Sunrise Manor Residential Care Home

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Simi Rai conducted an unannounced Required 1 Year visit. LPA Rai met with Lead Staff, Meylinda Soriano and stated the purpose of today's visit. LPA Rai observed 3 staff and 5 residents at the facility. During visit, LPA Rai toured the inside and outside of the facility. When touring the outside area of the facility, the exits were cleared of obstruction. LPA Rai toured the facility kitchen and observed food supply of at least 2 days of perishable food and at least 7 days of nonperishable food. Sharps and medications were locked in secured areas. LPA observed additional food supply areas and secured areas for cleaning supplies and laundry detergents. LPA Rai toured the facility to include 5 resident rooms, 1 staff room, living room, dining room, kitchen and garage. 5 Out of 5 resident bedrooms had available bedding, drawers, and functioning lights. The facility bathroom had available soap, paper towels, and trash cans with lids. The hot water temperature in the bathroom sinks ranged from 118.9 -119.1 degrees F. Fire extinguisher was observed and inspected on 10/15/2025. Facility smoke detectors and carbon monoxide detectors were in working condition. The last disaster drill was conducted 07/08/2026. LPA Rai observed a complete first aid kit at the facility. LPA Rai reviewed facility records for 2 staff and 2 residents. LPA Rai reviewed resident medications and central stored medication records. Continuation on LIC 809-C, Page 1 of 2. Page 2 of 2. During today's visit, LPA Rai cleared three deficiencies issued on 07/13/2026. Licensee provided a written plan of action to follow physician's order for half-bed rail and ensure staff are not using full-bed rails, to ensure R1's contractures are addressed in the Appraisal/Needs and Services Plan and obtain written documentation by the appropriately skilled professional and to ensure resident's medications are not stored outside of the originally received container. During today's visit, LPA observed the physician's order for half-bed rail, reviewed Appraisal/Needs and Services Plan addressing resident's contractures and medications were not stored outside of the original received container. LPA Rai provided Letter of Deficiency Citations Cleared for deficiencies issued during today's visit. No deficiencies were cited per California Code of Regulations, Title 22. This report was reviewed with Lead Staff, Meylinda Soriano and a copy of the report was provided. LIC 858 and LIC 859 were provided.the state’s words, verbatim · CDSS document, Oct 1, 2026

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Simi Rai and Licensing Program Manager (LPM) Romeo Manzano conducted an unannounced case management visit to deliver a Decision and Order letter on behalf of the Department. LPA and LPM met with Licensee/Administrator, Aida Miranda and stated the purpose of today's visit. LPA Rai observed 5 residents and 2 staff at the facility. During visit, LPA Rai handed the Decision and Order letter to Aida Miranda directly. Aida verbalized receiving the letter via certified mail last week, 07/10/2026. Licensee stated that she has not opened certified letter upon receipt on 7/10/26 assuming it was regarding her civil penalty invoice. Aida stated she was not aware what the mail was about. During today's visit, LPA Rai amended the case management visit conducted on 07/01/2026. Deficiencies were advertently cited and civil penalty will no longer be assessed. However, Technical Assistance (TA) was provided to ensure facility files are kept in tact. During visit, LPA and LPM observed a 7-day medication container for 3 residents located on the top of the dining room table, in accessible to residents in care. S1 & S2 stated they pre-pour 2 days of medications at a time for resident (R1). LPA and LPM advised staff and Licensee/Administrator to ensure medications were not pre-poured in case resident's physician were to change prescription orders. Continuation on LIC 809-C, Page 1 of 2. Page 2 of 2. LPA and LPM observed resident (R1) in bed with full bed rails attached to the hospital bed. R1 has an order for half-bed rails. Staff S1 and S2 admitted that they use the full bed rail at night. The Department does not have exception in place for R1. LPA and LPM observed R1 to have contractures on both hands and the Appraisal/Need and Services Plan did not address the contractures. During inspection, LPA and LPM observed a container of rice on the floor. LPA/LPM suggested for staff to separate the staff food from resident food, in case the resident were to consume food in the kitchen. Food that are provided from free pantry services should not be consumed by residents in care. Food containers should not be on the floor even if in a container due to risk of contamination. LPA and LPM observed 3 and half bread loafs in a bag on top of the fridge and there was mold on the bread. LPA and LPM observed mold growing all over the loafs. LPA and LPM observed grime inside the racks in the fridge. S2 stated that clean the fridge once a week. Licensee/Administrator Aida Miranda addressed the ramp leading to the front door of the facility. She stated the maintainence employee was informed and will fix the ramp. The ramp is able to use for now and needs to be maintained. Deficiencies were cited per California Code of Regulations, Title 22, please see LIC 809-D. During today's visit, repeat deficiencies were cited for the following California Code of Regulations, Title 22: CCR 87608(a)(5)(B). A civil penalty of $250 will be assessed for 1 repeat violation within 12 months of the initial citation. If the deficiency is not corrected by POC due date, an additional $100 will be assessed until the deficiency is corrected. Please see LIC421FC. This report was reviewed with Licensee/Administrator, Aida Miranda and a copy of the report was provided. Appeal Rights were provided.the state’s words, verbatim · CDSS document, Jul 13, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87626(a)(1),(b)(1-3) · Plan of correction due date: Jul 20, 2026

