Little Brook Care Home

Type of visit: Case Management - Health Checks

On March 16, 2026, Licensing Program Analyst (LPA) Lavinia Muscan conducted a case management visit assessing residents plan of care, including prescribed treatments, to ensure they were being implemented according to physician instructions. No immediate health and safety concerns were identified related to residents during today’s visit. No citations were issued per Title 22 Regulations. Exit interview conducted and copy of the report left at facility.the state’s words, verbatim · CDSS document, Mar 16, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Lavinia Muscan arrived on February 17, 2026 to conduct the annual inspection. During today's annual inspection, the Compliance and Regulatory Enforcement Tool was used. LPA reviewed resident (3) and staff files (2). All resident files contained the required paperwork. All staff files contained the required paperwork. All staff have current first aid and CPR training. Facility was clean and well organized. Facility is current on fire drills. Staff training contained the required initial training. LPA and Administrator toured the facility together to ensure the health and safety of residents in care. The areas toured included resident rooms, bathrooms, kitchen, and common areas and outside area. The food supply is within compliance, 2 days of perishable and 7 days worth of non-perishable food items. Grab bars were present at the toilet and in the shower. All exits were unobstructed. The disaster drill is current. The administrator's certificate is current. There is a side gate for emergency access. LPA checked the kitchen area for the ability to prepare and store food. Knives and Sharp objects found to be locked . LPA observed cleaning products and other toxins to be locked away. LPA observed the area used for medication to be locked and inaccessible to residents. LPA observed smoke detectors and carbon monoxide detector at the care home are operational. Fire extinguisher is ready for emergency use. Water temperature is within compliance. In the areas toured, there were no health or safety violations observed. LPA requested a copy of the LIC 500, LIC610E and current liability insurance to be sent to the Department by end of the month. Exit interview conducted. A copy of this report was printed and given to Administrator.the state’s words, verbatim · CDSS document, Feb 17, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Angela Hood arrived at the facility unannounced and met with the Administrator, Persida Pop, to conduct a Required-1 Year Inspection. LPA conducted an inspection of the care home to ensure compliance with Title 22 regulations. There are six (6) bedrooms, six (6) bathrooms, and one (1) shower room for resident use. LPA observed bedrooms to be properly furnished, with appropriate bedding and lighting. The bathrooms were in sanitary condition, properly maintained, and the hot water temperature was observed to be 108.3 degrees F. LPA checked the kitchen area for the ability to prepare and store food. Care home has required (2) two-day perishable and (7) seven-day non-perishable food supply on hand. LPA observed knives, cleaning products and other toxins to be locked away and inaccessible to residents. LPA observed the outdoor area and perimeter of the care home to be free of clutter and debris and there appeared to be no potential safety hazards to the residents in care. Smoke and carbon monoxide detectors are operational. Fire extinguishers and first aid kit are maintained and ready for emergency use. LPA checked medication storage and found medications to be locked away and inaccessible to the residents. LPA reviewed six (6) resident files and also reviewed three (3) staff files. As a result of this visit, no deficiencies were cited per California Code of Regulations, Title 22. Exit interview conducted and copy of report provided.the state’s words, verbatim · CDSS document, Apr 15, 2025

Allegation investigated: -Staff did not provide resident’s medication as prescribed.

