Shasta Residential Care

Allegation investigated: Staff did not allow resident back into facility after hospitalization.

On July 15, 2026, Licensing Program Analyst (LPA) Eboni Bentley arrived at the facility unannounced for a subsequent complaint investigation visit into the above allegation. LPA was greeted and granted entry after stating the purpose of the visit to staff. Licensee/Administrator Kevin Dinh was contacted and arrived shortly to assist with the visit. Regarding the allegation: Staff did not allow resident back into facility after hospitalization. During the course of the investigation LPA reviewed facility documents including: Resident Roster, Staff Roster, Physician's Report, Resident Medication Administration Record, and Hospital Medical Records. Interviews were conducted with residents, staff, and witnesses. On March 2, 2026, Resident #1 (R1) moved into the facility. A record review revealed, R1 was admitted to the hospital on March 3, 2026, due to refusal of medication and aggressive behaviors toward facility staff. REPORT CONTINUES ON LIC9099-C…. Substantiated On March 5, 2026, the resident was scheduled to be discharged from the hospital, however, the facility refused to allow R1 to return. During an interview, Licensee/Administrator Kevin Dinh, stated “I have a right to refuse to take a resident back” and admitted that no written eviction notice was issued the resident. Based on interviews which were conducted and the records that were reviewed, the preponderance of evidence standard has been met, therefore the following allegation: Staff did not allow resident back into facility after hospitalization is deemed SUBSTANTIATED. A deficiency is being cited on the attached LIC 9099-D, as per Title 22, Division 6, Chapter 8 of the California Code of Regulations. An exit interview was conducted with Administrator Kevin Dinh and a copy of this report, LIC9099-D, LIC811, and appeal rights were provided at the end of the visit.the state’s words, verbatim · CDSS document, Jul 15, 2026 · control 22-AS-20260305084042

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87224(a) · Plan of correction due date: Jul 16, 2026

87224 (a)Eviction Procedures - The licensee may evict a resident for one or more of the reasons listed in Section 87224(a)(1) through (5). Thirty days written notice to the resident is required...This requirement was not met as evidenced by: Based on interview confirmation, Resident 1 (R1) was not allowed to come back to the facility after a visit to the hospital on May 5, 2026. R1 was discharged from the hospital May 5, 2026 and Licensee/Administrator stated to LPA that they do not have to accept the resident back.the state’s words, verbatim · CDSS document, Jul 15, 2026

Plan of correction: Licensee/Administrator Kevin Dinh agrees to read and review regulation section 87224 Eviction Procedures, and send LPA Bentley a signed statement of acknowledgement and understanding by end of day on POC due date of July 16, 2026.

Type of visit: Required - 1 Year

On May 21, 2026, Licensing Program Analyst (LPA) Eboni Bentley conducted an unannounced required 1-Year annual visit using the CARE Inspection Tool. Upon arrival at the facility, LPA Bentley was greeted and granted entry staff after stating the purpose of the visit.. Administrator (Admin) Kevin Dinh was contacted via telephone and arrived at the facility a short time later. Admin Kevin Dinh has an administrator certificate with an expiration date of October 15, 2027. The facility is a single level structure, licensed for six (6) non-ambulatory residents of which on may be bedridden and a hospice waiver for six (6) residents. The home consists of the following: Three (3) resident bedrooms, one (1) staff bedroom, three (3) bathrooms, living room area, dining room area, kitchen, outdoor covered patio seating area, and an attached two car garage. During the visit, LPA Bentley toured the interior and exterior of the physical plant with AD Dinh and the following was observed: There were no bodies of water or obstructions on the premises. All rooms were inspected. Beds and bedding supplies were available, lighting was provided, and storage for each resident’s personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. Bathrooms were found to be clean and operational. The water temperatures in three bathrooms measured between 111.5 degrees F to 113.5 degrees F. A comfortable temperature of 75 degrees F was maintained throughout the facility. CONTINUE TO LIC809-C PAGE LPA Bentley observed the facility to be sanitary and appropriately furnished at the time of visit. Storage areas for cleaning supplies, toxins, and sharps objects were securely stored and locked. The kitchen was inspected and there is a two-day supply of perishable and seven-day supply of non-perishable food available. There is a two car garage with a washer and dryer that were observed to be in working condition. Facility has emergency food supply and water supply available. The backyard has a covered patio area with tables and chairs was available. Emergency safety drill was last conducted on March 9, 2026 and are conducted quarterly. First aid kit is maintained and contains all the necessary elements. Smoke and carbon monoxide alarms were tested and observed operational. A working telephone (714-798-7218) remains available, and the facility has a device that can be used for video teleconference purposes. The facility has one (1) fire extinguisher in the kitchen that was charged and last serviced on March 10, 2026. Liability Insurance is effective September 15, 2025 through September 15, 2026. LPA Bentley conducted an audit of six (6) resident files (R1-R6), four (4) staff files (S1-S4), and conducted three (3) staff interviews, and five (5) resident interviews. A review of the Medication and Medication Administration Record (MAR) was also conducted. Based on today’s observations, no deficiencies are being cited sit as per Title 22 Division 6 Chapter 8 of the California Code of Regulations. A technical violation was issued. An exit interview was conducted, and a copy of this report, and technical violation were provided to Administrator Kevin Dinh.the state’s words, verbatim · CDSS document, May 21, 2026

