The Magnolia Home

Type of visit: Required - 1 Year

At 12:40 p.m. on 06/27/25 Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced annual inspection. LPA met with licensees Ukarjit Kaur and Celena Sherman and disclosed the reason for the visit. The facility was last visited on 09/10/26 for a complaint visit. It is a single story building with three (03) bedrooms, three (03) bathrooms, office, kitchen, common areas, and outdoor areas. There are two (02) additional dwelling units (ADUs) near the property which are appropriately separated from the main property to provide security and confidentiality for all residents. Neither ADU has access to the facility. The facility has an approved fire clearance for five (05) non-ambulatory residents, of which one (01) may be bedridden in Bedroom #3. The facility serves residents with dementia. The front yard was maintained and free of hazards. At the main entrance, LPA observed postings for COVID precautions, personal rights, rights of resident councils, theft and loss policy, facility sketch, facility license, emergency contacts, and administrator certificate. Walls, floors, windows, screens, and blinds were clean and in good repair. At 12:55 p.m. LPA measured the room temperature to be 74 degrees Fahrenheit. Activities, board games, a television, furniture in good repair, and art supplies were available in the living room. At approximately 1:10 p.m., LPA observed a fully charged fire extinguisher near the kitchen. It was last inspected on 09/15/26 and had a tag attached. At 1:20 p.m. five (05) out of five (05) auditory alarms were tested and operational. All auditory alarms are centrally connected. A hallway closet contained hygiene supplies, incontinence supplies, paper supplies, and an adequate supply of fresh linens. At 1:30 p.m. the smoke and carbon monoxide detectors were tested and deemed operational. Smoke detectors were hard-wired and operated simultaneously when tested. Two (02) out of two (02) fire doors also closed appropriately when tested. At 1:40 p.m., LPA called out from the house telephone was called. It was deemed operational. LPA observed an adequate supply of perishable and non-perishable foods in the refrigerator, freezer, and pantry. The stove hood was clean. Appliances were in good condition. Sharps were locked below the counter. Cleaning solutions were locked below the sink. Medications and a complete first aid kit were locked in a kitchen cabinet. At 1:55 p.m., LPA conducted a medication review for three (03) out of five (05) residents. All medications were maintained in the proper quantities. A laundry area near the kitchen contained a washing machine and dryer. Both were in working order. The facility has four (04) bedrooms. Two (02) bedrooms are shared, one (01) is private, and one (01) serves as a staff room. The staff room was unlocked but free of hazards. All bedrooms contained a chair, lighting, nightstand, closet storage, and a bed with adequate bedding. All furnishings were clean and in good condition. At 2:10 p.m., LPA measured the water temperature in the shared bathroom to be 106.1 degrees Fahrenheit. The facility has three (03) bathrooms. Two (02) bathrooms are private, and one (01) is shared. Resident bathrooms contained liquid soap, paper towels, trash cans with a tight fitting lid, grab bars near the toilet and shower, and a non-skid mat in the shower. Outdoor areas were maintained and contained fruit-bearing trees and gardened areas. A jacuzzi was locked and had no water inside. The patio contained furniture in good condition with adequate shade. Ramps leading out were secure. The emergency exit path was free from obstructions. The northern exit gate was unlocked. At 2:30 p.m., LPA reviewed resident and personnel files. All files were complete and available for audit. No immediate health or safety concerns observed during today’s visit.the state’s words, verbatim · CDSS document, Sep 30, 2026

Type of visit: Case Management - Other

At 9:45 a.m. on 05/14/26 Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced complaint visit. LPA met with staff and disclosed the reason for the visit. Today’s case management visit was conducted in conjunction with complaint investigation #31-AS-20251110164024 to ensure staff review hospital discharge documents and conduct a proper reassessment prior to resident readmission to the facility after hospital visits. Telephonic interview with the administrator at approximately 9:45 a.m. this morning revealed they will request an amendment to recent hospital discharge paperwork to correct an error. No immediate health or safety concerns observed during today’s visit. Exit interview conducted. Copy of report provided.the state’s words, verbatim · CDSS document, May 14, 2026

Allegation investigated: Facility neglect resulted in a resident sustaining a pressure injury

