Sunrise Terrace RCFE I

Allegation investigated: Staff mismanage residents medications

On 9/2/2026 at 9:30am Licensing Program Analyst (LPA) Haner-Tomasko arrived unannounced at the facility to investigate the above allegation to this complaint. LPA met with Administrator Edwin Ingan and explained the purpose of the visit. During a visit conducted on 7/30/2026 and today’s visit LPA checked the wellbeing of the residents in care and conducted interviews. LPA also conducted the facility annual inspection during today’s visit. On the allegation, staff mismanage residents medications; it was alleged that on a day in August 2026 Resident #1 (R1) was observed in bed with two medication cups left within arm’s reach of them on their bedside table. One cup had two pills in it and the other had one pill in it. It was also alleged that R1 stated the medication in the cup with one pill was an as needed (PRN) medication and R1 had not requested it. (Conitnued on LIC9099-C) Substantiated Review of R1’s medical assessment dated 12/26/2025 states that they are not able to manage their own medications and are at risk if given access to hazardous items. LPA observation and staff interviews reveal R1 shares a room with another resident. Staff stated R1 insists on having their medication placed on their bedside table so they can take it when they want to. Interviews and record review reveal that the two pills in the one cup left for R1 are carbidopa-levodopa scheduled at 12:00pm. According to available resources, the effectiveness of carbidopa-levodopa depends on the medication being taken at consistent times each day to ensure stable levels in the body and maintain steady symptom control. Staff stated the cup containing one pill was a lorazepam 0.5mg tablet. Record review reveals R1 is prescribed the lorazepam twice daily and PRN. Staff state the dose left on the table was scheduled for 8:00am but R1 likes to determine when they want to take it. During a visit conducted on 8/11/2026 LPA observed R1 to have a bottle of Tums left on their bedside table. Based on all interviews conducted and documents obtained, at this time the above allegation was found to be substantiated, the facility left centrally stored medication unlocked for R1 who is not able to manage their own medications and the medications were accessible to other residents in care, there is a preponderance of the evidence to prove that the alleged violation occurred. Exit interview conducted, deficiencies cited on LIC9909-D page, report signed, appeal rights and report provided to the Administrator. Regarding the use of communal soap staff interviews revealed that the bar of soap was purchased by one of the care staff for Resident #2 (R2) and used it to provide R2 bed baths. The Administrator states they typically purchase liquid soap because they think using communal bar soap is not hygienic. California Code of Regulations, Title 22, Division 6, Chapter 8 requires facilities to provide hygiene items of general use such as soap but does not specify whether the soap must be liquid, bar, or any particular form. Regarding residents not having liquids to drink within arm’s reach. During visits conducted on 7/30/2026, 8/11/2026, and today’s visit LPA observed each resident to have a liquid drink within reach. LPA also observed the facility had multiple drink options including water, a variety of juices, coffee, tea, and soda. Residents who are able to communicate, stated that staff bring them something to drink with each meal and if they need more, they can call staff for assistance. Staff stated that they feel they are good about providing residents with something to drink throughout the day especially those that cannot communicate. They said that they cannot force the residents to drink but they encourage them to drink liquids throughout the day. Based on all interviews conducted and documents obtained, at this time the above allegation was found to be unsubstantiated, meaning that the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. Exit interview conducted, report signed, and report provided to the Administrator.the state’s words, verbatim · CDSS document, Sep 2, 2026 · control 29-AS-20260730114026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(h)(2) · Plan of correction due date: Sep 3, 2026

(h) ...(2)Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. This requirement was not met as evidenced by: Based on observation, interviews and record review, the Licensee did not comply with the section cited above when they left medication accessible to residents which poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Sep 2, 2026

Plan of correction: Administrator states they have not been leaving medications and will schedule training for staff who manage medications on the importance of locking medications leaving them unattended, residents taking their medication timely and other residents having access to the medications. They will email LPA training documents and signed roster on or before 9/16/2026.

