Juliet Stephen Rest Home

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Steve Chang conducted an unannounced annual inspection visit, and met with House Manager (HM) Joseph Oliva. LPA toured the facility inside and out with HM. License, Administrator Certificate, and personal rights posters were observed in the facility. 3 residents and 2 staff were observed in the facility. 2 residents went to day program. LPA reviewed 2 resident file and 2 staff files. Family room, living room, kitchen, dining area, 2 restrooms, and laundry room were inspected. 6 single resident bedrooms, 2 restrooms, and 2 staff rooms were inspected. Two day perishable food supplies and seven day nonperishable food supplies were observed sufficient. Medication closet, knives closet, and chemical closet were observed locked. Room temperature was at 71 degree F, and hot water temperature was at 116 degree F in facility. Fire extinguisher was serviced on 4/18/2026. The facility was equipped with fire alarm system, smoke and carbon monoxide detectors. Carbon monoxide detectors were tested by HM, and were working. First aid box, and flash lights were observed in the facility. Front yard and backyard were inspected. There was no obstruction to block the walkways. The last time the facility conducted the emergency and fire drill was on 4/10/2025. The emergency drill should be done quarterly. The centrally stored medication form of resident R2 was observed inaccurate and not up to date. Deficiencies noted today. See LIC809-D. Exit interview was conducted with ADM. This report was provided to ADM for signature. A copy of the report was provided to ADM.the state’s words, verbatim · CDSS document, May 26, 2026

Type of visit: Case Management - Annual Continuation

Licensing Program Analyst (LPA) Santino Fortes conducted an unannounced Annual Continuation visit and met with Dominica Oliva, Administrator. The visit was a continuation of the Required 1 Year Annual Inspection that was started on 5/27/2025. LPA Fortes reviewed the resident medication records for residents R1-R5. LPA observed Facility License and Resident Personal rights were posted. LPA reviewed facility records for 3 staff, 5 clients and observed to be complete. LPA reviewed 5 client’s medications, centrally stored medication records and observed to be complete. No deficiencies were cited during today's visit as per California Code of Regulations Title 22. Exit interview was conducted with ADM. This report was reviewed and a copy was provided to ADM for signature.the state’s words, verbatim · CDSS document, Jun 4, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Santino Fortes conducted an unannounced annual inspection, and met with Administrator (ADM) Dominica Oliva. ADM stated facility has 2 staff and 5 clients. LPA toured the facility inside and out. There were 6 resident rooms (shared/single), 2 staff rooms, 1 living room, 1 family room, and Kitchen. LPA observed resident rooms each with a chair, night stand, sufficient lighting and chest of drawers. Room temperature was 73.7 * F. Hot water temperature was Bathroom, 113.5*F, Bathroom 114* F and kitchen 113.5* F. LPA observed the first aid kit to be complete. Smoke and carbon monoxide detectors functioned properly when tested. Fire extinguishers were serviced on 5/9/25 and 5/20/25. Staff conducted a fire drill on 4/10/25. Restrooms observed to have non skid flooring. LPA observed 2 days perishable food supply and 7 days non-perishable food supply. Refrigerator temperature observed at 34* F and Freezer temperature -7* F. LPA observed medication storage, knives storage, and cleaning product storage locked and inaccessible to clients in care. The front and back yards of the facility were inspected. Exits and walkways were unobstructed. Facility has NO storage sheds, and Garage is used to store beds, shelving, wheelchairs and care supplies. LPA observed Facility License and Resident Personal rights were posted. Due to time constraints inspection was not able to be completed. No deficiencies were cited during today's visit as per California Code of Regulations Title 22. Exit interview was conducted with ADM. This report was reviewed and a copy was provided to ADM for signature.the state’s words, verbatim · CDSS document, May 27, 2025

Allegation investigated: Resident sustained multiple other injuries while in care. Facility staff are not following resident's care plan. Facility staff are not assisting resident with toileting. Facility staff are not meeting resident's hygiene needs. Facility staff are not ensuring that resident is adequately/ nutritionally fed. Facility staff are not ensuring that resident is changed into clean clothing. Facility staff took away resident's call light.

