Cypress Garden Home Care

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) De Leon arrived at 10:15am to conducted a 1 year annual visit to the facility above. LPA met with back up to Administrator Robert Budai and explained the purpose of the visit. A tour of the inside and outside of the facility was conducted with Administrator. The following was inspected and noted during the annual visit: Infection Control: The facility has submitted a current Infection Control Plan. The facility has EPA approved disinfectants spray and cleaners. The facility has a 30 day supply of PPE. Facility staff need to be trained upon hire and annually thereafter on infection control and plan. Physical Plant & Environment Safety: The facility is a 5 bedroom with 2 on suite bathrooms and 1 main restroom for residents, staff and visitors. The facility currently occupies 4 residents, and is staffed with 4 staff and 2 administrators. The facility is clean, safe and sanitary. The pathways are clear of any obstructions. The facility has sufficient space inside and outside for activities and visiting. The gates are self-closing and self-latching. The facility has outdoor furniture for residents use with shaded area. Laundry room has working washer and dryer. Water was tested in the main restroom measured at 152.2 F, Administrator turned down water heater and LPA at end of visit tested and measured at 143.6, Administrator adjusted the water heater and will check temperature again and adjust if needed. Operational Requirements: The Facility is operating in compliance with fire clearance. The facility provided current liability insurance valid till 06/15/2026. The fire clearance is granted for 6 non-ambulatory, of which 1 may be bedridden. Hospice wavier granted for 4. Continued 809-C Staffing: The facility employes 4 staff and 2 Administrators. Staff records are kept confidential. Staff records were reviewed for 4 staff and 2 Administrators. 2 out of 6 records had fingerprint clearance and associations with criminal record statements, personnel record or application, First Aid and CPR certificates and Health screening with TB results. All records had fingerprint clearances, 1st Aid and CPR. Administrator file was reviewed for continuing education which was not available for review. Administrator Certificate expired 04/18/2026 and other administrator certificate was verified on CCL pending list. Personnel Records & Training: The facility keeps confidential binder with taps for each staff member. Files lacked training hours and subjects for 2025-2026 for 20 hours. Some staff had training records but did not met the required hours and new staff files need 40 hours of initial training. Resident Records & Incident Reports: The facility keeps separate files on each resident confidentially. Four Files were reviewed for signed Admission Agreements, Medical Assessments LIC. 602A Physicians Report, ID and Emergency contact forms, Appraisal Needs and Services plans (ANS), TB results, Personal Rights, and Safeguard for personal property and valuables. Files were current and up to date. Resident Rights Information: All require postings were posted in common areas of facility. Personal rights, Theft and Loss policy, Nondiscrimination notice, CCL Complaint poster is posted on entry and LTCO poster is posted in the dining room. Planned Activities: The facility offers activities to all residents in care. Activities include books, magazines, newspapers, TV watching, daily walks, group discussions and communications, and puzzles. The facility has sufficient space to allow for activities indoors and outdoors. Food Service: The facility handles and prepares food safely. The facility has 2 day perishables and 7 day non-perishables to meet the food service requirement. Food, snacks and drinks are available when the residents want them. Emergency supply of food and water is available in the garage. Incidental Medical & Dental: Facility provides transportation or assist in providing transportation to medical and dental appointments when needed. The medications records were reviewed for all 4 residents in care. Each Residents has a Medication Administration Records (MAR) and the Centrally Stored Medication and Destruct Records (CSMDR). LPA completed a full audit of residents medication, all medications were stored in the original containers, prescription labels were not altered, and no medications were expired. Doctors orders were present in resident files. Continued 809-C Disaster Preparedness: The current emergency disaster forms were posted. The facility did not have disaster drills quarterly for 2026 year. The fire extinguishers were charged. The dual smoke and carbon monoxide detectors are present and hard wired throughout the facility. The facility has disaster supplies present with extra food and water. Residents with Special Health Needs: The facility does accept dementia residents in care. All items that could pose a danger, sharps, cleaners were locked separately in cupboards. The facility does have 1 hospice residents in care, care plan is up to date and present. The facility does have one Home Health resident in care, home health plan is present and kept up to date. The facility does not have any current residents on oxygen. The facility has exiting door alarms, tested and working properly. The facility does not have delayed egress, secured perimeters with locked gates or doors. Exit interview conducted, deficiencies cited, copy of report and appeal rights printed for Administrator.the state’s words, verbatim · CDSS document, Apr 24, 2026

