D & C Elderly Home

Type of visit: Case Management - Deficiencies

On 09/22/2026 at approximately 9:40 AM, Licensing Program Analyst (LPA) Jamaly conducted an unannounced case management visit at the facility to follow up on the handling of resident cash resources identified during the investigation of complaint with CCN#27-AS-20260914085037. LPA met with the Administrator (AD) and explained the purpose of the visit. During the complaint investigation, LPA obtained information indicating that the facility had accepted and maintained cash belonging to Resident 1 (R1), despite the facility's stated position that it did not handle resident cash resources. During an interview conducted on 07/20/2026, and 9/22/2026, AD stated that the facility does not handle resident money. However, AD acknowledged that, upon R1's admission to the facility and at R1's request, the facility accepted $300 in cash belonging to R1 for safekeeping. AD stated that facility staff maintained a tracking sheet to document R1's expenditures and retained receipts for purchases made on behalf of R1. AD further stated that, at R1's request, the facility also maintained R1's identification documents. On 07/15/2026, LPA reviewed R1's records and observed documentation supporting that the facility had accepted and maintained R1's cash resources. LPA observed LIC 405, Record of Client's/Resident's Safeguarded Cash Resources, containing a handwritten statement signed by AD and R1 which stated, "The facility will not handle the resident's money." LPA also observed documentation of R1's expenditures and receipts for purchases made on R1's behalf. In addition, LPA observed that the facility maintained a cash balance of $252.70 belonging to R1 in the facility. LPA Jamaly reviewed the facility's LIC 400, Affidavit Regarding Client/Resident Cash Resources. The LIC 400 states that the facility will not handle any cash resources of persons within the facility. Page 2 LPA reviewed the facility's Plan of Operation and R1's Admission Agreement, handling cash resources was not mentioned in those documents. During the interview conducted on 09/15/2026, AD confirmed that the facility did not have a surety bond because the facility was not handling resident cash resources. LPA reviewed the facility records and did not observe LIC 402, Surety Bond, on file for the protection of resident cash resources. Based on interviews, record review, and observation, the licensee accepted and safeguarded R1's cash resources without maintaining the required surety bond and without notifying the licensing agency and filing the required bond documentation. Per California Code of Regulations (CCR) – deficiency was cited during today's visit. An exit interview was conducted with Corina Dragnea and a copy of this report with appeal right were provided to the facility..the state’s words, verbatim · CDSS document, Sep 22, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87216(a) · Plan of correction due date: Sep 30, 2026

87216 Bonding (a) Each licensee, other than a county, who is entrusted to safeguard resident cash resources, shall file or have on file with the licensing agency a copy of a bond issued by a surety company to the State of California as principal. This requirement was not met as evidenced by: Based on interview and record review, the facility handled $300 of R1’s personal funds without a surety bond, which was inconsistent with the facility’s Plan of Operation which poses a potential risk to the health and safety of residents in care.the state’s words, verbatim · CDSS document, Sep 22, 2026

Plan of correction: The licensee/administrator will review the applicable regulations regarding the handling of residents’ personal funds. The licensee/administrator will submit a written statement confirming that the applicable regulations have been reviewed and that the facility will not handle residents’ funds unless the required surety bond is obtained.

Allegation investigated: Staff denied resident visitors Staff denied resident access to hospice care