Licensing Program Analyst (LPA) Angela Hood arrived at the care home today, 10/2/24, and met with the Administrator, Persida Pop, to deliver complaint investigation findings into the above stated allegation. During the course of the investigation, LPA conducted interviews, a medications count, and obtained documentation pertinent to the investigation. During a visit conducted on 6/19/24, LPA conducted a medication count for resident (R1) comparing the resident's medication lists on file with the medication centrally stored for the resident. LPA observed three (3) medications for R1 that were over the amount documented. Due to facility receiving a citation regarding the same violation in a separate inspection conducted on 9/25/24, no additional citations will be issued regarding allegation. Based on a medication count and records reviewed, the preponderance of evidence standards have been met. Therefore, the above allegation is found to be SUBSTANTIATED. No citations are being issued today. Exit interview conducted. A copy of this report and appeal rights were provided. Signature on these forms acknowledges receipt of these documents. Substantiated Allegation: Staff not meeting resident’s hygiene needs Interviews conducted with residents (R2, R3, R4, R5, R6, and R7) indicated that their hygiene needs are being met at the care home. Interviews with staff (S1, S2, S3, and S4) indicated that they believe all the residents' hygiene needs are being met. Interview with S1 indicated that they brush the residents’ teeth, as well as shower or sponge bath residents as scheduled. During visit conducted on 10/2/24, S2 was providing a sponge bath to R4. During visit conducted on 6/19/24, LPA observed that R1 appeared clean and groomed. Allegation: Staff did not obtain back up power for an extended amount of time. There are no Title 22 Regulations requiring the facility to obtain back up power, however, the complaint was regarding additional concerns arising from the power outage. Interviews with S1 and S2, who were present during the outage, indicated that there were no issues during the power outage, such as lack of food supply or emergency lighting. S1 and S2 indicated that there were no issues with the facility temperature during the power outage. S2 indicated that the facility purchased heaters so the facility would not be cold. Interviews with R3 and R4, who were present during the power outage, indicated that there were no issues that arose. Interview with Administrator indicated that they purchased a generated during the outage to ensure all residents had lightening and heat. Allegation: Staff does not ensure facility has enough food supply to provide for residents in care. At visits conducted on 6/19/24 and 10/2/24, LPA observed that care home to have the required (2) two-day perishable and (7) seven-day non-perishable food supply on hand. Interviews with R2, R3, R4, R5, R6, and R7 indicated that there is always plenty of food at the care home. Interviews with S1, S2, S3, and S4 indicated that the care home always has plenty of food on hand. S4 indicated that they always like to be prepared and order food before it gets too low. Allegation: Staff is having inappropriate interaction with resident in care. Interviews conducted with R2, R3, R4, R5, R6, and R7 indicated that they have never witnessed staff treating residents inappropriately. R2, R3, R4, R5, R6, and R7 indicated that all the staff treat them well. R2, R3, R4, R5, R6, and R7 indicated that all the staff treat them well and they have no concerns regarding the staff. Interviews with S1, S2, S3, and S4 indicated that they have never witnessed staff treating residents inappropriately. Based on interviews conducted and observations, although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. Therefore, the allegations are UNSUBSTANTIATED. No deficiencies are being cited. Exit interview conducted. A copy of the report was provided.the state’s words, verbatim · CDSS document, Oct 2, 2024 · control 59-AS-20240614145902

Allegation investigated: -Facility is not providing medications as prescribed

Licensing Program Analyst (LPA) Angela Hood arrived at the care home today, 9/25/24, and met with the Administrator, Persida Pop, to deliver complaint investigation findings into the above stated allegation. During the course of the investigation, LPA reviewed documentation and conducted a medication count. Allegation: Facility is not providing medications as prescribed. During a visit conducted on 6/19/24, LPA conducted a medication count for resident (R1) comparing the resident's medication lists on file with the medication centrally stored for the resident. LPA observed three (3) medications for R1 that were over the amount documented. Based on a medication count and records reviewed, the preponderance of evidence standards have been met. Therefore, the above allegation is found to be SUBSTANTIATED. Per California Code of Regulations, Title 22, Division 6, Chapter 8, a deficiency is being cited on the attached 9099-D page. Exit interview conducted. A copy of this report and appeal rights were provided. Signature on these forms acknowledges receipt of these documents. Substantiated Allegation: Staff are on drugs while providing care to the residents. Interviews conducted with S1 and S2 indicated that they have never witnessed staff using drugs or having substance intoxication from drugs while working in the care home. R1, R2, R3, resident (R4), and R5 did not have any concerns about the staff in the care home. Based on interviews conducted, although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. Therefore, the allegations are UNSUBSTANTIATED. No deficiencies are being cited. Exit interview conducted. A copy of the report was provided.the state’s words, verbatim · CDSS document, Sep 25, 2024 · control 59-AS-20240524095425

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(4) · Plan of correction due date: Sep 26, 2024

87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility (...) by compliance with the following: (4) The licensee shall assist residents with self-administered medications as needed. This requirement is not met as evidenced by: Based on medication count and records reviewed, the facility did not ensure that resident (R1) was receiving medications as prescribed, which poses an immediate health, safety, and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Sep 25, 2024

Plan of correction: Licensee has implemented medication counts and provided the most recent medication count documentation to LPA during visit. Facility agrees to complete bi-weekly audits of all medications for the next month and submit documentation to LPA.

