Archer Residential Care

Type of visit: Required - 1 Year

On today's date Licensing Program Analyst (LPA) William Vanegas made an unannounced visit for the purposes of conducting an annual inspection. Upon arrival LPA was greeted and granted entry to the facility by facility staff. Designated Person was available to assist with the annual inspection. LPA began a tour of the facility and observed the following. The facility is a two storied home equipped with six bedrooms three of which are utilized for residents in care, one of which is vacant, and one of which is utilized by an individual who rents a room located on the second floor. Additionally the facility is equipped with three bathrooms, and an attached two car garage. LPA observed kitchen area to be clean and free of any mildew and debris. LPA observed kitchen area to have a dishwasher, refrigerator, gas stove, and a microwave. All appeared to be in good repair and tested operational. LPA observed facility to have a two day supply of perishable food, a seven day supply of non-perishable food, and a sufficient amount of emergency water on hand. LPA observed all resident bedrooms to be large enough to walk about freely and to accommodate all required furnishings. The bedrooms were observed to be equipped with the following: A chest of drawers, a bed, clean linens in good repair; meaning no strains or tears, a chair, a reading lamp, and enough storage space to store personal belongings. LPA observed all restrooms to be clean and free of any mildew and debris. LPA observed restrooms to have operational toilets and faucets, additionally the restrooms have all required furnishings such as grab bars, slip resistant floor matts, and a shower chair available. Hot water temperature tested between 132.3 and 133.4 degrees Fahrenheit a deficiency was issued on today's date. CONTINUED ON LIC809-C LPA observed all smoke detectors and carbon monoxide detectors to be operational and in good repair. LPA observed all fire extinguishers to be fully charged and have an updated service tag on them. LPA observed first aid kit to have all required items including the following: Adhesive tape, scissors, tweezers, bandages, a thermometer, and a first aid manual. LPA conducted a tour of the exterior of the facility and observed the following. The exterior has an outdoor shaded sitting area, backyard is large enough to participate in outdoor activities upon resident request. LPA observed the backyard to be free of any hazards or obstructions along the facility. Side gates were observed to be free of any obstructions blocking the exit routes and they were observed to be unlocked. LPA reviewed six resident files, and three staff files. All files (staff and resident) were observed to have all required files and staff training was documented correctly and in the staff files. LPA reviewed resident Medication Administration Record (MAR) and medications on hand. All medications appeared to be documented correctly. Per LPA review all medications are being administered per physicians report. Based on observations made during today's inspection deficiencies will be issued per title 22 chapter 6 division 8 of the California Code of Regulations. An exit interview was conducted and copy of this report, a copy of the deficiency, and appeal rights were provided to the facility.the state’s words, verbatim · CDSS document, Jul 20, 2026

Allegation investigated: Facility staff did not seek appropriate medical treatment for resident, resulting in resident death