The state marks this report as 64 pages; the online copy we transcribed has 8. You can request the full file from the county licensing office.

Allegation investigated: Staff not giving resident access to hearing aid.

Licensing Program Analyst (LPA) conducted a subsequent complaint visit to the facility above to deliver final findings in the complaint investigation. LPA met with Gabriela Soo and explained the purpose of the visit. LPA De Leon conducted the initial 10-day visit on 08/21/2024 conducted staff interviews and requested and received records. LPA conducted witness interviews on 08/19/2024 at 3:40pm and 4:19pm, on 08/21/2024 and on 05/01/2025 at 10:01am. On the allegation: Staff not giving resident access to hearing aid. LPA interviewed staff, witness and review medical records which revealed R1 did wear hearing aids. The hearing aids were brought to the facility on admission and when people came to visit R1, R1 did not have hearing aids in and visitors would have to request the help from staff to find them, or they were not put on the charger to charge, or the batteries were not in them to use. LPA reviewed the Safeguard for Property and Valuables it has declined written across the page and no signature of the residents or the responsible parties. Continued 9099-C Substantiated According to one witness interview this form was not given to the resident or RP on admission to fill it out. Another witness interview revealed the staff helped with hearing aids on several visits, but R1 also refused the hearing aids at other times and did not want to put them on with visitors. Staff and witness interviews revealed that you could speak in a clear loud voice and communicate with R1 and that is how R1 wanted to communicate at times. The facility did not feel responsible for taking care of the hearing aids and batteries. Based on the LIC. 602A medical records for R1, R1 wore hearing aids and needed assistance and R1 is able to refuse to wear them at times the facility accepted R1 into care knowing he needed assistance with hearing aids therefore the allegation is Substantiated at this time. Exit interview conducted, copy of report and appeal rights printed for Administrator. LPA interviewed witness that revealed they had never seen R1 left soiled in urine, R1 had wounds, and those wounds never got worse and cleared up quickly which would not have occurred if R1 had been frequently left soiled in urine. Interviews also revealed R1 was having difficulty in the evening, became combative at times and refused care. Based on the evidence this allegation is deemed Unsubstantiated at this time. On the allegation: Resident sustained pressure sore while in care of staff. LPA interviewed staff, witness and reviewed medical records which revealed R1 did have two pressure sores during R1’s time at the facility due to being bedridden or in a recliner chair all day, R1 did get staff assistance for rotating and turning according to Hospice recommendations for R1. According to Hospice R1’s pressure sores were caused from being bedbound with skin breakdown due to disease progression, the pressure sores did not get worse and one was cleared within 2 week period and the other within a month and that would not have happened if the facility was not taking care of R1 properly. Based on the evidence this allegation is deemed Unsubstantiated. On the allegation: Resident sustained multiple UTI’s while in care of staff. LPA De Leon interviewed staff, witnesses and reviewed medical records which revealed R1 had a history of UTI’s, R1 was taking medication for UTI’s and when R1 was admitted to Hospice R1 had a current UTI and Medical records stated R1 had a history of UTI’s. Based on the evidence this allegation is deemed Unsubstantiated. Exit interview conducted and copy of report printed for Administrator.the state’s words, verbatim · CDSS document, May 21, 2025 · control 29-AS-20240816102248

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(a)(3) · Plan of correction due date: May 28, 2025