Allegation investigated: Resident is dehydrated due to staff neglect

On 9/2/2026 at 9:30am Licensing Program Analyst (LPA) Haner-Tomasko arrived unannounced at the facility to investigate the above allegation to this complaint. LPA met with Administrator Edwin Ingan and explained the purpose of the visit. During a visit conducted on 8/11/2026 and today’s visit LPA checked the wellbeing of the residents in care and conducted interviews. LPA also conducted the facility annual inspection during today’s visit. On the allegation, resident is dehydrated due to staff neglect; it was alleged that on a day in August 2026 Resident #1’s (R1’s) urine was observed to be extremely dark in color, indicating extreme dehydration. (Continued on LIC9099-C) Unsubstantiated LPA recently investigated a similar complaint with complaint control #29-AS-20260806142616. During visits to the facility conducted on 7/30/2026, 8/11/2026, and today’s visit LPA observed each resident to have a liquid drink within reach. LPA also observed the facility had multiple drink options including water, a variety of juices, coffee, tea, and soda. R1 stated staff are good about providing them with liquids to drink throughout the day and if they need more they can call them. Residents who are able to communicate, stated that staff bring them something to drink with each meal and if they need more, they can call staff for assistance. Staff stated that they feel they are good about providing residents with something to drink throughout the day and that R1 can be particular about what they like to drink but they ensure they have what R1 likes. They said that they cannot force the residents to drink but they encourage them to drink liquids throughout the day. Based on all interviews conducted and documents obtained, at this time the above allegation was found to be unsubstantiated, meaning that the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. Exit interview conducted, report signed, and report provided to the Administrator.the state’s words, verbatim · CDSS document, Sep 2, 2026 · control 29-AS-20260806142616

Type of visit: Required - 1 Year

At 9:30am, on 9/2/2026, Licensing Program Analyst (LPA) Haner-Tomasko arrived at the facility unannounced to conduct the annual facility inspection. LPA met with Administrator Edwin Ingan, announced who he was and the reason for the visit. Administrator and LPA conducted a full tour of the facility. This facility is a single story residential home with four resident bedrooms (two are dual occupancy) and two full bathrooms (one is a jack and jill style bathroom en-suite to the two dual occupancy rooms and one is for public/shared use). There is a living room, family room, kitchen and dining area. A staff room is located near the kitchen. Access to the laundry room and garage is through locked doors for resident safety. LPA observed upon arriving to the facility all doors and cabinets required to be locked due to hazardous items were locked. LPA noted that the backyard has seating and shade for residents and visitors. The facility has wired smoke detectors in each room that are all working, the carbon monoxide detector is near the kitchen and functioning normally. LPA observed a fire extinguisher near the kitchen that was tagged current and in the green compression range, serviced on 10/14/2025. LPA tested facility hot water at 109.0°F, within regulation temperatures 105-120°F. LPA observed at least 2-days of perishable and at least 7-days of nonperishable foods. LPA noted that the facility has no obstructions in hallways, doorways or exits. Medications are locked in a medication cart. LPA conducted a medication audit and reviewed the facilities Centrally Stored Medication Records (CSMRs), noting a total of nine (9) medications belonging to three (3) different residents not recorded on the facility CSMRs. LPA conducted a staff and resident file review. LPA and Administrator conducted a review of the annual care tool modules. Exit interview conducted, deficiency cited on LIC809-D page, report signed, report and appeal rights provided to the Administrator.the state’s words, verbatim · CDSS document, Sep 2, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(h)(6) · Plan of correction due date: Sep 16, 2026

(h) The following requirements shall apply to medications which are centrally stored:(6) The licensee shall be responsible for assuring that a record of centrally stored prescription medications for each resident is maintained... This requirement was not met as evidenced by: Based on observation, interviews and record review, the Licensee did not comply with the section cited above when a total of nine medications belonging to three different residents were not documented on the centrally stored which poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Sep 2, 2026

Plan of correction: Staff recorded the medications on each residents centrally stored medication record during LPA visit. Administrator states they will conduct training on documenting centrally stored medication and email training documents and signed staff roster to LPA 9/16/2026.

Allegation investigated: Staff do not ensure cleaning supplies, knives, and other similar items that can pose danger to residents are in a locked storage.

