak at a loud volume for residents with difficulty hearing. Interview with S2 at approximately 12:30 p.m. today revealed they have not yelled at residents. S2 also confirmed that S1 does not yell at R1 or any other residents. Record review did not reveal any pertinent information to this allegation. LPA observed both S1 and S2 acting with respect and dignity towards all residents during today’s visit. Based on observations and interviews, there is no evidence suggesting staff do not treat residents with respect. Therefore, the allegation is deemed UNSUBSTANTIATED at this time. Regarding the allegation "Staff hit resident" it was alleged S1 twisted R1’s arms and legs which left bruises. R1 showed LPA bruises on both hands and arms today at approximately 11:30 a.m. R1 had about ten (10) dark purple-colored blotchy bruises on their knuckles, wrists, and lower arms which were about 1 cm x 1 cm. Interview with R1 at 11:30 a.m. revealed S2 hits them when nobody is around. R1 also said S1 hits them, and R1 occasionally sees a man in their room at night who wants to kill R1. Interviews with four (04) out of five (05) other residents revealed they have not been hit by staff nor have they heard or witnessed staff hit R1. Interviews with S1 and S2 revealed they have never hit R1, twisted R1’s arm, or inflicted any other kind of physical abuse towards R1 or any other residents. Interview with the administrator revealed no staff have hit residents. Review of R1’s file revealed R1 had assessments performed by their physician on (07/09/25) and their social worker on 08/15/25. Neither assessment revealed any pertinent information about R1’s bruising. Based on observations, record review, and interviews, there is insufficient evidence to verify the allegation is true. Therefore, the allegation is deemed UNSUBSTANTIATED at this time. No immediate health or safety concerns were observed during today’s visit. Exit interview conducted. Copy of report provided.the state’s words, verbatim · CDSS document, Aug 19, 2025 · control 31-AS-20250815151717

Type of visit: Required - 1 Year

At approximately 10:00 a.m. on 08/19/25, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced annual inspection. LPA met with staff and disclosed the reason for the visit. LPA called the licensee at approximately 11:00 a.m. and confirmed that staff could sign today’s report in their absence. The facility was last visited on 06/17/24 for a complaint visit. It is a single story building with five (05) bedrooms, two (02) bathrooms, kitchen, garage, common areas, and outdoor areas. It has an approved fire clearance for six (06) nonambulatory residents, of which one (01) may be bedridden in Bedroom #5. The facility serves residents with dementia. Approved hospice waivers for six (06). At the main entrance, LPA observed a screening station for infectious diseases which contained hand sanitizer, a digital thermometer, and a visitor sign-in sheet. Postings were observed at the front for the infection control plan, emergency disaster plan, personal rights, house rules, rights of resident councils, theft and loss policy, ombudsman contacts, confidential complaint contacts, facility sketch with emergency exit routes clearly labelled, administrator certificate, facility license, and COVID postings. Walls, floors, windows, screens, and blinds were clean and in good repair. The living room at the front contained furniture in good repair, television, reading material, a covered fireplace, and a house telephone. The telephone was called at approximately 10:10 a.m. and deemed operational. The dining room contained a piano, board games, television, and furniture in good repair. Surveillance cameras were used in common areas. A sufficient supply of linens and towels were located in the hallway closet. At approximately 10:15 a.m. LPA observed a fully charged fire extinguisher in the kitchen. At 10:25 a.m. LPA observed a fully-stocked first aid kit near the office area. Confidential files were also locked in the office area. The garage was locked and contained medications, an extra refrigerator, cleaning supplies, medications, and other resident supplies. At 10:30 a.m. LPA measured the room temperature to be 73 degrees Fahrenheit. Four (04) out of four (04) auditory alarms were turned on and functioning during today's visit. The facility had five (05) private bedrooms. All bedrooms contained a lamp, a chair, nightstand, and a bed with adequate bedding. All furnishings were clean and in good condition. All hospital-style beds had wheels in the locked positions. The facility had two (02) bathrooms. One (01) bathroom is private to Bedroom #1, and one (01) is shared. All bathrooms contained liquid soap, paper towels, handwashing instruction sign, trash can with a tight-fitting lid, grab bars near the toilet and shower, and a non-skid mat in the shower. At approximately 10:45 a.m. LPA measured the water temperature in the shared bathroom to be 105.1 degrees Fahrenheit. LPA observed an adequate supply of perishable and non-perishable foods in the kitchen. The stove hood was clean. Appliances were in good condition. Sharps were locked below the counter top. A washing machine and dryer were located near the kitchen. Both were in working order. LPA observed a covered patio area in the rear of the facility. The patio contained furniture in good condition. At approximately 11:00 a.m., smoke and carbon monoxide detectors were tested and operational. Detectors were hard-wired and operated simultaneously. Two (02) out of two (02) fire doors closed when the detectors were tested. All emergency exit paths were free from obstructions. The exit gate was unlocked. Evacuation routes were posted. At approximately 11:15 a.m. LPA conducted a record review of resident and personnel files. All files were complete and available for audit. During today’s inspection, no immediate health or safety concerns were observed. Exit interview conducted. Copy of report provided.the state’s words, verbatim · CDSS document, Aug 19, 2025