Type of visit: Case Management - Other

On 9/5/24, LPA Kevin Mknelly arrived unannounced to deliver amended complaint findings originally delivered 8/1/24. LPA met with the administrator. No additional citations are issued as the result of the visit. Report reviewed and copy provided.the state’s words, verbatim · CDSS document, Sep 5, 2024

Allegation investigated: Staff did not ensure reporting requirements were followed Staff did not ensure medications were dispensed in a timely manner

On 8/1/24 Licensing Program Analyst (LPA) Kevin Mknelly spoke to Persida Pop, Administrator to deliver complaint findings for the above allegation. LPA reviewed resident records, facility records and conducted extensive interviews. LPA finds that the allegations cited above are substantiated. While R1 was a resident at the facility, R1 experienced seizures/ hospitalization on 12/14/23, a skin tear on 1/5/24 and a hospitalization for UTI on 1/15/24. These incidents were not reported to CCL as required. During the course of this investigation, several other violations are noted and will be reported on in a subsequent Facility Evaluation Report. Report continued Substantiated Staff did not ensure medications were dispensed in a timely manner- On 8/29/24, LPA conducted a follow-up visit to the facility in response to additional information regarding R1 not receiving a prescribed medication. Home Health records noted that R1 was prescribed Modafinil on 9/15/23. R1 was then admitted to one of the licensee's homes in December 2023. R1 was transferred to this home on 1/2/24. At the time of admission, the licensee received a print out from R1's treating hospital, that, though not a signed physician's order, did list Modafinil as one of R1's medication- with a notation that the medication cannot be "refilled at this time." The list was printed on 12/4/23. In interview with the Administrator, Persida Pop, on 8/29/23, Administrator stated that they thought the Modafinil was discontinued. Administrator did not contact the physician for clarification nor a discontinue order. In January 2024, R1's responsible party contacted R1's physician regarding the need for Modafinil. A new order was written and the medication was delivered on 1/11/24. LPA's review of the facility's Medication Administration record (MAR) for R1, did not record Modafinil administred until 1/13/24. As a result of this investigation, LPA finds allegation to be (S) Substantiated - A finding that the complaint is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. The following deficiencies were cited on 9099-D, per Title 22 Regulations, Division 6. (A)This poses an immediate Health and Safety risk to clients/residents in care. (B) This poses a potential Health and Safety risk, or personal rights violation, to clients/residents in care. Report reviewed with Administrator . Copy of this report and appeal rights provided. Staff did not ensure catheter care was provided to resident in care- Home health records noted that staff are aware of monitoring and emptying requirements of R1’s catheter. Health issues such as bleeding or UTI’s were monitored and medical care was provided by health care professionals as needed. As a result of this investigation, LPA finds allegation to be (US)Unsubstantiated - A finding that the complaint is Unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Exit interview with administrator.the state’s words, verbatim · CDSS document, Aug 1, 2024 · control 59-AS-20240116101651

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465 · Plan of correction due date: Aug 1, 2024

Incidental Medical and Dental Care- (e) For every prescription and nonprescription PRN medication for which the licensee provides assistance there shall be a signed, dated written order from a physician, on a prescription blank, maintained in the residents file, and a label on the medication. This requirement was not met based on records and interviews that found R1 did not have written orders, licensee did not confirm orders and licensee did not promptly administer medications when received. This posed an immediate risk to R1.the state’s words, verbatim · CDSS document, Aug 1, 2024

Plan of correction: Licensee licensee will arrange for an audit/ consultation from a licenseed professional familiar with medication requirements in RCFEs by the POC 9/17/24 with the consultation to occur by 9/30/24. Confirmation of the audit to be submitted by 9/17/24.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211 · Plan of correction due date: Aug 1, 2024

Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports as …: (1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence … (D) Any incident which threatens the welfare, safety or health of any resident, … This requirement was not met in two incidents for R1 that were not reported to CCLD. This posed a potential risk.the state’s words, verbatim · CDSS document, Aug 1, 2024

Plan of correction: Licensee has had this issue addrerssed previously while thes was investigated. Previous POCs have been cleared. No further issues are present at this time. POC cleared at this visit.