On 8/28/2026 at 9:30 AM Licensing Program Analyst (LPA) Reza Jamaly arrived unannounced at the facility to deliver investigation findings regarding allegations noted above. LPA met with staff on duty and explained the purpose of the visit. Administrator (AD) Corina Dragnea was notified and arrived shortly after. During the investigation, LPA conducted interviews with Reporting Party (RP), AD, Staff 1 (S1), Staff 2 (S2), Hospice Agency (D-ARH), Administrator (AD1) of Southern End Care Home, Hospice Nurse1 (HN1) and reviewed R1's record. 1. Staff denied resident visitors LPA conducted interview with RP on 8/14/2026, LPA also reviewed emails RP sent to LPA Arvin on 4/13, 16, 20/2026. Per RP, "on 4/8/2026 myself and administrator of the new home care I located to enroll R1, contacted the facility via business telephone listed, it was answered by S1, we coordinated with S1 that transport company will arrive to move R1 to new home care on Thursday 4/9/2026 at 9: AM. Substantiated Page 2 They were denied entry to the facility, they returned two more times that day to attempt to remove R1 for safe transport to new facility, each time they were refused entry inside the facility". LPA interviewed administrator of new facility (AD1), AD1 stated RP coordinated with me to check on R1 to make sure R1 is okay. When I got there, I got into the facility, talked to S2 and explained that I want to meet R1. I checked R1, everything looked good. LPA asked if AD1 knew R1 before, AD1 state no, I was told by RP to check R1 while RP was outside of the facility inside the car. AD1 added that that on another occasion (doesn’t remember exact date), I witnessed RP called facility about R1 release. Also, RP texted me stating that RP called facility multiple time but they are not answering the phone. LPA interviewed HN1 who was part of transportation team to move R1 on 4/11/2026, HN stated "when we got there, AD denied our entry and stated you cannot move R1 until a paper is signed by RP. Per HN1 a lot of communication happened between AD, police and RP, finally RP sent a document to police phone and police provided to AD and we moved R1. HN1 added that I signed an inventory sheet regarding R1 clothes, hygiene Items and other belongings that were placed inside a box. It was a rainy day; I could not find the chance to check one by one but moved that box to new home". HN1 confirmed that 4 attempt were done by American River Hospice to move R1. LPA asked if other HN1 teammates were denied entry to the facility. HN1 stated; I don't exactly know about others but we had a meeting about this incident, another nurse also shared that they have been denied entry as well but I don't remember who shared this concern. LPA interviewed AD regarding allegation above, AD stated no visitor been denied of entry to the facility. I was not at the facility when AD1 came to the facility, an individual later identified as AD1 entered the facility on 4/8/2026 without prior notice and identified self as R1's friend visiting from out of state, staff contacted me, after communication with AD1, visitation was permitted. On 8/28/2026 LPA Jamaly interviewed with S1, S1 stated no body coordinated about R1 pick up on Apr 8 and 9, I just got a call on Friday Apr 10 and told them that you should contact with AD about R1 release, other than that I did not have any interaction with police or any other person about R1. Page 3 2. Staff denied resident access to hospice care LPA interviewed RP on 8/14/2026, Per RP, American River Hospice ordered the transport 4 separate times, also tried to contact AD several times but AD did not answer the phone. RP added that police got involved on April 9, 10, and 11. I called AD on 4/11/2026 at 9:00 am and asked the reason for not releasing R1, AD asked me to write a statement taking all responsibilities of R1 and sign it. Finally, I signed a statement as requested, finally R1 released. 8/28/2026 LPA Jamaly interviewed Director of American River Hospice (D-ARH) where R1 recently been enrolled to receive hospice services. D-AHR stated that RP enrolled R1 on 4/10/2026, RP signed all paper works, we arranged to move R1 from current facility to new one on 4/10/2026 but AD did not allow us to move R1, based on RP's request, we arranged transportation with two drivers and one nurse again on 4/11/2026 but AD refused again, until police got involved. There were hours of communication between police, RP, AD. LPA asked D-ARH if AD knew that R1 is under your services? D-ARH stated yes that our nurse completed evaluation at this facility, and we told them that R1 is under our services. LPA interviewed AD and asked the reason for the refusal to release R1, AD stated, how I can release a bed bound and non-verbal resident to strangers who I never see in my life. RP just sent drivers and a nurse who I never saw before. I asked police, drivers and nurse if they could take all future responsibilities and sign a paper in this regard, but they all refused to do so. I just needed RP to write a statement taking the responsibilities and sign it. RP told me, I don't know how to write and what to write, then I provided a template and sent it to RP. Finally, RP sent the required statement and I released it. R1 on 4/11/2026. LPA asked if AD knew that R1 is under new hospice services, AD stated yes, a nurse came on 4/10/26 and evaluated R1 but nobody told me that contract was signed between RP and new hospice agency. LPA Jamaly interviewed AD, if any direct call has been placed to RP during 4/8/2026- 4/11/2026, AD stated that no call is made to RP within these three days despite all challenge, finally on 4/11/2026 RP called AD and agreed to sign a paper. LAP observed an email was sent by AD on Apr 10, 26 at 6:00 AM to RP asking to provide details of person who would be responsible for R1 release, such as name, relationship, placement name and authorization of release from RP. Page 4 LPA Jamaly reviewed POA letter signed by RP in Sep 2012. Per this document, RP has full power and authority to do and undertake all acts on behalf of R1 including the right to make financial contacts, to initiate, defend, commence or settle legal actions on R1's behalf. LPA reviewed 30-day’s Notice of Relocation effective 3/25/2026 to 4/23/2026. Per this notice, R1 considered bedridden, and facility is not approved to care for bedridden residents in the room currently occupied by R1. Based on interview conducted, document reviewed, facility failed to allow hospice agency entry to facility and facility failed to release R1 as requested by power of attorney despite issuing 30 days eviction notice. So, this allegation is SUBSTANTIATED. A finding that the complaint is substantiated means that the allegations are valid because the preponderance of the standard has been met. Deficiencies cited on the LIC 9099-D, per Title 22 Regulations. An exit interview was conducted with AD Corina Dragnea and a copy of this LIC 9099, LIC 9099-D page and appeal rights provided to facility.the state’s words, verbatim · CDSS document, Aug 28, 2026 · control 27-AS-20260413134818