On 7/30/2026 at 2:00pm Licensing Program Analyst (LPA) Haner-Tomasko arrived unannounced at the facility to investigate the above allegation to this complaint. LPA met with Licensee Albert Gregorio and explained the purpose of the visit. Licensee and LPA conducted a full tour of the facility. LPA also collected relevant documentation and conducted interviews. When Administrator Edwin Ingan arrived he took over and the Licensee left. On the allegation, Staff do not ensure cleaning supplies, knives, and other similar items that can pose danger to residents are in a locked storage; it was alleged that on a day this month in the hallway bathroom, the cabinets with cleaning supplies was left unlocked and the knife drawer in the kitchen was unlocked with keys left in the lock. (Continued on LIC9099-C) Substantiated While touring the facility during today's visit, at 2:05pm LPA noted the cabinet under the kitchen sink unlocked and unattended with a can of aerosol Easy Off oven spray. At 2:12pm the drawer that is not lockable to the left of the stove/oven containing a steak knife and at 2:13pm a butcher knife in the drawer that is not lockable to the left of the dishwasher underneath the utensil container with the handle visibly sticking out. At 2:18pm LPA observed a bottle of glass cleaner in the east side yard and at 2:20pm LPA noted the shed in the backyard was unlocked and unattended. The shed contained multiple sharp landscaping tools, three tubs of grout compound, a plastic basin with a steak knife in it, and eleven (11) paint/sealant cans. During today's visit LPA noted the kitchen knife drawer and hallway bathroom cabinet to be locked. Staff stated that the knife drawer lock was recently fixed but before it was fixed the keys would get stuck in the lock. Staff stated the hallway bathroom cabinet was left unlocked this month because they had just pulled something out of it to use in another room and admitted that they did leave the cabinet unattended. Resident record review determined three of five residents are at risk if given access to knives and cleaning chemicals. Based on all interviews conducted and documents obtained, at this time the above allegation was found to be substantiated, there is a preponderance of the evidence to prove that the alleged violation occurred. Exit interview conducted, deficiency cited on LIC809-D page, report signed, appeal rights and report provided to the Administrator.the state’s words, verbatim · CDSS document, Jul 30, 2026 · control 29-AS-20260730114026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87309(a) · Plan of correction due date: Aug 31, 2026

(a) ... the licensee shall ensure that disinfectants, cleaning solutions,... knives,... tools, sharp objects, and other similar items which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage. This requirement was not met as evidenced by: Based on observation, interview, and record review, the licensee did not ensure items that could pose a danger to residents were locked when unattended which poses an immediate health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Jul 30, 2026

Plan of correction: Staff locked up the items when they were discovered during the tour. Administrator states they will conduct training with the staff and email LPA the staff training summary and signed staff roster on or before 8/6/2026.

The state marks this report as 4 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Type of visit: Case Management - Annual Continuation

At 01:00pm, on 08/28/2025, Licensing Program Analyst (LPA) Haner-Tomasko arrived at the facility unannounced to conduct the case management - annual continuation visit. LPA met with Administrator Edwin Ingan, announced who he was and the reason for the visit. LPA noted the smoke detectors and sprinkler system were serviced by Mid Coast Fire Protection on 11/4/2024. Medications are locked in a medication cart. LPA conducted a sample medication audit and reviewed the facilities Centrally Stored Medication Records, finding no violations. LPA conducted a staff and resident file review. LPA and Administrator conducted a review of the annual care tool modules. There were no deficiencies cited at this time. Exit interview conducted, report signed, and report provided to the Administrator.the state’s words, verbatim · CDSS document, Aug 28, 2025

Allegation investigated: Staff neglect resulted in a resident sustaining pressure injuries Staff neglect resulted in a resident's change in medical condition Staff did not meet a resident's showering needs while in care Staff mishandled a resident's medications Staff did not meet a resident's diabetic needs Staff are not properly trained Staff did not meet a resident's mobility needs while in care