Allegation investigated: Staff did not seek timely medical attention for resident Staff did not provide adequate hygiene care to resident

At approximately 9:30 a.m. on 07/16/25 Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced complaint visit. LPA met with staff and later the administrator and disclosed the reason for the visit. To investigate the allegations above, LPA conducted an initial visit on 05/22/25 and interviewed the administrator, one (01) staff, and six (06) out of six (06) residents between 9:15 a.m. and 11:00 a.m., toured the facility inside and out at 9:30 a.m., and conducted a record review of pertinent records, including but not limited to an admission agreement, medical assessment, care plan, and staff and client rosters at 11:30 a.m. Regarding the allegation "Staff did not seek timely medical attention for resident" it was alleged R1 had sores on their leg which were not reported to their medical staff. Interview with R1 at 10:00 a.m. on 05/22/25 revealed they found an insect in their sock about one (01) week ago. Unsubstantiated R1 noted the insect bit or stung them several times, and they had some red sores from it. R1 stated their foot swelled because they are allergic to bees. R1 noted the sores were painful at times, but the pain went away after a while. Interview with S1 at 10:45 a.m. on 05/22/25 revealed they brought R1 to a clinic within 24 hours of noticing the bites. Interview with the administrator at 11:00 a.m. on 05/22/25 confirmed that S1 took R1 to the clinic the day after discovering their leg sores. The administrator also noted that R1 had a history of leg swelling and edema, however the clinic staff noted R1’s sores were not an edema or swelling. Record review of R1’s clinical notes revealed R1 went to the clinic on 05/15/25 for assessment of their leg. Records indicated that no follow-up was necessary. R1 also disclosed that a nurse at the clinic said the sores were likely bug bites. Based on interviews and record review, staff sought medical treatment for R1 within a day of discovering R1’s sores. Therefore, the allegation is deemed UNSUBSTANTIATED at this time. Regarding the allegation "Staff did not provide adequate hygiene care to resident" it was alleged R1 was not bathed in over a week and had fecal matter near their urethra. Interview with S1 revealed that the facility does not record logs for bathing and incontinence care. S1 noted that four (04) out of six (06) residents receive assistance with bathing and incontinence care. S1 checks those residents every two (02) hours and changes them if needed. S1 approximated that each resident is assisted with incontinence needs “three (03) to four (04) times” per shift. S1 stated that they change R1 every time before leaving the facility to ensure their hygiene is maintained. Interview with the administrator confirmed that residents are checked for incontinence needs every two (02) hours, and R1 was checked more frequently due to a history of incontinence issues. Interview with Staff #2 (S2) at 1:15 p.m. on 06/05/25 confirmed that residents are checked for incontinence needs at least every two (02) hours and bathed at least two (02) times per week. Interview with R1 revealed S1 was “a sweetheart” and changed and bathed R1 regularly. R1 had no issues with their care. Interview with Resident #2 (R2) at 9:15 a.m. on 05/22/25 revealed they had no issues with their incontinence and bathing care and had no irritation. Interview with Resident #3 (R3) at 9:35 a.m. on 05/22/25 revealed that staff were “very strict” about incontinence and bathing care and assisted R3 with bathing and toileting more frequently than R3 felt necessary. Based on interviews and record review, although the allegation is valid, there is no evidence to suggest that the staff did not provide adequate hygiene care. Therefore, the allegation is deemed UNSUBSTANTIATED at this time. No immediate health or safety concerns were observed during today’s visit. Exit interview conducted. Copy of report provided.the state’s words, verbatim · CDSS document, Jul 16, 2025 · control 31-AS-20250516113423