87626 Contractures (a) (1) If the contractures do not severely affect functional ability and the resident is able to care for the contractures by him/herself. This requirement is not met as evidenced by: Based on interview and record review, Licensee did not ensure there was an Appraisal/Needs and Services Plan address R1's contractures or written documentation by the appropriately skilled professional due to resident R1 has contractures on both hands which poses/posed a potiential health,the state’s words, verbatim · CDSS document, Jul 13, 2026

Plan of correction: Licensee/Administrator to submit a written plan of action to ensure R1's contractures are addressed in the Appraisal/Needs and Services Plan and obtain written documentation by the appropriately skilled professional by POC due date. (con't) safety and/or Personal Rights risk of residents in care.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87465(h)(5) · Plan of correction due date: Jul 20, 2026

87465 Incidental Medical and Dental Care (h) The following requirements shall apply to medications which are centrally stored: (5) Each resident's medication shall be stored in its originally received container. No medications shall be transferred between containers. This requirement is not met as evidenced by: Based on interview and observation, Licensee did not store resident's medication in its original container and staff were using 7-day pill box to store resident's medications which poses/posed a potiential health, safety and/or Personal Rights risk of residents inthe state’s words, verbatim · CDSS document, Jul 13, 2026

Plan of correction: Licensee/Administrator to submit a written plan of action to ensure resident's medications are not stored outside of the originally received container by POC due date. (con't) care.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87608(a)(5)(B) · Plan of correction due date: Jul 20, 2026

87608 Postural Supports (a)(5)(B) 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 evidenced by: Based on interview and records reviewed, resident R1 has an physician's order for half-bed rail, but staff is still using full bed rail at night which poses/posed a potential health, safety and/or Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Jul 13, 2026

Plan of correction: Licensee/Administrator to submit a written plan of action to follow physician's order for half-bed rail and ensure staff are not using full-bed rail by POC due date.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Simi Rai conducted an unannounced Case Management - Deficiencies visit. LPA met with Staff (S1) Meylinda Soriano and stated the purpose of today's visit. LPA Rai spoke with Licensee/Administrator Aida Miranda over the telephone and stated the purpose of today's visit. LPA Rai observed 2 staff and 4 residents at the facility, as 1 resident is in the hospital. This is an amended report, deficiencies were inadvertently cited on 07/01/2026 and were removed from the report. The purpose of the visit is to follow up on deficiencies cited during Required 1 Year Inspection on 10/14/2025. During today's visit, LPA Rai observed bathroom lights in all bathrooms appropriate for the use of each room and sufficient to ensure the comfort and safety of all persons in the facility. LPA Rai observed resident using bed rails and staff provided physician's orders for use of bed rails. During today's visit, LPA Rai reviewed staff files and observed all staff associated to the facility. LPA Rai observed the last training records on file for S1 were from 2019. S1 stated she did not get training last year in 2025. LPA Rai reviewed 5 out of 5 resident files. 5 Out of 5 resident files did not have LIC 625 Appraisal/Needs and Services Plan. 4 Out of 5 resident files did not have LIC 621 Client/Resident Personal Property and Valuables. 2 Out of 5 resident files did not have signed LIC 613 Personal Rights. 2 Out of 5 resident files did not have updated LIC 602A Physician's Report as residents have the diagnosis of Dementia. Continuation on LIC 809-C, Page 1 of 2. Page 2 of 2. LPA Rai reviewed disaster drill records which were conducted on July 24, 2024. S1 stated they have no record of the disaster drills from last year. LPA Rai requested the following documents to be emailed/faxed by tomorrow Thursday, July 2nd which include by not limited to copies for R1-R5's Identification and Emergency Information, Appraisal/Needs and Services Plan and Physician's Report. Deficiencies were cited per California Code of Regulations, Title 22, please see LIC 809-D. During today's visit, repeat deficiencies were cited for the following California Code of Regulations, Title 22: HSC 1569.625(b)(1), CCR 87506(b)(16), CCR 87463(a), CCR 87463(h), and HSC 1569.695(c). A civil penalty of $1,250 will be assessed for 5 repeat violation within 12 months of the initial citation. If the deficiency is not corrected by POC due date, an additional $100 will be assessed until the deficiency is corrected. Please see LIC421FC. Licensee/Administrator Aida Miranda to notify the Department when she is out of town and not overseeing the facility and update the LIC 603 as necessary. This report was reviewed with Staff, Meylinda Soriano and a copy of the report was provided. Appeal Rights were provided. On 07/13/2026, Licensing Program Analyst (LPA) Simi Rai conducted a visit and this case management report is being amended as the deficiencies were inadvertently cited on 07/01/2026. Licensee/Administrator Aida Miranda stated the necessary documents were provided to the Department but were not placed in the resident's files or facility files. LPA Rai will provide Technical Assistance (TA) to ensure facility files are organized with the appropriate documents. Civil penalty will not be assessed. No deficiencies were cited per California Code of Regulations, Title 22. This report was reviewed with Licensee/Administrator, Aida Miranda.the state’s words, verbatim · CDSS document, Jul 1, 2026