On 8/5/2025 at 8:10am Licensing Program Analyst (LPA) Haner-Tomasko arrived unannounced at the facility to further investigate the allegations to this complaint. LPA met with Administrator Edwin Ingan and explained the purpose of the visit. During the visit, LPA interviewed staff and the administrator. On the allegation: Staff neglect resulted in a resident sustaining pressure injuries. It was alleged R1 sustained pressure sores from facility staff seating R1 in a side chair next to the bed with their feet pressing on the floor and not moving him all day. LPA record review and interviews revealed R1 had a fall at home on 1/5/2025. LPA interview with R1’s family member (P1) revealed R1 lived at home prior to 1/6/2025 and did not have any wounds or pressure injuries. On 1/6/2025 R1 was admitted to Arroyo Grande hospital where they stayed until discharged to this facility from the hospital on 1/9/2025. (Conitnued on LIC 9099-C) Unsubstantiated LPA review of hospital records for R1 during their stay from 1/6/2025 to 1/9/2025 revealed R1 was admitted to the hospital due to weakness and had discharge diagnoses of malaise and fatigue, diarrhea, anasarca, anemia of chronic disease, BPH with urinary obstruction, essential hypertension, obesity, and type 2 diabetes mellitus. Hospital records indicate a wound was noted by hospital staff on R1’s buttock on 1/6/2025 at 2:21pm. Hospital discharge notes state resident discharged to facility on service with Home Health. Review of Central Coast Home Health (CCHH) notes for R1 revealed the first nurse visit for R1 at the facility was on 1/14/2025 and at this visit the nurse noted “pressure ulcer wound location: right buttock…”. No other wounds were noted. The next nurse visit was on 1/17/2025 and the nurse noted three wounds; Wound 1 was a stage one pressure injury located on R1’s coccyx with a size of length: 0cm, width: 0cm, depth: 0cm, status of closed - present on admission, 100% red/pink and no wound pain. Wound 2 was a stage 2 pressure injury located on R1’s left heel, with status of closed and surrounding tissue intact, onset date 01/15/2025. Wound 3 was a lateral left heel blister, with a status of closed, onset date of 01/16/2025. LPA staff interviews revealed they noticed a blister on R1's left heel when they showered them on 1/10/2025 and reported it to R1's family. Record review of R1’s facility file reveal no note of skin issues or pressure injuries. Staff stated they would encourage R1 to recline their feet up and would offer a pillow to float their feet, but R1 often refused or would remove the pillow. P1 purchased padded foot booties for R1’s feet, staff would put them on, but R1 did not always tolerate them. Based on all interviews conducted and documents obtained, at this time the above allegation was found to be unsubstantiated, meaning that the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. On the allegation: Staff neglect resulted in a resident's change in medical condition. It was alleged while in the facilities care, R1 was transported to the Emergency Room for various issues caused by the Care Facility that they never had at home. LPA record review revealed throughout R1’s stay at the facility from 1/9/2025 to 2/28/2025 R1 was sent to the emergency room on two occasions, 1/21/2025 and 2/28/2025. Record review and interviews revealed on 1/21/2025 staff and CCHH nurse noted blood in R1’s urine. Facility staff called 911 and R1 was transported to Sierra Vista Regional Medical Center around 1:27pm. Hospital discharge notes indicate resident was discharged on the same day around 8:54pm and returned to the facility with the discharge diagnosis of hematuria. (Continued on 9099-C) LPA record review and interviews revealed on 2/28/2025 Staff 1(S1) assisted R1 with their morning routine. S1 stated after transferring R1 to the recliner in their room R1 was trembling, sweating, and responsive. S1 stated they suspected R1’s blood sugar was too high or too low, S1 called R1’s family member (P1) regarding the symptoms. In interview with P1, P1 suggested S1 give R1 apple juice to see if it helps and call 911 if they think it’s needed. R1 refused the apple juice and S1 called 911 around 8:00am. LPA record review and staff interviews revealed R1 did not have a physician order to test blood glucose levels and took metformin twice daily to manage their diabetes. LPA record review of R1’s hospital records revealed R1 was discharged from the hospital to a skilled nursing facility on 3/5/2025 and discharge diagnoses of hypoglycemia, new onset atrial fibrillation, and altered mental status. R1 did not return to the facility after this hospitalization. P1 stated they couldn’t return R1 to the facility after the issues R1 had. Based on all interviews conducted and documents obtained, at this time the above allegation was found to be unsubstantiated, meaning that the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. On the allegation: Staff did not meet a resident's showering needs while in care. It was alleged R1 was only receiving bed baths since they moved in because the facility does not have an American’s with Disabilities Act (ADA) shower room. R1 had a shower chair on wheels and shower bench, but neither of these worked with the facility showers. LPA noted the facility is not required to have ADA showers/baths per Title 22 regulations. LPA noted the shared bathroom has a walk-in shower with a 4.5 inch ledge to step over to get in. Text messages between the Administrator and P1 reveal R1 had a shower on 1/10/2025. LPA interviews with staff revealed if R1 wanted a shower they would assist them to do so, but R1 often refused showers stating they were afraid of falling. Staff stated when R1 was willing they would place towels down on the bathroom floor, place a shower chair on the towels, R1 would sit in the chair and staff used the handheld shower head to shower R1. When R1 refused showers, staff would offer bed baths using warm water, soap and towels to care for R1 in bed. Staff stated R1’s family did not tour the facility prior to admission. LPA interview with P1 confirmed they did not tour the facility before as the hospital was attempting to quickly discharge R1 and P1 used a placement agency to find a facility for R1. Based on the information obtained, the allegation is deemed unsubstantiated at this time. (Continued on 9099-C) On the allegations: Staff did not meet a resident's diabetic needs and staff mishandled a resident's medications. It was alleged facility staff did not provide R1 their meals and medications timely causing frequent low blood sugar not noticed by staff, and R1 allegedly lost weight. LPA record review and staff interviews revealed R1 did not have a physician order to test blood glucose levels and took metformin twice daily to manage their diabetes. LPA reviewed medication administration record which showed medication was given as prescribed and staff stated R1 knew their medications and regularly asked for them on time. Record review of R1’s LIC602 noted R1 requires a diabetic diet. Staff stated P1 would bring R1 food to eat based on their diet needs. P1 also wrote down meal preferences for the facility to follow for R1 and R1 knew they were diabetic and would not request anything outside of these preferences. Based on all interviews conducted and documents obtained, at this time the above allegation was found to be unsubstantiated, meaning that the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. On the allegation: Staff are not properly trained. It was alleged the facility has too many high need residents and unqualified people managing them and not trained well. Many don’t seem trained at all. LPA record review of staff training for the years of 2024 and 2025 revealed 3 of 3 staff completed required training per Title 22 and California Health and Safety Code for staff at this facility type. LPA resident interviews revealed they receive the care they need, staff offer them showers or bed baths, and additional care. Based on the information obtained, the allegation is deemed unsubstantiated at this time. On the allegation: Staff did not meet a resident's mobility needs while in care. It was alleged R1 sustained pressure sores from facility staff seating R1 in a side chair next to the bed with their feet pressing on the floor and not moving him all day, a wheelchair was brought for R1 and staff never put R1 in it. LPA staff interviews revealed R1 requested to be in bed or the recliner in his room. Staff attempted to get R1 to spend time in the living room on multiple occasions but R1 often refused or would spend a short period of time outside his room and request to return to his room. Based on the information obtained, the allegation is deemed unsubstantiated at this time. During the course of the investigation LPA noted a violation and cited on a separate case management report. Exit interview conducted, report signed and provided.the state’s words, verbatim · CDSS document, Aug 5, 2025 · control 29-AS-20250307152743

