Alta Loma Gardens Residential Care #2

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Gabriela Castro conducted an unannounced required annual visit using the Compliance and Regulatory Enforcement (CARE) Tool. LPA was greeted by Eva Tancinco and explained the reason for the visit. Ana Stark Pleitez, Administrator arrived shortly thereafter. The facility is licensed to serve residents ages sixty (60) and older. The approved capacity is six (6) non-ambulatory residents. The facility is approved to retain no more than four (4) residents receiving hospice care. There was one (1) residents under hospice care during inspection. Facility Tour & Observations Personal Rights postings (LIC 613C and Ombudsman), Complaint Poster (PUB 475), and nondiscrimination notice were observed in a common area. “Oxygen in Use / No Smoking” signs were not observed throughout the facility. Residents had access to personal space, privacy, and adequate storage. No firearms/weapons were present. Physical Plant The facility is located in a residential area and is a one-story home consisting of six (6) resident bedrooms and four (4) restrooms, including two private resident restrooms, one guest restroom, and one caregiver restroom. The facility also includes a living room, kitchen, dining area, garage with an extra washer and dryer, front yard, and backyard. The property includes caregiver corridors located within and near the garage area. LPA observed all six (6) resident bedrooms and verified that each contained the required furnishings, including a bed, mattress, linens, dresser, chair, and adequate lighting. Cleaning supplies and toxic substances were observed to be inaccessible to residents and stored in a locked kitchen cabinet beneath the sink and in a hallway closet. Bathrooms were observed to be clean and equipped with required grab bars near toilets and inside showers, as well as non-skid mats. During the visit, the hot water temperature measured above 140°F, which exceeds the required range of 105°F–120°F. A citation will be issued. Extra linens and towels were observed to be available in a hallway cabinet. (continued on 809C) Smoke and carbon monoxide detectors were tested, found to be functional, and observed to be interconnected throughout the facility. Fire extinguishers were observed to be readily available throughout the facility. No bodies of water were present on the premises. The backyard contained shaded seating areas, as well as additional washers, dryers, and refrigerators. Passageways and exits were observed to be clear and unobstructed. 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 cabinet. Health-Related Services & Records Four (4) resident files were reviewed and found to contain current required documents, including Admission Agreements, Pre-Placement Appraisals, Consents, Needs and Services Plans, Physician’s Reports, ambulatory status documentation, and Rights Acknowledgments. During record review, LPA observed deficiencies in resident records. Residents R1–R3 were missing updated annual Needs and Services Plans. Additionally, residents R1 and R3 did not have physician orders for the use of bed rails maintained in their files. Deficiencies will be cited. Disaster Preparedness Last fire/earthquake drill was conducted on April 3, 2026, with logs available. LIC 610D Emergency Disaster Plan was posted on front entry bulletin board. Emergency supplies (water, food, flashlights, batteries, first aid) were observed in the garage. Infection Control Plan was updated. Personnel Records & Training Four (4) staff files were reviewed and included criminal record clearances, CPR/First Aid, required training and TB screenings. Administrator Certificate for Ana Pleitez was valid through May 25, 2027. Insurance Liability insurance was in compliance. An exit interview was conducted with Eva Tancinco, Caregiver. During the inspection, deficiencies were observed and cited on the attached LIC 809D/809C in accordance with Title 22, Division 6 regulations. A copy of this report, LIC 809D/809C, and Appeal Rights were provided.the state’s words, verbatim · CDSS document, May 28, 2026

The state marks this report as 9 pages; the online copy we transcribed has 6. You can request the full file from the county licensing office.

