Sunset Coast Assisted Living 3

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA), Debbie Correia, made an unannounced visit to conduct the required One-Year Inspection. LPA Correia was greeted by Caregiver Valeria Rivera, identified herself, and explained the purpose of the visit. The facility is licensed to serve 6 residents aged 60 and above, all six (6) of whom may be non-ambulatory of which must reside in bedrooms #1, #2, and #4. In January of 2024, the facility was granted a Hospice waiver for six (6) residents in care. Licensee Christina Tapia arrived a short time later, to join the visit. During today’s visit two (2) of the six (6) residents were present, the remaining four (4) residents were attending Day Program. A review of records revealed resident records including but not limited to; a current Physician's Report, Resident Appraisal, Needs & Services Plan, Identification and Emergency Information, and Admission Agreement, were current and complete. In addition, personnel records were reviewed for Criminal Record Clearance, required training, Health/TB Screening Report, First Aid and CPR certification, and qualifications that were also current and complete. The facilities last disaster drill was conducted in January of 2026. The facility has a current lease agreement and liability insurance. A review of medication administration records was accurate and complete, and medications were kept in a locked med-cart. Toxins and other hazardous materials were housed in locked cabinets/garage and inaccessible to residents in care. [Continued on LIC 809C] [Continuation of LIC 809] LPA Correia, accompanied by Licensee Tapia and caregiver Rivera, conducted a facility tour, and inspected resident rooms. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Required postings were observed. Resident bedrooms contained the required furnishings. Resident showers were equipped with non-skid flooring and grab bars, and in working order. The temperature at taps used by residents measured at 113.8 degrees Fahrenheit. The facility doors, windows and screens were in good repair. Extra linens, hygiene supplies, and Personal Protective Equipment (PPE), and night lights in hallways were present. LPA also observed a landline, smoke and carbon monoxide detectors, a fire extinguisher that were present, operational, and/or current, and a First Aid Kit. The facility had an adequately sized common area and a shaded outdoor area for activities and visitation. There were no bodies of water on the facility grounds. Per Licensee Tapia there are there are no firearms or ammunition on the facility premises. Based on today’s inspection, there are no deficiencies being cited. An exit interview was conducted and a copy of this report, and Licensee Rights - LIC 9058 (rev. 01/16) will be provided to Licensee Tapia, whose signature on this form acknowledges receipt of these documents.the state’s words, verbatim · CDSS document, Jan 26, 2026

Allegation investigated: Staff did not maintain a comfortable temperature Facility had insufficient staff to meet resident needs

Licensing Program Analyst (LPA), Sabel Martinez, conducted an unannounced a follow up complaint investigation visit, and delivered complaint findings. The LPA introduced himself and disclosed the purpose of the visit to Caregiver Priscilla Rivero. Throughout the investigation, the Department secured records and conducted interviews with external and internal sources, including staff and residents. It was alleged staff did not maintain a comfortable temperature. On July 22nd, 2024, it was reported to the Department the facility temperature was too hot for residents, and staff had not addressed it. Interviews with internal and external source reported witnessing fans in residents’ bedrooms, and portable air conditioning units throughout the facility. During the initial investigation visit, the LPA witnessed air circulating fans in each of the resident bedrooms. On subsequent visits, the LPA witnessed portable air conditioning units in the hallways and living room area of the facility. (See LIC 9099-C for continuation of report.) Unsubstantiated There were no statements, or evidence to corroborate the facility was not maintained at a comfortable temperature, therefore, the allegation was unsubstantiated. It was alleged the facility had insufficient staff to meet resident needs. On July 22nd, 2024, it was reported to the Department the facility only employed one live-in caregiver and this caregiver was not able to meet all the residents’ needs. Interviews with internal and external source, including sources who frequently visited the facility, did not have any concerns with the residents’ needs not being met. Interviews and review of records revealed that during the time in question, the facility employed two live-in caregivers. The LPA also reviewed the ambulatory status, care needs, number of staff present, and staff response times. Although there were conflicting statements made regarding how many staff were employed by the facility, the facility had additional staff who may respond to the facility and assist. Based on the evidence obtained, there was not enough evidence to prove the alleged violations occurred, therefore, the allegations were unsubstantiated. An exit interview was conducted with Caregiver Priscilla Rivero, to whom a copy of this report, and Licensee/Appeals Rights (LIC 9058), were provided.the state’s words, verbatim · CDSS document, Mar 20, 2025 · control 08-AS-20240722104503