Type of visit: Case Management - Deficiencies

On 8/5/2025 at 8:10am Licensing Program Analyst (LPA) Haner-Tomasko arrived unannounced at the facility to conduct a case management visit. LPA met with Administrator Edwin Ingan and explained the purpose of the visit. During a recent complaint visit to the facility LPA noted during file review and staff interviews that Resident #1 (R1) moved into the facility in January 2025. It was alleged that neglect from the staff caused R1 to sustain a pressure injury on their left foot. Staff stated R1 moved into the facility with the pressure injury and the administrator stated they noted the pressure injury on 1/10/2025 when assisting resident with shower. Staff stated they did not document the pressure injury and the review of R1’s file revealed no documentation of the pressure injury. LPA record review of home health records reveal nurse notes during a visit to R1 on 1/17/2025 note two wounds on R1’s left heel. Per Title 22 regulations facilities are required to document when changes such as a physical health condition is observed. Since the facility did not document when the wound’s on R1’s left heel were observed it is difficult to determine when and where the pressure injuries developed. Based on interviews conducted and record review, the facility did not document an observed change to R1’s physical health. Pursuant to Title 22, California Code of Regulations, the following deficiencies are cited on LIC809-D. Exit interview conducted, appeal rights and copy of this report issued.the state’s words, verbatim · CDSS document, Aug 5, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87466 · Plan of correction due date: Aug 19, 2025

Observation of the Resident ...When changes such as...deterioration of...a physical health condition are observed, the licensee shall ensure that such changes are documented... This requirement was not met as evidenced by: Based on interviews and record review, the licensee did not comply with the section cited above when they observed a change in R1's physical health condition and did not document the change which poses a potential health and safety risk to clients in care.the state’s words, verbatim · CDSS document, Aug 5, 2025

Plan of correction: Administrator stated they will create a policy to document resident changes in condition this may include updating their reappraisals. Administrator will email LPA the policy and documentation of staff training on the policy on or before 8/19/2025.

