Complete Senior Living

Type of visit: Case Management - Annual Continuation

To complete annual inspection of 1/14/26, LPA Jeung reviewed clients' medication records and staff training records. Pharmacy provides Centrally Stored Medications Records for most of the residents. Centrally Stored Medications Records are maintained accurately. No deficiencies are cited today. See Technical Advisory Notes--3 pages.the state’s words, verbatim · CDSS document, Jan 29, 2026

Type of visit: Required - 1 Year

LPA Audrey Jeung toured facility and grounds of this 1-level home, consisting of 6 client bedrooms--all with half bathrooms and exit doors--one staff break room, one common half bathroom, one full bathroom for staff, office, kitchen, living and dining rooms. There is a fenced and level backyard and wooden deck around the sides and back of building. Washer and dryer are located in one car garage. No accessible bodies of water or fire safety hazards observed. PPE supply is inspected. Fresh and non-perishable food supplies are maintained. A comfortable temperature is maintained, lighting is sufficient for comfort and safety and hot water temperature tested. Toilet and bathing facilities are equipped with grab bars and nonskid flooring material. Liquid soap is available at all sinks. First-aid kit is inspected and complete. A Disaster and Mass Casualty Plan is posted. There are 6 residents present and 3 staff. No one is receiving hospice services. Client records are reviewed. Criminal record clearances or exemptions for facility staff or other individuals who have client contact have been reviewed, including required staff records. Vivian Fragiacomo is a RCFE administrator (x 11/26) that oversees facility operations. Due to time constraints, staff training records and clients' medication records will be reviewed at a later date. The following information/forms are requested to be submitted to CCLD BY 1/21/26: - Personnel Report (LIC500) - Emergency Disaster Plan (9- page LIC610D) - Bedridden plan of operation - Proof of current liability insurance Deficiencies of the RCFE California Code of Regulations, Title 22, Division 6, Chapter 8 are observed and cited on following pages. See also Technical Advisory Notes--3 pages.the state’s words, verbatim · CDSS document, Jan 14, 2026

Type of visit: Case Management - Annual Continuation

To complete annual inspection of 1/21/25, LPA Jeung reviewed staff records and clients' Centrally Stored Medications Records. Deficiencies of the California Code of Regulations, Title 22, are cited on a following page. Completed Emergency Disaster Plan (LIC610E) is requested to be signed, dated and submitted to CCLD BY 2/24/25.the state’s words, verbatim · CDSS document, Feb 10, 2025

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.625(b)(2) · Plan of correction due date: Feb 24, 2025

HEALTH AND SAFETY CODE ... training requirements shall also include an additional 20 hours annually, 8 hours of which shall be dementia care training... & 4 hours...postural supports, restricted health conditions, and hospice care, as required by...1569.696. This training shall be administered on the job, or in a classroom setting, or both, and may include online training. This requirement is not met, as there is no record that 1 out of 5 staff received annual training on dementia, postural supports, restricted health conditions and hospice care.the state’s words, verbatim · CDSS document, Feb 10, 2025

Plan of correction: Proof of required annual training for Staff #6 on dementia, postural supports, restricted health conditions, hospice care to be sent to CCLD BY DUE DATE

From the deficiency page — Deficiency type: Type B · Section cited: CCR87411(c)(1) · Plan of correction due date: Feb 24, 2025

PERSONNEL REQUIREMENTS - GENL Staff providing care shall receive appropriate training in first aid from persons qualified by such agencies as the American Red Cross. This requirement is not met, as there is no evidence that 2 out of 5 staff have current first aid training, which poses a potential health, safey or personal rights risk to clients in care. Staff #1 and #4 do not have proof of first aid training.the state’s words, verbatim · CDSS document, Feb 10, 2025

Plan of correction: Proof of current first aid training for staff #1 and #4 will be sent to CCLD BY DUE DATE

Type of visit: Required - 1 Year

LPA Audrey Jeung toured facility and grounds of this 1-level home, consisting of 6 client bedrooms--all with half bathrooms and exit doors--one staff break room, one common half bathroom, one full bathroom for staff, office, kitchen, living and dining rooms. There is a fenced and level backyard and wooden deck around the sides and back of building. Washer and dryer are located in one car garage. No accessible bodies of water or fire safety hazards observed. PPE supply is inspected. Fresh and non-perishable food supplies are maintained. A comfortable temperature is maintained, lighting is sufficient for comfort and safety and hot water temperature tested at 116 degrees. Toilet and bathing facilities are equipped with grab bars and nonskid flooring material. Liquid soap is available at all sinks. First-aid kit is inspected and complete. A Disaster and Mass Casualty Plan is posted. There are 5 residents present and 3 staff. Two residents receive hospice services. Client records are reviewed. Criminal record clearances or exemptions for facility staff or other individuals who have client contact have been reviewed. Other required staff records--including current first aid training and health screenings--will be reviewed at a later date. Vivian Fragiacomo is a RCFE administrator (x 11/24) that has submitted education certificates for renewal of administrator certificate. The following information/forms are requested to be submitted to CCLD BY 2/4/25: - Administrative Organization (LIC309) - Designation of Administrative Responsibility (LIC308) - Personnel Report (LIC500) - Emergency Disaster Plan (LIC610D) - Bedridden plan of operation - Proof of current liability insurance - Infection Control Plan (LIC9282) Deficiencies of the RCFE California Code of Regulations, Title 22, Division 6, Chapter 8 are observed and cited on following page.the state’s words, verbatim · CDSS document, Jan 21, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(c) · Plan of correction due date: Jan 22, 2025