Licensing Program Analyst (LPA) Hanna Gough arrived at the facility for the purpose of investigating the above mentioned complaint allegation. LPA was greeted and granted entry by staff. LPA met with House Manager (HM) Miriam Esquivel and discussed the purpose of the visit. The investigation into the allegation of Facility staff did not seek appropriate medical treatment for resident, resulting in resident death revealed the following: On June 14, 2025, around 1PM Resident #1 (R1) was picked up from the facility by their Responsible Party and was admitted to the hospital on June 15, 2025, with a diagnosis of pneumonia. R1 was admitted to the facility on May 4, 2019. LPA observed a Physicians Report for R1 dated May 28, 2024, stating that R1 has Down Syndrome, cannot manage their own medications and are able to communicate their needs. R1 had a Resident Appraisal dated June 4, 2019, signed by R1’s responsible party, that stated that they had a chronic cough. LPA observed an Individualized Program Plan (IPP) for R1 dated November 1, 2024, where the facility Administrator and R1s responsible party were both present. Continue on 9099C Unsubstantiated The IPP stated that R1 has a chronic cough and that they had cough medication prescribed as needed. LPA observed progress notes by R1’s physician dated May 28, 2025, stating that R1’s chest was clear, reviewed R1’s medication list and to continue the present plan of care for R1. Per R1’s medication list for the month of June 2025, R1 was prescribed FT Tussin DM by a physician to be given to R1 by mouth every six hours as needed. Per facility’s Medication Administration Records, R1 was given a dose of medication on the morning of June 14, 2025. The facility flow sheet for R1 that stated on June 14, 2025, R1 presented with a cough and congestion, no fever and their primary physician was notified. Per facility visitor log, R1’s responsible party signed the log at 12:40 pm on June 14, 2025, and took R1 for an overnight home visit. On June 15, 2025, the facility staff contacted R1’s responsible party and was informed that R1 was admitted to the hospital for pneumonia. The Department received an incident report on June 16, 2025, stating that on June 14, 2025, R1 presented with signs of cough and congestion with R1’s primary physician and responsible party notified. LPA obtained a text message screenshot sent on June 14, 2025, at 8:04 AM by facility staff to R1’s physician informing them of R1’s cough. R1’s primary physician did not respond with additional instructions for the facility staff. During interviews it was revealed that two of three staff informed LPA that R1’s responsible party was informed verbally upon pick up of R1’s cough and congestion and that R1’s responsible party took them home every weekend. Three of three staff informed LPA that R1 did not have a fever on June 14, 2025, and did not present with a cough or congestion earlier in the week until June 14, 2025. One of three staff informed LPA that they gave R1’s responsible party all medications including the cough medication and informed R1’s responsible party that R1 was given a dose earlier that morning. During interviews with R1’s responsible party it was revealed that they picked R1 up from the facility around 1pm and stated that R1 looked sick. R1’s responsible party informed LPA that they did not question staff about R1’s condition and denied staff informed them of R1’s cough. R1’s responsible party informed LPA that they took R1 home gave them aspirin and put them to bed. R1 woke up had dinner and seemed to be doing better. R1’s responsible party informed LPA that they took their temperature in the evening after dinner and R1 presented a fever so they gave R1 more aspirin and put them back to bed. Per R1’s responsible party, R1 had become incontinent during the night. R1’s responsible party assisted R1 in cleaning up and shortly after R1 sustained an unwitnessed fall. At that point, the decision was made by R1's responsible party to transport them to the hospital. Continue on 9099-C The Department reviewed medical records from Los Alamitos Hospital for R1 from June 15, 2025, through June 19, 2025. The medical records state that R1 has a history of down syndrome, thyroid disease, obesity, elevated triglycerides, chronic cough, and acid reflux. R1 was admitted to the hospital on June 15, 2025, with a diagnosis of pneumonia and had a rapid decline while admitted. R1 passed away in the hospital on June 19, 2025, with the cause of death being listed as acute respiratory failure, viral pneumonia and down syndrome. Based on interviews, record review and information gathered during the investigation the preponderance of evidence standard has not been met, therefore the above allegation is deemed UNSUBSTANTIATED. Meaning although the above allegation may have happened there is not a preponderance of evidence to prove the alleged violation occurred. An exit interview was conducted with (HM) Miriam Esquivel and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Sep 30, 2025 · control 22-AS-20250711143419

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Hanna Gough arrived at the facility to conduct the required annual inspection and was greeted and granted entry by staff. LPA met with and informed Administrator (AD) Lacy Faddoul the purpose of the visit. The facility currently no residents in care. The facility is a two story home with six bedrooms, living room, kitchen, dining room, three bathrooms, attached two car garage and a backyard. The facility appears clean, safe and sanitary. The renter is background cleared and associated to the facility. All resident bedrooms had the required components and furnishings. The facility has extra clean linens in a hall closet located by the resident bedrooms. Resident bathrooms had toilet paper, paper towels, and non slip mats. LPA tested the water at 131.1-131.7. LPA observed AD turn the water heater down. LPA observed the kitchen to be free vermin. LPA observed the knives to be locked in a kitchen cabinet located by the oven and made inaccessible. LPA observed a two day perishable and seven day non-perishable food supply on hand. LPA observed the resident centrally stored medication cabinet located in the kitchen to be locked and made inaccessible. LPA observed a fire extinguisher located in the kitchen charged and with a service date of March 7, 2025. LPA observed the renters room to be locked and made inaccessible. LPA observed the emergency food supply located in the garage. LPA observed toxins and chemicals to be stored in the locked garage making them inaccessible. LPA observed the backyard to be free of obstructions. LPA observed a shaded seating area in the backyard for resident use. LPA reviewed AD file and no discrepancies were observed. LPA and AD tested the carbon monoxide and smoke detectors and they were found to be operational. LPA observed the last fire drill conducted on April 12, 2025. Continue on LIC 809-C Based on today’s inspection a technical violation was noted per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted with AD Lacy Faddoul and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Jun 30, 2025

