The Splendor of Carmichael at Keane

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Angela Hood arrived at the facility unannounced and met with the Administrator, Alex Tellez, 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 and seven (7) 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 118.2 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 and cleaning products 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 detectors 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 four (4) 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. Copy of report provided.the state’s words, verbatim · CDSS document, Oct 14, 2025

Allegation investigated: -Staff are not providing care and supervision -Staff are not providing assistance with ADLs -Staff did not seek timely medical -Staff are not providing medications as prescribed -Staff are handling residents in a rough manner

Licensing Program Analyst (LPA) Angela Hood arrived at the care home today and met with the Administrator, Maria Williams, to deliver complaint investigation findings regarding the above allegations. During the course of the investigation, LPA conducted a medication count, interviews, and obtained documentation pertinent to the investigation. Interviews with staff (S1, S2, S3, and S4) indicated that staff are providing good care to residents and are assisting with all activities of daily living (ADLs), including supervision of the residents. Interviews with residents (R2 and R3) indicated that all their needs are being met by facility staff and that they are receiving assistance with ADLs. R2 and R3 indicated that they are receiving good care at the facility. R2 indicated that they have a buzzer they can utilize next to the bed to let staff know they need assistance. Interview with the home health nurse indicated that they had no concerns regarding the facility not providing care and supervision to residents, as well as assistance with ADLs. ************************************************Continued on LIC9099-C************************************************* Unsubstantiated According to medical records, resident (R1) was sent out to the hospital on October 8, 2024, October 29, 2024, and November 23, 2024. Upon review of medical records, there was no indication that the facility did not seek timely medical attention for R1. Interviews with S2, home health nurse, administrator, and licensee indicated that, when R1 fell out of their bed on October 8, 2025, they were sent to the hospital. Home health records indicated that R1 was sent to the Emergency Room on October 8, 2024. Interview with S1 indicated that staff seek timely medical attention for residents by contacting emergency medical services or hospice services. Interviews with the home health nurse and administrator indicated that R1 was having constipation issues due to pain medication. Home health nurse indicated that R1 was receiving suppositories for constipation that were not working. Home health nurse and administrator indicated that R1 was sent to the hospital and prescribed a stool softener due to suppositories not working. Home health nurse and administrator indicated that a bowel movement (BM) chart was kept for R1. Facility provided R1’s BM chart for November 2024, which did not indicate any missed BM. On January 24, 2025, LPA conducted a medication count for residents (R4, R5, and R6), comparing the residents’ medication lists on file with medication centrally stored for the residents. LPA did not observe any medication errors. Interviews with R2 and R3 indicated that they receive all their medications as prescribed. Interviews with S1, S2, S3, and S4 indicated that all residents are receiving their medications as prescribed. Interview with the home health nurse indicated that they had no concern regarding the facility providing medications to residents as ordered. Interviews with S1, S2, S3, and S4 indicated that they have never witnessed staff handling residents in a rough manner. Interviews with R2 and R3 indicated that staff have never handled them too roughly and they have never witnessed staff handling other residents in a rough manner. Based on medication count, 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 violations 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, Aug 13, 2025 · control 59-AS-20241118114356

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Angela Hood arrived at the care home today and met with the Administrator, Maria Williams, to conduct a case management visit in relation to a separate inspection conducted on today’s date, August 13, 2025. The facility provided LPA an Unusual Incident/Injury Report LIC624 regarding resident (R1) for an incident that occurred on October 8, 2024. The LIC624 received indicated that emergency medical services were not utilized and were not needed. However, interviews, medical records, and home health records indicated that R1 was sent to the emergency room on October 8, 2024. The facility did not submit additional information regarding the emergency room visit to CCL as required. The facility provided LPA with Personnel Records LIC501 for staff (S2, S3, S4, and S5), which were incomplete. The LIC501s had missing personal information for each staff member. As a result of today's inspection, deficiencies are being cited pursuant to California Code of Regulations, Title 22, Division 6, Chapter 8. Deficiencies are listed on 809-D pages. Exit interview was conducted. A copy of this report and appeal rights were provided.the state’s words, verbatim · CDSS document, Aug 13, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1) · Plan of correction due date: Aug 27, 2025

87211 Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: (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 of any of the events specified...This report shall include the resident's name, age, sex and date of admission; date and nature of event; attending physician's name, findings, and treatment, if any; and disposition of the case. This requirement was not met as evidenced by: Based on documentation obtained, the facility did not submit an incident report regarding resident (R1) being sent to the emergency room on October 8,2024, which poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Aug 13, 2025

Plan of correction: Facility agrees to complete a statement of understanding and submit to LPA by the POC due date of August 27, 2025.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87412(a)(5) · Plan of correction due date: Aug 27, 2025

87412 Personnel Records (a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: (5) Home address and telephone number. This requirement was not met as evidenced by: Based on documentation obtained, the facility did not have complete personnel records for staff (S2, S3, S4, and S5), which poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Aug 13, 2025

Plan of correction: Facility agrees to complete a statement of understanding, as well as complete all personnel records for current staff members and submit to LPA by the POC due date of August 27, 2025.

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Angela Hood met with the Administrator, Luigi Vo, to conduct a Pre-licensing visit. Administrator has a current certificate #6067873740 with an expiration date of 11/3/2026. LPA conducted an inspection of the care home to ensure compliance with Title 22 regulations. There are six (6) bedrooms and six (6) bathrooms for resident use. LPA observed facility to be properly furnished, including appropriate bedding and lighting in bedrooms. Bathrooms were in sanitary condition and properly maintained. Hot water temperature was observed to be 118 degrees F. LPA checked the kitchen area for the ability to prepare and store food. 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 detectors at the care home to be operational. Fire extinguishers and first aid kit are maintained and ready for emergency use. LPA reviewed three (3) resident files and also reviewed three (3) staff files. Pre-licensing passed and Component III was completed. Applicant has satisfied all requirements in accordance to Title 22, California Code of Regulations. Application is pending and LPA will forward findings to the Centralized Application Bureau (CAB) for final review and approval. CAB will further contact applicant on final status of application. A copy of this report was provided to the facility. Exit interview conducted.the state’s words, verbatim · CDSS document, Sep 26, 2024

Type of visit: Office

Component II completion: Successful Facility Type: Residential Care Facility for the Elderly (RCFE) Application Type: Change in Ownership (CHOW) Capacity: 6 Census (if any clients in care): 5 COMP II Participants: Luigi Vo, Applicant/Administrator Interview Method: Telephone interview On September 17, 2024 at 10:10 AM, Applicant/Administrator participated in COMP II. Identification of the Applicant/Administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, Applicant/Administrator confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. S During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility Operation: License type, client/resident populations, and program. 2. Admission Policies 3. Staffing Requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General Provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing Readiness Exit interview conducted with Applicant/Administrator. Report sent via email and request to return sign copy to CAB by end of business day today.the state’s words, verbatim · CDSS document, Sep 17, 2024