American River Care Home 2

Type of visit: Required - 1 Year

On 8/27/26 at 12:55 Licensing Program Analyst (LPA) Kevin Gould arrived at for the purpose of conducting a required 1 year annual inspection. LPA met with Administrator, Harue Seki and together conducted a tour of the home. LPA and Administrator evaluated the physical plant to ensure the health and safety of the residents in care. Areas inspected are including but not limited to the kitchen, resident bedrooms; resident bathrooms, living and dining room and outdoor areas. LPA observed the facility to be free of odor, clean and in good repair. LPA observed that all rooms are equipped with the required furniture and sufficient lighting throughout the facility. LPA measured the water temperature, temperature measured at 114 degrees F which meets the 105-120 degree Fahrenheit regulation. LPA observed sufficient seven day non-perishable and two day perishable food supplies. Fire extinguishers and smoke detectors are current and in compliance with fire safety. LPA notes the facility had the required carbon monoxide detectors. First aid kit was checked and is complete. LPA observed centrally stored medications secure from residents. Per California Code of Regulations, Title 22 there were no deficiencies cited during today's inspection. An exit interview was conducted, and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Aug 27, 2026

Allegation investigated: Staff are not Criminally Record Cleared

Licensing Program Analyst (LPA) Kevin Gould conducted an unannounced complaint inspection at American River Care Home 2 RCFE on 5/29/26 at 1:50pm to inform the licensee of complaint allegation mentioned above and deliver findings. Based on the documents reviewed during the investigation process, the allegations are substantiated. LPA reviewed the current staff schedule and compared to the associated staff listings in department systems and determined that one staff member has no criminal record clearance and three staff members have a criminal record clearance but not associated to the facility. The Department has determined, based on the preponderance of the evidence obtained during this investigation, that the allegation of criminal record clearance is substantiated. Report Continued on LIC 9099-C. Substantiated The following deficiency is cited per California Code of Regulations, TITLE 22. An immediate civil penalty was issued during today's inspection. Exit interview was conducted with facility staff. Appeal Rights were issued, and a copy of this report was left at the home.the state’s words, verbatim · CDSS document, May 29, 2026 · control 27-AS-20260529085047

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(2) · Plan of correction due date: May 30, 2026

Criminal Record Clearance: All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: Obtain a California clearance or a criminal record exemption as required by the Department. This requirement was not met as evidenced by LPA review of staff records where LPA observed one staff member at the facility without a current criminal record clearance on file which poses an immediate health, safety or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, May 29, 2026

Plan of correction: Administrator has agreed to ensure staff members obtain a live scan. and have them associated. Administrator will also submit a step by step plan/procedures to ensure all staff have a criminal record clearance prior to working at the facility.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(3) · Plan of correction due date: May 30, 2026

Criminal Record Clearance: All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: Request a transfer of a criminal record clearance as specified in Section 87355(c). This requirement was not met as evidenced by LPA review of staff records where LPA observed three staff members at the facility without a current criminal record clearance transerred to this facility on file which poses an immediate health, safety or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, May 29, 2026

Plan of correction: Administrator has agreed to ensure staff members criminal record clearances are associated to this facility and have them associated. Administrator will also submit a step by step plan/procedures to ensure all staff have a criminal record clearance prior to working at the facility.