Allegation investigated: Staff handle resident roughly during hoyer lift transfers Staff hit resident Staff do not treat resident with respect

At approximately 9:30 a.m. on 07/16/25 Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced complaint visit. LPA met with staff and later the administrator and disclosed the reason for the visit. To investigate the allegations above, LPA conducted an initial visit on 06/05/25 and toured the facility inside and out at approximately 12:55 p.m., interviewed staff and residents between 1:10 p.m. and 1:40 p.m., and conducted a record review of pertinent records at 2:00 p.m. Today, LPA reviewed staff training records around 9:45 a.m. and toured the facility at 10:00 a.m. Regarding the allegation “Staff handle resident roughly during hoyer lift transfers“ it was alleged staff hurt the ankles and feet of Resident #1 (R1) when transferring them with the Hoyer lift. LPA observed a Hoyer lift, a mechanical lift used to safely transfer residents, in R1’s bedroom around 1:30 p.m. on 06/05/25. Unsubstantiated Interview with R1 at 1:30 p.m. on 06/05/25 revealed the Hoyer lift was “terrible” and did not like to be transferred with it. R1 noted they were only transferred in the Hoyer lift for about a week while recovering from leg pain. Interview with R1’s roommate, Resident #2 (R2) at 1:40 p.m. on 06/05/25 revealed they never saw R1 get injured when transferred. Interview with Staff #1 (S1) at 10:10 a.m. today and Staff #2 (S2) at 10:20 a.m. today revealed they were both trained on how to use the Hoyer lift. Neither S1 nor S2 recalled R1 being hurt from using the lift. Interview with the administrator at approximately 3:00 p.m. today revealed the Hoyer lift was only used with R1 and no other residents. S1 and S2 used the Hoyer lift for about one (01) week, and no incidents of pain were reported from R1. Record review of staff training records revealed S1 and S2 were trained and qualified to use the Hoyer lift. Based on interviews and observations, although the allegation is valid, there is not enough evidence to verify it is true. Therefore, the allegation is deemed UNSUBSTANTIATED at this time. Regarding the allegations “Staff hit resident” and “Staff do not treat resident with respect“ it was alleged S1 and S2 frequently hit and treated R1 with disrespect. Similar allegations of “Staff physically abused resident” and “Staff threatened resident” were investigated on 05/22/25 as part of complaint investigation #31-AS-20250516113423 and found to be unsubstantiated. Interview with the administrator at approximately 2:05 p.m. on 06/05/25 revealed no staff hot or disrespected any residents. The administrator also noted that R1 spoke hysterically and was confused from an infection during the month of May 2025, so reports of abuse may have been caused form confusion. Interview with R1 revealed they denied ever being hit or disrespected by staff. Interviews with four (04) out of five (05) other residents revealed they had not witnessed or experienced abuse or disrespect in the home. Interview with one (01) out of five (05) other residents did not reveal any pertinent information. Interviews with S1 and S2 confirmed that they have treated all residents with respect and never abused any residents. Based on interviews and observations, there is no evidence to verify the allegation is true. Therefore, the allegation is deemed UNSUBSTANTIATED at this time. No immediate health or safety hazards were observed during today’s visit. Exit interview conducted. Copy of report provided.the state’s words, verbatim · CDSS document, Jul 16, 2025 · control 31-AS-20250602111246