Type of visit: Case Management - Deficiencies

On 8/1/24/24, Licensing Program Analyst (LPA) Kevin Mknelly, conducted a case management visit while delivering complaint findings and met with Administrator. On 1/16/24, the department received a complaint regarding R1. While the complaint findings were delivered for those allegations, additional deficiencies were found in the course of the investigation. LPA observed medications unattended during investigation visits on 5/23/24, caregiver dispensed medications to small cups on the kitchen counter and left the medications unattended to attend to a resident, and 6/11/24, a resident’s prescription nasal spray was on a kitchen counter. There are residents with dementia in care at the time. R1 had a LIC 602 in file that had identified it as having been for a prior facility with an examination date of 10/20/23 and a MD signature of 10/2023. The LIC 602 was not current for conditions for R1. R1 was admitted with pressure injuries that are noted to have begun in November 2023 that were not identified in the October LIC 602. As a result of this inspection, the following deficiencies were cited on 809-D, per Title 22 Regulations, Division 6. (A)This poses an immediate Health and Safety risk to clients/residents in care. (B) This poses a potential Health and Safety risk, or personal rights violation, to clients/residents in care. Report reviewed. Copy of report and appeal rights providedthe state’s words, verbatim · CDSS document, Aug 1, 2024

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(h)(2) · Plan of correction due date: Aug 29, 2024

Incidental Medical and Dental Care (h)The following requirements shall apply to medications. which are centrally stored:(2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication.This requirement was not met based on observations on 2 occasions where medications were left unsecured, for a short time, in an accessible area to residents. This posed a potential risk to residentsthe state’s words, verbatim · CDSS document, Aug 1, 2024

Plan of correction: Licensee will retrain staff who handled medications to strictly abide by the requirement that meds are not unsecure in the facility. submit proof of train. The POC is due by 8/29/24

From the deficiency page — Deficiency type: Type B · Section cited: CCR87458(b)(2) · Plan of correction due date: Aug 29, 2024

Medical Assessment (b) The medical assessment shall include, but not be limited to: (2) Documentation of prior medical services and history and current medical status… This requirement was not met by a review of records finding R1 had medical condition not identified in the LIC 602. This posed a potential risk to R1. This requirement was not met based on record review that found R1’s LIC 602 to was not current to medical conditions at admission.the state’s words, verbatim · CDSS document, Aug 1, 2024

Plan of correction: Licensee will sumbit a plan for review, assessments and updates of physician reports as needed for resident change of condition not previously identified. POC due by 8/29/24.

Type of visit: Office

An informal conference was conducted at 9:30am on June 13, 2024 with Sacramento North Regional Office via Microsoft Teams. The purpose of this informal conference meeting is to address the recently issued citations. The Administrator was told that this Informal conference is a part of the Administrative Action process, and that further noncompliance may result in an elevation to a formal noncompliance conference, which could lead to a referral to the Department's legal division for possible revocation of license. The following Licensing staff were present: Licensing Program Analyst (LPA) Angela Hood and Licensing Program Manager (LPM) Maribeth Senty The following facility representatives were present: Administrator Persida Pop The following topics were covered during today's meeting: · Licensee has four (4) newly licensed facilities and there are concerns with compliance at two (2) locations (Little Brook Care Home and Little Brook Care Home #3). · Administrator coverage at all facilities · Citations issued address the following topics: · Observation of changes in residents’ conditions · Arranging timely medical treatment · Medications being distributed as prescribed with accurate documentation · Ensuring all medication remain locked and inaccessible to residents **************************************************Continued on LIC809-C********************************************** · Ensuring transportation to medical appointments · Personal rights of residents to receive medical care · Eviction notices and notifying CCLD of evictions · Ensuring all annual training is conducted for staff · Ensuring all medical assessments for newly retained residents have been conducted within 1 year of admittance · Plan of corrections have been received for all citations · Technical Support Program referrals offered twice prior to meeting and were declined Administrator indicated that there are no residents at Little Brook Care Home #4. Administrator stated that they have a second Administrator to assist with the three (3) facilities that currently have residents. During discussion with Administrator, it was observed that the Administrator did not have a clear understanding regarding the importance of following physician’s orders regarding dialysis appointments. The Department reiterated that it is the facility’s responsibility to ensure the residents’ medical appointment, if missed, are rescheduled within the same week or that, if scheduled transport is missed, alternative transportation is provided to the appointment. The Department discussed technical support at least 5 times during the meeting and Administrator declined. The Department will continue to offer technical support. Administrator will continue to work with LPA to ensure the facility remains in compliance with regulations. Administrator agrees to contact LPA if Technical Support is necessary. An exit interview was conducted and a copy of this report will be provided to the facility via email. A copy must be signed and returned to the Department.the state’s words, verbatim · CDSS document, Jun 13, 2024