(a)...: (3)When residents require prosthetic devices, vision and hearing aids, the staff shall be familiar with the use of these devices, and shall assist such persons with their utilization as needed. This requirement was not met as evidenced by: Based on interview and medical records R1 wore hearing aid and the facility did not always assist R1 with the hearing aids when needed which poses a potential health, safety and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, May 21, 2025

Plan of correction: Administrator will review regulation 87465 and understand the requirements of staff and helping residents and provide training to staff in these requirements, send LIC 500 and proof of Licensee, administrator and staff training.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Rankin arrived at 9:10 am to conducted a 1 year annual visit to the facility above. LPA met Licensee/Administrator Gabriella Soo and explained the purpose of the visit. A tour of the inside and outside of the facility was conducted with Administrator. The following was inspected and noted during the annual visit: Infection Control: The facility has submitted a current Infection Control Plan. The facility has EPA approved disinfectants spray and cleaners. The facility has a 30 day supply of PPE. The facility is provided annual training for infection control with all staff. Physical Plant & Environment Safety: The facility is a 5 bedroom and 3 bathroom home currently occupying 6 residents and 3 staff and 2 administrators. The facility is clean, safe and sanitary. The pathways are clear of any obstructions. The facility has sufficient space inside and outside for activities and visiting. The gates are self-latching and self-closing. The facility has table and chairs available outside with shaded area for resident use. Laundry room has working washer and dryer. Operational Requirements: The Facility is operating in compliance with fire clearance. The facility provided current up to date liability insurance. The facility is granted for 6 non-ambulatory with 1 can be bedridden and Hospice wavier granted for 4. Continued 809-C Staffing: The facility employes 4 staff and 2 Administrators. Staff records are kept confidential. Staff records were reviewed for 5 staff. Staff records had fingerprint clearance and associations with criminal record statements, personnel record or application, First Aid and CPR certificates and Health screening with TB results. Administrator file was reviewed for continuing education and Administrator Certificate is valid till 04/18/2026. Personnel Records & Training: The facility keeps confidential binder with taps for each staff member. Training records were present for 2024-2025 for 20 plus hours of annual training. Resident Records & Incident Reports: The facility keeps separate files on each resident confidentially. Five Files were reviewed for signed Admission Agreements, Medical Assessments LIC. 602A Physicians Report, ID and Emergency contact forms, Appraisal Needs and Services plans (ANS), TB results, Personal Rights, and Safeguard for personal property and valuables. Files are current meeting all required forms on file. Resident Rights Information: All require postings were posted in common areas of facility. Personal rights, Rights to Resident Council, Theft and Loss policy, Nondiscrimination notice in addition to a CCL Complaint poster, and LTCO poster. Planned Activities: The facility offers activities to all residents in care. Activities include books, magazines, newspapers, TV watching, daily walks, group discussions and communications, and puzzles. The facility has sufficient space to allow for activities indoors and outdoors. Food Service: The facility handles and prepares food safely. The facility has 2 day perishables and 7 day non-perishables to meet the food service requirement. Food, snacks and drinks are available when the residents want them. Emergency supply of food and water is available in the garage. Incidental Medical & Dental: Facility provides transportation or assist in providing transportation to medical and dental appointments when needed. The medications records were reviewed for all 5 residents with the Centrally Stored Medication and Destruct Records (CSMDR) all were up to date, legible and written as prescribed. LPA completed a full audit of residents medication, all medications were in original containers, prescription labels were not altered, No medications were expired, doctors orders were present and dispensing instructions were followed. Continued 809-C Disaster Preparedness: The current emergency disaster forms were posted. The facility provide disaster drills for 2025. The fire extinguishers were charged and receipt was dated within 1 year. The dual smoke and carbon monoxide detectors are present and hard wired throughout the facility. the facility had emergency food and water present. Residents with Special Health Needs: The facility does accept dementia residents in care. All items that could pose a danger, sharps, cleaners were locked separately in cupboards. The facility does have 1 hospice residents in care, care plan is up to date and present. The