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Gabriela Castro conducted a Case Management visit to conduct a Health and Safety check. LPA met with AJ Espino, Caregiver and explained the purpose of the visit. During today’s visit, LPA toured the facility with AJ Espino and observed the facility to be clean and in good repair. All indoor and outdoor passageways were observed to be free of obstruction. The facility had nonperishable food supplies sufficient for a minimum of one week and fresh perishable food supplies sufficient for a minimum of two days. Hot water was tested and measured within the regulatory standard of 105°F to 120°F. LPA did not observe any immediate health and safety concerns during today’s visit. An exit interview was conducted with , and a copy of this report was provided.the state’s words, verbatim · CDSS document, Mar 13, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Kimberly Ramirez conducted an annual inspection visit on 7/29/2025 and was greeted by Caregiver Bobbie Johnson-Robertson. LPA Ramirez identified herself and 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 the required furniture, linens and lighting. 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 coating in showers. LPA Ramirez observed seated shower chairs in bathrooms. Food Service: LPA Ramirez observed a sufficient supply of nonperishables 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). LPA Ramirez observed R1 eating breakfast at the table. LPA observed R1 eating orange slices and a whole sausage patty and toast. Per R1’s recent physician’s report, R1 has a special diet which requires foods to be mechanically soft and chopped meats. Based on this observation and record review, LPA Ramirez will issue a deficiency. See 809-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 the facility land line. Disaster Preparedness: The facility has the Emergency Disaster Plan (LIC610D/9 pages) in place. LPA Ramirez observed facility sketches with exits and emergency exits routes throughout various locations of the facility. LPA Ramirez observed an emergency food supply. Residents with Special Needs: No large bodies of water were observed Knives, sharps or other items that could pose a danger to residents with dementia, were observed to be inaccessible. 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. LPA Ramirez observed Centrally Stored Medication and Destruction Record. The facility provides incidental medical services. Staffing: Administrator Certificate for Ana Barrera Pleitez with an expiration date of 05/25/2025. Per Administrator Pleitez, her Administrator’s certificate is pending renewal. 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 did not observe required annual training. LPA will issue a deficiency based on this observation. LPA Ramirez observed TB testing results, Health screening, fingerprint clearance for two (2) out of the two (2) personnel record reviewed. Infection Control: Staff 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 six (6) non-ambulatory residents over the age of 59 years old. This facility may retain no more than four (4) hospice residents. There were three (3) residents on hospice during time of inspection. Resident Records/Incident Reports: LPA reviewed resident records for five (5) 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 for four (4) out of the five (5) residents in care. LPA Ramirez did not observe a medical assessment for R3. LPA Ramirez will issue a deficiency based on this observation. Three (3) deficiencies were observed and documented during this annual inspection. Exit interview was conducted. A copy of this report, 809-D and appeals rights was emailed.the state’s words, verbatim · CDSS document, Jul 29, 2025

Type of visit: POC

LPA Ramirez was greeted by Direct Support Staff (DSP) Alvin John Espino and explained the purpose of the visit. LPA Ramirez returned to the facility to clear deficiency issued on 6/04/2024 during annual inspection. LPA Ramirez observed R3 resident file, and emails from Admin Cert Unit indicating Administrator Ana M Barrera Pleitez (6035281740) certificate is pending verification. Administrator Pleitez will forward certificate to LPA once it is issued. No further action is required. Deficiency has been cleared. Exit interview was conducted. A copy of this report, and Letter of Deficiencies Cleared, was provided.the state’s words, verbatim · CDSS document, Jun 21, 2024