Type of visit: POC

Licensing Program Analyst (LPA) Angela Hood arrived unannounced at the facility today, 5/29/24, and met with Administrator, Persida Pop, to follow-up on five plan of corrections made to the facility on 5/23/24 to be corrected on 5/24/24. Plan of corrections were not received by 5/24/24. As a result of this visit, civil penalties in the amount of $2,500 were assessed because the facility did not comply with a plan of corrections for the time period of 5/24/24 thru 5/29/24. Exit interview was conducted with Administrator. A copy of this report and appeal rights were provided. Administrator's signature on these forms acknowledges receipt of these documents.the state’s words, verbatim · CDSS document, May 29, 2024

Allegation investigated: -Staff did not provide a proper eviction notice to resident or resident's authorized representative

Licensing Program Analyst (LPA) Angela Hood arrived unannounced at the care home today, 5/23/24, and met with the Administrator, Persida Pop, to deliver complaint investigation findings into the above stated allegation. During the course of the investigation, LPA conducted interviews and obtained documentation pertinent to the investigation. ***********************************************Continued on LIC9099-C**************************************************** Substantiated Allegation: Staff did not provide a proper eviction notice to resident or resident’s authorized representative. On 12/30/23, resident (R1) and their responsible party received an unlawful eviction notice from the facility. The eviction notice did not provide a list of referral agencies or alternative housing options, as well as information about the resident’s right to file a complaint with the Department with the name, address, and telephone number of the nearest office of community care licensing and the State Ombudsman. The Department obtained a copy of the notice on 1/19/24. The Department did not review the eviction notice prior to the facility providing a copy to R1 and their responsible party. Interview with Administrator indicated that they provided a copy to the Ombudsman and not the Department when the notice was issued. LPA advised the Licensee to submit any eviction notices to the Department and provided information on how to create a lawful eviction notice. A lawful eviction notice was created on 1/23/24 and provided to the Department. Based on records reviewed and interviews conducted, the preponderance of evidence standards have been met. Therefore, the above allegation is found to be SUBSTANTIATED. Per California Code of Regulations, Title 22, Division 6, Chapter 8, deficiency is being cited on the attached 9099-D page. Exit interview conducted. A copy of this report and appeal rights were provided. Signature on these forms acknowledges receipt of these documents. Allegation: Staff reported false medical emergency needs for resident in care According to interviews with the Administrator, staff (S1), and resident (R1’s) responsible party, the facility contacted emergency medical services (EMS) for R1 on 12/28/23. Interview with Administrator indicated that EMS was contacted due to R1 having diarrhea 4 times. Administrator indicated that R1’s responsible party suggested sending R1 to the hospital and R1 refused to go with EMS. Interview with R1’s responsible party indicated EMS contacted them indicating that they were contacted due to R1 having chronic diarrhea and not being able to give their own insulin. R1’s responsible party indicated that R1 refused to go with EMS. Interview with S1 indicated that R1 sometimes has diarrhea and has a prescription medication for diarrhea. S1 indicated that they do not recall why EMS was contacted on 12/28/23 but didn’t believe it was for diarrhea. S1 indicated that R1 refused to go with EMS. According to EMS Prehospital Care Report, dated 12/28/23, they were dispatched to the facility due to the owner reporting that R1 was having chronic diarrhea for 3 weeks and new weakness. EMS responders contacted R1’s Power of Attorney (POA) who initially wanted R1 to be transported to the hospital due to R1 being too weak to self-administer insulin. EMS responders spoke with care staff and the facility owner, whom both indicated that R1 did not self-administer insulin that evening. R1’s account corroborated that they did not administer their insulin. Owner refused to give EMS responder’s their name and only stated that they are the Administrator. Administrator claimed that a care staff contacted EMS. Care staff denied this statement indicating that the Administrator contacted EMS. EMS responders then contacted the POA once more and, upon finding that the Administrator contacted EMS, the POA decided against transporting R1 to the hospital. EMS report indicated that R1’s vitals were taken and were within normal limits. EMS ended services with R1. The EMS report did not indicate that R1 refused services or that services were not needed. Based on interviews conducted and documentation obtained, although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. Therefore, the allegation is UNSUBSTANTIATED. No deficiencies are being cited. Exit interview conducted. A copy of the report was provided.the state’s words, verbatim · CDSS document, May 23, 2024 · control 59-AS-20240112110717