On 7/16/24, Licensing Program Analyst (LPA) Grace Donato conducted an unannounced complaint investigation visit. LPA met with Administrator Dominica Oliva and explained the purpose of today's visit. Regarding the allegation of resident R1 sustained multiple other injuries while in care, Reporting Party (RP) stated that R1 has a lot of tears on his arms and a bruise on his eye. RP stated that he/she always sees client with new bruises and bandages. According to an interview with a staff member (S3), R1 did sustain bruising to the arms due to R1 pulling the call cord and the curtains. Staff has since placed pillows and requested foam padding to place around the window to prevent further injuries. A responsible party (F1) was also interviewed and stated that he/she has asked hospital staff if they could assess R1 for abuse or neglect. Hospital staff told F1 that R1 was well taken care of and believed that the facility was providing the appropriate level of care that R1 needs. Home Health Nurse (RN) also did not believe that R1 was abused or neglected in any way while residing in the facility. page 1 of 4 Unfounded LPA Dolores observed that there are no bruises on R1s eyes. Skin was observed clean (hands and face). No visible band-aid observed. Regarding the allegation of facility staff are not following resident's care plan, RP stated that R1s brace legs are too tight that the legs are swollen due to poor circulation. R1s legs are contracted because staff are not exercising R1. Based on interviews, RN mentioned that the staff were told to follow the wound care clinic’s orders which was taught to them. RN also had staff demonstrate what was taught to them to gauge their understanding of what to do. Another LVN mentioned that R1 has braces and and staff were advised not to remove this. A staff member (S1) mentioned that the RP removed the foot cap to give air out to the foot. The nurse even said don’t remove it but still removed it. Another staff (S4) stated that home health nurses as well as the wound care clinic nurses and doctors instructed staff to elevate R1’s heels and use booties. Staff were also instructed initially not to touch or change the wound dressing. After three weeks or so, staff were instructed to clean the wound daily with saline, then apply an ointment and rebandage the wound until R1s next appointment. Regarding the allegations of facility staff are not assisting resident with toileting, facility staff are not meeting resident's hygiene needs & facility staff are not ensuring that resident is changed into clean clothing. RP stated that R1 is not being allowed to pivot to bedside commode, has not been bathed since moving into this facility, R1’s clothes that are soiled with food is not being changed, RP has seen R1 with the same clothes for 3 days. LPA Dolores was able to interview three residents and Investigation Bureau (IB) was able to interview a resident. Three of these residents stated that they didn’t have issues with the care in the facility. A resident (R1) stated that staff help her, they help R1 with shower, change clothes & change diapers. Another resident (R2) mentioned that staff helps with grooming, showering, transferring, assisting with meals. R4 mentioned that he/she is unable to turn and staff roll him/her to the side to change diaper. page 2 of 4 IB also interviewed a staff member (S3) and mentioned that he/she helped clean R1. S3 checks on residents every 2-3 hours to see if they are still in bed, change their diapers and gives them a daily bath or a shower. Another staff member (S2) stated that job duties and responsibilities includes cleaning the residents, assisting them with their needs, washing their clothes, assisting to eat, checking on them every 2 hours and every minute, showering, changing their clothes, and helping each other. S1 also shared that they assist R1 to the commode. There are times they gave R1 diapers but more often they bring R1 to the commode or bathroom. R1 stayed in the last room, the bathroom was very close. LPA Dolores also observed that R1 was wearing a grey long sleeve with blue plaid pajama pants. R1's clothing was not observed to be dirty with obvious stains or dirt. No foul odor observed. R1's hair was not combed. There was 2 brown crumbs of food that was very small on R1's beard. R1 had a table tray in front of him with a snack and water. Regarding the allegation of facility staff are not ensuring that resident is adequately/ nutritionally fed, RP stated that RP has seen R1 being fed cookies and peanuts and rarely has RP seen client being fed a full meal. During the interviews, R2 stated that they had breakfast and lunch but could not recall if they ate dinner. R3 stated that they give 3 meals. R4 mentioned that living here is good. They give 3 meals a day and snacks. S1 also mentioned that they were feeding R1 the regular food. 3 meals a day. Regarding the allegation that facility staff took away resident's call light, RP stated that staff took R1s call light away months ago because R1 calls too much. According to interviews, S1 mentioned that R1 pulls the call light and at one time R1 pulls it and they have to put it back. R1 pulls himself up with the call light. So many timed R1 yanked it. No one took it away from him. There wasn’t a problem with the call light. page of 3 of 4 LPA Dolores observed during a visit that R1s call cord was disconnected. LPA observed the call cord was placed on top of the dresser where R1's TV is located. S3 stated they removed the call cord because R1 kept pulling the cord for no reason. They have staff who check in on the R1 multiple times every hour of the day to ensure R1 is okay. S3 re-connected the call cord during visit. S3 pressed the call cord and LPA observed the call cord was operable. Based on interviews and observations, the department has determined that that the allegations were false, could not have happened and/or is without a reasonable basis, therefore the allegations are UNFOUNDED. Report is reviewed and copy is provided. Page 4 of 4the state’s words, verbatim · CDSS document, Jul 16, 2024 · control 26-AS-20230315144631

