Above All Care 3

Allegation investigated: Staff did not provide adequate supervision resulting in resident leaving the facility.

Licensing Program Analyst (LPA) Rose Ruppert made an unannounced visit to deliver findings for a complaint being investigated by the Department. LPA was greeted and granted entry by Staff at 1pm. LPA met with Laura Oudinot, Administrator to deliver findings. It was alleged that Staff did not provide adequate supervision resulting in resident leaving the facility. LPA reviewed the following documents from Resident #1 (R1)'s file: Identification and Emergency Information Form, Pre-Admissions Appraisal, Appraisal Needs and Services Plan, Physician's Report and Admissions Agreement. Four of four staff members stated the resident has always verbalized wanting to return home since Resident #1 (R1) was admitted on February 1, 2026. Per Physician's Report, dated January 30, 2026 , R1's primary diagnosis is dementia. The Physician's Report also states the resident is not able to leave facility unsupervised. (Continued on LIC 9099) Substantiated (Continued from LIC 9099) On September 9, 2026, Resident #1 (R1) voiced to their roommate and staff that they wanted to go home. Staff were unaware R1 contacted transport until a vehicle arrived at the facility. Staff tried to redirect the resident and the Administrator (AD) spoke to the driver and the driver drove away; stating the vehicle was too small to accommodate R1. Staff continued to redirect the resident but R1 contacted the transportation agency, a second time. A second vehicle arrived at the facility and R1 immediate went into the van. AD also spoke to the second driver but, since the resident stated they wanted to leave, the driver left the facility with the resident. Staff immediately contacted the local police department and were told to contact the police department near the resident's former home, for a health and safety check; as well as the Long Term Care Ombudsman. R1 does not have any immediate family; nor Power of Attorney. R1 arrived at the destination and the local police department (PD) conducted a health and safety check. It was determined, by PD, that R1 was unable to reside at the residence and R1 was taken to a facility for care. An Unusual Incident Report was submitted to the Department regarding the incident on September 11, 2026 by the facility. Per LPA interviews, four of four staff confirmed the events on September 9, 2026; stating that they could not prevent R1 from leaving. LPA interviewed one of two residents. One resident confirmed the events on September 9, 2026, stating R1 wanted to return home and was not prevented from leaving. Three of three witnesses were interviewed. Two of three witnesses confirmed the facility was not able to prevent R1 from leaving the facility. One of three witnesses could not confirm, nor deny the allegation. Based on LPA's file review and interviews the preponderance of the evidence standard has been met. Therefore, the allegation that Staff did not provide adequate supervision resulting in resident leaving the facility is Substantiated. An exit interview was conducted with Administrator, Laura Oudinot, and a copy of this report, LIC 9099-D, Appeal Rights and LIC 811 were provided to the facility.the state’s words, verbatim · CDSS document, Sep 25, 2026 · control 22-AS-20260912135545

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87464(f)(1) · Plan of correction due date: Sep 26, 2026

(f) Basic services shall at a minimum include: (1) Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). This requirement was not met as evidenced by: A dementia resident left the facility, unassisted, and was not provided care and supervision, as (Continued) as required from the Physician's Report. This posed an immediate health and safety risk to one of five persons in care.the state’s words, verbatim · CDSS document, Sep 25, 2026