Type of visit: Case Management - Deficiencies

On March 9, 2026, Licensing Program Analyst (LPA) Eboni Bentley conducted a case management deficiency visit after observing a deficiency while conducting complaint visit:22-AS-20260305084042. Per record review, Staff #1 (S1) and Staff #2 are not associated to the facility. Per interview with Administrator Kevin Dinh stated, S1 began working at the facility on January 15, 2026 and S2 began working at the facility on October 20, 2025. Both S1 & S2 as full-time caregivers for 5 days per week. During today's visit, LPA observed S1 and S2 working at the facility and providing care to residents in care. A deficiency was cited by Title 22 Division 6 Chapter 8. CIVIL PENALTIES ASSESSED. An exit interview was conducted, and a copy of this report, LIC809-D, LIC811, LIC421BGand appeal rights were provided to Administrator Kevin Dinh.the state’s words, verbatim · CDSS document, Mar 9, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(3) · Plan of correction due date: Mar 10, 2026

87355 (e)(3) All individuals subject to a criminal record review... shall prior to working, residing or volunteering in a licensed facility: (3)Request a transfer of a criminal record clearance... This requirement is not met as evidenced by: Based on observation, interview, and record review, the licensee did not comply with the section cited above. LPA reviewed S1 & S2’s record and found that they are not associated with the facility. This poses an immediate health, and safety, risk to persons in care.the state’s words, verbatim · CDSS document, Mar 9, 2026

Plan of correction: The Licensee stated they will associate S1 & S2 to the facility and submit a written statement of acknowledgement and understanding to CCLD via email by POC due date.

Type of visit: Required - 1 Year

On May 23, 2025, at 8:00am, Licensing Program Analyst (LPA) Eboni Bentley conducted an unannounced required 1-Year annual visit using the CARE Inspection Tool. Upon arrival at the facility, LPA Bentley was greeted and granted entry by Caregiver (CG) Allen Jao. Administrator (AD) Kevin Dinh was contacted via telephone and arrived at the facility a short time later. AD Kevin Dinh has an administrator certificate with an expiration date of 10/15/2025. The facility is a single level structure, licensed for six (6) non-ambulatory residents of which on may be bedridden and a hospice waiver for six (6) residents. The home consists of the following: Four (4) resident bedrooms, three (3) bathrooms, living room area, dining area, kitchen, outdoor covered patio seating area, and an attached two car garage. During the visit, LPA Bentley toured the interior and exterior of the physical plant with CG Jao and AD Dinh and the following was observed: There were no bodies of water or obstructions on the premises. All rooms were inspected. Beds and bedding supplies were available, lighting was provided, and storage for each resident’s personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. Bathrooms were found to be clean and operational. The water temperatures in three bathrooms measured 109.7 degrees F to 114.6 degrees F. A comfortable temperature of 73 degrees F was maintained throughout the facility. CONTINUE TO LIC809-C PAGE LPA Bentley observed the facility to be sanitary and appropriately furnished at the time of visit. Storage areas for cleaning supplies, toxins, and sharps objects were not securely stored and locked and a deficiency is being cited. The kitchen was inspected and there is a two-day supply of perishable and seven-day supply of non-perishable food available. There is a two car garage that as two three entry points of which two out of three was kept unlocked throughout the inspection. There is a refrigerator in the garage with an additional supply of perishable items and resident medication found stored inside, unlocked at the time of the visit, for which a deficiency is being sited. The washer and dryer were observed to be in working condition. Facility has emergency food supply and water supply. A covered patio area with tables and chairs was observed. The backyard and front yard were found unkept and not well maintained. A technical violation was issued for the yards and a screen door on the garage door, found with holes and in disrepair. Emergency safety drill was last conducted on March 10, 2025 and are conducted quarterly. First aid kit is maintained and contains all the necessary elements. Smoke and carbon monoxide alarms were tested and observed operational. A working telephone (714-798-7218) remains available, and the facility has a device that can be used for video teleconference purposes. The facility has one (1) fire extinguisher in the kitchen that was charged and last serviced on March 21, 2025. Liability Insurance is effective September 15, 2024 through September 15, 2025. LPA Bentley conducted an audit of six (6) resident files (R1-R6), four (4) staff files (S1-S4), conducted three (3) staff interviews, and five (5) resident interviews. A review of the Medication and Medication Administration Record (MAR) was conducted. Based on today’s observations, four deficiencies and a technical violation were cited during this visit as per Title 22 Division 6 Chapter 8 of the California Code of Regulations. An exit interview was conducted, and a copy of this report, deficiency pages, and appeal rights were provided to Administrator Kevin Dinh.the state’s words, verbatim · CDSS document, May 23, 2025