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1(a)(11) · Plan of correction due date: Sep 15, 2026

87468.1(a) Residents in all residential care facilities for the elderly shall have all of the following personal rights...To have their visitors, including ombudspersons and advocacy representatives, permitted to visit privately .. This requirement was not met as evidenced by: Based on interview and record review conducted by LPA Jamaly, administrator did not ensure visitors get acces to the facility to check on resident who is on end of life as requested by resident's family member which poses an immediate health and safety risks to resident in carethe state’s words, verbatim · CDSS document, Aug 28, 2026

Plan of correction: Administor/Licensee will review resident's personal rights and facility visitation policy and submit a sign statement that policy reviewed. The Administrator will provide training to all direct-care staff regarding residents' visitation rights and submit a copy of the staff training that include training title, trainees signature and date of trainig by due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(16) · Plan of correction due date: Sep 15, 2026

87468.1(a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (18) To move from the facility. This requirement was not met as evidenced by: Based on interview and record review conducted by LPA Jamaly, administrator did not allow residents family to transfer resident to another facility even after issuance of relocation (eviction) by the facility, which poses an immediate health and safety risks to resident in carethe state’s words, verbatim · CDSS document, Aug 28, 2026

Plan of correction: Administrator/Licensee will review eviction procedure and resident's personal rights and send a signed statement that relavent regulations are reviewed. The Administrator will provide training to all staff regarding residents' rights related to leaving or moving from the facility and send proof of training completion that includes training title, trainees signature and date of trainig by due date.