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced Required 1-year Visit on 06/04/2024. LPA was met by Caregiver Bobbie Robertson and explained the purpose of the visit. The facility is licensed to serve six (6) residents over the age of 60, of which six (6) may be non-ambulatory and has a hospice waiver approved for four (4). There are currently two (2) residents receiving hospice care at this facility. Video surveillance was observed in common areas. LPA OBSERVATIONS: The facility is a single-story dwelling located on a residential street and consists of four (4) resident bedrooms, three (3) bathroom, kitchen, dining room, living room, attached garage, front yard, and backyard. LPA Ramirez observed auditory devices on entry of door to be operational, sliding door and exits. Front Yard: Was clean and well maintained. No hazards were observed. Kitchen: LPA Ramirez observed sufficient 2 days of perishables and 7-day supply on non-perishables. LPA Ramirez observed knives and sharps located in kitchen cabinet, to be inaccessible to six (6) out of six (6) residents in care. LPA Ramirez observed several bottles of cleaning solutions and disinfectants located under kitchen sink, to be inaccessible to six (1) out of one (1) resident in care. Kitchen sink water temperature was measured at 116.5 degrees F. Kitchen appliances were observed to be clean and in working order. Dining Room/Living room: Dining room was observed to be clean and contained one table with plenty of seating. Living room was observed to have plenty of seating and lighting. Nearby thermostat was observed to read 71-degree F. Linen Closet: Contained plenty linens, towels, and hygiene products. SEE 809-C Resident Rooms 1-4: LPA Ramirez inspected four (4) resident bedrooms and observed all bedrooms to contain required furnishings, lighting, and linens. Bathrooms 1-3: Water temperature in all bathrooms were measured to be within 105- 120 degrees F. Backyard: Was clean and well maintained. No hazards were observed. Plenty of shade and seating was observed. Garage: PA Ramirez observed emergency water and extra PPE/linens, and toiletry items in this area. Access to garage was observed to be inaccessible to six (6) out of six (6) residents in care. Emergency Drills/Emergency Disaster Plan/First Aid Kit: LPA Ramirez observed Emergency & Disaster Plan (LIC 610E) during inspection. Last fire drill was conducted on 03/24/24. Carbon Monoxide Detectors/Fire Alarm/Fire Extinguisher: LPA observed carbon monoxide in hallways and smoke detectors were observed to be operable. Personnel Records: Personnel records are maintained at facility. LPA Ramirez reviewed staff files for two (2) staff. LPA Ramirez observed an expired Administrator’s certificate for Stark Pleitez, Ana with an expiration date of 05/25/2021. LPA Ramirez will issue Type B deficiency based on this observation. LPA Ramirez observed required annual training, CPR and First Aid for two (2) out of the two (2) personnel records reviewed. LPA Ramirez observed TB testing results, Health screening, fingerprint clearance and job application for two (2) out of the two (2) personnel records reviewed. Resident Records: Five (5) out of the six (6) resident records were accessible to LPA Ramirez. R1 and R2 were observed to missing required annual medical assessment. LPA Ramirez will issue two (2) Type B deficiencies based on this record review and observation. Liability Insurance & Infection Control Plan: Facility will send proof of liability insurance within 7 calendar days. Facility will infection control plan within 7 calendar days. Exit interview was conducted. Three (3) deficiencies were cited during this inspection. A copy of this report, 809-D and appeals rights was provided.the state’s words, verbatim · CDSS document, Jun 4, 2024

Type of visit: POC

Licensing Program Analyst (LPA) Mora conducted an unannounced plan of correction (POC) visit to follow up on deficiencies noted on 03/07/2024. LPA met with John Robles Jr (Caregiver) and explained the reason for the visit. On 03/07/2024, LPA Mora conducted a subsequent complaint visit and the following was cited: 1. Title 22 Section Code 87204(a) - Facility was over capacity due to having a 7th resident. The facility has 5 residents. Administrator submitted a statement that they will comply with this regulation on 03/08/2024. 2. Title 22 Section Code 87307(a)(2)(B) - There was a resident residing in a room licensed as "Office". The room is now being used as intended. Administrator submitted a statement that they will comply with this regulation on 03/08/2024. 3. Title 22 Section Code 87208(a)(7)(A) - The garage was being used as a sleeping area for staff and there was no permits allowing this. Also, the garage was not licensed as a living/sleeping area for staff. During today's visit, LPA observed that the bed sheets on the bed in the garage have been removed and the bed will be stored in the garage, but be used for sleeping. The Administrator also submitted a statement that the garage will be used as intended and no one will sleep in the garage on 03/08/2024. 4. Title 22 Section Code 87307(d)(4) - There was a step down when opening a door in the kitchen area leading to a hallway that leads to the garage. This step down is not noticeable and can be a tripping hazard. This door was unlocked when LPA visited the facility. During today's visit, LPA observed that this area is now inaccessible to the residents due to Administrator installing an auto lock on the door. 5. Title 22 Section Code 87705(j) - All exit doors did not have an auditory device. During today's visit, LPA observed that all exit doors have an auditory device and were operable. Exit interview was conducted with John Robles Jr (Caregiver) and a copy of this report was provided.the state’s words, verbatim · CDSS document, Mar 19, 2024

Allegation investigated: Facility is operating beyond the terms and conditions of their license. Facility's plan of operation is not current. Facility does not provide a safe environment for the residents in care. Facility does not have auditory devices in all exits.