From the deficiency page — Deficiency type: Type B · Section cited: HSC 0000000 · Plan of correction due date: Jul 8, 2026

This deficiency was inadvertently cited on 07/01/2026.the state’s words, verbatim · CDSS document, Jul 1, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 000000 · Plan of correction due date: Jul 8, 2026

This deficiency was inadvertently cited on 07/01/2026.the state’s words, verbatim · CDSS document, Jul 1, 2026

From the deficiency page — Deficiency type: Type B · Section cited: HSC 00000 · Plan of correction due date: Jul 8, 2026

This deficiency was inadvertently cited on 07/01/2026.the state’s words, verbatim · CDSS document, Jul 1, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Manuel Monter conducted an unannounced annual inspection visit, and met with Administrator Aida Miranda. During the visit, LPA observed 4 residents and 2 staff. LPA explained the purpose of the visit. LPA toured the facility inside out with ADM which included the Living room, kitchen, dining room, 2 restrooms and 5 residents bedrooms. The staff area of the facility was also inspected. The front yard and backyard were inspected. There was no obstruction to block the walkways. While Touring the hallway bathroom farthest from homestead road, LPA observed the bathroom had very dim lighting. While touring the resident bedroom farthest from homestead road (and door exiting to Los Padres Blvd), LPA observed a resident R1 using a bed with full bed rails. LPA asked to see the doctors order for full bed-rails. ADM stated she has the order, but cannot find it. Two-day perishable food supplies and seven day nonperishable food supplies were observed. LPA observed the medication storage area, knives storage area, and cleaning product storage area as locked and inaccessible to residents in care. Room temperature was at 75 degrees F, and hot water temperature was measured at 112 degrees F in resident bathrooms. The facility fire extinguisher was last serviced on October 2025. The facility was equipped with smoke and carbon monoxide detectors. Smoke detectors was tested by ADM, and were functional. LPA observed facility first aid kit and facility fire/earthquake drill log. The facility's last drill was on July 2024. LPA reviewed facility records for 3 staff. LPA requested to review staff training records. ADM stated she conducted the training's for her staff, but didn't document any of the training's. LPA reviewed staff S3's file. LPA cross referenced S3's name with Guardian, and S3 is not associated to the facility. LPA reviewed facility records for 3 residents. R1's Physicians report is dated June 12, 2020 and Needs and services plan is dated July 2020. R1 also does not have a safeguards for personal property form. R2's physician's report is dated October 23, 2023. ADM could not produce a copy of R2's Needs and services plan to review or his/her safeguards for personal property form. R3's physicians report is dated September 14, 2020. ADM could not provide LPA with a copy of R3's needs and services plan or safeguards for personal property form. LPA reviewed 3 resident medications and centrally stored medication records. LPA conducted interviews with 1 staff and 2 residents. Deficiencies are being cited during today's visit, See LIC809-D. This report was reviewed with Administrator Aida Miranda and a copy of the signed report was provided. Appeal Rights were provided.the state’s words, verbatim · CDSS document, Oct 14, 2025

