Empathy

Allegation investigated: Resident is not receiving medication as prescribed.

On May 4, 2026, the Department of Social Services staff conducted an unannounced visit to this facility to continue investigation of the above allegation and to deliver findings. The Department was met by Licensee Hemalata Bansode and the purpose of the visit was explained. Investigation consisted of the following: On December 11, 2023, the Department conducted an unannounced initial visit to the facility to investigate the complaint allegation mentioned above and it was determined that the complaint required further investigation. On December 19, 2023, the department conducted interview with R1. On April 29, 2026, the department made an attempted visit to conduct subsequent complaint visit and to deliver findings. At 1:00pm, the department arrived at facility, rang doorbell and there was no answer. The department made calls to numbers on file for the facility and there was no answer, The department left voice message for a return call. At approximately 1:26pm the Licensee returned the department's call and informed her that there are currently no residents in placement at the facility. On May 4, 2026, the Department requested and obtained the following documents: Medication orders (dated: 9/15/2023 ), MAR (dated: Dec 2023 ), Physician’s report (dated 12/11/19), and shift notes (dated 12/3/23) The department interviewed Administrator (A1), There were no staff nor residents available to interview as there are currently no residents in placement. Page 1 of 2 Unsubstantiated The investigation revealed the following: Allegation: Resident is not receiving medication as prescribed. The detail of the complaint alleges that R1 “does not get medication safely and timely” On May 4, 2026, the department interviewed Administrator/Licensee (A1) who denied allegation stating that medication for all residents are always given as prescribed. According to A1 in some cases when a resident’s blood pressure is at a certain level, then the medication is to be held. Staff held R1’s medication due to her blood pressure being low. Licensee stated that she followed the medical professional’s advice to hold R1’s medication on 12/3/23. On 12/19/23 the department interviewed R1 regarding the allegation and R1 denied the allegation, stating that “she made sure she got her medications when she was at Empathy.” During the interview, R1 further stated that there was never a time when she did not get her medications. On May 4, the department reviewed and evaluated the following documents: Medication orders (dated: 9/15/2023 ), MAR (dated: Dec 2023 ), Physician’s report (dated 12/11/19), and shift notes (dated 12/3/23). The documents showed no discrepancies and that the facility followed the medical professional’s order to hold R1’s medication. Based on the information gathered, there is insufficient evidence to support the allegation mentioned above; 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 conducted with Hemalata Bansode. There were no deficiencies cited during today’s visit. Copy of report provided. Page 2 of 2the state’s words, verbatim · CDSS document, May 4, 2026 · control 18-AS-20231204123205

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA), Armando Perez made an unannounced visit to the facility for the purpose of conducting a required annual inspection. The LPA was granted entry by staff to conduct the inspection and met with Manager, Mayuresh Bansode. The LPA informed the Manager of the purpose for the visit. The inspection included the following: LPA toured the facility inside and outside. LPA observed the facility to be clean and in good repair. The facility consists of four (4) resident bedrooms, one (1) staff office, two (2) bathrooms, a kitchen and dinning area, a living room area, a garage and laundry room, and a table with umbrella for shade and yard with sufficient seating and space for activities. The home is maintained at a comfortable temperature for the clients. Lighting is sufficient for safety and comfort. Water temperature measured within regulation requirements. Laundry facilities and a locked cabinet is present for storing laundry soap and other chemicals. All outdoor and indoor passageways are free of obstruction. Emergency lighting is available. There is a telephone working at this location. The LIC 610, emergency disaster plan is maintained. There are no firearms at this home and no bodies of water observed. LPA began review of client records. three (3) records were reviewed. LPA reviewed for identification and emergency information, admission agreement, medical assessment, and TB test results, needs and service plans, placement, functional assessment, centrally stored medication/destruction records, safeguard for personal property/valuables, and personal rights notification. LPA observed client records to be available and complete. Continued on LIC 809-C. LPA reviewed employee records- Three (3) records were reviewed. LPA reviewed employee records for first aid certification, criminal record clearance or an exemption, health screening and TB test results, employee rights, training verification, and current administrator certification; expiration date 04/03/2027. LPA observed two of three staff did not have TB test results available for review during the inspection. A deficiency will be issued. LPA observed facility kitchen had the ability to prepare food in clean environment and possessed equipment in good working condition. Food supply meets the requirement of one (1) week supply of nonperishable and two (2) day supply of perishables. Emergency food and water supply is present. There is a locked location for sharps in the kitchen. Medications are centrally stored. There is a locked cabinet in the kitchen allocated for medication storage. Centrally stored medication and destruction logs are maintained. Medications reviewed appear to have been dispensed accurately. LPA made observation throughout the inspection process to assess if the facility remains in conformity with the State Fire Marshall regulations. Smoke detectors and carbon monoxide detectors were tested and found to be operational. Fire extinguisher was purchased and is in compliance until 12/31/2025. Fire drills are conducted quarterly at the facility with the last drill on 03/13/2025 . Based on the information received during this visit today in the areas reviewed, there is one deficiency that is being cited per Title 22, Division 6 of The California Code of Regulations. This LIC 809 report was reviewed with the facility representative and a copy was provided.the state’s words, verbatim · CDSS document, Jul 7, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Yolanda Delgado arrived unannounced to conduct an annual inspection. Upon arrival LPA was greeted by facility staff and granted entry. LPA began inspection with introduction, visit purpose and provided the facility caregiver with LPA identification and business card. Resident record review began- Four (4) records were reviewed. LPA reviewed for admission agreement, medical assessment and TB test results, consent forms, identification and emergency information, appraisal needs and service plans, centrally stored medication/destruction records, safeguard for personal property/valuables, and personal rights notification. This facility is meeting documentation requirements. Physical Plant and Safety of Environment/Operational Requirements- LPA toured the facility inside and outside. The home is maintained at a comfortable temperature for the clients. Lighting is sufficient for safety and comfort. Water temperature measured 112.0 degrees F. Laundry facilities and a locked cabinet is present for storing laundry soap and other chemicals. All outdoor and indoor passageways are free of obstruction. A locked area is provided for medications and sharp objects. LPA verified there is a telephone working at this location. Food Service- Food supply meets the requirement of one week supply of nonperishable and 2 day supply of perishables food on hand. A menu is posted, foods are dated to assure safety. Food prep areas are clean and organized. (Continued on next page) (Continued on from Page 1) LPA began review of employee records- Three (3) records were reviewed. LPA reviewed employee record for first aid certification, fingerprint clearance, personnel/job application, health screening and TB test results, criminal record statement, employee rights, training verification, and current administrator certification. CPR and requirements have been met. The facility employs enough staff to maintain cleanliness and meet the needs of the clients in care. Administrator certification is present and current. LPA made observation throughout the inspection process to assess if the facility remains in conformity with the State Fire Marshall regulations. The facility has not exceeded its capacity limitation and the structure remains unchanged according to the approved floor plan. Smoke detectors and carbon monoxide detectors were tested and found to be operational. Fire extinguisher are tested or replaced annually and were last done so on 05/20/2021. The facility is conducting emergency disaster drills. The last disaster drill was conducted on 05/13/2024. LPA allocated time to prepare this report for delivery. Based on the information received during this visit today, there are three (3) following deficiency is being cited and Civil Penalties for $500 per Title 22, Division 6 of The California Code of Regulations. This report, 809-D, Civil Penalties assessment, Appeal Rights was reviewed with and a provided to the facility representative. Appeal Rights were also provided at the time of the exit interview.the state’s words, verbatim · CDSS document, Jul 29, 2024