Licensing Program Analyst (LPA) Luis Mora conducted an unannounced subsequent complaint visit to determine the validity of the above-mentioned allegations. LPA met with Takyra Armstrong (Caregiver) and explained the reason for the visit. The investigation consisted of the following: On 07/20/2023, LPA Mora obtained copies of the resident, staff rosters, and the facility sketches. LPA interviewed Administrator, Staff 1 - Staff 2 (S1 - S2), Resident 1 - Resident 7 (R1 - R7) and toured the facility. During today's visit, LPA Mora interviewed Administrator, Staff 3 - Staff 5 (S3 – S5), Resident 1 (R1), Resident 2 (R2), Resident 4 (R4), Resident 5 (R5) and Resident 7 (R7) and toured the facility. The investigation revealed the following: regarding the allegation "facility is operating beyond the terms and conditions of their license", it is alleged that the facility is overcapacity and has a total of 7 residents. Facility is licensed to serve 6 residents. Interviews with Administrator and staff and tour conducted on 07/20/2023 confirmed that the facility did have a total of 7 residents. LPA observed the 7th resident in the office room. During today’s visit, LPA observed a total of 5 residents. (Continued to LIC 9099-C) Substantiated Regarding the allegation " facility's plan of operation is not current", it is alleged that it is possible that the caregivers’ room was repurposed into a resident bedroom leading to the staff sleeping in the garage. Administrator stated that the garage and the room near the garage where both licensed as "Administrator Living Area" and she had beds in there because there are times that she and her children sleep in there or staff will ask to sleep in there. LPA reviewed the facility sketch in the Community Care Licensing Department (CCLD) records that was submitted during the application and pre-licensing process and observed that the facility sketch has the garage labeled as “garage” and the room near the garage is labeled as “office”. The pre-licensing visit conducted on 07/19/2019, list a staff room (most likely the office room) and a garage. There is no mentioned of “Administrator Living Area”. During the tour conducted on 07/20/2023, LPA observed bunk beds bunched up together on one side of the garage without any linens and a separate bed with linens and the room that is supposed to be the office was occupied by a resident. During today’s visit, the bunk beds without linens and the separate bed with linens are still in the garage and there is a TV with cable box, a heater, some clothes in a box next to the bed. The office room is vacant and there are some boxes being stored in there. Facility does not have any permits that allows them to use the garage as a living/sleeping area. Regarding the allegation "facility does not provide a safe environment for the residents in care", it is alleged that there is a step down in the hallway leading from the kitchen area to the garage. The step down is not easily identified, and a piece of tile is missing in the area right below the step down and this could cause a trip hazard. During the tour on 07/20/2023, the LPA observed that as soon as you open the door from the kitchen area there is a hallway that leads to the garage and office room. The floor in the kitchen area is about 3-4 inches higher than the floor in this hallway which creates a step down and can be a tripping hazard. Staff interviewed stated that residents are not allowed to go into this area and that this door needs to be locked. During both tours, the LPA observed that the door was not locked. Regarding the allegation "facility does not have auditory devices in all exits", it is alleged that there are no alarms on the doors leading to outside. During the tour on 07/20/2023, LPA observed that only the front door has an auditory device. There are 3 exit doors leading to outside that do not have an auditory device which are the back sliding door, the bathroom in bedroom #3, and the exit door in the office room. During today’s visit, all exit doors are missing an auditory device. Facility has dementia resident and are required to have auditory devices on all exit doors. Based on record review and interviews conducted, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulations Title 22, Division 6, Chapter 8 are being cited and a civil penalty will be issued. Refer to LIC 9099-D and LIC 421IM. During the tours, LPA observed that there is a room that has a wall in the middle that separates the two residents in that room. On one side of that wall is a closet for R1. The wall extends halfway which allows a passage way from R2's living area to R1's living area. Administrator stated that this is considered bedroom 3 and it was licensed the way it is. LPA reviewed the original facility sketch for this facility that was provided during the application and pre-licensing process and observed that the sketch does show wall in the middle of bedroom 3 that extends halfway. Regarding the allegation "facility does not have sufficient staff to care for the residents", it is alleged that there is only one staff working. Administrator and staff interviewed stated that there are 2 staff working per shift except for graveyard there is only 1 staff working. Residents interviewed could not corroborate the allegation and stated that there is enough staff to meet their needs. Regarding the allegation "facility's common areas are being used as sleeping area", it is alleged that staff are sleeping in the living room. Administrator and staff denied the allegation. Residents interviewed could not corroborate the allegation. 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. Exit interview held and a copy of the report was providedthe state’s words, verbatim · CDSS document, Mar 7, 2024 · control 28-AS-20230714082450