Type of visit: Office

At approximately 1:30 p.m. on 06/18/25 Licensing Program Analyst (LPA) Nicholas Reed initiated an unannounced case management visit at the Woodland Hills-South Regional Office. LPA met with the licensee and disclosed the reason for the visit. The purpose of today’s case management visit was to issue deficiencies previously noted at the facility during complaint investigations on 06/05/25 and 06/17/25 of complaints # 31-AS-20250602111246 and # 31-AS-20250616164325. During the investigations, LPA requested records for all residents. Record review at 10:30 a.m. on 06/17/25 revealed that Resident #1 (R1) was admitted without a medical assessment within the past twelve (12) months. R1 also did not have a preplacement appraisal, admission agreement, care plan. inventory list, or signed personal rights form. R1 was admitted with a G-tube and a catheter and was receiving hospice services, yet the licensee admitted at 1:20 p.m. on 06/18/25 that the facility did not retain R1’s hospice paperwork. R1 was readmitted to the facility around 06/11/25 with a Total Parenteral Nutrition (TPN) line and a catheter but no home health services or documents. Resident #2 (R2) had a medical assessment which was older than twelve (12) months. The facility did not update the care plan for Resident #3 (R3) within the past twelve (12) months. Resident #4 (R4) signed up for a private room in their admission agreement. R4 also did not have signed consent forms, tuberculosis results, inventory sheet, or signed personal rights form. Around 10:00 a.m. on 06/17/25 and at 1:00 p.m. on 06/05/25, LPA observed R4 was in a shared room with R3. Additionally, R3 and R4 both noted that they did not enjoy living with one another in the same room. Licensee to submit a written statement that all resident records, including but not limited to, medical assessments, appraisals, care plans, consent forms, and admission agreements, will be reviewed and completed. In lieu of all deficiencies cited on this report, the administrator demonstrated a lack of ability to provide appropriate care and supervision for residents. Deficiencies are assessed on the corresponding LIC 809-D page. Exit interview conducted. Appeal rights discussed. Copy of report provided.the state’s words, verbatim · CDSS document, Jun 18, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87457(c) · Plan of correction due date: Jul 3, 2025

87457 Pre-Admission Appraisal (a) Prior to admission, the prospective resident... shall be interviewed by the licensee... (c)... a determination of the prospective resident's suitability for admission shall be completed. This requirement was not met as evidenced by: Based on record review, the licensee did not comply with the section cited above through not documenting a preplacement for Resident #1 (R1) which posed a potential risk to the Health, Safety, or Personal Rights of persons in care.the state’s words, verbatim · CDSS document, Jun 18, 2025

Plan of correction: Licensee to submit a written statement that all resident records, including but not limited to, medical assessments, appraisals, care plans, consent forms, and admission agreements, will be reviewed and completed.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87505 · Plan of correction due date: Jul 3, 2025

87505 Documentation and Support - Each facility shall document in writing the findings of the pre-admission appraisal and any reappraisal or assessment which was necessary. This requirement was not met as evidenced by: Based on record review, the licensee did not comply with the section cited above through not updating the reappraisal for Resident #3 (R3) within twelve months which posed a potential risk to the Health, Safety, or Personal Rights of persons in care.the state’s words, verbatim · CDSS document, Jun 18, 2025

Plan of correction: Licensee to submit a written statement that all resident records, including but not limited to, medical assessments, appraisals, care plans, consent forms, and admission agreements, will be reviewed and completed.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87507 · Plan of correction due date: Jul 3, 2025