Allegation investigated: Staff did not inform authorized representative of Hospice services for resident Staff approved hospice services for resident without consent of the authorized representative Unlawful eviction Staff took resident off hospice without the consent of authorized representative Staff did not allow authorized representative to use own hospice company for resident

On 8/28/2026 at 9:30 AM Licensing Program Analyst (LPA) Reza Jamaly arrived unannounced at the facility to deliver investigation findings regarding allegations noted above. LPA met with staff on duty and explained the purpose of the visit. Administrator (AD) Corina Dragnea was notified and arrived shortly after. To investigate the complaint, LPA conducted interviews, reviewed R1 records, subpoenaed and reviewed R1 hospice documents. 1. Staff did not inform authorized representative of Hospice services for resident. Regarding above allegation, AD provided a written statement stating: " RP was repeatedly informed and involved in communication concerning R1 change of condition, hospice evaluation, eligibility and possible enrolment. On 3/13/26, 3/16/26/,3/17/26,3/23/26 and 3/24/26 RP was informed when hospice initially indicated that R1 did not qualify for services and was subsequently informed when hospice determined that R1 did qualify. Unsubstantiated Page 2 On 3/17/26, RP expressed support for R1 re-enrollment in hospice, on 3/24/26, RP expressed that RP is happy to hear that R1 qualified for hospice and confirmed that RP had received messages from the hospice RN". LPA Jamaly observed text message from AD to RP sent on 3/13/26 at 1:43 PM, it reads " There is a change in R1 health, R1 seems weaker and refused to eat. I called the doctor and asked if R1 would be appropriate under hospice care. He thinks it is. What do you think? " RP Replied on 3/16/26 at 11:19 AM " yes… please proceed as you deem appropriate… thank you so much AD for knowing to follow up- I appreciated you so much!" LPA observed a text message from AD sent to RP on 3/23/26 at 10:45 AM, it reads " we received a visit from hospice nurse again and told us that R1 DOES qualify for hospice service". RP replied on 3/24/26 at 7:PM, it reads " thank you for update and I am happy to hear this news- I hope you are also…". During LPA's interview with RP on 8/14/26, RP stated that we talked about hospice verbally, S1 texted me that hospice agency is coming, I was expecting that all paperwork be coordinated before and be in writing. LPA asked if RP was aware of communications between hospice agency and facility while R1 was on Blossom Ridge Hospice during 2024 and Sep 2025? RP stated yes, but they sent me discharged paper for signature and I signed it at last minute after they went under investigation for medical fraud and after they understood that paperwork should be signed. On 8/21/2026 LPA Jamaly subpoenaed and reviewed R1 hospice paperwork from Blossom Ridge. Per Blossom Ridge Hospice Admission Service Agreement dated 1/13/2023, RP acknowledged and signed it as R1 authorized representative. Also, RP signed Hospice Benefit Election Form dated 1/13/2023 on behalf of R1, form is marked " Patient is Unable to Sign". 2. Staff approved hospice services for resident without consent of the authorized representative LPA observed text message from AD sent to RP on 3/17/26 at 2 PM, it reads" we have not changed R1 to hospice, we were told R1 doesn't qualify for hospice as R1 doesn't have a terminal diagnosis" RP replied to AD on 3/17/26 at 3:32 PM, it reads " Whatever you want for R1 I support your decision- I was excited for a minute when you thought we might be able to put R1 back on hospice- I am glad the Dr. support that, thank you". Page 3 LPA observed text message from AD sent to RP on 3/17/26 at 7:40 PM, it reads" The nurse came to evaluate R1 and said R1 doesn't qualify for hospice at this time as R1 still eating and drinking but they will be open to come back if there will any significant changes". LPA interviewed with RP regarding allegation above on 8/14/26. RP stated that everything had been arranged with hospice agency, they notified me at last minute and I refused to sign it because I was suspicious about this hospice agency. AD used this agency (Arias Hospice) for their other facilities as well. LPA reviewed R1 records, per documents and interview with RP and AD, R1 has been in hospice for two times, first at Blossom Ridge Home from 1/13/2023 to 9/8/2025 and second time at Southern End Care Home from 4/11/2026 after release from D & C Elderly Home till end of R1's life. When LPA asked if allegation is about first or second time of hospice services, RP stated its about recent hospice agency (Arias Hospice) but the reason for enrolling and discharging R1 from previous hospice in 2025 (Blossom Ridge Home) is still unclear for me. LPA subpoenaed and reviewed R1's documents from Blossom Ridge Home, per Admission Service Agreement dated 1/13/2023, RP acknowledged and singed it as R1 authorized representative. Also, RP signed Hospice Benefit Election Form dated 1/13/2023 on behalf of R1, form is marked " Patient is Unable to Sign". 