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87204(a) · Plan of correction due date: Mar 8, 2024

87204 Limitations - Capacity and Ambulatory Status. (a) A licensee shall not operate a facility beyond the conditions and limitations specified on the license, including specification of the maximum number of persons who may receive services at any one time…. This requirement is not met as evidenced by: Based on observation and interviews, the licensee did not comply with the section cited above, which poses an immediate health, safety, or personal rights risk to persons in care. Facility was over capacity due to having a 7th resident.the state’s words, verbatim · CDSS document, Mar 7, 2024

Plan of correction: Licensee will ensure that Title 22 Section Code 87204 are met at all times. Additionally, Licensee will write a statement that they will comply with this regulation and submit statement by 03/08/2024. This deficiency will result in an immediate civil penalty for operating beyond the approved capacity.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87307(a)(2)(B) · Plan of correction due date: Mar 8, 2024

87307 Personal Accommodations and Services. (a) Living accommodations and grounds shall be related to the facility's function. The facility shall be large enough to provide comfortable living accommodations and privacy for the residents, staff, and others who may reside in the facility. The following provisions shall apply: (2) Resident bedrooms shall be provided which meet, at a minimum, the following requirements: (B) No room commonly used for other purposes shall be used as a sleeping room for any resident. This includes any hall, stairway, unfinished attic, garage storage area, shed or similar detached building. This requirement is not met as evidenced by: Based on observation and interviews, the licensee did not comply with the section cited above, which poses a potential health, safety or personal rights risk to persons in care. Resident 6 was residing in a room licensed as "Office".the state’s words, verbatim · CDSS document, Mar 7, 2024

Plan of correction: Licensee will ensure that Title 22 Section Code 87307 are met at all times. Additionally, Licensee will write a statement that they will comply with this regulation and submit the statement to CCLD by 03/08/2024.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87208(a)(7)(A) · Plan of correction due date: Mar 15, 2024

87208 Plan of Operation. (a) Each facility shall have and maintain a current, written definitive plan of operation. The plan and related materials shall be on file in the facility and shall be submitted to the licensing agency with the license application. Any significant changes in the plan of operation which would affect the services to residents shall be submitted to the licensing agency for approval. The plan and related materials shall contain the following: (7) Sketches, showing dimensions, of the following: (A) Building(s) to be occupied, including a floor plan that describes the capacities of the buildings for the uses intended and a designation of the rooms to be used for nonambulatory residents and for bedridden residents, other than for a temporary illness or recovery from surgery as specified in Sections 87606(d) and (e). This requirement is not met as evidenced by: Based on observation and interviews, 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 garage is being used as a sleeping area for staff and there is no permits allowing this. Also, the garage was not licensed as a living/sleeping area for staff.the state’s words, verbatim · CDSS document, Mar 7, 2024

Plan of correction: Licensee will ensure that Title 22 Section Code 87208 are met at all times. Additionally, Licensee is to request a building permit to operate the garage as a staff room, and will submit permit and updated facility sketch to CCLD for approval or remove the bed from the garage and write a statement that they will use the garage as intended.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87307(d)(4) · Plan of correction due date: Mar 8, 2024

87307 Personal Accommodations and Services (d) The following space and safety provisions shall apply to all facilities: (4) Stairways, inclines, ramps and open porches and areas of potential hazard to residents with poor balance or eyesight shall be made inaccessible to residents unless equipped with sturdy hand railings and unless well-lighted. This requirement is not met as evidenced by: Based on observation and interviews, the licensee did not comply with the section cited above, which poses a potential health, safety or personal rights risk to persons in care. There is a step down when opening a door in the kitchen area leading to a hallway that leads to the garage. This step down is not noticeable and can be a tripping hazard. This door was unlocked when LPA visited the facility.the state’s words, verbatim · CDSS document, Mar 7, 2024

Plan of correction: Licensee will ensure that Title 22 Section Code 87307 are met at all times. Additionally, Licensee will write a statement of how they will address the tripping hazard issue and submit the statement to CCLD by 03/08/2024.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87705(j) · Plan of correction due date: Mar 8, 2024

87705 Care of Persons with Dementia (j) The licensee shall have an auditory device or other staff alert feature to monitor exits, if exiting presents a hazard to any resident. This requirement is not met as evidenced by: Based on observation and interviews, the licensee did not comply with the section cited above, which poses a potential health, safety or personal rights risk to persons in care. All exit doors did not have an auditory device.the state’s words, verbatim · CDSS document, Mar 7, 2024

Plan of correction: Licensee will ensure that Title 22 Section Code 87705 are met at all times. Additionally, Licensee will install auditory devices on all exit doors by 03/08/2024.