Type of visit: Required - 1 Year

At 08:10am, on 08/5/2025, Licensing Program Analyst (LPA) Haner-Tomasko arrived at the facility unannounced to conduct the annual facility inspection and two other visit types. LPA met with Administrator Edwin Igan, announced who he was and the reason for the visit. Administrator and LPA conducted a full tour of the facility. This facility is a single story residential home with 4 resident bedrooms (two are dual occupancy and two are single occupancy) and there are two full bathrooms (one is a jack-and-jill style bathroom between the two dual occupancy bedrooms and one is for public/shared use). There is a family room, living room, dining room, and kitchen. A staff room is located off the hallway. Access to the laundry room and garage is through locked doors for resident safety. LPA noted that the backyard has seating and shade for residents and visitors. LPA noted fresh fruit and snacks in the kitchen for residents to enjoy. The facility has wired smoke detectors in each bedroom. The carbon monoxide detector is in the dining room and functioning normally. LPA observed a fire extinguisher near the kitchen that was tagged current and in the green compression range, serviced on 10/16/2025. LPA observed at least 2-days of perishable and at least 7-days of nonperishable foods. LPA noted that the facility is clean and in good repair with no obstructions in hallways, doorways or exits. LPA was not able to complete the annual inspection and may return at a later time to finish. Administrator needed to leave during the visit and LPA reviewed report with Lead Staff Allan Estacio. There were no deficiencies cited at this time. Exit interview, report signed, and report provided.the state’s words, verbatim · CDSS document, Aug 5, 2025

Type of visit: Case Management - Deficiencies

At 7:45am on 03/11/2025, Licensing Program Analysts (LPAs) Jeffries and Haner-Tomasko arrived to the facility unannounced to conduct a Case Management visit and a subsequent complaint on a separate report. LPAs met with Administrator, Edwin Ingan, announced who they are and the reason for the visit. As a result of the subsequent complaint investigation conducted on this visit, it was discovered that the facility has failed to repot any changes in conditions with Serious Incident Reports (SIR) of the residents or any Deaths Reports that have occurred or Hospice Notifications. LPA reviewed both the Serious Incident Report file, Death Reports, and Hospice Notifications (Efax for review for 405802274) and found zero SIR's, zero Death reports, and zero Hospice Notifications. LAP's reviewed Resident 1 (R1) Hospital visit discharge paper work dated 01/21/2025. This hospitalization was not reported to Community Care Licensing by the facility or Administrator. This is a failure to report to licensing and a citation for Reporting Requirements [87211(1)(a)] is issued from this report. Licensee stated that they have had deaths and hospice residence in the past 3 years at this facility. Administrator stated that he had faxed report to LPA Rankin. On 03/11/2025 LPA Jeffries confirmed by phone call that all reports Administrator submitted were filed, LPA Jeffries noted zero reports file for this facility. Report read, citation issued, appeal rights and report provided.the state’s words, verbatim · CDSS document, Mar 11, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1) · Plan of correction due date: Mar 25, 2025

Reporting Requirements 87211(a)(1) 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... if any; and disposition of the case. This requiorment was not met by evidence of failure to report R1 hospitalization and admission of Administrator which put residents in potential danger.the state’s words, verbatim · CDSS document, Mar 11, 2025

Plan of correction: Administrator will train all Administrators and staff of reporting and will provide evidence to LPA Jeffries by email on or before 03/25/20.

Type of visit: Required - 1 Year

At 2:00pm on 09/30/2024, Licensing Program Analyst (LPA) Jeffries arrived unannounced to the facility to conduct the annual inspection. LPA met with Licensee Edwin Ingan, announced who he was and the reason for the visit. At 2:05pm Licensee and LPA conducted a facility tour. This is a 5 bedroom 2 bathroom, kitchen, living room and backyard outdoor area with shading for residents in care. LPA observed 2 days of perishable and 7 days of nonperishable foods. LPA observed all fire extinguishers to be in compliance with regulations. LPA observed all fire detractors and carbon monoxide detector to be in working order. LPA noted that all rooms have proper lighting, linin, and storage meeting CCLD regulations. Licensee and LPA conducted a sample medication audit and found centrally stored medication log to be accurate. LPA noted that medications are locked in a medication cabinet in the living room. LPA noted that resident files secured in a cabinet in the living room and staff are secured at a central office as licences has 4 other facilities. LPA did not observe and hazards or obvious dangers to residents in care. LPA observed a adequate supply of PPE at the facility and noted that facility has a universal mass supply for all five facilities under this Licensee. LPA observed the facility to be clean and organized and every appliance to be in good working order. LPA conducted a medication audit, LPA noted that medication audit did not reveal any violations or citations. Licensee and LPA conducted a full review of the annual control tools kit, including all modules. LPA did not note any other violations or citations during this annual and the full annual care tools review. LPA noted that there were no citations or violations as a result of this annul inspection. Exit interview, report read and report provided.the state’s words, verbatim · CDSS document, Sep 30, 2024

Allegation investigated: Staff did not properly secure the resident's medications.

