Cunningham Res. Care Home III

Allegation investigated: Facility did not allow resident to have a visitor at the facility.

On November 5, 2025, at 9:30 a.m., Licensing Program Analyst (LPA) Antonine Richard conducted a complaint visit and delivered the findings. LPA met with Administrator Alicia Cunningham and explained the purpose of the visit. LPA and the Administrator toured the facility. The investigation consisted of the following: On November 5, 2025, LPA Richard requested and obtained the residents' and staff roster, the Admission Agreement, Physician reports, and the facility's Emergency and Disaster Plan for a Resident Care Facility for the Elderly (dated November 5, 2025). LPA interviewed the Administrator (A1), two staff members #1-2 (S1-S2), and one resident #2 (R2). LPA attempted to interview residents R3 and R4, but they refused to participate. LPA was unable to interview R1 because R1 passed away in 2023. Continued Report LIC9099C Unsubstantiated Allegation: The Facility did not allow resident to have a visitor at the facility. The complaint alleged that on December 17, 2021, the facility did not allow a resident to have a visitor for the purpose of providing palliative care. On November 5, 2025, from 10:00 AM to 11:30 AM, LPA Richard interviewed Administrator #1 (A1), who denied the allegation. A1 explained that the facility was following the Centers for Disease Control and Prevention (CDC) guidelines because the representative from the care agency was unable to provide documentation confirming a negative COVID-19 test. Afterward, A1 contacted the agency, which then sent a representative with a document showing a negative COVID-19 test result, allowing the representative to provide care to the residents. During the same time frame, LPA interviewed two staff members (S1 and S2), who also denied the allegation and emphasized their commitment to keeping the residents safe during the pandemic. LPA also interviewed one resident #2 (R2), who expressed satisfaction with how the facility managed the pandemic, stating that they felt safe throughout the lockdown. LPA attempted to interview two additional residents (R3 and R4), but both refused to participate. LPA observed that the facility has an approved and current Emergency and Disaster Plan on file. Report Continued on LIC9099C Based on the information collected from the facility, interviews, and records reviewed, LPA found no evidence to support the above allegations. Although the allegations may be valid or have occurred, there is insufficient evidence to establish whether the alleged violations took place or did not. Therefore, the allegation is unsubstantiated. No deficiencies cited. An exit interview was conducted. A copy of this report was provided to the Administrator, Alicia Cunningham.the state’s words, verbatim · CDSS document, Nov 5, 2025 · control 18-AS-20211217154654

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Janira Arreola conducted a required annual visit. LPA met with Licensee and Administrator, Alicia Cunningham, who was informed of the purpose of the visit. At time of visit there was (1) resident and (3) staff present. The facility is a one story home with (5) bedrooms and (2) bathrooms with attached garage. The facility does not have a pool or fire arms. The facility is designated as a residential care facility for the elderly. LPA conducted a tour of the interior and exterior, reviewed facility documents and conducted interviews. LPA observed the following: Infection Control: LPA observed the hand washing stations in the facility restrooms and kitchen had hand hygiene supplies. LPA observed PPE equipment and cleaning supplies to do regular cleaning of the facility. The facility has an infection control plan and documented training for staff on infection control. Physical Plant: Physical plant, floors, windows, and doors were observed, along with fixtures and furniture. The facility's outdoor area was observed to be free of hazards and contained outdoor furniture and shaded area for clients. Laundry equipment was observed to be in good working condition. The sharp and dangerous objects were observed to be locked and inaccessible to clients. The smoke detector and carbon monoxide was operational, and the hot water temperature 118.5F. Based on LPA observations of posted facility sketch work permits and observation of the facility restrooms have been renovated. The restrooms are functioning and completed during today's visit. Remodeling was initiated on 11/6/2024 per the signed work permits. Based on Licensee and staff interviews the renovations were conducted (1) restroom at a time. Technical note was documented as the licensee stated they were not aware of the need to inform Licensing of the renovations. Licensee stated they would inform licensing of any future renovations, relocations or related incidents occurring at the facility. The licensee agreed to send the LPA a written notification pending the city walk through and approval of the work conducted. Food Service: LPA observed facility kitchen possessed equipment in good working condition. LPA observed the facility met the required 2-day supply of perishable and 7-day supply of non-perishable foods. Record Review and Resident/Staff Files: LPA reviewed staff files and training which met the department requirements along with criminal clearance. The staff schedule show adequate staff coverage. Resident files were reviewed and possessed all required paperwork. The facility does not currently provide cash handling to residents in care. Based on LPA file review, Licensee was informed the current copy of the lease agreement for the home is needed to update the facility file, as well as any dementia care plan. Licensee agreed to send this to LPA by 12/6/2024. LPA reviewed the licensee's file and found all required personnel paperwork. The administrator certificate posted expired 7/24/2022. The licensee stated they had renewed their certificate but had not received it in the last (2) years. Technical note was documented for the licensee to send proof of check and certified mail package sent to renew their certificate. The licensee agreed to send this to the LPA to inquire on the administrator's status as the Department website and public line does not have a current status for the renewal by 12/6/2024. The Department is currently behind on renewals and a deficiency will not be cited at this time. Health Related Services/ Incidental Medical Services: All resident medication was locked in a kitchen cabinet. LPA reviewed resident medications for (2) residents. LPA found all medication accounted for on the Medication Administration Record (MAR). Disaster preparedness: LPA reviewed the facility's emergency and disaster plan. LPA reviewed documentation showing last fire drill conducted 9/21/2024. LPA observed all facility exits were clear from obstructions. The facility posses a complete first aide kit and emergency supplies. An exit interview was conducted where a copy of this report was reviewed and provided.the state’s words, verbatim · CDSS document, Nov 25, 2024