Allegation investigated: Staff does not provide residents with nutritious meals. Facility does not post menu. Staff does not prevent resident from posing a hazard to other residents.

Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced initial complaint investigation visit on 02/13/24 regarding the above allegations. LPA Ramirez was met by Caregiver Bobbie Robertson and explained the purpose of the visit. The investigation consisted of the following: LPA Ramirez requested and obtained copies of Resident Roster (LIC 9020), Staff#1 - 2 interviews(S1 – S2), Resident#3-5 interviews (R3 – R5 ), Attempted interview of Resident#1, 2, 6 (R1, R2, R6) Resident# 1-6 (R1- R6) record review, copy of Alta Loma Gardens Residential Care#2 General Facility Information and House Rules, copy of facility sample menu, copies of Resident# 1-6 (R1-R6): Physician Report, Daily Notes from 02/06/2024 through 02/12/2024, and physical plant tour. See 9099-C for continuation. Unsubstantiated The investigation revealed the following. Regarding Allegation(s): Staff does not provide residents with nutritious meals- It is alleged staff do prepare nutritious meals, like fruits and vegetables. LPA Ramirez conducted physical tour at approximately 8:20 am. LPA Ramirez observed R4 and R5 seated at the dining room table, eating breakfast. LPA Ramirez observed a decent serving of diced potatoes, scrambled eggs, bacon, and a croissant on R5’s plate. LPA Ramirez viewed facility Daily Notes dated 02/06/2024 through 02/12/2024, for all six (6) residents that documents date, time, meal intake% and description of what eat resident consumed. LPA Ramirez observed a variety of meals documented and observed fruits and vegetables being documented on somedays. LPA Ramirez observed staff documented most meals were 80% to 100% consumed on most days for each resident. Two (2) out of two (2) staff interviewed denied this allegation. Three (3) out of six (6) residents interviewed denied this allegation. R1 was sleeping during tour and could not be interviewed. R2 and R6 are receiving hospice care and could not be interviewed. 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. Facility does not post menu- It is alleged the facility does not post a menu of meals to be served. LPA Ramirez observed facility sample menu during file review. Per Title 22, Division 6, Chapter 8, Article 10 Food Services, 87555 General Food Service Requirements (b)(6)- The following food service requirements shall apply: In facilities for sixteen (16) persons or more, menus shall be written at least one week in advance and copies of the menus as served shall be dated and kept on file for at least 30 days. Facilities licensed for less than sixteen (16) residents shall maintain a sample menu in their file. Menus shall be made available for review by the residents or their designated representatives and the licensing agency upon request. Two (2) out of two (2) staff interviewed denied this allegation. 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. See 9099-C for continuation. Staff does not prevent resident from posing a hazard to other residents- It is alleged that staff allow delivery packages to pile up in facility hallway and resident is unable to open door. Two (2) out of two (2) staff interviewed denied this allegation. LPA Ramirez toured facility including each resident room. LPA Ramirez did not observe any hazards inside or outside the facility. LPA Ramirez observed R1 and R3 to have private rooms. LPA Ramirez was able to enter R3’s room and did not observe any hazards. LPA Ramirez did observe several large bags with various unknown packaged items, in front of R3’s closet area. LPA Ramirez observed sufficient space for R3 and for staff to provide care and supervision. 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. Exit interview was conducted and a copy of this report and appeals rights was provided.the state’s words, verbatim · CDSS document, Feb 13, 2024 · control 28-AS-20240212095842

Allegation investigated: Staff physically abused resident in care. Staff speaks to resident in an inappropriate manner. Staff left resident in wheelchair for an extended period of time.