Plan of correction: Administrator (AD) will provide in-service to staff and document the dementia care topic discussed. AD will email LPA by POC due date.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Claudia Gutierrez made an unannounced visit for the purpose of conducting a Required/Annual Inspection. LPA was greeted and granted entry by Staff Eva De Lazo and the purpose of the inspection was discussed. Assistant Administrator (AAD) Laura Oudinot arrived at approximately 1:30 p.m. During the inspection, LPA and AAD conducted a tour of the inside and outside of the facility, common areas, resident rooms, kitchen, garage and observed the following: This is a two-story home with four resident bedrooms, two bathrooms, and attached two-car garage on the first floor. The second story is used solely as staff quarters. All resident bedrooms had the required furnishings. LPA observed all resident beds had linens and blankets. The backyard has a shaded sitting area. LPA observed residents watching television in the living room and resting in their respective bedrooms. Bathrooms were observed to be free of debris and mildew and faucets and toilets were operational. Water temperature tested at 118.9 degrees Fahrenheit. LPA observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food as required by regulations. Smoke detectors and carbon monoxide detectors tested operational. Fire extinguisher was observed to be fully charged with service tag dated July 21, 2025. Gas stove, microwave, laundry washer and dryer were inspected and all, with the exception of the gas stove, were observed to be operable. Gas stove was observed to require a multi-purpose lighter in order to operate; a Deficiency was cited on today's date. Toxic chemicals, cleaning solutions, and disinfectants were observed to be inaccessible to residents. Medication was observed to be centrally stored in a locked cabinet. LPA conducted record review of five resident files and three staff files. LPA interviewed residents and staff. (Cont. LIC809-C) Based on the observations made during today’s inspection, one deficiency is being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted, and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Mar 24, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Claudia Gutierrez made an unannounced visit for the purpose of conducting a Required/Annual Inspection. LPA was greeted and granted entry by Staff Eva De Lazo and LPA explained the purpose of the inspection. Administrator (AD) Nicolas Oudinot and Shelly Yamashiro arrived at approximately 9:00 am. During the inspection, LPA and Staff De Lazo conducted a tour of the inside and outside of the facility, common areas, resident rooms, kitchen, garage and observed the following: This is a two-story home with four resident bedrooms, two bathrooms, and attached two-car garage on the first floor. The second story is used solely as staff quarters. All resident bedrooms had the required furnishings. LPA observed all resident beds had linens and blankets. The backyard has a shaded sitting area. LPA observed residents watching television in the living room and resting in their respective bedrooms. Bathrooms were observed to be free of debris and mildew, faucets and toilets were operational. Water temperature tested at 115.5 degrees Fahrenheit. LPA observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food as required by regulations. Smoke detectors and carbon monoxide detectors tested operational. Fire extinguisher was observed to be fully charged with service tag dated July 9, 2024. Gas stove, microwave, washer, and dryer were all inspected and observed to be operable. Toxic chemicals, cleaning solutions, and disinfectants were observed to be inaccessible to residents. Medication was observed to be centrally stored in a locked cabinet. LPA conducted record review of four resident files and three staff files. LPA interviewed residents and staff. (Cont. LIC809-C) Based on the observations made during today’s inspection, no deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted, and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, May 16, 2025

Type of visit: Required - 1 Year

On 7/19/2024, Licensing Program Analyst (LPA) Janette Romero conducted an unannounced visit to the facility for a required annual inspection. LPA was greeted and granted entry by Caregiver, Eva De Lazo who was informed of the purpose of the visit. Administrator, Nicolas Oudinot was contacted over-the-phone and also informed of LPA's visit. The facility has a fire clearance for six (6) non-ambulatory elderly residents and an approved hospice waiver for two (2). LPA toured the facility with Caregiver De Lazo and observed the facility is made up of a two-story home with four (4) resident bedrooms, two (2) bathrooms, a staff room, kitchen, dining room and attached garage. During the tour, Caregiver De Lazo tested one (1) of the smoke alarm/carbon monoxide detectors and LPA observed it to be operational. LPA also observed charged fire extinguishers mounted throughout the facility, which were serviced on 7/9/2024. LPA toured the kitchen and observed food was stored in a safe and healthful manner. The facility had more than a 2-day supply of perishable foods and 7-day supply of non-perishable food items. Medications are secured in a locked kitchen cabinet. Indoor and outdoor passageways were free of obstruction. The facility has an outdoor shaded seating area for resident leisure. No bodies of water were observed on the premises. Resident bedrooms had the required furniture and lighting. Bathrooms had grab bars and non-skid mats in the showers. LPA also observed the facility has additional clean linens and towels stored in a hallway closet. The living room fireplace has an adequate screen to make it inaccessible for the residents in care. LPA reviewed random staff and resident files. Resident files reviewed had signed admission agreements and updated physician reports. Staff files reviewed had a criminal record clearance and a valid first aid/CPR certification. During today's visit, LPA did not observe any issues or concerns. An exit interview was conducted where this report was reviewed and provided to Caregiver De Lazo.the state’s words, verbatim · CDSS document, Jul 19, 2024