St. Daniel's Home for the Elderly II

Type of visit: Case Management - Annual Continuation

Licensing Program Analyst (LPA) Gabriela Castro conducted an unannounced subsequent annual inspection visit on 01/09/2026 and was greeted by Lorraine Yee, Lead Caregiver . LPA explained the purpose of the visit. On 12/23/2025, LPA conducted the initial unannounced annual inspection; however, due to time constraints, a subsequent visit was required to complete the annual inspection. The facility is licensed to serve six (6) residents, ages 60 and over, including five (5) non-ambulatory residents, of which one (1) may be bedridden. The facility holds a hospice waiver for six (6) residents. At the time of inspection, two (3) residents were receiving hospice care. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: Food Service: Refrigerators/freezers were maintained at proper temperatures (refrigerators maximum of 40 degrees °F and freezer 0-degree °C) with sufficient supply of 2-day perishable and 7 days non-perishable food. Fresh produce, proteins, and dry goods were stocked. Knives and were observed in a locked kitchen drawer. (Continued on LIC809C) Resident Records: Five (5) residents files were reviewed and contained current required documents Admissions Agreements, Pre-Placement Appraisals, Consents, Needs/Service Plans, Physician’s Reports with TB/ambulatory status and Rights acknowledgments. Personnel Records & Training: Three (3) staff files were reviewed and included criminal record clearances, CPR/First Aid, required training and TB screenings. Administrator Certificate for Deborah Davis was valid through January 15, 2027. Disaster Preparedness: Last fire/earthquake drill was conducted on December 10, 2025, with logs available. LIC 610D Emergency Disaster Plan was posted in kitchen bulletin board. Emergency supplies (water, food, flashlights, batteries, first aid) were observed in the garage. Infection Control Plan was updated. Insurance: Liability insurance was in compliance with an expiration date of March 6, 2026. An exit interview was conducted with the Lorraine Yee, Lead Caregiver. During the inspection, the facility was observed to be following Title 22, Division 6 regulations. No deficiencies were cited at this time. A copy of the report was provided.the state’s words, verbatim · CDSS document, Jan 9, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Gabriela Castro conducted an unannounced required annual visit utilizing the Compliance and Regulatory Enforcement (CARE) Tool. LPA was greeted by Justine Trinidad, Caregiver, and informed him of the purpose of the visit. Administrator Deborah Davis and Lead Caregiver Lorraine Yee arrived shortly thereafter and participated in the inspection. The facility is licensed to serve six (6) residents, ages 60 and over. The license permits five (5) non-ambulatory residents, of which one (1) may be bedridden. The facility also holds a hospice waiver for six (6) residents. At the time of the inspection, three (3) residents were receiving hospice services. Facility Tour & Observations: Personal Rights postings (LIC 613C and Ombudsman), Complaint Poster (PUB 475), and nondiscrimination notice were observed in a common area. Residents had access to personal space, privacy, and adequate storage. No firearms/weapons were present. “No smoking - Oxygen in Use signs” in various locations of the facility. Physical Plant The facility is located in a residential neighborhood and is a one-story home consisting of five (5) resident bedrooms, three (3) bathrooms, a living room, kitchen, dining area, attached garage, front yard, and backyard. Each resident bedroom was observed to contain the required furnishings, including a bed, mattress, linens, dresser, chair, and adequate lighting. (Continued on LIC809C) Cleaning supplies and other toxic substances were observed to be inaccessible to residents and secured in locked kitchen and bathroom cabinets. Bathrooms were clean and equipped with required grab bars in showers and near toilets, as well as non-skid mats. Hot water temperatures were measured observed to be slightly below the required range of 105°F to 120°F. Extra linens and towels were available and stored in hallway cabinets and hallway closet. Smoke and carbon monoxide detectors were observed to be functional. A fire extinguisher was observed in the laundry room and hallway near the front entrance. No bodies of water were observed on the premises. The backyard was observed to provide shaded seating. Passageways and exits were observed to be clear and unobstructed. Health-Related Services & Records Three (3) residents’ medications were reviewed. Medications were observed to be centrally stored in a locked closet by the front door entrance. Medication Administration Records (MARs) were reviewed and observed to be current. Due to time constraints, LPA will return at a later date to complete annual inspection. No deficiencies are being cited at this time. Exit interview was conducted with Lorraine Yee, Lead Caregiver. A copy of this report will be emailed due to printer problems.the state’s words, verbatim · CDSS document, Dec 23, 2025

Allegation investigated: Staff did not follow doctor's orders for resident's medication. Staff did not provide medical assistance to resident. Staff withheld resident's hearing aids.

Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced initial complaint investigation visit on 2/6/2025 regarding the above allegations. LPA was greeted by Caregiver Justin Trinidad and explained the purpose of the visit. Administrator Deborah Davis arrived shortly after to assist with visit. The investigation consisted of the following: LPA Ramirez requested and obtained copies of Resident/Client Roster (LIC 9020), Staff#1 - 3 interviews (S1 – S3), Interview of Resident#1-4 (R1 – R4), Attempted interview of Resident#5 (R5), Copies of R5’s: Admission Agreement, Physician’s Report (LIC 602A), Centrally Stored Medication and Destruction Record (LIC 622), Hospice Care Plan, Medication Administration Record (MAR) for the month of December 2024 & January 2025, Identification and Emergency information form (LIC 601), Resident Appraisal (LIC 603A), Preplacement Appraisal Information (LIC 603) Client/Resident Personal Property and Valuables (LIC 621) and physical plant tour. See 9099-C for continued report. Unsubstantiated The investigation revealed the following: Regarding allegation(s): Staff did not follow doctor's orders for resident's medication. It is alleged staff did not administer R5 morphine according to R5’s physician orders. R5 was admitted into the facility on 12/29/2024. During record review, LPA Ramirez observed a physician’s order for PRN (as needed) medication of morphine sulfate powder 100/5ML-give 0.25 milliliter for pain every 4 hours, with a start date of 12/30/2024. On 01/05/2025, R5’s physician ordered R5’s PRN of morphine sulfate powder 100/5ML- 0.25 milliliter for pain every 4 hours to change to every 2 hours-administer 0.5ML (10mg) and is now to be administered as a scheduled medication. Review of R5’s MAR for 12/30/2024 through 1/4/2025, revealed staff administered morphine sulfate as a PRN, per R5’s physician orders. Review of R5’s MAR dated 1/5/2025 through 1/6/2025, revealed staff administered morphine sulfate as a scheduled medication, per R5’s physician order. Three (3) out of the three (3) staff interviewed denied this allegation. Four (4) out of the four (4) residents interview denied this allegation. R5 is not available for an interview. LPA Ramirez contacted R5’s responsible party via phone but, R5’s responsible party was unavailable for an interview. Although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. Staff did not provide medical assistance to resident. It is alleged staff did not provide R5 with first aid to a wound on R5’s arm. R5 began receiving hospice care on 12/29/2024. Three (3) out of the three (3) staff interviewed denied this allegation. Staff interviews revealed, on 1/3/2025, staff#1 (S1) saw 2 drops of dried blood on the left edge sleeve of R5’s white tee shirt. S1 checked R5’s left arm and saw a small scratch, no larger than a quarter on R5’s lower arm. S1 revealed the scratch was not bleeding at the time and did appear to need first aid. S1 revealed later that day R5’s responsible party visited R5 and pointed out the dried blood drops on R5’s shirt. S1 advised R5’s responsible party of earlier observation. S1 stated “Hospice was on their way to assess R5 and I asked them to look at R5’s arm, the nurse said it appeared like a small scratch.” LPA Ramirez reviewed hospice care notes dated 1/3/2025 and 1/5/2025 and did not observe hospice care staff document any new injuries to R5 or R5 requiring wound care during visits. Four (4) out of the four (4) residents interview denied this allegation. R5 is not available for an interview. LPA Ramirez contacted R5’s responsible party via phone but, R5’s responsible party was unavailable for an interview. Although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. SEE 9099-C Staff withheld resident's hearing aids. It is alleged staff withheld R5’s hearing aids. Three (3) out of the three (3) staff interviewed denied this allegation. Four (4) out of the four (4) residents interview denied this allegation. R5 is not available for an interview. LPA Ramirez contacted R5’s responsible party via phone but, R5’s responsible party was unavailable for an interview. Staff interviews revealed, R5 was able to remove their own hearing aids and would remove them before bed so staff could charge them. Staff revealed R5 would sometimes request to have staff remove R5’s hearing aids. Although staff interviews revealed R5 had hearing aids, LPA Ramirez observed Client/Resident Personal Property and Valuables (LIC 621) form; section B- Personal property/valuables removed- indicating hearing aids, glasses and a wedding band were removed by R5’s responsible party on 12/29/2024 and was signed by R5’s responsible party. Although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. No violations were cited during this visit. Exit interview was conducted. A copy of this report was provided.the state’s words, verbatim · CDSS document, Feb 7, 2025 · control 28-AS-20250131162807