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Simi Rai conducted an unannounced case management visit to follow up on the Type A and Type B deficiencies cited on 9/24/2024. LPA Rai met with Lead Staff, Maylinda Soriano and stated the purpose of today's visit. Lead Staff notified Licensee/Administrator Aida Miranda of LPAs' visit and S1 stated Licensee/Administrator was not available at the time and unable to be present during today's visit. LPA Rai observed 2 staff and 5 residents in the facility. During today's visit, LPA Rai inspected the backyard and observed the exits were free of obstruction. LPA Rai observed the exit doors and window screens of residents' rooms are clean and in good repair. LPA Rai observed two sheds containing gardening tools were locked and inaccessible to residents in care. LPA Rai inspected the kitchen and hallway and the air vents were covered with new vents. LPA Rai inspected the kitchen refrigerator and did not observe medications unlocked and accessible to residents' in care. During visit, LPA Rai provided letter of the Deficiency Citations cleared. No deficiencies were cited at this time as per California Code of Regulations, Title 22. This report was reviewed with Lead Staff, Maylinda Soriano and a copy of the report was provided.the state’s words, verbatim · CDSS document, Nov 27, 2024

Allegation investigated: Food served is not stored at appropriate temperature. Facility bathroom shower mat and curtain have mold.

Licensing Program Analysts (LPA) Simi Rai and Marcela Yanez conducted an unannounced visit to conclude the complaint investigation. LPA Rai met with Lead Staff, Gina Sobrevilla and stated the purpose of today’s visit. On 6/5/2023, the Department received a complaint with the above allegations. On 6/13/2024, the Department conducted an initial investigation at the facility. Continuation on LIC 9099-C, Page 1 of 3. Unsubstantiated Page 2 of 3. Food services is not stored in at appropriate temperatures. On 6/13/2023, the Department interviewed 5 residents (R1-R5). One resident refused to answer questions related to the allegation. Four out of four resident stated they have no complaints or issues about the food temperature when served to the residents. R1 stated he/she is particular with the food and it is never served at cold temperature but if there was an issue, R1 would let staff know for assistance. On 6/13/2023, the Department interviewed 2 staff (S1-S2). Two out of two staff stated the staff serve the residents warm food and they keep the food warm with the microwave. S1 and S2 stated they will warm/heat the food if residents had a concern. During visit on 6/13/2023, LPA tested the microwave and there are no issues with the microwave. On 6/13/2023, the Department interviewed former resident (F1) and witness (W1). F1 stated the staff would cook 1 items at time and they plated the food as each item was being cooked so when the food was served to the residents, some items were not warm anymore. F1 did notify the staff but F1 did not request for the food to be warmed. W1 stated the food was pretty good when W1’s resident moved into the facility, but it was repetitive and breakfast would be served cold. Facility bathroom shower mat and curtain have mold. On 6/13/2023, the Department interviewed 5 residents (R1-R5). One resident refused to answer questions related to the allegation. Four out of four residents stated they have not observed mold on the shower mat or shower curtain. On 6/13/2023, the Department interviewed 2 staff (S1-S2). Two out of two staff stated there is no mold on the shower mat and shower curtains. S1 stated 4 out of 5 residents take sponge baths in bed and 2 out of 5 residents prefer to take a shower in the bathroom and staff will assist with the shower. S2 stated the shower mat and shower curtain was replaced due the items being old due to normal wear and tear. During visit on 6/13/2023, LPA observed 2 out of 2 bathrooms and LPA did not observe any mold on shower curtains. LPA did not observe shower mats since the residents use shower chair. Page 3 of 3. On 6/13/2023, the Department interviewed former resident (F1) and witness (W1). F1 stated the shower mat would have mold on the suction cups and would be placed on the grab bars but the shower mats were cleaned. F1 did not say anything about shower curtains having mold. W1 stated one of the bathrooms had mold, but did not specify which bathroom and did not observe mold on the shower curtains. Based on the interviews conducted with