3.Unlawful eviction LPA Jamaly reviewed R1 file and observed 30-day notice for relocation is emailed to RP on 3/25/2026 at 8:30 AM which is effective from 3/25/2026 to 4/23/2026. The reason for relocation is mentioned as R1 change of condition, after evaluation and being considered as bedridden since R1 room was not fired cleared for a bedridden resident. LPA interviewed AD and reviewed written statement regarding this allegation, it states " my decision to issue the 30-day notice was because of R1 change of condition and the need for transfer to an appropriate setting if her needs could no longer be safely and legally accommodated in the room R1 occupied, which was not approved for a bedridden resident…I observed increasing changes in R1 functional abilities. R1 was spending substantially more time in bed, had increasing difficulty maintaining a seated position in wheelchair, became increasingly rigid and stiff, and required considerably more assistance with positioning and personal care. Page 4 There were times when R1 was unable to turn or reposition self in bed and staff had to turn R1 to provide incontinence care. I also observed difficulty reaching for items such as R1 drinking glass". Per AD, R1 physician and hospice contacted regarding R1 change of condition, hospice was discussed during the 3/13/26 physician conduct, and a hospice nurse subsequently came to the facility and evaluated R1. The hospice admission was not completed because RP didn’t sign the hospice paperwork. Per email sent to R1 physician on 4/9/26, AD asked R1 PCP to provide a written statement confirming R1 current condition as bedridden, provide any relevant medical assessment regarding R1 functional status, and any care recommendation or restriction. R1 PCP responded to above request via letter issued on 4/9/26 as bellow:" …it's my understanding that the patient will begin to transition to hospice care imminently, and that the next of kin is planning to move R1 to a different care-home. I will therefore defer the determination of R1 bedbound vs non-ambulatory status until such time when I can solicit an unbiased opinion from the hospice team as it would be unreasonable at this time to force the patient to come into the office solely for this determination. LPA interviewed RP via phone on 8/14/2026 and asked why RP thinks the 30 days relocation/eviction notice issued by facility on 3/25/2026 is unlawful? RP stated that I was in tough situation, facility was trying to kick R1 out after 14 years, they did not talk about eviction when I was at the facility on 3/18/2026. I did not know about this term (unlawful eviction), I called officer of day, explained the situation and they wrote this. LPA asked if RP reviewed R1 Admission Agreement, RP stated I reviewed it after this happened, I didn't know about eviction procedure before because it was signed 14 years ago and we were in communication via phone call and text message. 4.Staff took resident off hospice without the consent of authorized representative Per RP R1 was assigned Hospice care, as recommended need by caretaker and owner (AD), sometime in 2024 and released in September 2025 unbeknownst to me until last day of care. Reasons are still unclear. AD stated during interview with LPA Jamaly that RP was definitely aware and in communication with the facility when R1 was recommended hospice and when discharged. Per AD, Blossom Ridge Hospice where R1 was residing can't release any document to AD because R1 already discharged. AD submitted a written statement to the department, it reads" RP signed intake doc 1/13/2023 and discharge doc 9/8/25. R1 discharged from hospice care due to non-terminal illness/no longer need of hospice care. page 5 On 8/14/2026 LPA Jamaly interviewed RP about this allegation and asked if this allegation, RP stated I still don't know why R1 was discharged from hospice on Sep 2025. RP in another statement mentioned that RP signed discharge paper and has been aware of all communication between hospice agency and facility about R1. LPA reviewed Blossom Ridge Hospice Discharge Form dated 9/12/2025 and observed RP's handwritten signature and date. LPA also interviewed Executive Director of this hospice agency on 8/28/2026, Hospice ED confirmed that RP was aware of our communication and signed the discharge paper. Also, LPA observed RP's handwritten signature and date on Notice of Medicare Non-Coverage from dated 9/10/2025. 5.Staff did not allow authorized representative to use own hospice company for resident Regarding this allegation, AD stated that RP was informed and actively involved in the hospice discussions. LPA Jamaly observed text message from AD to RP sent on 3/13/26 at 1:43 PM, it reads " There is a change in R1 health, R1 seems weaker and refused to eat. I called the doctor and asked if R1 would be appropriate under hospice care. He thinks it is. What do you think? "RP Replied on 3/16/26 at 11:19 AM " yes… please proceed as you deem appropriate… thank you so much AD for knowing to follow up- I appreciated you so much!" LPA also observed text message RP sent to ED on 3/17/2026 at 3:32 PM, it reads" Whatever you want for my mom I support your decision". LPA Jamaly interviewed RP on 8/14/2026 and asked if facility gave you a chance to choose your own hospice agency and if RP offered an alternative hospice agency. RP stated' I didn't have any alternative agency in mind at that time, but I was suspicious about the hospice agency that was offered by AD (Arias Hospice Care) because AD has called the R1 physician to approve R1 as bedridden in order to give them a chance putting R1 in their favorite hospice agency and I was notified by R1 physician about this conversation. Also, facility was using this hospice agency for their other facilities as well. LPA also interviewed AD and asked if RP was given choice to use won hospice agency, AD stated yes, but RP did not give me own option, and I picked Arias Hospice agency because of providing high quality services and having good experience working with them. Based on the interviews conducted, and records reviewed, the preponderance of evidence standard is not met, and this allegation is UNSUBSTANTIATED. A finding of unsubstantiated means the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. An exit interview was conducted with Administrator, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Aug 28, 2026 · control 27-AS-20260327084535