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Christine Dolores arrived unannounced to conduct the facility's required 1-year annual inspection. LPA met with Administrator, Dominica Oliva. During visit, LPA toured the facility to include the living room, kitchen, resident bedrooms, staff bedrooms, bathroom, common areas, garage, and exterior. All fire exit routes were free and clear of obstruction. Facility temperature maintained between 71 - 73 degrees Fahrenheit. Fire extinguisher last serviced on 04/29/2024. Carbon monoxide detector present. Facility has at least 2 days worth of perishables and 7 days worth of non-perishable foods. Refrigerator temperature maintained at 35 degrees Fahrenheit. Freezer temperature maintained at -3 degrees Fahrenheit. Items inside the refrigerator observed covered and labeled. Sharp objects, chemicals, disinfectants, and medications observed locked. Resident bedrooms equipped with beds, linens, adequate lighting, night stands, chair, and dresser. 3 residents with half bed rails has a physician's order on file. 1 resident's hospice care plan addresses the order for full bed rails. Resident bedrooms has operable door alarms and pull cords. Bathrooms equipped with grab bars, hygiene products, paper supplies, and non-slid mats. Hot water temperature maintained at 112 degrees Fahrenheit. LPA reviewed 4 resident files were complete to include an admission agreement, medical assessment, TB result, emergency contact information, consent forms, appraisal/needs and services plan, safeguard of personal property and valuables, and personal rights. LPA reviewed 4 residents centrally stored medications. SEE LIC809-C. LPA observed resident (R1) was not given 1 prescribed routine cream daily, as instructed by the physician because R1's prescription was written on the facility's medication record as a PRN. LPA observed resident (R2) was not dispensed 1.5 days of routine medication. Based on the facility's records, R2 had started the medication on 05/09/2024 but was only dispensed 7.5 out of 9 days of medication. R2's medication administration record did not show any missed medication. Facility was unable to provide reasoning. Photographs taken of R1 and R2's medication. LPA reviewed 3 staff files were complete to include a fingerprint clearance, 1st aid certification, health screening TB result, employee rights, and training. Facility has an emergency disaster plan. Facility has emergency lighting. Facility is conducting emergency drills quarterly, last drill was conducted in May 6, 2024. Administrator was advised. 1 resident on hospice requires an oxygen concentrator. Resident has a back-up oxygen tank. Oxygen in use signs posted on the front door. Posters observed to include but not limited to if you see something say something, facility license, emergency disaster plan. Documents requested to include the LIC500 and liability insurance by 05/18/2024. Deficiencies were cited per California Code of Regulations, Title 22. See LIC809-D. This report was reviewed with Administrator, Dominica Oliva and a copy of the report and appeal rights were provided.the state’s words, verbatim · CDSS document, May 17, 2024

Allegation investigated: Resident sustained a pressure injury while in care.

Licensing Program Analyst (LPA) Christine Dolores arrived unannounced to deliver the finding of the above allegation. LPA met with Administrator, Dominica Oliva. On 03/15/2023, the Department received the complaint alleging resident (R1) sustained a pressure injury while in care of the facility. On 03/16/2023, the initial complaint investigation was conducted. During the investigation, it was found prior to admission R1 already had sustained a pressure injury on the right heel and buttox that was not honestly disclosed and observed during the admission process. After observing the pressure injury, the facility’s Licensee requested home health service for R1 to receive wound care. After months of the pressure ulcer teetering between improving and getting worse again from receiving wound treatment, the Licensee requested a referral to a wound care clinic at a hospital. SEE LIC9099-C. Unfounded While receiving wound care treatment, it was discovered that R1’s pressure ulcer would likely not heal without vascular intervention, however, R1 was too weak to undergo any vascular intervention. The clinic decided to treat the wound conservatively instead. Staff followed instructions from the wound care doctor and demonstrated their understanding to the home health nurses. Staff reported and documented that R1 had frequent visitors that removed R1’s wound dressings and the boots R1 was to continuously wear to off-load the wound. Despite staff telling R1’s visitors to not remove it, R1’s visitors did not listen. R1’s responsible party and home health nurses were aware of the situation with R1’s visitors. Facility staff were instructed to be firm with the visitors to not interfere with R1’s care. The Department has investigated the above allegation. Based on interview, record review and observation the above allegation is UNFOUNDED meaning the allegation is false, could not have happened, and/or is without a reasonable basis. No deficiencies were cited per California Code of Regulations, Title 22. This report was reviewed with Administrator, Dominica Oliva and a copy of the report was provided.the state’s words, verbatim · CDSS document, Nov 30, 2023 · control 26-AS-20230315144631

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.