clients and staff and based on observation and records review, although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the above allegations did or did not occur, therefore the allegations are UNSUBSTANTIATED. No deficiencies cited from California Code of Regulations, Title 22. Exit interview conducted with Lead Staff, Gina Sobrevilla and a copy of the report was provided. Page 2 of 3. Residents are left unsupervised by staff. On 6/13/2023, the Department interviewed 5 residents (R1-R5). One resident refused to answer questions related to the allegation. Four out of four residents stated they do not recall a time when there was no staff present in the facility. R1 stated he/she does not ask for assistance. R4 stated he/she needs assistance and staff are able to assist him/her when required. On 6/13/2023, the Department interviewed 2 staff (S1-S2). Two out of two staff stated there are always two staff at the facility. S2 stated when staff need to go to the bank, then there will be at least one staff at the facility for a short moment. During visit on 6/13/2023, LPA observed two staff at the facility, overseeing 5 residents present at the facility. On 6/13/2023, the Department interviewed former resident (F1) and witness (W1). F1 stated it happened twice when staff S3 told F1 that there was no one working at the facility and S3 just arrived at the facility for his/her shift. F1 cannot recall the specific dates. W1 stated he/she observed frequently there was one staff present at the facility and two staff present at the facility in the day time. Facility kitchen floor has a hole. On 6/13/2023, the Department interviewed 5 residents (R1-R5). Two residents refused to answer requested related to the allegation. Three out of three residents stated they have observed no holes on the kitchen floor. On 6/13/2023, the Department interviewed 2 staff (S1-S2). Two out of two staff stated they have not observed a hole on the kitchen floor. S1 and S2 have been a caregiver for 9 years at the facility and not observed a hole in the kitchen floor. During visit on 6/13/2023, LPA observed the kitchen and the kitchen floor. LPA did not find any holes on the kitchen floor. On 6/13/2023, the Department interviewed former resident (F1) and witness (W1). F1 stated he/she did not observe a hole on the kitchen floor. W1 stated he/she did not observe a hold in the kitchen floor. Page 3 of 3. Facility shower knob does not have a valve for hot water, so water is either scalding hot or lukewarm. On 6/13/2023, the Department interviewed 5 residents (R1-R5). One resident refused to answer questions related to the allegation. Four out of four residents stated they are able to adjust the heat of the shower water with the shower knob. On 6/13/2023, the Department interviewed 2 staff (S1-S2). Two out of two staff stated the water temperature in the bathroom shower can be adjusted and they use the shower knob to adjust the water temperature. S1 stated two residents need assistance with showers and they are able to use the shower knob without issue. S2 stated they replaced the shower knob 6 months ago due to normal wear and tear. During visit on 6/13/2023, LPA observed 2 out of 2 bathrooms and both bathrooms have a valve for hot water. LPA tested water temperature in bathroom #2 since this is the bathroom residents use for showers and water temperature ranged from 98 degrees F to 122 degrees F. LPA observed the shower knob can be turned left and right. On 6/13/2023, the Department interviewed former resident (F1) and witness (W1). F1 stated he/she liked hot showers, and the water was either scalding hot or lukewarm wherein the water would change within 30 seconds. W1 stated he/she did not know if there was anything wrong with the shower, but there was a problem with the water and there was a new valve placed in the shower. The Department has completed the investigation of the above allegations. Based on interviews conducted and record reviews, the department has found that the above allegations were UNFOUNDED, meaning that the allegations were false, could not have happened and/or are without a reasonable basis. No deficiencies cited from California Code of Regulations, Title 22. Exit interview conducted with Lead Staff, Gina Sobrevilla and a copy of the report was provided.the state’s words, verbatim · CDSS document, Sep 24, 2024 · control 26-AS-20230605152553

Allegation investigated: Facility is not in good sanitary conditions. Staff neglected resident who was found in urine and feces.