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Christina Valerio and LPA Reza Jamaly arrived unannounced to conduct an annual required inspection. LPAs met with facility staff, and explained the purpose of the visit. Shortly after, LPAs were met by Administrator Corina Dragnea. LPAs toured the facility to ensure compliance with Title 22 regulation. LPAs observed resident bedrooms to be fully furnished, clean, and free from odors. Resident bathrooms were observed to be clean, sanitary, and stocked with hygiene supplies. The hot water was measured to deliver hot water at a temperature of 105.0 , which is within the required range of 105.0 - 120.0 degrees F. The living rooms were observed to be fully furnished, clean, and organized. The kitchen was observed to have working appliances, sharps locked and inaccessible to residents, and to be clean. The facility was observe to have an adequate supply of food with an emergency supply of food located in the garage. Residents were observed in their room taking a nap or outside in the living room watching television. The backyard was observed to have an area for shaded visits or outdoor activities. Emergency exits were observed to be free from obstructions. The fire extinguisher was fully charged with the last day of inspection on May of 2025, which is within regulatory compliance. LPAs observed one (1) staff file and one (1) resident file. Files were observed to be up to date with required documentation. LPA Reza requested the following annual documentation be sent to Reza.Jamaly@dss.ca.gov: LIC 500, LIC 308, LIC 610, and copy of liability insurance. Per California Code of Regulations (CCR) - Title 22 - no deficiencies were observed during today's visit. An exit interview was held, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Mar 24, 2026

Allegation investigated: Staff do not keep exit free from obstruction Staff speak inappropriately to residents in care Staff do not ensure that residents who are at risk for elopement are supervised at night