Type of visit: POC

Licensing Program Analyst (LPA) Sabel Martinez conducted an unannounced Plan of Correction (POC) visit. The LPA introduced himself and disclosed the purpose of the visit to Caregiver Priscilla Rivero. During today’s visit, the LPA reviewed documents and cleared the POCs that were due. The LPA printed POC letter and provide it to the staff. An exit interview was conducted with Caregiver Priscilla Rivero, to whom a copy of this report, and Licensee/Appeals Rights (LIC 9058), were provided.the state’s words, verbatim · CDSS document, Mar 20, 2025

Type of visit: Case Management - Annual Continuation

Licensing Program Analyst (LPA) Sabel Martinez conducted an announced Annual Continuation visit. The LPA inroduced himself to Caregiver Samantha Rivero. The facility was licensed for a capacity of six (6) non-ambulatory residents. The facility also had an approved hospice waiver for six (6). During today's visit. the LPA reviewed facility records, including but not limited to, the facility's Plan of Operation, Infection Control Plan, and Emergency disaster plan. The LPA confirmed the facility had an active liability insurance on file. Required licensing posting were observed in visible areas of the facility. Review of records revealed the facility did not document emergency drills, and that several staff records were not kept at the facility. Additionally, review of records and interviews revealed Resident # 1 (R1) was bedridden and the facility did not have an approved fire clearance for bedridden residents. A five hundred dollar ($500) immediate civil penalty was assessed for the fire clearance violation. These deficiencies were cited in an LIC 809D form and a plan of correction was jointly formulated with Caregiver Samantha Rivero. An exit interview was conducted with Samantha Rivero. A copy of this report, LIC 809D, LIC 811, and the Licensee/Appeal Rights (LIC9058), were emailed to Administrator Christine Tapia.the state’s words, verbatim · CDSS document, Feb 20, 2025

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.695(c) · Plan of correction due date: Feb 20, 2025

1569.695 Emergency Plans (c) A facility shall conduct a drill at least quarterly for each shift. The type of emergency covered in a drill shall vary from quarter to quarter, taking into account different emergency scenarios. An actual evacuation of residents is notrequired during a drill. While a facility may provide an opportunity for residents to participate in a drill, it shall not require any resident participation. Documentation of the drills shall include the date, the type of emergency covered by the drill, and the names of staff participating in the drill. This requirement was not met as evidenced by: Based on review of records, the licensee did not ensure quarterly drills were conducted, nor documented, which posed a pontential health, safety and personal rights risk to 5 of 5 residents in care.the state’s words, verbatim · CDSS document, Feb 20, 2025

Plan of correction: Caregiver agreed to review emegency drill policy, conduct an emegency drill with all staff and submit proof to the LPA by 3/20/25.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87412(f) · Plan of correction due date: Feb 20, 2025

87412 Personnel Records (f) All personnel records shall be available to the licensing agency to inspect, audit, and copy upon demand during normal business hours. Records may be removed if necessary for copying. Removal of records shall be subject to the following requirements: This requirement was not met as evidenced by: Based on review of records, the licensee did not ensure personnel records were kept at the facility, which posed a potential health, safety and personal rights risk to 5 of 5 residents in care.the state’s words, verbatim · CDSS document, Feb 20, 2025

Plan of correction: Caregiver agreed to submit personnel records for S1, S2, and S3, to LPA by 3/20/25. The records include the LIC 501, LIC 503, LIC 508, Background clearance letters, and first aid and CPR certificates.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87202(a)(2) · Plan of correction due date: Feb 20, 2025

87202 Fire Clearance (a) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department, or district providing fire protection services, or the State Fire Marshal. Prior to accepting or retaining any of the following types of persons, the applicant or licensee shall notify the licensing agency and obtain an appropriate fire clearance approved by the city, county, or city and county fire department, or district providing fire protection services, or the State Fire Marshal. (2) Bedridden persons This requirement was not met as evidenced by: Based on review of medical assessment and interviews, the licensee did not ensure the facility had an approved fire clearance for a bedridden resident (R1), which posed an immediate health, safety, and personal rights risk to 1 of 5 residents in care.the state’s words, verbatim · CDSS document, Feb 20, 2025