At approximately 9:00 a.m. on 03/25/26 Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced complaint visit. LPA met with the administrator and disclosed the reason for the visit. Regarding the allegation "Facility neglect resulted in a resident sustaining a pressure injury" it was alleged Resident #1 (R1) was hospitalized with a large wound in their groin area. To investigate the allegations above, LPA conducted an initial visit on 11/13/25 and interviewed staff, a home health nurse, and residents between 9:10 a.m. and 12:30 p.m., conducted a record review of pertinent records at 10:00 a.m., including but not limited to a medication list, care notes, and staff and resident lists, and toured the facility inside and out at 10:15 a.m. LPA conducted a subsequent visit today and toured the facility at 9:10 a.m. and reviewed home health records and photographs at 9:30 a.m. Unsubstantiated *** This amendment was created to correct an error on the original report - LPA NR 05/14/26*** Interview with the administrator at 10:30 a.m. on 11/13/25 revealed R1 had no deep tissue pressure injuries upon admission. Telephone call with R1’s home health nurse at approximately 11:00 a.m. on 11/13/25 revealed R1 had some redness around their left ankle but no pressure injuries. The home health nurse sent photos of R1’s ankle from 10/31/25 showing redness but no open skin. Record review of R1’s home health care plan indicated they started services on 10/10/25 for assistance with Parkinson’s disease, heart disease, and a Stage 2 pressure ulcer on their left ankle. Nurse notes from 10/31/25 and 11/04/25 also indicated R1 had a Stage 2 pressure injury on their left ankle. No other pressure injuries or skin tears were noted. Interview with Staff #1 (S1) at 9:30 a.m. revealed R1 was hospitalized on 11/08/25 after expressing some pain from an unwitnessed fall. Record review of R1’s hospital records indicated they had a stage 2 pressure injury on the ankle. There was no indication of a wound around the groin area. Interviews with Staff #2 (S2) at 9:00 a.m. on 11/13/25, S1, and the administrator revealed they had not observed any wounds, redness or pressure injuries around R1’s groin area prior to or after R1’s hospitalization. Based on interviews and record review, there is not enough evidence to indicate facility neglect led to R1 sustaining a pressure injury. 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, Mar 25, 2026 · control 31-AS-20251110164024

Allegation investigated: Facility staff was unable to provide resident's medical information to emergency services. Facility staff are not keeping accurate resident records.

On 12/23/2025 at approximately 09:30 AM, Licensing Program Analyst (LPA), Angelica Segovia conducted an unannounced initial complaint visit to the facility to investigate the above allegation(s). LPA was greeted by the caregiver and stated the reason for their visit. The Administrator, Ukarjit Kaur arrived shortly after to assist with today’s visit. To investigate the allegation(s) at 09:35 AM, LPA requested census, resident and staff roster. At 09:45 AM, LPA requested pertinent documentation related to the investigation. At approximately 10:30 AM, LPA conducted a physical plant tour, to ensure the health and safety of the residents. In Between 10:30 AM – 12:30 PM, LPA attempted interviews with three (3) residents (R1-R3) and two (2) staff members (S1-S2). (Continue to LIC 9099-C) Unsubstantiated Regarding the allegation: Facility staff was unable to provide resident's medical information to emergency services. It was alleged that S2 was unable to provide medical information related to a resident in care. To investigate the allegation, LPA attempted interviews with three (3) residents and two (2) staff members. LPA’s interview with R3 revealed that the facility staff will provide medical attention to them if needed and have done so. However, R3 stated that they do not feel comfortable with the Emergency Personnels that have serviced the facility in previous dates, due to their inability to comprehend the severity of their diagnosis. LPA attempted to interview R1 and R2 but they were asleep and could not be interviewed. LPA’s interview with both S1 and S2 revealed that they are able to and have provided medical information for all three (3) residents when Emergency Services have arrived. Further interview with S2, revealed that an isolated incident regarding R1 occurred on 12/16/2025, where Emergency Services were called due to R1 exhibiting a medical episode where their concern for R1’s health and safety arose. S2 stated that emergency personnel were not willing to assess R1 but instead questioned them if they knew when to call for emergency services. LPA’s record review of R1’s Face Sheet showcased medical information such as but not limited to: Primary Insurance, Medications and Resident’s Physician Information. Additional record review of R1’s file confirmed medical information such as their Medical Subscriber Identification, Responsible Person (if any), and Medical Doctor contact information. Further record review of R1’s Admission Record contained additional pertinent information related to R1. Supplementary record review of the Department of Social Services Provider Information Notice (PIN) dated 6/24/2025, examples of when facilities should call 911 for their residents are listed and states, “…In uncertain situations, licensees should prioritize resident health and safety and call 9-1-1 to ensure appropriate medical attention is received” which correlates with S2’s interview that they were concerned for R1’s health and safety. Based on interviews and record review, there is not enough information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time. (Continue to LIC 9099-C) Regarding the allegation: Facility staff are not keeping accurate resident records. It was alleged that facility staff were not maintaining current records related to a resident in care. To investigate the allegation, LPA conducted interviews with two (2) staff members. LPA’s interview with S1 revealed that they have all three (3) residents’ records readily available for review and updated as needed. LPA’s interview with S2, revealed that on 12/16/2025, Emergency Services were called for R1, where they provided R1’s record, although Emergency Personnel did not find the information given to be suffice. During LPA’s record review, LPA confirmed that all three (3) residents’ records were readily available and contained information such as but not limited to: Resident’s Legal Name, Birthdate, Ambulatory status and Centrally Stored Medication. Additional record review of R1’s file confirmed it to contain their Medical Assessment and Needs and Services. Although, LPA observed not all information to be indicated in just one form but in multiple forms, the information required was available if needed. LPA advised S1 to perhaps consolidate residents’ medical information for a more seamless review of documentation. Based on interviews and record review, there is not enough information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time. No immediate health and safety issues observed during the day of the visit. Exit interview was conducted and a copy of this report was provided to the Administrator.the state’s words, verbatim · CDSS document, Dec 23, 2025 · control 31-AS-20251217093819