At 12:40pm on 07/11/2024, Licensing Program Analyst (LPA) Jeffries arrived unannounced to the facility to investigate the allegation to this complaint. LPA met with Administrator Edwin Ingan announce who he is and the reason for the visit. LPA conducted interviews. As to the allegation of, "Staff did not properly secure the resident's medication,' It was alleged that on 07/09/2024 at 1:21pm a reliable witness (person with license or credentials indicating expertise training) observed the medication cart in the living room with keys in cart and two residents sitting next to cart with no staff present. It was discovered in LPA Jeffries interviews on 07/11/2024 of Staff 1 (S1) who was working on 07/09/2024 at the time when medication cart was left unattended. S1 stated that they were conducting medication pass when S1 was called to assist another staff and visiting nurse to resident room and left key in medication cart. There were two Residents in the same room as the medication cart with keys and no staff present. Based on admission, and reliable witness there is enough evidence at this time to support the allegation of, "Staff did not properly secure the resident's medications." and is substantiated at this time. Exit interview, report read, appeal rights and report provided. Substantiatedthe state’s words, verbatim · CDSS document, Jul 11, 2024 · control 29-AS-20240710085719

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(1) · Plan of correction due date: Jul 11, 2024

87465 Incidental Medical and Dental Care (1) Medications shall be centrally stored... (2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees ... This requirement was not met by evidence of Medication Cart found with keys when staff unsupervised with resident present on 07/1/2024, which poses an imminent danger to residents in care.the state’s words, verbatim · CDSS document, Jul 11, 2024

Plan of correction: Administrator agreed to change medication distribution procedure by relocateing the mediation cabinet to a double secure location in the facility.

Allegation investigated: Staff spoke another language in front of residents in care.

At 11:00am on 07/03/2024, Licensing Program Analyst (LPA) Jeffries arrive unannounced to conduct the initial investigation to the allegation to this complaint. LPA met with Administrator, Edwin Ingan, announced who he is, and the reason for the visit. LPA conducted interviews, reviewed documentation and issued final findings on this visit. As to the allegation of, “Staff spoke another language in front of residents in care.” On 07/01/2024, at approximately 12:30pm, it was observed by a reliable witness (person with license or credentials indicating expertise training) that the Facility Administrator, Edwin Ingan, and Direct Care Staff (S1) were conversating in Tagalog language while residents in care were in the close proximity. It was discovered through interviews of Administrator and S1 on 07/03/2024, that both admit to communicating in Tagalog in front of Residents in care through kitchen opening. Both stated that none of the residents in care speak or fully understands the language of Tagalog. CONTINUED on LIC9099-C Substantiated On 07/03/2024, LPA Jeffries reviewed 4 of 4 Residents’ LIC602’s (Physicians Reports) indicating that 3 of 4 Residents have cognitive impairment or Dementia. LPA noted that English is the primary language of 4 of 4 residents. On 06/03/2024, S1 was observed by a reliable witness speaking Tagalog while providing direct care of resident and subsequently the facility was citied for personal rights violation on 06/06/2024 for that violation. The Administrator conducted training of which verification of personal rights training was sent by email to LPA on 06/11/2024. This is the second violation of resident’s personal rights, by speaking a forging language in the direct presence of residents in care who have cognitive impairment to dementia diagnosis which does not accord residents dignity in their relationships with staff. At this time there is enough evidence to support the allegation of, “Staff spoke another language in front of residents in care.” and is substantiated at this time. Exit interview, report read, citation and civil penalty issued, report and appeal rights provide.the state’s words, verbatim · CDSS document, Jul 3, 2024 · control 29-AS-20240702091140

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(1) · Plan of correction due date: Jul 3, 2024

87468.1 Personal Rights ... (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (1) To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement was not met by evidence of Staff speaking language which resident did not speak or understand while in direct proximity on 07/01/2024. which poses a potential risk to resident in care.the state’s words, verbatim · CDSS document, Jul 3, 2024

Plan of correction: Licensee will conduct a 1 hour personal rights training for all staff associated to this facility. Administrator will show who the training was by, the staff that attended, the name of the class and the hours the class was conducted and the dates staff attendance. Administrator will email LPA the above information.