Plan of correction: Caregiver agreed to provide R1 an eviction notice, or submitting an LIC 200 requesting bedridden change, to the Department by 2/21/2025.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sabel Martinez conducted an announced Annual Required visit. The LPA introduced himself to Caregivers Jose Angel Rivero and Samantha Rivero. The facility was licensed for a capacity of six (6) non-ambulatory residents. The facility also had an approved hospice waiver for six (6). During the visit, the LPA conducted a tour of the facility and inspected resident bedrooms. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Bedrooms contained the required furnishings. Doors, windows, screens, toilets, and showers were in working order. Extra linens and hygiene supplies were present, as well as Personal Protective Equipment. The facility had sufficient space to facilitate dining, laundry, and resident activities. There was at least 2 days of perishable food, and at least 7 days non-perishable food present, all safely stored. Cooking/dining equipment and utensils were present. There were no toxic chemicals/poisons accessible to residents. Medications were labeled and stored in a locked medication cart. No pools, nor bodies of water were observed on the premises. Due to time constraints, an additional visit on a subsequent day is required to complete the annual inspection. An exit interview was conducted with Samantha Rivero. A copy of this report and the Licensee/Appeal Rights (LIC9058) were emailed to Administrator Christine Tapia.the state’s words, verbatim · CDSS document, Jan 29, 2025

Allegation investigated: Uncleared staff working at facility

Licensing Program Analyst (LPA), Sabel Martinez, conducted an unannounced complaint investigation visit to investigate the above allegation. The LPA introduced himself and disclosed the purpose of the visit to Caregiver Tahi Fakvaa, who was the only caregiver at the facility at the time of the visit. Caregiver Sandra Austria arrived during the visit and assisted the LPA. Review of records, along with a search in the Department's Guardian System revealed Staff # 1 (S1). Did not have an active Criminal Background clearance. This deficiency was cited in an LIC 9099D form and a civil penalty of $500 was assessed in an LIC 421BG form. A plan of correction was jointly formulated with Administrator Christine Tapia, who arrived during the visit. An exit interview was conducted with Administrator Christine Tapia, to whom a copy of this report, LIC 811 Confidential names list, LIC 9099D, and Licensee/Appeals Rights (LIC 9058), were provided. Substantiatedthe state’s words, verbatim · CDSS document, Jul 30, 2024 · control 08-AS-20240722104503

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(1) · Plan of correction due date: Jul 30, 2024

87355 Criminal Record Clearance(e) 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:(1) Obtain a California clearance or a criminal record exemption as required by the Department or This requirement was not met as evidenced by: Baed on review of records, the Department's Guardian system, and interviews, the Licensee did not ensure S1 was background cleared prior to working and residing at the facility.the state’s words, verbatim · CDSS document, Jul 30, 2024

Plan of correction: Administrator agreed to have not have (S1) work, nor reside at the facility unitl a background clearance was obtained. S1 left the facility, therefore, the POC was cleared on today's date.

The state marks this report as 3 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Allegation investigated: Resident did not have access to internet services

Licensing Program Analyst (LPA) Sabel Martinez conducted a complaint investigation visit regarding the above allegation. The LPA introduced himself and disclosed the purpose of the visit to Caregiver Sandra Austria. Owner Patricia Tapia and Administrator Christine Tapia arrived during the visit. Throughout the investigation, the Department reviewed records and conducted interviews. It was alleged a resident did not have access to internet services. On 6/12/24, it was reported to the Department facility staff had removed the internet access for Resident # 1 (R1). An interview with R1 noted R1 had access to the facility internet service since R1 was admitted to the facility. When R1 was no longer able to access the internet service, R1 notified facility staff, but the internet service was not restored. R1 could not recall if the internet service was a service offered during admission. An interview with the facility owner confirmed the facility had internet services previously, but this service was not meant for resident use. Instead, this service was meant for camera surveillance use in the facility. Unsubstantiated Since the cameras were not yet in use, the facility decided to disconnect the internet until further notice. Staff initially believed R1 was accessing the internet through R1’s mobile device, and only discovered R1 had been connecting to the facility’s internet when it was disconnected. It was relayed to R1 that R1 could access the internet through R1's mobile device, if that was what R1 desired. An interview with an external source revealed conflicting statements regarding why the internet service was disconnected. This source corroborated R1 had internet access since R1’s admission, but that the internet service was disconnected due to R1 mismanaging R1’s money. This source confirmed R1 had a history of mismanaging money. A review of R1’s admission agreement confirmed there was no mention of internet service provided at the facility, nor any additional charge for such service. Although Title 22 indicates facilities must afford privacy when a resident uses the internet, and ensure a device is available for all residents during reasonable hours, if the facility offers internet service, there is no regulation that requires the facility to provide internet service. Based on the evidence obtained, the allegation was unsubstantiated. An exit interview was conducted with Owner Patricia Tapia and Administrator Christine Tapia, to whom a copy of this report, and Licensee/Appeals Rights (LIC 9058), were provided.the state’s words, verbatim · CDSS document, Jun 18, 2024 · control 08-AS-20240612112640