The state marks this report as 6 pages; the online copy we transcribed has 5. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

On today's date, Licensing Program Analyst (LPA) LPA Rosie Quiroz made an unannounced visit on this day for the purpose of conducting an Annual Required-1 year inspection visit. LPA was greeted by Caregiver Thelma Asprec. LPA Quiroz called and spoke to Licensee/Administrator (L/AD) Kevin Dinh and discussed purpose of today’s visit. (L/AD) Dinh arrived during today's visit. The facility is a one story home which consists of: 3 shared resident bedrooms, 1 caregiver bedroom, 2 bathrooms designated for residents, 1 bathroom designated for visitors, residents and staff, living-room, kitchen with dining area, back yard with ample shade and outdoor furniture, garage with operational washer and dryer. The facility is licensed for age range 60 and over, approved for capacity of 6 Non-Ambulatory residents, of which 1 may be bedridden and has a hospice waiver for 6 residents. Bedridden resident in Room #4 only. There is currently (1) one resident receiving hospice care services. Administrator Kevin Dinh has a current Administrator's certificate which expires on 10/25/2024. LPA along with L/AD Dinh toured the interior and exterior of facility. LPA observed kitchen for proper sanitation and cleanliness. LPA observed sharp objects locked and secured in cabinet in kitchen area, and observed toxin substances to be locked and inaccessible to residents in care in locked and secured closet in garage area. The food was observed to meet the minimum requirement of two days perishable and seven days nonperishable food supply for residents in care. Resident bedroom areas were observed to have required furnishings including but not limited to: lamp, bed, mattress, night stand and clean linen. LPA interacted and interviewed 5 of 5 residents during facility tour. The water temperature in resident bathrooms were measured to be within 110.0- 112.8 degrees Fahrenheit. The Grab bars and non-slip mats were observed in resident bathrooms and shower room. Room temperature inside the facility was recorded to be 71 degrees F. CONTINUED NEXT LIC 809-C PAGE... CONTINUED... The outside grounds were inspected during facility tour, and no bodies of water were observed. No pool available at this facility. Walkways around the home were clear of hazards. There are no security bars or weapons on the premises. LPAs observed and tested functional and operational carbon monoxide and smoke alarms. (L/AD) Dinh reports fire drills are conducted quarterly with staff and residents. Last facility fire drill was conducted on 3/25/2024. LPA Quiroz reviewed whether the facility is operating within capacity limitations and reviewed repeated violations, no repeated violations assessed. During today's visit, LPAs reviewed five of five resident records, centrally stored medications and four personnel files. Resident and personnel files were found to be within Title 22 California Code of Regulations. Based on the observations made during today’s visit; there are no deficiencies being cited per Title 22 Division 6 of the California Code of Regulations. This report was read and reviewed with L/AD Dinh, and a copy of this report, LIC 858s, LIC 859 were provided at exit.the state’s words, verbatim · CDSS document, Jun 3, 2024