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.683(a) · Plan of correction due date: Jun 6, 2024

1569.683 Eviction notices; reasons for eviction contents; service (a) In addition to complying with other applicable regulations, a licensee of a residential care facility for the elderly who sends a notice of eviction to a resident shall set forth in the notice to quit the reasons relied upon for the eviction, with specific facts to permit determination of the date, place, witnesses, and circumstances concerning those reasons. In addition, the notice to quit shall include all of the following: (2) Resources available to assist in identifying alternative housing and care options, including public and private referral services and case management organizations. (3) Information about the resident's right to file a complaint with the department regarding the eviction, with the name, address, and telephone number of the nearest office of community care licensing and the State Ombudsman. This requirement is not met as evidenced by: Based on interviews conducted and records reviewed, the facility did not include required information in R1’s eviction notice prior to serving notice, including housing resources and the resident’s rights to file a complaint with contact information of the nearest community care licensing office and the State Ombudsman, which poses a potential health, safety, and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, May 23, 2024

Plan of correction: LPA provided licensee with information on how to complete a lawful eviction letter. Licensee provided updated and lawful letter to LPA on 1/19/23. Licensee agrees to submit a statement of understanding regarding what information should be included in an eviction letter by the POC due date of 6/6/24.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87224(2) · Plan of correction due date: Jun 6, 2024

87224 Eviction Procedures (f) A written report of any eviction shall be sent to the licensing agency within five (5) days. This requirement if not met as evidenced by: Based on interviews conducted and records reviewed, the facility did not provide the Department with a written report of R1’s eviction within five (5) days, which poses a potential health, safety, and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, May 23, 2024

Plan of correction: Licensee agrees to submit a statement of understanding regarding submitting a written report of eviction to the Department within five (5) days by POC due date 6/6/24.

Allegation investigated: -Facility is not providing medications as prescribed -Facility staff interfered with resident's right to receive medical care

Licensing Program Analyst (LPA) Angela Hood arrived unannounced at the care home today, 5/23/24, and met with the Administrator, Persida Pop, to deliver complaint investigation findings into the above stated allegations. During the course of the investigation, LPA obtained documentation pertinent to the investigation, conducted a medication count for 3 residents, and conducted interviews. Allegation: Facility is not providing medications as prescribed. LPA conducted a medication count for residents (R1, R2 & R3), comparing the residents' medication lists on file with medication centrally stored for the residents. LPA observed four (4) medications for R1 that were over the amount documented and there were two (2) medications for R1 that were under the amount documented. LPA observed four (4) medications for R2 that were over the amount documented. LPA observed five (5) medications for R3 that were over the amount documented and there was one (1) medication that was under the amount documented. ********************************************Continued on LIC9099-C****************************************************** Substantiated Allegation: Facility staff interfered with resident's right to receive medical care. According to interviews with the Administrator and R1’s responsible party, R1 had a dialysis appointment scheduled 2/8/24. Interviews indicated that R1 goes to dialysis three times per week. Interviews indicated that R1 did not make their appointment on 2/8/24. Interview with the Administrator indicated that R1 did not make their dialysis appointment due to the road being blocked by SMUD for repairs to a power line. Administrator also stated that Regional Transit (RT) was unable to pick up R1 for the appointment due to SMUD blocking the roadway. Interview with SMUD indicated that they were conducting work on a broken pole from 2/4/24-2/8/24 and that tree work was involved as well. SMUD indicated that they have no record of the road being blocked or closed. According to documentation obtained from RT, a driver arrived at the care home on 2/8/24 at 9:49am to pick up R1 and take them to their dialysis appointment. Documentation indicated that the RT driver went to the facility door and was advised by facility staff that R1 was eating and needed more time. The RT driver attempted to call the facility phone and it went straight to voicemail. The RT driver attempted to contact the facility an additional time and left a voice message. Documentation indicated that the RT driver departed the facility at 9:56am. RT notes indicated that staff from the facility kept calling to rebook the trip and, when informed RT could not, staff would hang up. RT noted that they attempted to ask the facility staff if R1 still needed a return trip transport from the dialysis appointment and staff would hang up with no response. Documentation indicated that an RT driver arrived to pick up R1 from their dialysis appointment at 2:42pm, however, R1 was not at the appointment location for pick up. RT staff indicated that R1 has set appointments with RT for transport to and from their dialysis appointments three times per week. Administrator stated that the 2/8/24 dialysis appointment is the only one R1 missed. Based on medication counts, records reviewed, and interviews conducted, the preponderance of evidence standards have been met. Therefore, the above allegations are found to be SUBSTANTIATED. Per California Code of Regulations, Title 22, Division 6, Chapter 8, deficiencies are being cited on the attached 9099-D page. Exit interview conducted. A copy of this report and appeal rights were provided. Signature on these forms acknowledges receipt of these documents. Allegation: Facility is not providing resident with diabetic diet Interviews with the Administrator indicated that they grocery shop for the facility either every day or every other day. LPA observed resident (R1’s) diet restrictions posted on the refrigerator. The posting indicated that R1 is on a low sodium, sugar, potassium, and phosphorus diet. The posting also lists all the food items and drinks that R1 should not consume as part of the diet restrictions. Interviews with the Administrator and staff (S1 & S2) indicated that R1 was receiving a diabetic diet while they resided at the care home. Interviews indicated that R1 was provided sugar free and low sodium food. Based on interviews conducted and documentation obtained, 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. No deficiencies are being cited. Exit interview conducted. A copy of the report was provided.the state’s words, verbatim · CDSS document, May 23, 2024 · control 59-AS-20240214141242