87507 Admission Agreements (a) The licensee shall complete an individual written admission agreement, as defined in Section 87101(a), with each resident or the resident's representative, if any. This requirement was not met as evidenced by: Based on record review, the licensee did not comply with the section cited above through not comlpeting an admission agreement for Resident #1 (R1) which posed a potential risk to the Health, Safety, or Personal Rights of persons in care.the state’s words, verbatim · CDSS document, Jun 18, 2025

Plan of correction: Licensee to submit a written statement that all resident records, including but not limited to, medical assessments, appraisals, care plans, consent forms, and admission agreements, will be reviewed and completed.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87467(a) · Plan of correction due date: Jul 3, 2025

87467 Resident Participation in Decisionmaking (a) Prior to, or within two weeks of the resident’s admission, the licensee shall arrange a meeting... to prepare a written record of the care the resident will receive in the facility. This requirement was not met as evidenced by: Based on record review, the licensee did not comply with the section cited above through not comlpeting a care plan for Resident #1 (R1) which posed a potential risk to the Health, Safety, or Personal Rights of persons in care.the state’s words, verbatim · CDSS document, Jun 18, 2025

Plan of correction: Licensee to submit a written statement that all resident records, including but not limited to, medical assessments, appraisals, care plans, consent forms, and admission agreements, will be reviewed and completed.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87458(a)(1)(A) · Plan of correction due date: Jun 20, 2025

87458 Medical Assessment (a) Prior to a person's acceptance as a resident, the licensee shall obtain... (1) A physical examination... and results of an examination for...: (A) Communicable tuberculosis. This requirement was not met as evidenced by: Based on record review, the licensee did not comply with the section cited above through not documenting a preplacement for Resident #1 (R2the state’s words, verbatim · CDSS document, Jun 18, 2025

Plan of correction: Licensee to take R2 to get tested for tuberculosis and submit a copy of the results.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87633(b) · Plan of correction due date: Jun 20, 2025

87633 Hospice Care of Terminally Ill Residents (b) A current and complete hospice care plan shall be maintained in the facility for each hospice resident. This requirement was not met as evidenced by: Based on record review, the licensee did not comply with the section cited above through not maintaining a hospice care plan for Resident #1 (R1) which posed a potential risk to the Health, Safety, or Personal Rights of persons in care.the state’s words, verbatim · CDSS document, Jun 18, 2025

Plan of correction: Licensee to obtain hospice paperwork for R1 and submit all documents to LPA by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87405 · Plan of correction due date: Jul 3, 2025

87405 Administrator - Qualifications and Duties (d) The administrator shall have the qualifications… for… (1) Knowledge of the requirements for providing care and supervision appropriate to the residents. This requirement was not met as evidenced by: Based on record review, the licensee did not comply with the section cited above through providing insufficient care and supervision which posed a potential risk to the Health, Safety, or Personal Rights of persons in care.the state’s words, verbatim · CDSS document, Jun 18, 2025

Plan of correction: Licensee to find an accredited vendor for administrator training and to show proof of an appointment by the POC due date.

Allegation investigated: Staff physically abused resident Staff threatened resident