Allegation investigated: Staff did not properly secure the resident's medications. Staff spoke another language in front of residents.

At 9:44am on 06/06/2024, LPA Jeffries arrived at the facility unannounced to conduct the initial investigation visit to the allegation to this complaint. LPA met with Licensee Edwin Ingan announced who he is and the reason for the visit. LPA conducted interviews, requested documentation, determined final findings, and issued the final findings below. As to the allegation of, “Staff did not properly secure the resident's medications.” It was alleged that on 06/03/2024 the facilities medication cart was unlocked and unattended in the presence of residents while caregivers were providing care in separate resident room. I was discovered through interviews, documentation, and admission that on 06/03/2024 witness 1 (W1) who is a Reliable Source (person with license or credentials indicating expertise training) arrived at the facility, knocked on the facility front door to no answer, then entered through a side door, and discovered medication cart with unlocked drawer in the facility primary living room, with Resident 1 (R1) and R2 both sitting in same room as the unlocked medication cart. CONTINUED on LIC9099-C Substantiated On 06/06/2024, LPA conducted interviews with Staff 1 (S1) and S2 who stated that the medication cart drawer was unlocked during the time of W1’s visit to the facility on 06/03/2024. S1 and S2 also stated that during the time of W1 visit S1 and S2 were the only staff on duty. On 06/06/2024, LPA conducted interviews with Resident 1 (R1) and R2, who stated that they were in the living room area every day for the past week. At this time there is enough evidence that, “Staff did not properly secure the resident’s medication.” and is substantiated at this time. As to the allegation of, “Staff spoke another language in front of resident.” It was alleged that on 06/03/2024 W1 observed S1 and S2 speaking in Tagalog while providing hands on direct care to resident in care whose primary language is English and does not speak or understand Tagalog. I was discovered through interviews, documentation, and admission that on 06/03/2024 W1 who is a Reliable Source (person with license or credentials indicating expertise training) arrived at the facility, knocked on the facility front door to no answer, then entered through a side door and discovered that S1 and S2 were providing direct, hands-on care to R3, in R3’s room. On 06/05/2024, LPA interviewed W1, who stated that S1 and S2 were speaking in Tagalog while both were standing over, hands on, direct care to R3. W1 also stated that over the past 24 months W1 has spoken to both S1, S2 and facility Administrator a minimum of 4 separate visits to the facility on speaking resident primary language while providing care as a personal rights violation to residents in care address treating residents in care with dignity. On 06/05/2024, LPA conducted interviews with S1 and S2 who both admitted to speaking Tagalog while providing direct care to R3 on 06/03/2024. S1 and S2 both acknowledged that R3 does not speak or understand Tagalog. LPA noted that on 08/11/2023 and 05/09/2023 LPA spoke with Administrator, S2, and S3 on addressing the residents’ personal rights concerns with treating residents with dignity by speaking resident primary language while in the presents or direct care of a resident, and highlighting the importance of residents with cognitive decline, dementia, and Alzheimer’s in this regard. Based on interviews, observations and admission, there is enough evidence to support the allegation of, “Staff spoke another language in front of resident.” and is substantiated at this time. Exit interview, report read, citations issued, appeal rights, and report provided.the state’s words, verbatim · CDSS document, Jun 6, 2024 · control 29-AS-20240604112518

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(1)(a) · Plan of correction due date: Jun 6, 2024

87465 Incidental Medical and Dental Care (1) Medications shall be centrally stored... (2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees ... This requirement was not met by evidence of Medication Cart found to be unlocked and staff unsupervised with resident present on 06/03/2024, which poses an imminent danger to residents in care.the state’s words, verbatim · CDSS document, Jun 6, 2024

Plan of correction: Licensee will conduct medication retraining for all staff at this facility. And will provided direct medication supersession for the next 60 days. Administrator will check in with LPA on 06/07/2024 and 07/07/224 and 08/07/2024 as to medication security.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(1) · Plan of correction due date: Jun 20, 2024

87468.1 Personal Rights ... (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (1) To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement was not met by evidence of Staff speaking a language which residents did not speak or understand while providing direct care on 06/03/2024. Which poses a potential risk to resident in care.the state’s words, verbatim · CDSS document, Jun 6, 2024

Plan of correction: Licensee will prived Personal Rights training for S1 and S2 by 06/20/2024 and submit proof to LPA my email or fax.