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced required annual inspection visit on 2/6/2025 and was greeted by Caregiver Lorraine Yee. Administrator Deborah Davis arrived shortly after. LPA Ramirez explained the purpose of the visit. The facility is located on a residential street and is a single store dwelling.LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: Physical Plant and Environment safety: Disinfectants, cleaning solutions, poisons and other items that could pose a danger if readily available to residents, were observed to be inaccessible to residents. LPA Ramirez observed carbon monoxide detectors and smoke alarms in hallways. LPA Ramirez inspected four (4) resident rooms. All resident bedrooms contained required furniture, linens and lighting. Resident bedroom#4 is currently unoccupied, and shared resident bedroom#2 currently only has one (1) resident. Water temperatures in all grooming and bathing areas were measured to be with 105 – 120 degrees F. LPA Ramirez observed grab bars near toilets and inside shower. LPA Ramirez observed non-slip mat in showers. Shower was observed to be wheelchair accessible. LPA Ramirez observed the facility den was converted into a resident room. The licensee must obtain prior approval from this licensing agency to change plan of operation, including facility sketch. LPA Ramirez will issue type B violation based on observation. Food Service: LPA Ramirez observed sufficient supply of nonperishable for one week and perishable foods for a minimum of two days in the facility kitchen area. Soaps, detergents, and cleaning compounds were observed to be stored away from food supplies. Freezers and refrigerators were observed to be clean and within temperatures of 0-degree F (-17.7 degree C), and refrigerators with maximum temperature of 40-degree F. (4 degree C). Planned Activities: LPA Ramirez observed board games, magazines, and other activities for residents. Residents Rights-Information: LPA Ramirez observed the following postings in common areas throughout the facility: Complaint Poster (PUB 475), personal rights, and nondiscrimination notice. LPA Ramirez observed facility land line. Disaster Preparedness: The facility has the Emergency Disaster Plan (LIC610D/9 pages) in place. Last documented emergency drills were conducted on 1/3/2025 and 11/3/2024. LPA Ramirez observed facility sketches with exits and emergency exits routes throughout various locations of the facility. LPA Ramirez observed emergency food supply located in pantry. See 809-C Residents with Special Needs: LPA Ramirez observed a pool with a locked gate around it. LPA Ramirez observed signs posted indicating “No smoking - Oxygen in Use” in various locations of the facility. LPA Ramirez observed several oxygen tanks in resident rooms secured in stands. Auditory devices were observed to be in working order. Health Related Services/Incidental Medical Services: The medications are centrally stored in the medication closet and in bubble packs and/or original containers. The facility uses the Medication Administration Record (MAR) log to document medications given. The facility provides incidental medical services. Staffing: Administrator Certificate for Deborah Davis was received by Administrator Certification Bureau and is pending. Staff employed are over the age of 18 and are fingerprint cleared and associated to the facility. Personnel Records Training: Staff files are maintained at the facility. LPA Ramirez observed required annual training, CPR and First Aid for two (2) out of the three (3) personnel records reviewed. LPA Ramirez observed TB testing results, Health screening, fingerprint clearance and job application for three (3) out of the three (3) personnel records