Allay Gardens

Allegation investigated: Staff crushed residents' medication without consent.

Licensing Program Analyst (LPA) Evelin Rios arrived at this facility to conduct an unannounced complaint visit to investigate the above mentioned allegation. LPA was granted entry into the facility by the administrator and LPA explained the reason for the visit. An entrance interview was conducted. The investigation consisted of the following: From approximately 8:35 AM to 9:11 AM, LPA Rios conducted a physical plant tour of the facility to ensure the health and safety of the residents in care. During this time, LPA interviewed one (1) of two (2) residents, Residnet #2 (R2) and Residnet #1 (R1). R1 was unable to respond to interview questions due to their medical condition. No immediate health or safety concerns were observed during the tour. (Continue to LIC9099) Unsubstantiated From 9:12 AM to 10:00 AM, LPA interviewed the administrator and reviewed and obtained documentation, including but not limited to: residents' Physician’s Reports, Pre Admission Appraisals, Appraisal/Needs and Services Plans, R1's Centrally Stored Medication Administration Records, and R1's hospice documentation. At approximately 11:18 AM LPA Rios interviewed one (1) other staff member. The investigation revealed the following: Allegation: Staff crushed residents' medication without consent. Regarding the allegation, it is reported that staff crushed residents’ medications and mixed them into their food prior to serving, without the residents’ knowledge. Interview with R2, revealed they do not receive staff assistance with medication administration. According to R2, they store and take their medication without staff assistance. LPA’s review of R2's Physician's Report dated 12/31/2025 confirms that R2 is able to manage and store their own medication and is also able to self administer their own medication. R2 confirms they have witnessed staff crush medication for R1 in the facility and place crushed medication into R1's pudding. According to R2 they have lived at this facility for about a month and this was also done at the previous facility where R1 and R2 were residing. Interview with the administrator and staff revealed they are crushing R1's medication and mixing it into soft foods. According to the administrator they are following a medication protocol continued from the previous facility and confirmed medication administration with R2's Hospice agency. The administrator also stated R2 is always told when the medication is being provided. LPA's review of R1's Physician's report dated 04/16/2026 revealed R1 is unable to administer own medication. Review of hospice documentation revealed their is physician's order in place indicating it is "ok to crush Prescription Ordered (PO) medication". Hospice documentation also noted R1 is on a puree diet. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated. No deficiencies cited. Exit interview conducted. Copy of this report provided to the administrator.the state’s words, verbatim · CDSS document, Jun 3, 2026 · control 31-AS-20260528083448

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Evelin Rios conducted an announced Pre-Licensing Inspection with the applicant representative, Shanna Rucker and the administrator Mohummed Abdullah. An application to operate a Residential Care Facility for the Elderly (RCFE) was received by Community Care Licensing (CCL) on 01/17/2025. A fire clearance was approved on 04/18/2025 for five (05) non-ambulatory residents and one (01) bedridden resident for a total capacity of six (06). At entry LPA observed appropriate postings and a sign in area for visitors. A tour of the physical plant was initiated at approximately 9:30 a.m., and the following was observed: KITCHEN: The kitchen is equipped with a refrigerator, microwave, stove, two ovens and dishwasher. There is a sufficient supply of seven day non-perishable food items, properly stored. Applicant has a sufficient amount of tableware, dishes and utensils to accommodate the capacity of the facility. Knives and sharps were observed locked in a closet by the kitchen. Centrally stored medication, medication records and first aid kit will be locked in a closet by the kitchen. The fire extinguisher is located by the kitchen and was observed fully charged with purchase date 03/15/2025. Facility is equipped with a functional land line and portable telephone. COMMON AREAS: The common areas include the two living rooms and dining area. The common areas are furnished with couches, recliners and televisions. There is a fireplace that is properly screened. The dining room table is large enough to sit the capacity of the facility. Floors and furniture were observed to be in good repair. LAUNDRY: The washer and dryer are located in a locked laundry room. Detergents will be stored in the laundry room. GARAGE: The garage accessible and attached to the house. Cleaning supplies, chemicals and detergents are locked in a cabinet in the garage. LPA observed a staff workstation and resident and staff records will be kept in a locked filling cabinet. BATHROOMS: The facility has three (3) bathrooms. Resident bathrooms were observed to have the proper fixtures, grab bars, and non-skid mats. The hot water temperature was measured in two (02) bathrooms and was within regulation. BEDROOMS: There are four (4) bedrooms. Per STD 850, Bedroom #3 has bedridden fire clearance. Bedrooms #3 and #4 are shared. The applicant furnished the resident bedrooms with beds, night stand, chairs, chest of drawers, and bedding. The bedrooms have sufficient lighting and closet space. Facility windows and screens were observed in good repair. SURROUNDING GROUNDS: The driveway, passageways and entrance to the home was clear of obstruction. All entry and exit doors have a functional auditory alarms when the doors open. The backyard is fenced in and has a patio and appropriate backyard furniture to accommodate six (6) residents. The facility's backyard has sufficient space for outdoor activities. There are no bodies of water. The smoke detectors are hard wired and inter-connected. LPA observed the licensee test one smoke detector and it set off all smoke detectors through out the facility. The facility is equipped with one (01) carbon monoxide detector that was tested and observed to be functioning properly. The applicant representative and administrator completed component III. Pre-Licensing is complete and this facility has no deficiencies. This report will be sent to Centralized Application Bureau (CAB). You will be notified by the CAB Analyst when the license has been approved. Exit interview was conducted. A copy of this report was signed and provided.the state’s words, verbatim · CDSS document, Jul 16, 2025

Type of visit: Office

Component II completion: Successful Facility Type: RCFE Application Type: Initial Capacity: 6 Census (if any clients in care): 0 COMP II Participants: Mohummed Abdullah Interview Method: Telephone Interview On June 24, 2025, applicant/administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and administrator confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, Jun 24, 2025