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(4) · Plan of correction due date: May 24, 2024

87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility (...) by compliance with the following: (4) The licensee shall assist residents with self-administered medications as needed. This requirement is not met as evidenced by: Based on medication count and records reviewed, the facility did not ensure that residents (R1, R2, & R3) were receiving medications as prescribed, which poses an immediate health, safety, and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, May 23, 2024

Plan of correction: Facility agrees to have all care staff providing medications sign a statement of understanding of job duties addressing medication management and to submit statements to LPA by the POC due date of 5/24/24. Facility will also complete bi-weekly audits of all medications for the next month and submit documentation to LPA.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(2) · Plan of correction due date: May 24, 2024

87465 Incidental Medical and Dental Care (a) A plan for incidental medical(…)shall be developed by each facility. The plan shall encourage routine medical(…)care and provide for assistance in obtaining such care, by compliance with the following: (2) The licensee shall provide assistance in meeting necessary medical(…)needs. This includes transportation which may be limited to the nearest available medical(…)facility which will meet the resident's need. In providing transportation the licensee shall do so directly or make arrangements for this service. This requirement is not met as evidenced by: Based on interviews conducted and records reviewed, the facility did not ensure R1 received transportation services to their dialysis appointment, which poses an immediate health, safety, and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, May 23, 2024

Plan of correction: Licensee agrees to create a plan ensuring all residents have transportation to medical and dental appointments and to submit plan to LPA by the POC due date of 5/24/24.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1(a)(16) · Plan of correction due date: May 24, 2024

87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (16) To receive or reject medical care or other services. This requirement is not met as evidenced by: Based on interviews conducted and records reviewed, the facility interfered with R1’s right to receive dialysis treatment on their scheduled appointment date, which poses an immediate health, safety, and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, May 23, 2024

Plan of correction: Licensee agrees to submit a statement of understanding and create a plan to ensure residents receive medical services by the POC due date of 5/24/24.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Angela Hood arrived unannounced today, 5/23/24, and met with the Administrator, Persida Pop, to conduct a case management visit regarding information obtained during a complaint investigation, #59-AS-20240112110717, that was completed on 5/23/24. Emergency Medical Services (EMS) Prehospital Care Report dated 12/28/23 indicated that EMS was dispatched to the facility due to the owner reporting that resident (R1) was having chronic diarrhea for 3 weeks and new weakness. EMS report indicated that R1’s Power of Attorney (POA), R1, Administrator, and care staff stated that R1 was unable to self-administer insulin that evening, due to weakness. Interview with the Administrator indicated that they had a meeting with R1’s POA and physician by phone regarding chronic diarrhea and not eating. Administrator indicated that R1 was not receiving hospice services and was declining. Administrator indicated that R1 is not able to self-administer insulin during the PM shift. Care notes provided by the facility for the month of December 2023 did not indicate any instances of R1 having diarrhea or not being able to self-administer insulin. During the investigation, the Department requested documentation for all incidents where EMS were contacted regarding R1, any communications between the facility and R1’s physician, and incident reports pertaining to R1. Communication with the Administrator indicated that they did not contact R1’s physician and only reached out to the family and home health nurse. The Department requested documentation with correspondence between the facility and R1’s family and home health nurse. To date, the facility was unable to provide the requested documentation. Due to the information above, per California Code of Regulations, Title 22 Division 6, Chapter 8, a deficiency is being cited on the attached 809-D page. Exit interview was conducted. A copy of this report and appeal rights provided.the state’s words, verbatim · CDSS document, May 23, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87466 · Plan of correction due date: May 24, 2024