reviewed. Infection Control: There are using appropriate hand hygiene and wearing gloves while assisting clients. Staff are cleaning and disinfecting often for high touched surfaces. Facility has an Infection Control Plan in place. Operational Requirements: The fire clearance is approved for five (5) non-ambulatory and one (1) bedridden. During resident record review, LPA Ramirez observed Resident#1’s (R1), Resident#2’s (R2), Resident#4’s (R4), physician report indicated they are bedridden. The facility fire clearance is approved for one (1) bedridden only. LPA Ramirez will issue a type A violation and assess a $500 civil penalty. This facility may retain no more than six (6) hospice residents. There were three (3) residents under hospice care during inspection. Resident Records/Incident Reports: LPA reviewed resident records for four (4) residents in care. Resident records are maintained at the facility. Admission Agreement, Physician's Report (including T.B and Ambulatory Status), Consent for Medical Treatment, Preplacement Appraisal Information, Resident Pre-Appraisal, Care Plan/Appraisal/Needs and Services Plan, Resident Rights were observed. Two (2) violations were observed and cited during this annual inspection. One (1) civil penalty was assessed during this annual inspection. Exit interview was conducted. A copy of this report, 809-D, LIC 421IM, and appeals rights was provided via email.the state’s words, verbatim · CDSS document, Feb 6, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced Annual Required Visit on 01/14/2024. LPA was met by Administrator Deborah Davis and explained the purpose of the visit. Facility is licensed to residents 60 years old and above. The facility is approved for 1 bedridden and 5 non-ambulatory. The facility may retain 6 hospice residents. LPA requested and obtained a copy of Personnel Report (LIC 500), Resident Roster (LIC 9020) and copy of liability insurance. LPA OBSERVATIONS: The Facility is a single-story building in a residential area with four (4) resident bedrooms, two (2) shared resident bathrooms, one (1) staff bedroom, one (1) staff bathroom, kitchen, dining room, living room, den/tv room, front yard, backyard and attached car garage. Front Yard: Was clean and well maintained. No hazards were observed. Kitchen: LPA observed kitchen to be clean and appliances appeared to be in working order. LPA observed sufficient 2 days of perishables and 7-day supply on non-perishables. Kitchen sink water temperature was measured at 112.3 degrees F. Dining Room/Living room/Den/TV room: Dining room was observed to be clean and contained table and 5 chairs. Living room area has 2 recliners and additional seating for clients and guests. Den/Tv room was observed to be clean and contained plenty of seating. Linen Closet: Contained plenty linens, towels, and hygiene products. Resident Rooms 1 - 4: All contained the required furnishings, linens and were observed to be clean. All rooms except rooms #2 and #4 are shared. See 809-C Bathrooms: Shared resident bathroom# 1 was observed to be clean and contained soap and paper towels. Signs promoting hand washing were observed. Grab bars were observed near toilet and shower. Water temperature in this bathroom was measured at 112.3 degrees F which is in the required 105 – 120 degrees F. Shared resident bathroom #2 water temperature was measured at 106 degrees F which is in the required 105 – 120 degrees F. Grab bars were observed near toilet and shower. Centrally Stored Medications: LPA’s observed hallway closet located near entry to be locked and inaccessible to residents. Attached Garage: LPA observed extra bedding supplies, cleaning products and hygiene products. Garage was locked and inaccessible to residents. Backyard: Clean and free from hazards. Gated pool was observed with a lock. LPA observed plenty of seating and shaded area. LPA observed carbon monoxide in hallways. Smoke detector is hard wired and tested during visit. LPA observed auditory sensors on front door and sliding door. Administrator certificate was observed for Deborah Davis with an expiration date of 01/15/2025. No deficiencies are being cited. Exit interview was conducted with Administrator Davis and a copy of this report was provided via email due to printer problems.the state’s words, verbatim · CDSS document, Jan 14, 2024