At approximately 9:05 a.m. on 05/22/25 Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced complaint visit. LPA met with staff and disclosed the reason for the visit. To investigate the allegations above, LPA interviewed the administrator, one (01) staff, and six (06) out of six (06) residents between 9:15 a.m. and 11:00 a.m. today, toured the facility inside and out at 9:30 a.m., and conducted a record review of pertinent records, including but not limited to an admission agreement, medical assessment, care plan, and staff and client rosters at 11:30 a.m. Regarding the allegation "Staff physically abused resident" it was alleged Staff #1 (S1) hit Resident #1 (R1) four (04) times. Interview with R1 at 10:00 a.m. today revealed they have not been abused or witnessed abuse in the home and denied ever being hit by staff. Interviews with five (05) out of five (05) other residents confirmed that there is no physical abuse in the home. Interviews with S1 at 10:45 a.m. and the administrator at 11:00 a.m. today confirmed staff have not physically abused any residents. Unsubstantiated LPA did not observe any indications of physical abuse during the facility tour. Based on observations and interviews, there were no signs of staff physically abusing residents. Therefore, the allegation is deemed UNSUBSTANTIATED at this time. Regarding the allegation "Staff threatened resident" it was alleged S1 physically and verbally threatened R1. Interview with R1 revealed they debate with and occasionally yell at S1. R1 noted they were not verbally abused or threatened by S1 or any staff. Interview with Resident #2 (R2) at 9:35 a.m. today revealed they were R1’s roommate for the past year. R2 never witnessed physical abuse, verbal abuse, or threats from S1 or other staff towards R1. Interviews with four (04) out of four (04) other residents confirmed that they have experienced or heard threats or verbal abuse from S1 or any staff. Interviews with S1 and the administrator confirmed S1 and other staff have not threatened or verbally abused residents. LPA did not hear any threats or verbal abuse during the facility tour. Based on observations and interviews, there were no signs of staff threatening or verbally abusing residents. Therefore, the allegation is deemed UNSUBSTANTIATED at this time. No immediate health or safety risks were observed during today's visit. Exit interview conducted. Copy of report provided.the state’s words, verbatim · CDSS document, May 22, 2025 · control 31-AS-20250516113423

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.

Allegation investigated: Resident sustained a pressure injury due to lack of care from staff

At approximately 4:25 p.m. on 04/09/25 Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced complaint visit. LPA met with staff and disclosed the reason for the visit. To investigate the allegations above, LPA conducted an initial visit on 04/01/25 and conducted a record review of pertinent records at 8:45 a.m. including but not limited to an admission agreement, medical assessment, and care plan, toured the facility at 9:00 a.m., and interviewed the administrator over the phone at 9:15 a.m. and staff and residents between 9:30 a.m. and 10:00 a.m. LPA conducted a record review of medical records at 2:00 p.m. on 04/08/25 and interviewed Visitor #1 (V1) at 2:15 p.m. on 04/08/25 and Resident #1 (R1) at 3:45 p.m. on 04/08/25. Today, LPA toured the facility inside and out at 4:30 p.m. Regarding the allegation "Resident sustained a pressure injury due to lack of care from staff" it was alleged R1’s pressure injury worsened due to insufficient staff care. Substantiated Regarding the allegation “Staff do not treat residents with dignity or respect” it was alleged multiple staff yelled at a resident. Interview with R1 revealed they were treated respectfully by staff, but they overheard Staff #1 (S1) and Staff #2 (S2) yelling at Resident #2 (R2). R2 was not available for interview. LPA interviews with three (03) out of four (04) residents revealed staff treat residents with respect and do not yell. Interview with the administrator revealed staff yelled to R1 and R2 because they were hard of hearing. Interview with Staff #1 (S1) at 9:30 a.m. on 04/01/25 and Staff #3 (S3) at 9:40 a.m. on 04/01/25 confirmed that staff increase their volume of speech when talking to residents who are hard of hearing. LPA did not hear any yelling or name calling during visits on 04/01/25 and today. Based on observations and interviews, staff treat residents with respect. Therefore, the allegation is deemed UNSUBSTANTIATED at this time. Exit interview conducted. Copy of report provided. Interview with the administrator and staff #1 (S1) revealed R1 was hospitalized in February 2025 due to developing a prohibited health condition; a Stage 3 pressure injury. A few days later, R1 was readmitted back to the facility with the same condition with physician orders to reposition R1 every 2 hours. R1 received home health services to care for the pressure injury about three (03) times a week. Caregivers tried to assist R1 in repositioning and caring for their injury, but R1 always refused care. The Administrator and staff revealed that they had knowledge that R1’s pressure injury(s) was/were not healing and continued to be Stage 3. Interview with R1 revealed no staff assisted them with caring for their pressure injury. Interviews with other residents revealed no pertinent information to R1’s wound care. Interview with V1 confirmed R1 was non-compliant with staff care and refused treatment. V1 also noted that R1 was soiled with urine and feces during multiple visits. A review of R1’s preplacement appraisal and medical assessment revealed they were admitted to the facility on 09/24/24 with a Stage 1 pressure injury on their coccyx. Review of R1’s medical records revealed that on 02/05/25, R1 had a new and unstageable wound on their left buttock. A wound consultation from 02/14/25 revealed R1 was diagnosed with a Stage 3 pressure injury on their sacrum. R1 was hospitalized on 03/26/25 with a Stage 4 pressure injury on their sacrum. The facility did not have any home health records available. Based on record reviews and interviews, staff were aware of R1’s prohibited health condition which got worse due to R1’s noncompliance and lack of care. Furthermore, the facility readmitted R1 back with a Stage 3 pressure injury without doing proper reassessment. Therefore, based on overall investigation, the allegation is deemed SUBSTANTIATED at this time. A deficiency is cited on the LIC 9099-D page. A $500 immediate civil penalty is assessed today for a violation resulting Immediate hazard to health and safety of resident to R1. The licensee was informed that additional civil penalties might be assessed based on Health and Safety Code 1569.49(e) or (f), or 1548(e) or (f), 1568.0822(e) or (f). Exit interview conducted. Appeal rights discussed. Copy of report provided.the state’s words, verbatim · CDSS document, Apr 9, 2025 · control 31-AS-20250328130540