CRIMINAL RECORD CLEARANCE A licensee or applicant for a license may request a transfer of a criminal record clearance from one state licensed facility to another...by providing....to the Department. This requirement is not met, as staff #1 has been working for a month, but criminal record clearance has not been associated to this facility. Licensee failed to ensure that all staff maintain criminal record clearance & association to facility. This poses an immediate health, safety, or personal rights risk to clients in care.the state’s words, verbatim · CDSS document, Jan 21, 2025

Plan of correction: Criminal record clearance transter request shall be sent to CCLD with photo ID. Proof of correction to be sent to CCLD BY DUE DATE

From the deficiency page — Deficiency type: Type A · Section cited: CCR87608(a)(5) · Plan of correction due date: Jan 22, 2025

POSTURAL SUPPORTS Bed rails that extend the entire length of the bed are prohibited except for residents who are currently receiving hospice care and have a hospice care plan that specifies the need for full bed rails. This requirement is not met, as full bed rails are used for client #2 in room 2. Licensee failed to prohibit use of full bed rails, which poses an immediate health, safety or personal rights risk to clients in care.the state’s words, verbatim · CDSS document, Jan 21, 2025

Plan of correction: Full bed rails will be removed or reduced to half size. Proof of correction to be sent to CCLD BY DUE DATE

Allegation investigated: - Resident was illegally evicted

On 01/04/2023 at 2:30pm, Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced complaint investigation visit in order to deliver finidings regarding the allegations referenced above. LPA met with administrator Vivian Fragiacomo and explained the purpose of today's visit. During the course of the investigation, LPA conducted inteviews, and reviewed documents received from the facility pertinent to the investigation and R1. It is found that there is conflicting information recieved from the complainant versus the facility and other interviews conducted. The resident was not evicted as the facility did not evict R1, and rather R1 was voluntairly removed from the facility by the responsible party per items reviewed. This allegation is unfounded. This agency has investigated the complaint alleging, "Residnet was illegally evicted". We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. We have therefore dismissed the complaint. No citations issued. Report is reviewed with Vivian. Unfoundedthe state’s words, verbatim · CDSS document, Jan 4, 2024 · control 14-AS-20231205102303

Type of visit: Case Management - Annual Continuation

On 01/04/2023 at 1pm, Licensing Program Analyst (LPA) conducted an unannounced case management annual continuation visit to complete the annual that was began on 12/06/2023. LPA met with administrator Vivian Fragiacomo and explained the purpose of today's visit. During todays visit LPA conducted record reviews for 2 residents and 4 staff. Present in the facility is 6 residents and -- staff.the state’s words, verbatim · CDSS document, Jan 4, 2024

Type of visit: Case Management - Annual Continuation

On 01/04/2023 at 1pm, Licensing Program Analyst (LPA) conducted an unannounced case management annual continuation visit to complete the annual that was began on 12/06/2023. LPA met with administrator Vivian Fragiacomo and explained the purpose of today's visit. During todays visit LPA conducted record reviews for 2 residents and 3 staff. Present in the facility is 6 residents and 4 staff. Two of which are agency staff. LPA reviewed the records indicated and all files reviewed are current. Administrator certificate is pending renewal and has not received the updated certificate as of this time. Administrator certificate is expired but renewal has been submitted but has not received yet. Facility does not handle resident monies. The following updated forms are being requested to be received by 01/11/2024: • LIC610D Emergency Disaster Plan • LIC 308 Designation of Administrative Responsibility • LIC 500 Personnel Report • Updated administrator certificate • LIC9020 Client Roster • Certificate of Liability Insurance There are no citations issued on this day. Report is reviewed with Vivian.the state’s words, verbatim · CDSS document, Jan 4, 2024

Type of visit: Required - 1 Year

On this day, Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced required 1 year annual inspection visit. LPA met with administrator Vivian Fragiacomo and explained the purpose of today's visit. LPA was allowed entry into the facility. This is a one level facility. Annual Fees are current. The physical plant was toured inside and outside to ensure the safety of the residents. LPA observed the facility kitchen which is clean and observed appliances are in good repair. Knives are stored in the kitchen locked in a drawer adjacent to the sink. Cleaning solutions are also locked below the sink. Perishable and non-perishable food items are observed as in place. LPA observed the medications as in place and locked in a hallway closet. The first aid kit observed as complete with required items. LPA observed that the facility is equipped with full sprinkler system, fire extinguishers are placed through out the facility inspected 04/13/23, smoke detector/carbon monoxide detectors are observed in place, and central heating system. PPE and additional food supplies are observed as in place in the garage. Laundry area is also observed as fully operational located in the garage. Emergency exit routes are observed inside and outside to be free and clear of obstructions. Water temperature was measured at 118F. LPA observed several resident rooms at random and all rooms appeared clean, free of odors, and contained all the required furniture per regulatory recommendations. Cleaning supplies are observed locked below kitchen sink and in the garage. COVID PPE and resident incontinence supplies are observed in place in the garage. This annual inspection be continued at a later date. Report is reviewed with Vivian. No citations issued.the state’s words, verbatim · CDSS document, Dec 6, 2023