Licensing Program Analysts (LPAs) Simi Rai and Marcela Yanez conducted an unannounced visit to conclude the complaint investigation. LPA Rai met with Lead Staff, Gina Sobrevilla and stated the purpose of today’s visit. On 7/6/2023, the Department received a complaint with the above allegations. On 7/13/2023, the Department conducted an initial investigation at the facility. Continuation on LIC 9099-C, Page 1 of 2. Unsubstantiated Page 2 of 2. It was alleged on 2/12/2023 when R1 was transferred to the hospital, R1 was found in urine and feces and the R1’s room was not in good sanitary conditions. On 7/13/2023, the Department interviewed staff S1 and ADM. ADM stated on 2/12/2023, R1’s conservator was notified regarding R1 refused to come out his/her bedroom for 2 days. ADM stated the floor was wet due to R1 continued to urinate in the continence pad for two days and refused staff to come into the room to assist. R1 would lock the door but staff had a key to open the lock. Staff called 911 on 2/12/2023 due to R1 had a unwitnessed fall in the room. Based on review of progress notes from 11/4/2015 – 2/8/2023, R1 has a history of refusing assistance with incontinence care and shower. Based on review of R1’s Physician’s Report dated 2/6/2017, R1 had neurocognitive impairment, bladder impairment and was confused/disoriented. Based on R1’s Appraisal/Needs and Services dated 2/10/2018, facility staff would motivate and encourage R1 for regular personal hygiene and cleanliness and remind R1 of bathing schedule. Based on documentation conversations between facility staff and R1’s conservator, R1 refused to be seen by R1’s doctor from 2021-2022. Based on the interviews conducted with clients and staff and based on observation and records review, although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the above allegations did or did not occur, therefore the allegations are UNSUBSTANTIATED. No deficiencies cited from California Code of Regulations, Title 22. Exit interview conducted with Lead Staff, Gina Sobrevilla and a copy of the report was provided.the state’s words, verbatim · CDSS document, Sep 24, 2024 · control 26-AS-20230706162258

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Marcela Yanez and Simi Rai conducted an unannounced annual inspection visit. LPAs met with Lead Caregiver (S1) Gina Sobrevilla and stated the purpose of today's visit. S1 called Licensee/Administrator and left a message on voicemail. During the visit, LPA observed 2 staff and 5 residents present at the facility. LPAs observed 2 residents walking around the facility, including the kitchen and living room. LPAs toured the facility inside and outside with S1 which included the Living room, kitchen, dining room, 2 bathrooms and 5 residents bedrooms and 1 staff room. LPAs observed 2 of 5 resident rooms (Bedroom #5 and #6) window screens are not in good repair wherein the screen is ripped in multiple area and the screen door in bedroom #5. LPAs observed a smoking area which staff S1 stated is used by residents. Behind the chair, LPAs observed more than 5 tools were on a table, not locked and accessible to the residents. Two-day perishable food supplies and seven day nonperishable food supplies were observed. LPAs observed 1 prescription medication in the refrigerator, located on the inside of the door, unlocked and accessible to residents. LPAs observed a cabinet in the kitchen which contained resident's medication was unlocked and accessible to residents. LPAs observed toxic chemicals under the kitchen sink including but not limited to 1 canister of Comet, 1 bottle of Bleach, 1 bottle of Dish soap. LPAs observed 2 vents one located above electric stove in kitchen and one located in the hallway above garage door to be uncovered and has dust and grease. Continuation on LIC 809-C, Page 1 of 2. Page 2 of 2. The knives storage area, and cleaning product storage area was locked and inaccessible to residents in care. Room temperature was at 83.4 degrees F, and hot water temperature in the bathroom sinks was ranged from 119.1 - 119.5 degrees F in both resident bathrooms. Fire extinguisher observed in the kitchen was serviced in 10/25/2023. The facility was equipped with smoke and carbon monoxide detectors and in working condition. LPAs observed facility first aid kit and the last disaster drill was conducted on 07/24/2024. LPA reviewed facility records for 2 staff and 2 residents. LPA reviewed 2 resident medications and centrally stored medication records. LPAs observed 5 out of 10 centrally stored medications for R1 and 6 out of 6 centrally stored medications was not recorded on centrally stored medication and destruction record. R2 Medication was not logged as well. Deficiencies were cited per California Code of Regulations, Title 22, please see LIC 809-D. Failure to correct the cited deficiency, on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. Licensee/Administrator was not present during exit interview. This report was reviewed with Lead Caregiver (S1) Gina Sobrevilla and a copy of the report was provided. Appeal Rights were provided.the state’s words, verbatim · CDSS document, Sep 24, 2024

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87463(b) · Plan of correction due date: Oct 1, 2024

87463 (b) The licensee shall immediately bring any such changes to the attention of the resident's physician and his family or responsible person. This requirement is not met as evidenced by: Based on interview and record review, R2's Appraisal/Needs and Services Plan was not signed by R2 and/or R2's responsible party which poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Sep 24, 2024

Plan of correction: Licensee/Administrator was not present during today's visit. Licensee/Administrator to submit a written plan of action understanding regulation and will ensure Appraisal/Needs and Services plans are created for residents by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87468(b)(1)(A) · Plan of correction due date: Oct 1, 2024