87466 Observation of the Resident: The licensee shall ensure that residents are regularly observed for changes in physical, mental, emotional and social functioning and that appropriate assistance is provided when such observation reveals unmet needs. When changes such as unusual weight gains or losses or deterioration of mental ability or a physical health condition are observed, the licensee shall ensure that such changes are documented and brought to the attention of the resident's physician and the resident's responsible person, if any. This requirement is not met as evidenced by: Based on records reviewed and interviews conducted, the facility observed changes in R1’s condition and did not document such changes or bring changes to the attention of R1’s physician or responsible party, which poses an immediate health, safety, and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, May 23, 2024

Plan of correction: Licensee agrees to complete a statement of understanding regarding observation of residents and create a plan to ensure all changes in residents’ conditions are documented and that their physician and responsible party are notified. Licensee will submit statement and plan to LPA by POC due date of 5/24/24.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87465(a)(1) · Plan of correction due date: May 24, 2024

87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following: (1) The licensee shall arrange, or assist in arranging, for medical and dental care appropriate to the conditions and needs of residents. This requirement is not met as evidenced by: Based on records reviewed and interviews conducted, the facility observed R1’s change in condition and did not seek medical attention timely, which poses an immediate health, safety, and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, May 23, 2024

Plan of correction: Licensee agrees to create a plan to ensure that, when a resident has a change in condition, the facility will arrange or assist in arranging appropriate medical care. Licensee shall submit to LPA by the POC due date of 5/24/24.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Angela Hood arrived at the facility unannounced on 4/24/24 and met with the Administrator, Persida Pop, to conduct a Required-1 Year Inspection. LPA conducted an inspection of the care home to ensure compliance with Title 22 regulations. There are five (5) bedrooms and six (6) bathrooms for resident use. LPA observed bedrooms to be properly furnished, with appropriate bedding and lighting. The bathrooms were in sanitary condition, properly maintained, and the hot water temperature was observed to be 108.7 degrees F. LPA checked the kitchen area for the ability to prepare and store food. Care home has required (2) two-day perishable and (7) seven-day non-perishable food supply on hand. LPA observed knives, cleaning products and other toxins to be locked away and inaccessible to residents. LPA observed the outdoor area and perimeter of the care home to be free of clutter and debris and there appeared to be no potential safety hazards to the residents in care. Smoke and carbon monoxide detectors are operational. Fire extinguishers and first aid kit are maintained and ready for emergency use. LPA checked medication storage and found medications to be locked away and inaccessible to the residents. LPA reviewed three (3) resident files and also reviewed two (2) staff files. As a result of this visit, no deficiencies were cited per California Code of Regulations, Title 22. Exit interview conducted and copy of report provided.the state’s words, verbatim · CDSS document, Apr 24, 2024

Allegation investigated: -Staff placed locks on the resident's door that violates the facility fire clearance -Staff did not ensure the facility had a working telephone

Licensing Program Analyst (LPA) Angela Hood arrived at the care home unannounced today, 2/22/24, and met with the Administrator, Persida Pop, to open a complaint and deliver complaint investigation findings regarding the above stated allegations. During today's visit, LPA tested the facility phone and observed all the doors in the facility. The facility has an operable phone line for residents' use. None of the facility doors prevent residents from exiting their bedrooms or the care home. Based on observation, although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. Therefore, the allegation is UNSUBSTANTIATED. No deficiencies are being cited. Exit interview conducted. A copy of the report was provided. Unsubstantiatedthe state’s words, verbatim · CDSS document, Feb 22, 2024 · control 59-AS-20240220102745