Type of visit: Required - 1 Year

On 08/21/2025, Licensing Program Analyst (LPA) Pang Lee arrived at the facility to conduct an unannounced annual inspection. LPA Lee met with administrator Harue Seki and explained the purpose of the visit. Administrator Harue assisted with today’s visit. Administrator certificate # is 6032138740 and will expire on 04/27/2027. The current census is 6 with 3 facility staff. This facility is a single story building licensed to serve five (5) non-ambulatory residents and one (1) can be ambulatory in room #3. The facility is approved for 2 hospice waiver. LPA Lee inspected the physical plant including but not limited to the common area, kitchen, dining area, resident bedrooms, resident bathrooms, laundry room and outside courtyards of the facility to ensure compliance with Title 22 regulations. LPA Lee observed the facility to be free of odor, clean and in good repair. LPA Lee observed bedrooms to be properly furnished with appropriate bedding and lighting. There are no bodies of water present. LPA Lee toured the kitchen and observed sufficient seven-day non-perishable and two-day perishable food supplies. Hot water temperature was measured at 116.8 degrees Fahrenheit in resident bathroom sink, which is within the required regulation of 105 to 120 degrees Fahrenheit. Grab bars and non-slip mats were observed to be stable and in good repair at this time. Smoke and carbon monoxide detectors are in compliance with fire safety. The fire extinguisher is located in the kitchen and was last serviced on 04/25/2025. LPA Lee observed the facility has a has a public telephone in the common area and the facility has the required posters posted. CONTINUED LIC 809-C Facility thermostat was observed at 76 degrees Fahrenheit. LPA Lee observed toxins located outside in a storage cabinet and kept locked and inaccessible to residents. LPA Lee observed sharp knives kept locked in the kitchen cabinet and inaccessible to residents. LPA Lee checked medication storage and found medication to be locked away and inaccessible to residents. LPA Lee reviewed 3 out of 6 residents' Medication Administration Records (MARs), along with the medications stored in the residents' medication boxes and found them to be complete. The first aid kit was checked and contained the required components. LPA Lee requested residents and staff files for review. LPA Lee reviewed resident files, and they were completed LPA Lee reviewed staff files, and it was also complete. LPA Lee reviewed staff criminal record clearances, and a review of staff records indicates that all facility staff or other individuals who require caregiver background checks are fingerprint cleared and associated with the facility. The following documents will be email to LPA by 08/28/2025 at the end of day 5:00 PM: (1) LIC 308 Designation of Administrative Responsibility (2) Copy of Administrator Certificate (4) LIC 610 Current Emergency Disaster Plan (5) Proof of Current Liability Insurance (6) LIC 500 Current Personnel Report As a result of this annual visit, the facility is in compliance with Title 22 Regulation. An exit interview was conducted with administrator Harue and a copy of these LIC 809 reports were provided to the facility.the state’s words, verbatim · CDSS document, Aug 21, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Ruth Wallace conducted an unannounced Required 1 Year Inspection Visit. LPA met with administrator and explained the purpose of the visit. Administrator Certificate expires 4/2/2025. LPA and administrator toured the physical plant including resident bedrooms, resident bathrooms, garage and backyard area. LPA observed the facility to be free of odor, clean and in good repair. LPA observed sufficient furniture and lighting throughout the facility. There are no bodies of water present. LPA observed sufficient seven day non-perishable and two day perishable food supplies. Hot water temperature was measured at 110.9 degrees Fahrenheit in kitchen sink, which is within the required regulation of 105 to 120 degrees Fahrenheit. Fire extinguishers and smoke and carbon monoxide detectors are in compliance with fire safety. Fire extinguisher last serviced 3/6/2024. LPA checked medication storage and found medication to be locked away and inaccessible to clients. First aid kit was checked and is complete. Emergency Disaster/Fire Drill conducted on 5/31/2024. LPA reviewed four resident files and three staff files, including criminal record clearances. A review of staff records indicates that all facility staff or other individuals who require caregiver background checks are Fingerprint cleared and associated to the facility. LPA verified staff training for staff file reviews. LPA requested the following updated documents for community care licensing to be submitted via email by June 12, 2024: LIC 308 Designation of Administrator, LIC 500 - Personnel Report, and Copy of Liability Insurance with expiration date. ruth.wallace@dss.ca.gov As a result of this visit, no deficiencies were cited, per California Code of Regulations, Title 22 and Health and Safety Code. Exit interview conducted with administrator. A copy of report and LIC 811 (Confidential Names) left at facility.the state’s words, verbatim · CDSS document, Jun 8, 2024