Type of visit: Prelicensing

Licensing Program Analysts (LPAs) Dang Nguyen and Juliana Barfield conducted an announced Pre-Licensing visit to observe the facility’s physical plant for compliance with Title 22, Division 6 of the California Code of Regulations and California Health & Safety Code. LPAs were greeted by, identified themselves to, and explained the purpose of the visit to the applicant’s representative, Administrator Christine Tapia. The facility fire clearance was granted on 10/05/2023 and reflected that the facility was approved for six (6) residents in total, of which all may be non-ambulatory, but none may be bedridden. The facility's fire clearance did not include endorsements for delayed-egress doors or secured perimeter, and neither were present during today's visit. The submitted facility sketch was consistent with the current layout of the facility. During today’s visit, LPAs, accompanied by the applicant’s representative, toured the interior and exterior of the facility and inspected each room. The facility was clean, sanitary, and in good repair. Pathways were well lit and free of obstruction and slip hazards. Resident bedrooms allowed for easy passage and contained the required furnishings. Toilets, sinks, and showers were in working order. The facility’s ambient internal temperature was complaint at 72 degrees F. Hot water temperature at taps accessible to residents were also compliant: Kitchen sink was 113 F, Bathroom #1 sink was 110 F, and Bathroom #2 sink was 111 F. The facility has enough linens, hygiene supplies, cooking and dining supplies, and perishable and non-perishable food for future resident use. All kitchen appliances were in working order. Kitchen Refrigerator temperature was 40 F, and Kitchen Freezer temperature was 0 F. Staff Refrigerator temperature was 21 F, and Staff Freezer temperature -18 F. [CONTINUED ON LIC 809-C] [CONTINUED FROM LIC 809] The facility has sufficient space and equipment to facilitate laundry, visitation, meetings, and resident activities. The facility has locked areas for storage of sharp objects, medication, and confidential resident and staff records. No pools or bodies of water were observed on the premises. There were no toxic chemicals/poisons, fireplaces, or open-faced heaters accessible to residents. Per the applicant’s representative, no firearms or ammunition are or will be stored at the facility. Smoke alarms, carbon monoxide detectors, emergency lighting, and facility telephone were all operational. Fire extinguishers were serviced within the last twelve months. A complete first aid kit was present. Required licensing postings were observed in visible areas of the facility. The items reviewed were complaint with Title 22, Division 6 of the California Code of Regulations and California Health & Safety Code. The applicant passed the pre-licensing inspection. LPAs also provided the Component III Training during today’s visit. Tapia was advised that the facility’s application is pending management final review and approval. An exit interview was conducted with the applicant’s representative, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.the state’s words, verbatim · CDSS document, Jan 18, 2024

Type of visit: Prelicensing

Licensing Program Analysts (LPAs) Dang Nguyen and Juliana Barfield conducted an announced Pre-Licensing visit to observe the facility’s physical plant for compliance with Title 22, Division 6 of the California Code of Regulations and California Health & Safety Code. LPAs were greeted by, identified themselves to, and explained the purpose of the visit to the applicant’s representatives, Patricia Tapia and Christine Tapia. During today’s visit, LPAs, accompanied by the applicant’s representatives, toured the interior and exterior of the facility and inspected each room. There are items which must be corrected for the facility to comply with regulations. The applicant did not pass the pre-licensing inspection, and a return visit will be required. An exit interview was conducted with the applicant’s representatives, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.the state’s words, verbatim · CDSS document, Jan 11, 2024

Type of visit: Office

Component II completion: Successful Facility Type: RCFE Application Type: INITIAL Capacity: 6 Census (if any clients in care): 0 COMP II Participants: Name - Christine Tapia CEO/Administrator Interview Method: Telephone interview On November 14, 2023, Applicant/Administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and 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. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of the 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 Readinessthe state’s words, verbatim · CDSS document, Nov 14, 2023