Allegation investigated: Questionable death

Licensing Program Analyst (LPA) Rose Ruppert made an unannounced visit to the facility to deliver findings for a complaint visit conducted on December 5, 2024. A complaint was registered with the Department on December 4, 2024. LPA was greeted and granted entry and explained the purpose of the visit. LPA met with Miriam Esquivel, Administrator Designee (AD) and explained the purpose of the visit. On December 5, 2024, LPA conducted a 10-day complaint visit to investigate the Questionable Death of Resident #1 (R1). LPA received R1’s: Identification (ID) Form, Physician's Report, Resident Appraisal, Individual Program Plan (IPP), Progress Notes, Medication Sheet for November 2024, Medical Flow Sheet and Personnel Report (LIC 500). LPA reviewed the Physician’s Report dated November 28, 2023, which lists R1’s diagnosis as cerebral palsy and mild intellectual disability. Per Resident Appraisal dated February 1, 2023, R1 does not require night observation. Facility Progress Notes showed there were no concerns noted. LPA reviewed the LIC 500 and determined there were two staff working for the five residents in care. (Continued on LIC 9099-C) Unsubstantiated (Continued from LIC 9099) During the course of the investigation, the Department interviewed two of two staff members who were present at the facility on the day R1 passed away on November 26, 2024. Two of two staff reported R1 was last seen on November 25, 2024, at 8:30pm when they gave R1 medications. R1 watched television in bedroom before falling asleep. Night staff did resident rounds on November 26, 2024, at 2:30am and R1 was asleep. LPA interviewed R1’s family member, who was surprised by R1’s unexpected passing. Family member wanted to know the cause of death and questioned if there was neglect involved. R1 has been placed at this facility since facility opened on September 1, 2024. Per interview with AD, on November 26, 2024, at 6:55am staff went into room to wake R1 and discovered R1 was not breathing and unresponsive. Paramedics were immediately called and contacted the Coroner’s Office. Coroner’s Office released R1 to be picked up by the mortuary on file. At 9:30am Mortuary arrived to the facility for R1 to be cremated. The timeline of events was corroborated by the staff and the family member. LPA obtained the Natural Death Summary Report from the Coroner’s Office dated November 26, 2024. The report stated resident, “…looks clean and well cared for and there are no concerns of abuse/neglect, and no history of trauma, injuries, or substance abuse.” LPA obtained a copy of the Certified Death Certificate. The Death Certificate dated December 18, 2024, listed R1’s causes of death as: Cardiopulmonary Arrest and Atherosclerotic Heart Disease. LPA spoke with R1’s family member who felt relief that there was an official cause of death and understood R1’s health diagnoses could have contributed to R1’s unexpected death. Although the above allegation may have happened there is not a preponderance of evidence to prove the alleged violation occurred; therefore, the questionable death allegation is unsubstantiated. An exit interview was conducted with Miriam Esquivel, Administrator Designee and a copy of this report was provided to the facility.the state’s words, verbatim · CDSS document, May 20, 2025 · control 22-AS-20241204151556

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Rose Ruppert made an unannounced visit to investigate a complaint received in our Regional Office on December 4, 2024. LPA was greeted and granted entry by caregiver. At the time of entry a grocery drop-off was also observed at the front door. LPA spoke with Licensee (LE) Lacy Faddoul regarding associating the staff to this location. Currently only the Licensee is associated. Residents and staff were moved from the property next door, Silver Lining Manor, in October 2024. LPA confirmed with Regional Office that three of three staff members and one live-in, non-staff member, have all been fingerprinted and cleared while living at the facility Silver Lining Manor. Licensee staff background clearances will be transferred to this location. Based on the observations and conversations made during today’s visit, the facility appears to be in compliance with Title 22 Division 6 of the California Code of Regulations, no deficiencies cited or civil penalties assessed on this date. An exit interview was conducted with Miriam Esquivel, Manager and a copy of the report was given at the time of visit, ***** THIS IS AN AMENDED REPORT *****the state’s words, verbatim · CDSS document, Dec 5, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87735(c) · Plan of correction due date: Dec 6, 2024

Report generated in error.the state’s words, verbatim · CDSS document, Dec 5, 2024

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Rose Ruppert made an unannounced case management visit and was greeted and granted entry into the facility by the Manager. The purpose of the visit was to deliver an amended report from December 5, 2024. LPA met with Miriam Esquivel, Manager at 2:03 PM and spoke with the Licensee, Lacy Faddoul, via phone. An exit interview with a copy of this report, and the amended LIC 809, were provided to the facility.the state’s words, verbatim · CDSS document, Dec 5, 2024