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87615(a)(1) · Plan of correction due date: Apr 10, 2025

87615 Prohibited Health Conditions (a) Persons who require health services for or have a health condition... shall not be admitted or retained in a residential care facility for the elderly: (1) Stage 3 and 4 pressure injuries. This requirement was not met as evidenced by: Based on interviews and record review, the licensee did not comply with the section cited above by retaining Resident #1 (R1) with a Stage 3 pressure injury which posed an immediate Health, Safety, or Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Apr 9, 2025

Plan of correction: The Licensee has agreed to conduct an in-service training with all staff regarding the cited section and submit proof of correction by tomorrow, 04/10/2025.

Type of visit: Office

At 1:00 p.m. on 07/30/2024, Regional Manager (RM) Angela Whittaker, Licensing Program Manager (LPM) Naira Margaryan, Licensing Program Analyst (LPA) Nicholas Reed, Licensee Anna Armenyan, and Consultant Viktorya Hayrapetyan met at the Woodland Hills-South Adult and Senior Care Regional Office for a Non-Compliance Conference (NCC). Today's NCC was held for a substantiated allegation of unlicensed care being provided on 07/02/2024 at 7312 Cantaloupe Ave, Van Nuys CA 91405. In addition, four (04) deficiencies were cited during an annual visit on 07/19/2024. After review of the facility file and discussion of recent violations, the Department has determined to issue an additional deficiency for insufficient administrator qualifications due to the nature of the recent violations. Deficiency is issued on the corresponding LIC 809-D page. Exit interview conducted. Appeal rights discussed. Copy of report provided.the state’s words, verbatim · CDSS document, Jul 30, 2024

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87405(d)(1) · Plan of correction due date: Aug 9, 2024

87405 Administrator - Qualifications and Duties - (d) The administrator shall have the qualifications... (1) Knowledge of the requirements for providing care and supervision appropriate to the residents. This requirement is not met as evidenced by: Based on interviews and observation, the licensee did not comply with the section cited above which poses a potential Health, Safety, or Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Jul 30, 2024

Plan of correction: Licensee has agreed to enter into a Compliance Plan and accept a Technical Support Program referral for further education by the POC due date.