87468 (b)(1)(A)The licensee shall have each resident and the resident's representative sign a copy of these rights, and the signed copy shall be included in the resident's record. This requirement is met as evidenced by: Based on interview and record review, R2's file did not contain a signed Personal Rights of Residents in All Facilities which poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Sep 24, 2024

Plan of correction: Licensee/Administrator was not present during today's visit. Licensee/Administrator to submit a written plan of action understanding regulation and will ensure residents' file did not contain a signed Personal Rights of Residents in All Facilities by POC due date

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87307(d)(6) · Plan of correction due date: Sep 25, 2024

87307(d) The following space and safety provisions shall apply to all facilities: (6) All outdoor and indoor passageways and stairways shall be kept free of obstruction. This requirement is not met as evidenced by: Based on observation and interview, the licensee did not ensure that sliding exit doors tracks were free of obstruction. LPAs observed a pole obstructing the sliding exit door tracks which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Sep 24, 2024

Plan of correction: Licensee/ Administrator was not present during today's visit. Licensee/Administrator to submit a written plan of action understanding regulation and will ensure written plan to ensure all indoor and outdoor passageways and stairways are free from obstruction and schedule in-service training by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(c) · Plan of correction due date: Oct 1, 2024

87303 Maintenance and Operation (c) All window screens shall be clean and maintained in good repair. This requirement was not met as evidenced by: Based on observation, two window screens in resident's room and 1 door screen for exit door was not clean and not in good repair which poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Sep 24, 2024

Plan of correction: Licensee/ Administrator was not present during today's visit. Licensee/Administrator to submit a written plan of action understanding regulation and will ensure window screens are clean and in good repair by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87457(c) · Plan of correction due date: Oct 1, 2024

87457(c)Prior to admission ... shall be completed and shall include an appraisal of his/her individual service needs in comparison with the admission criteria. This requirement is not met as evidenced by: Based on interview and record review, the licensee did not comply with the section cited above when 1 out of 2 resident files did not create an Appraisal/ Needs and Services plan which poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Sep 24, 2024

Plan of correction: Licensee/Administrator was not present during today's visit. Licensee/Administrator to submit a written plan of action understanding regulation and will ensure Appraisal/Needs and Services plans are created for residents by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Oct 1, 2024

87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by: Based of observation, two air vents above the stove and in the hallway were not covered and filled with dust which poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Sep 24, 2024

Plan of correction: Licensee/Administrator was not present during today's visit. Licensee/Administrator to submit a written plan of action understanding regulation and will ensure air vents are covered, clean and sanitary by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87465(h)(6) · Plan of correction due date: Oct 1, 2024

87465 Incidental Medical and Dental Care (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 for at least one year and includes: This requirement is not met as evidenced by: Based on observation and record review, R1's 5 out of 10 centrally stored medications and R2's 6 out of 6 centrally stored medications were not recorded on the Centrally Stored Medication log which poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Sep 24, 2024

Plan of correction: Licensee/Administrator was not present during today's visit. Licensee/Administrator to submit a written plan of action understanding regulation and will ensure centrally stored medications is recorded on the Centrally Stored Medication log by POC due date.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(h)(2) · Plan of correction due date: Sep 25, 2024

87465 (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, 1 prescription medication was in the refrigerator unlocked and a drawer in the kitchen which contains resident's medication was unlocked and accessible to residents which poses/posed an immediate Health, Safety, or Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Sep 24, 2024

Plan of correction: Licensee/ Administrator was not present during today's visit. Licensee/Administrator to submit a written plan of action understanding regulation and will ensure medications are stored inaccessible to residents and in-service training is scheduled by POC due date.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87705(f)(1) · Plan of correction due date: Sep 25, 2024

87705 Care of Persons with Dementia (f) The following shall be stored inaccessible to residents with dementia: (1) Knives, matches, firearms, tools and other items that could constitute a danger to the resident(s). This requirement is not met as evidenced by: Based on observation, LPAs observed more than 5 tools were in the backyard, not locked and accessible to residents with Dementia poses/posed an immediate Health, Safety, or Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Sep 24, 2024

Plan of correction: Licensee/ Administrator was not present during today's visit. Licensee/Administrator to submit a written plan of action understanding regulation and will ensure tools are stored inaccessible to residents and in-service training is scheduled by POC due date.