The state marks this report as 4 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Janira Arreola conducted a required annual visit. LPA was greeted and was granted entry and met with Licensee, Alicia Cunnigham , who was informed of the purpose of the visit. At time of visit there were (1) resident and one (3) staff present. The facility is a one story home with (5) bedrooms and (2) bathrooms with attached garage. The facility does not have a pool or fire arms. The facility is designated as a residential care facility for the elderly and the residents served are elderly ages 60 and above. LPA conducted a tour of the interior and exterior, reviewed facility documents and conducted interviews. LPA observed the following: Infection Control: LPA observed the hand washing stations in the facility restrooms and kitchen had hand hygiene supplies. LPA observed PPE equipment and cleaning supplies to do regular cleaning of the facility. The facility has an infection control plan and documented training for staff on infection control. Physical Plant: Physical plant, floors, windows, and doors were observed, fixtures and furniture were present and in good repair. The facility's outdoor area was observed to be free of hazards and contained outdoor furniture and shaded area for clients. Laundry equipment was observed to be in good working condition. The sharp and dangerous objects were observed to be locked and inaccessible to clients. The smoke detector and carbon monoxide was operational, and the hot water temperature 106.7F. During the time of the visit LPA observed insects on resident medication bin, and several flies and mosquitos in the facility living room. LPA also observed numerous bags of recyclable cans and bottles in garage and backyard. Deficiency was cited for facility staff to keep facility free of insects and free of excess debris as to not attract pests. Plan of correction was documented with licensee. LPA also observed the cleaning chemical in the resident restroom were secured with a wooden dowel and not a lock. Technical note was documented for staff to ensure cleaning chemicals are locked and inaccessible to residents. Food Service: LPA observed facility kitchen had the ability to prepare food and possessed equipment in good working condition. LPA observed the facility met the required 2-day supply of perishable and 7-day supply of non-perishable foods. Record Review and Resident/Staff Files: LPA reviewed staff files and training that contained staff criminal clearance and updated training along with CPR/First Aid. Client files were reviewed and possessed all required paperwork. Health Related Services/ Incidental Medical Services: All resident medication was locked in the kitchen cabinet. LPA reviewed resident medications for (2) residents and found all medication listed on MARS and all required labeling was found to be in place. LPA review MARS for all residents and found documentation was up to date and accounted for. Disaster preparedness: LPA reviewed the facility's emergency and disaster plan. LPA documented technical note for licensee to update the plan to new LIC610D. LPA reviewed documentation showing last fire drill conducted 11/1/23. LPA observed all facility exits were clear from obstructions. An exit interview was conducted where a copy of this report along with LIC809-D and appeal rights were provided to Licensee, Alicia Cunnigham.the state’s words, verbatim · CDSS document, Dec 21, 2023

The state marks this report as 5 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.