Licensing Program Analyst (LPA) Alma Gonzalez conducted an unannounced complaint visit to gather information pertaining to the above-mentioned allegations. LPA met with Administrator Ana Margarita Pleitez and explained the reason for the visit. The investigation consisted of: LPA conducted interviews with Administrator Ana Margarita Pleitez, Staff 1-2 (S1-2), and Residents 1-5 (R1-5). R6 was not in the facility at the time of visit. LPA obtained copies of Staff and Resident Rosters. LPA reviewed R1's facility file and S1-2's staff files and collected copies of documents pertinent to the investigation. LPA additionally conducted a tour of facility inside and out including resident rooms, restrooms, living room, kitchen and dining area. LPA observed clients in care. (See LIC9099C for continuation) Unsubstantiated Investigation revealed the following: Regarding allegation, Staff physically abused resident in care, it is alleged that a facility staff hit a resident on the hand and also kicked a resident's leg. Interviews conducted with Administrator Ana Margarita Pleitez and S1-2 revealed that staff did not physically abuse R1 or any other resident and have never hit any facility resident on their hands or kicked their legs. Facility staff all stated that all facility residents are treated with dignity and respect at all times. Staff stated that there is a zero-tolerance policy on abuse and will report any type of abuse if they observe any staff physically abusing a resident. LPA conducted interviews with 1 out of 6 residents who stated that they were hit on the hand and their leg was kicked by a staff that does not work in the facility anymore. 4 out of 6 residents stated that they have never been hit by staff and stated that they have not seen staff hit any other resident. 1 resident was not in the facility during LPA visit. LPA observed 5 out of 6 residents in the facility and did not observe anything of concern. LPA observed 1 resident in the living room watching television and 4 residents were in their rooms. LPA observed staff tending to residents needs. LPA reviewed staff files and observed that they receive annual training on abuse. Based on statements gathered from interviews conducted with staff, facility residents and LPA observations, there was not enough supportive evidence to concur with the reported allegation. For allegation, Staff speaks to resident in an inappropriate manner, it is alleged that facility staff call a resident names, body shame and make fun of resident's speech. Interviews conducted with Administrator Ana Margarita Pleitez and S1-2 revealed that staff have never called a resident names, body shamed or made fun of resident's speech. Facility staff all stated that all facility residents are treated with dignity and respect at all times. Staff also stated there is a zero-tolerance policy on any type of abuse and will report if they observe any staff verbally abusing a resident. LPA conducted interviews with 1 out of 6 residents who stated that a staff that does not work at the facility anymore called them names, body shamed them and also made fun of resident's speech. 4 out of 6 residents stated that they have never been called names, body shamed or made fun of by staff and stated that they have not seen or heard staff do that to any other resident. 1 resident was not in the facility during LPA visit. LPA observed 5 out of 6 residents in the facility and did not observe anything of concern. LPA observed 1 resident in the living room watching television and 4 residents were in their rooms. LPA observed staff tending to residents needs and did not observe or hear staff making inappropriate comments to any resident. LPA reviewed staff files and observed that they receive annual training on abuse. Based on statements gathered from interviews conducted with staff, facility residents and LPA observations, there was not enough supportive evidence to concur with the reported allegation. For allegation, Staff left resident in wheelchair for an extended period of time, it is alleged a facility staff neglected a facility resident by leaving them in their wheelchair for three hours. Interviews conducted with Administrator Ana Margarita Pleitez and S1-2 revealed that staff have never neglected a facility resident by leaving them in their wheelchair for three hours. Facility staff all stated that all facility residents are treated with dignity and respect at all times and they are constantly checking on residents to see if they need anything or need assistance. LPA conducted interviews with 1 out of 6 residents who stated that a staff that no longer works in the facility neglected them by leaving them in their wheelchair for three hours. 2 out of 6 residents stated that they have never been neglected and have never been left in their wheelchair for a long period of time. 2 out of 6 residents stated that they do not use a wheelchair and that staff tend to them in an appropriate amount of time and they have not been neglected by staff. 1 resident was not in the facility during LPA visit. LPA observed 5 out of 6 residents in the facility and did not observe anything of concern. LPA observed 1 resident in the living room watching television and 4 residents were in their rooms. LPA observed staff tending to residents needs and did not observe any resident left in a wheelchair for an extended period of time. Based on statements gathered from interviews conducted with staff, facility residents and LPA observations, there was not enough supportive evidence to concur with the reported allegation. Although the allegations 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. Exit interview held. A copy of the report was provided to Facility Caregiver Bobbie Robertson.the state’s words, verbatim · CDSS document, Dec 5, 2023 · control 28-AS-20231128083025