Primecare Assisted Living

Allegation investigated: Staff did not seek medical attention for resident in care.

Licensing Program Analyst (LPA) Tena Herrera conducted an unannounced complaint investigation visit regarding the above allegation. LPA met Administrators Mike and Hiransha Keerthisinghe and explained the purpose of the visit. The investigation consisted of: LPA obtained copies of Resident and Staff Rosters, Copies of the following Documents within Resident #1’s file: ID and Emergency Information, Physician Report, Provider Visit Report, Most Recent Hospitalization Report and Discharge Paperwork. LPA conducted interviews with 3 Staff (S1-S3), 1 Witness (W1) and 5 Residents (R1-R5). Continued on LIC9099-C Unsubstantiated The investigation revealed the following: Allegation: Staff did not seek medical attention for resident in care. It is alleged that R1 had swollen feet and their Power of Attorney (POA) refused to take them to the doctor. LPA interviewed 3 staff and each denied the allegation, staff stated that they work closely providing updates to R1’s responsible party/POA and are actively working on getting R1 an ultrasound for feet to determine cause of swelling. Interview with S3 revealed that R1 is checked on regularly and every 2 hours staff are assisting with elevating R1’s legs/feet to ensure proper circulation. Per R1’s hospital paperwork and discharge documents dated 9/7/26, R1 was hospitalized on 9/4/26 for a non-related matter, per hospitalization paperwork there was nothing noted stating any issues with R1’s lower extremities noted, the documentation stated that there was no deformity, no trauma, no tenderness to the lower extremities and R1 had symmetric strength and sensation to upper and lower extremities. R1 was discharged from hospital on 9/7/26 and brought to/admitted to the facility on the same day. LPA reviewed R1’s file and observed that R1 was visited by their assigned Nurse Practitioner (NP) on 9/15/26, per the Provider Visit Report, swelling in feet was observed and an order for R1 denied pain during time of visit and an order for an ultrasound was issued. LPA interviewed 5 residents and each denied the allegation, residents stated they are receiving proper care and medical attention. R1 stated that they are not in any pain, have seen a nurse within the last few days, are receiving physical therapy on their legs/feet. R1 showed LPA their legs/feet, there was no redness or bruising present, however, there was swelling in the feet, R1 stated that the swelling does not hurt them and they are able to move their feet and that the staff have had the NP assess their feet. LPA conducted interview with R1’s POA (W1) and it was revealed that R1 has ongoing swelling to feet due to them being bed bound and often times refusing to do their physical therapy and keeping their legs elevated which will then cause poor circulation and swelling. W1 stated they believe that R1 is in good hands with the facility staff, have been notified of the ongoing visits with the NP and facility staff is doing what they can to ensure the swelling is being taken care of. LPA has requested for administrator to provide a copy of the scheduled ultrasound visit for R1 once it becomes available. Based on LPAs observations, interviews which were conducted and review of Resident Files/Facility File Records, there was not enough supportive evidence to concur with the reported 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 this report was provided.the state’s words, verbatim · CDSS document, Sep 17, 2026 · control 28-AS-20260915143945

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Tena Herrera conducted an announced visit and met with Administrator Hiransha Keerthisinghe for the purpose of conducting a Pre-Licensing Inspection / Component III visit. The facility has an approved fire clearance to be licensed to serve 4 Ambulatory Residents in rooms 101,110,112, 16 Non-Ambulaotry Residents in rooms 103,104,105,113, 114,115,116.117,118 10 Bedridden Residents in rooms 106,107,108,111,119. The facility is a single story building that includes: 17 resident rooms (of which 7 rooms have a private half bath), 2 shower rooms, 4 full bathrooms, 1 visitor restroom, kitchen, dining area, activity room, administrator office, conference room, staff break room, reception area, lobby, linen supply closet, medication closet, emergency supply room, generator area, and laundry room. The physical plant was toured inside and out alongside and LPA utilized the Pre-Licensing Inspection Tool. The following was observed/inspected · Bedrooms are equipped with one bed, proper bedding, night-stand, chair, sufficient lighting, appropriate closet and drawer space. · Bedrooms are large enough to allow for easy passage between and comfortable for usage of beds and other required items of furniture. · Bedridden rooms had the 2 required exits, with door chimes that were tested and operable · Sufficient supply of linens available to permit weekly changing and are stored in linen storage cabinet. · Sufficient personal hygiene supply available. · Laundry machine (wash/dryer) observed and operable. · The bathrooms were toured and had working toilets/wash basin, showers had the required non slip mats, gab bars were observed near toilets and showers. (Continued on 809-C) · There are enough bath towels, hand towels and wash cloths. · Smoke Detectors and Carbon monoxide detectors are interconnected approved in the Fire Clearance, and facility has an emergency fire sprinkler system. · Fire extinguishers were observed and charged. · Cleaning solutions are stored in a locked closet and sharps/knives are securely locked in kitchen and inaccessible. · Kitchen cabinets, refrigerator/freezer, oven, microwave, dishwasher are in working condition, clean and sanitary. · Food Menu Samples observed. · Sufficient dishes, cups, and flatware are stored in the kitchen cupboards, inspected and in good repair. · There is a designated space for Medications to be locked and inaccessible to residents. · Resident and Staff files will be stored in a locked closet. · First Aid Kit was observed with manual. · Physical plant is in good repair, building and grounds are free from hazards, window screens are in good condition. · There are two patio areas that are shaded to accommodate residents, no bodies of water observed. · Hot water temperature measured between 109.6 and 115.1 F and is within Title 22 regulation of 105-120 F. · The property is equipped with central air and heating, temperature remains at comfortable temp. · Variety of activity supplies was observed within the activity room. · Each exiting door has a door chime, they were tested and operable. · Rooms have call buttons, these were tested, demonstrated to LPA and operable. · Activity calendar and food menu are posted. · Ombudsman, Complaint Poster and Resident Rights signage are clearly posted. Component III was also completed at the time of the visit and all required documents for Licensing were discussed. Facility met the physical plant requirements/ inspection as required per California Code of Regulations Title 22 Division 6. An exit interview was conducted, and a copy of this report has been furnished to the Applicants. Accordingly, LPA will submit a copy of this facility evaluation report to the Central Applications Bureau (CAB) for review. If the applicant has questions regarding the status of the application, they have been instructed to communicate with the CAB Analyst assigned to their application.the state’s words, verbatim · CDSS document, Jul 21, 2026