On February 09, 2026, at 9:45 AM, Licensing Program Analyst (LPA) Avelina Martinez arrived at the facility unannounced to conduct interviews and deliver complaint findings. LPA Martinez met with Corina Dragnea and explained the purpose of today's visit. Confidential interviews were conducted with seven individuals during the period of August 15, 2025, to February 09, 2026. Based on interviews conducted, facility tour, and records reviewed, it was determined that there was not sufficient evidence to substantiate the above complaint allegations. LPA Martinez interviewed four out of four residents. Information gathered from residents' interviews did not corroborate the above allegations. Additionally, three out of three staff members indicated all exit doors are kept free from obstruction. LPA Martinez also conducted a tour of the facility and inspected exit doors on February 09, 2026. The facility exit doors were free from obstruction during today's inspection. Unsubstantiated Three out of three staff members reported they did not speak to residents in care inappropriately. It was also learned that no resident has eloped from the facility, and the facility has awake staff for all shifts. In addition, the facility exit doors are alarmed. Three out three staff members reported they always supervise residents in care. Due to the above noted information, 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, and therefore the allegation are unsubstantiated. An exit interview was conducted, and a copy of this report was provided to the facility.the state’s words, verbatim · CDSS document, Feb 9, 2026 · control 27-AS-20250806191842

Type of visit: Required - 1 Year

On 3/27/25 at 1:20pm Licensing Program Analyst (LPA) Kevin Gould arrived at D & C Elderly Home for the purpose of conducting a required 1 year annual inspection. LPA met with Administrator, Corina Dragnea 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 115 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. LPA Requested the following documents for facility file: LIC 308 Designation of Facility Responsibility, LIC 500 personnel report, LIC 9020 client roster and current administrator certificate. 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, Mar 27, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Victoria Brown arrived unannounced to conduct a Required - 1 Year visit on 3/11/24 at 2:00pm. LPA observed the Administrator Certificate is on the pending list with Department of Social Services (CCL) and has not been received yet. LPA met with Corina Dragnea, Administrator and stated the purpose of todays visit. The facility is licensed for a capacity of 6 non-ambulatory residents of which 2 may receive hospice care services. There is 1 residents receiving hospice care services during this visit. LPA toured and inspected the physical plant inside and outside to ensure there are no safety hazards to residents. LPA observed 2-day perishables and 7-day non-perishables. The temperature inside the facility was observed to be at 76*F which is within the required range of 68-85*F. The hot water temperature was measured at 112.6*F which is within the required range of 105-120*F. LPA observed fire extinguisher(s), smoke and carbon monoxide detectors, and central heating and air in the facility. LPA observed the centrally stored medications area to be locked and inaccessible to residents. The first aid kit contained the required items such as sterile dressings, bandages, adhesive tape, scissors, tweezers, thermometers, antiseptic solution and guide. LPA reviewed 2 staff and 1 resident files and conducted interviews during this visit. Upon a file review the following items were discussed to be submitted with any changes annually: Licensing fees-Current Criminal Record Clearances LIS536-Current Administrative Organization LIC309-Current Designation of Administrative Responsibility LIC308-Submit Personnel Report LIC500-Submit Affidavit Regarding Client/Resident Cash Resources LIC400-NA Surety Bond LIC402-NA Facility Floor Plan/Plot Plan LIC999-Current Fire Clearance (consistent with terms and limitations of license)-NA Qualifications of Administrator/Facility Manager-Submit Articles of Incorporation/Organization, Constitution and bylaws-NA Partnership Agreement-NA Control of Property-Submit Emergency Disaster Plan LIC610-Submit Plan of Operation (Restricted Health Care Plan)-NA Admission Policies and Procedures-NA Health Screening Report-Facility Personnel LIC503-NA Bacteriological Analysis of Private Water Supply-NA In-service Training Program-NA Medication Procedures-NA Transportation Procedures-NA Job Description/Personnel Policies-NA Exemptions/Waivers and Exceptions-Current First aid/CPR certificates-Current Liability Insurance-Submit Infection Control Plan-Submit Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 8, no deficiencies are being cited during this visit. Exit interview held. A copy of todays’ report provided.the state’s words, verbatim · CDSS document, Mar 11, 2024