facility does have one Home Health resident in care, home health plan is present and kept up to date. The facility does not have delayed egress. The facility does not have any current residents on oxygen. The facility has exiting door alarms, tested and working properly. Exit interview conducted, copy of report printed for Administrator.the state’s words, verbatim · CDSS document, May 21, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Rankin arrived at 8:30 am to conducted a 1 year annual visit to the facility above. LPA met Licensee/Administrator Gabriella Soo and explained the purpose of the visit. A tour of the inside and outside of the facility was conducted with Administrator. The following was inspected and noted during the annual visit: Infection Control: The facility has submitted a current Mitigation Plan, Infection Control Plan and Emergency Disaster Plan. The facility has EPA approved disinfectants spray and cleaners. The facility has trash bins with covers. The facility has a 30 day supply of PPE. Physical Plant & Environment Safety: The facility is a 5 bedroom and 3 bathroom home currently occupying 6 residents and 4 staff, including the administrator. The facility is clean, safe and sanitary. The pathways are clear of any obstructions. The facility has sufficient space inside and outside for activities and visiting. The gate (on the street view right side of the facility) is being updated for ease of latching and self-closure. The facility has table and chairs available outside with shaded area for resident use. Laundry room has working washer and dryer. Operational Requirements: The Facility is operating in compliance with fire clearance. The facility provided current up to date liability insurance. All Dementia requirements are being met. Hospice wavier granted for 2, a request to update hospice waiver to 4 is being submitted. Staffing: The facility employes 2 staff and 2 Administrators. Staff records are kept confidential. Staff records were reviewed for 2 staff. Staff records had fingerprint clearance and associations with criminal record statements, personnel record or application, First Aid and CPR certificates and Health screening with TB results. Personnel Records & Training: The facility keeps confidential files for each staff member. Training records were current for required 2024 annual training requirements and additional training is scheduled. Resident Records & Incident Reports: The facility keeps separate files on each resident confidentially. Four Files were reviewed for signed Admission Agreements, Medical Assessments, LIC. 602A Physicians Report, ID and Emergency contact forms, Appraisal Needs and Services plans (ANS), Immunization records, TB results, Personal Rights, and Safeguard for personal property and valuables. Files are in compliance. Resident Rights Information: All require postings were posted in common areas of facility. Personal rights, Rights to Resident Council, Theft and Loss policy, Nondiscrimination notice in addition to a CCL Complaint poster, and LTCO poster. Planned Activities: The facility offers activities to all residents in care. Activities include books, magazines ,newspapers, TV watching, daily walks, group discussions and communications, and puzzles. The facility has sufficient space to allow for activities indoors and outdoors. Food Service: The facility handles and prepares food safely. The facility has 2 day perishables and 7 day non-perishables to meet the food service requirement. Food, snacks and drinks are available when the residents want them. Emergency supply of food and water is available in the garage. Incidental Medical & Dental: Facility provides transportation to medical and dental appointments when needed. The medications records were reviewed for all 4 residents with the Centrally Stored Medication and Destruct Records (CSMDR) all were up to date, legible and written as prescribed. LPA completed a full audit on two residents medication, all medications were in original containers, prescription labels were not altered, doctors orders were present and dispensing instructions were followed. Three residents had hospice care plans. Disaster Preparedness: The current emergency disaster forms were posted. The facility provide disaster drills for 2024, and will add additional drills to their schedules. The fire extinguishers were charged and receipt was dated within 1 year. The dual smoke and carbon monoxide detectors are present and hard wired throughout the facility. Residents with Special Health Needs: The facility does accept dementia residents in care. All items that could pose a danger, sharps, cleaners were locked separately in cupboards. The facility has a license for 6 Non Ambulatory which 1 may be bedridden on room 1. The facility does not have delayed egress. The facility does have one current residents with oxygen. The facility does have hospice and home health visits to the facility for residents in care. Exit interview conducted, copy of report printed for Administrator.the state’s words, verbatim · CDSS document, Jun 18, 2024

The state marks this report as 7 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.