Allegation investigated: -Facility refused visitor unjustifiably

On today's date, Licensing Program Analyst (LPA) Rosie Quiroz conducted an unannounced visit for the purpose to conduct 10-day inspection visit regarding the allegation listed above. LPA Quiroz was greeted by Caregiver 1 (CG1) and met with Caregiver 2 (CG2) and discussed purpose of today's visit. LPA Quiroz attempted to call Administrator Kevin Dinh with no response or call back. Regarding the allegation " Facility refused visitor unjustifiably," investigation revealed the following: Interviews conducted with three of four interviewees consisting of staff, resident and witness concluded visitor was not refused entry unjustifiably. Two of three interviewees consisting of staff stated, “Visitor was not refused entry, and they toured the facility on April 4, 2024 around lunch time 12pm.” Interview conducted with witness concluded facility entry was not refused on April 4, 2024. Therefore based on the preponderance of evidence through interviews and observations conducted by LPA Quiroz, the allegation that the " Facility refused visitor unjustifiably" is UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. This agency has investigated this complaint.Nothe state’s words, verbatim · CDSS document, Apr 10, 2024 · control 22-AS-20240404121611

Type of visit: Case Management - Deficiencies

On today's date, Licensing Program Analyst (LPA) Rosie Quiroz conducted a subsequent unannounced visit after delivering findings for complaint control # 22-AS-20240404121611. LPA Quiroz was greeted by Caregiver 1 (CG1) and met with Caregiver 2 (CG2) and discussed purpose of today's visit. LPA Quiroz attempted to call Administrator (AD) Kevin Dinh multiple times with no response or call back. Caregivers in care indicated "There's a person in charge when Kevin is away on vacations her name is Janice. LPA Quiroz called and spoke to AD Janice Jabonero who indicated "I didn't know he was on vacations. He asked me in February to cover during his absence but didn't tell me the dates. " (SEE LIC 809-D) On or about 2:35pm while conducting tour and interviewing Resident 3, LPA Quiroz observed centrally stored medication and vitamins stored on shelves in staff bedroom with door unlocked readily available for residents in care. On or about 2:53am while conducting inspection tour of living room and kitchen area, LPA Quiroz observed loose screen door in living room area, as evidenced by Caregiver 2 requiring to pull it out from frame and reinstalling it back in order to open screen door per Resident 1's request. On or about 2:40pm, while inspecting garage area, LPA Quiroz observed staff pulling on garage door stating "It's hard to open and close, we had to use both of our hands to open and close but now we just use one but pull hard." (SEE LIC 809-D) During today's inspection visit, while conducting tour of the facility and conducting interviews for complaint control #22-AS-20240404121611, the following deficiencies were observed and are being cited via this case management deficiency. 87303(a)-Maintenance and Operation 87405(a)-Administrator - Qualifications and Duties The facility is being cited per Title 22, Division 6 of the California Code of Regulations. An exit interview was conducted with Caregivers on site, and a copy of this report, 809-D Page, Appeal Rights and LIC 811 were provided at exit.the state’s words, verbatim · CDSS document, Apr 10, 2024

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87405(a) · Plan of correction due date: Apr 17, 2024

87405(a)Administrator - Qualifications and Duties:(a)All facilities shall have a qualified and currently certified administrator...The administrator shall have sufficient freedom from other responsibilities and shall be on the premises a sufficient number of hours to permit adequate attention to the CONT... management and administration of the facility as specified in this section. When the administrator is not in the facility, there shall be coverage by a designated substitute who shall have qualifications adequate to be responsible and accountable...This requirement was not met as evidenced by:the state’s words, verbatim · CDSS document, Apr 10, 2024

Plan of correction: AD Kevin Dinh will read and understand CCR 87405, submit proof of understanding of CCR 87405, LIC 500 and designation of responsibility LIC 308 by POC due date of 4/17/2024. Caregivers indicated AD Kevin Dinh on vacation providing first name and phone number of designated person in charge during his absence. CCLD was not notified of AD Dinh's absence. At 3:45pm, AD Jabonero indicated no knowledge of L/AD Kevin Dinh being on vacation. This poses an immediate risk to residents in care.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87303(a) · Plan of correction due date: Apr 17, 2024

Maintenance and Operation-87303(a): (a) The facility shall be clean, safe, sanitary and in good repair at all times...This requirement is not met as evidenced by, LPA Quiroz observed On or about 2:35pm while conducting tour and interviewing Resident 3, LPA Quiroz observed centrally stored CONT... medication and vitamins stored on shelves in staff bedroom with door unlocked readily available for residents in care.On or about 2:53am while conducting inspection tour of living room and kitchen area, LPA Quiroz observed loose screen door in living room area and staff struggling to open and closethe state’s words, verbatim · CDSS document, Apr 10, 2024

Plan of correction: door leading to garage door area. This poses a potential risk to residents in care.