Type of visit: Required - 1 Year

At approximately 9:15 a.m. on 07/19/2024, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced annual inspection. LPA met with staff and later the administrator and disclosed the reason for the visit. The facility was last visited on 11/22/2022 for a complaint visit. It is a single story building with five (05) bedrooms, two (02) bathrooms, kitchen, garage, common areas, and outdoor areas. It has an approved fire clearance for six (06) nonambulatory residents, of which one (01) may be bedridden in Bedroom #5. The facility serves residents with dementia. Approved hospice waivers for six (06). A file review was conducted prior to today’s visit. It was observed that the licensee corporation is in good standing with the Secretary of State but in “not good” standing with the Franchise Tax Board and was suspended on 07/01/2024. At the main entrance, LPA observed a screening station for infectious diseases which contained masks, sanitizer, a digital thermometer, and a visitor sign-in sheet. Postings were observed at the front for the infection control plan, emergency disaster plan, personal rights, house rules, rights of resident councils, non discrimination notice, emergency contacts, theft and loss policy, ombudsman contacts, confidential complaint contacts, facility sketch with emergency exit routes clearly labelled, administrator certificate, facility license, and COVID postings. Walls, floors, windows, screens, and blinds were clean and in good repair. The living room at the front contained furniture in good repair, television, reading material, an appropriately-grated fireplace, and a house telephone. The dining room contained a piano, board games, television, and furniture in good repair. Surveillance cameras were noticed and indicated in common areas. A sufficient supply of linens and towels were located in the hallway. At approximately 9:15 a.m. LPA observed a fully charged fire extinguisher in the kitchen. It was purchased on 02/11/2024. At 9:25 a.m. LPA observed a fully-stocked first aid kit near the office area. Confidential files were also locked in the office area. The garage was locked and contained medications, an extra refrigerator, cleaning supplies, and other extra supplies. At 9:35 a.m. LPA measured the room temperature to be 74 degrees Fahrenheit. Bedroom #5 is cleared for a bedridden resident. At approximately 9:40 a.m. LPA observed a constructed wall in the middle of Bedroom #5 creating two separate bedrooms. An updated facility sketch was not submitted to Community Care Licensing. This deficiency is cited on the attached LIC 809-D page. The auditory alarms on the exits of Bedroom #5 and the dining room were turned off during the visit. This deficiency is cited on the attached LIC 809-D page. Auditory alarms were observed on the bedroom doors of Bedroom #1, Bedroom #2, Bedroom #3, and Bedroom #4. LPA interviewed residents between 9:30 a.m. and 10:30 a.m. Three (03) out of five (05) residents stated the auditory alarms are turned on at night and disturb their comfort. This deficiency is cited on the attached LIC 809-D page. All bedrooms contained a lamp, a chair, nightstand, and a bed with adequate bedding. All furnishings were clean and in good condition. The facility has two (02) bathrooms. One (01) bathroom is private to Bedroom #1, and one (01) is shared. All bathrooms contained liquid soap, paper towels, handwashing instruction sign, trash can with a tight-fitting lid, grab bars near the toilet and shower, and a non-skid mat in the shower. At approximately 9:50 a.m. LPA measured the water temperature in the private bathroom to be 114.4 degrees Fahrenheit. LPA observed an adequate supply of perishable and non-perishable foods in the kitchen. The stove hood was clean. Appliances were in good condition. Sharps were locked below the counter top. Cleaning solutions and medications were locked in the garage. Detergents were locked above the laundry area. A washing machine and dryer were located near the kitchen. Both were in working order. LPA observed a covered patio area in the rear of the facility. The patio contained furniture in good condition. At approximately 10:30 a.m., smoke and carbon monoxide detectors were tested and operational. Detectors were hard-wired and operated simultaneously. Two (02) out of two (02) fire doors closed when the detectors were tested. All emergency exit paths were free from obstructions. The exit gate was unlocked. Evacuation routes were posted. Exit interview conducted. Appeal rights discussed. Copy of report provided.the state’s words, verbatim · CDSS document, Jul 19, 2024