Type of visit: Prelicensing

At 1:00 p.m. on 06/27/25 Licensing Program Analyst (LPA) Nicholas Reed conducted an announced prelicensing inspection. LPA met with applicants Ukarjit Kaur and Celena Sherman and disclosed the reason for the visit. Today’s prelicensing inspection is an initial application with no residents in care. The facility is a single story building with three (03) bedrooms, three (03) bathrooms, office, kitchen, common areas, and outdoor areas. There are two (02) additional dwelling units (ADUs) near the property which are appropriately separated from the main property to provide security and confidentiality for all residents. Neither ADU has access to the facility. The facility has an approved fire clearance for five (05) non-ambulatory residents, of which one (01) may be bedridden in Bedroom #3. The facility intends to serve residents with dementia. The front yard was maintained and free of hazards. At the main entrance, LPA observed postings for COVID precautions, personal rights, rights of resident councils, theft and loss policy, facility sketch, and confidential complaint contacts. Walls, floors, windows, screens, and blinds were clean and in good repair. At 1:10 p.m. LPA measured the room temperature to be 72 degrees Fahrenheit. Activities, board games, a television, furniture in good repair, and art supplies were available in the living room. At approximately 1:15 p.m., LPA observed a fully charged fire extinguisher near the kitchen. It was last inspected on 03/24/25 and had a tag attached. At 1:20 p.m. five (05) out of five (05) auditory alarms were tested and operational. A hallway closet contained hygiene supplies, paper supplies, and an adequate supply of fresh linens. At 1:30 p.m. the smoke and carbon monoxide detectors were tested and deemed operational. Smoke detectors were hard-wired and operated simultaneously when tested. Two (02) out of two (02) fire doors also closed appropriately when tested. At 1:40 p.m., the house telephone was called and deemed operational. LPA observed an adequate supply of non-perishable foods pantry. The stove hood was clean. Appliances were in good condition. The refrigerator and freezer temperatures were measured to be forty (40) and zero (00) degrees, respectively. Sharps were locked below the counter. Cleaning solutions were locked below the sink. Medications and a complete first aid kit were locked in a kitchen cabinet. A laundry area near the kitchen contained a washing machine and dryer. Both were in working order. The facility has three (03) bedrooms. Two (02) bedrooms are shared and one (01) is private. All bedrooms contained a chair, lighting, nightstand, closet storage, and a bed with adequate bedding. All furnishings were clean and in good condition. The office area had paper supplies and a computer. The facility has three (03) bathrooms. Two (02) bathrooms are private, and one (01) is shared. Resident bathrooms contained liquid soap, paper towels, trash cans with a tight fitting lid, grab bars near the toilet and shower, and a non-skid mat in the shower. A commode was available as well. At approximately 1:50 p.m. LPA measured the water temperature in the bathroom in Bedroom #2 to be 119.0 degrees Fahrenheit. Outdoor areas were maintained and contained fruit-bearing trees and gardened areas. A jacuzzi was observed with a 4-point locking system employed. The jacuzzi was also drained, so it was not considered a hazardous body of water. The patio contained furniture in good condition with adequate shade. Ramps leading out were secure. The emergency exit path was free from obstructions. The northern exit gate was unlocked. Pre-Licensing is complete and this facility has no deficiencies. Exit interview conducted. Copy of report provided.the state’s words, verbatim · CDSS document, Jun 27, 2025