PRS - Capricorn Retreat

Type of visit: Case Management - Incident

On August 27, 2026, Licensing Program Analyst (LPA) Ivan Avila, conducted a case management visit regarding an incident that was reported to the Department on August 19, 2026. LPA met with Administrator Grace Puckett and explained the purpose of the visit. The department is following up on an Incident Report submitted by the facility on August 19, 2026 concerning a resident fall. At approximately 6:00 AM on August 19, 2026, staff discovered R1 on their bedroom floor. Staff assisted R1 to a seated position and staff observed R1 to have a cut on their left eyebrow. R1 was then taken to Mercy Medical Center for evaluation. The evaluation indicated slight abnormalities in the neck, but R1 did not exhibit tenderness in the area. Medical staff discharged R1 and instructed staff to monitor R1 for any changes or concerning symptoms. During today's visit, LPA obtain further information regarding R1. Several topics were discussed. No deficiencies cited during today's inspection. Exit interview conducted and copy of the report was provided.the state’s words, verbatim · CDSS document, Aug 27, 2026

Type of visit: Required - 1 Year

On May 6, 2025, Licensing Program Analyst (LPA) Ivan Avila arrived at the facility unannounced to conduct a 1-year annual inspection and met with Grace Puckett and Laurie Schlottman and explained the purpose of the visit. LPA and Administrators toured facility together to ensure the health and safety of residents in care. Kitchen: The kitchen appeared clean and the appliances and fixtures functional during the time of visit. The LPA observed a sufficient supply of perishable and non-perishable food at the facility; Sharp objects are stored in a locked area. Water temperature measured within the required range. Bedrooms: The LPA observed resident bedrooms furnished with at least one night stand, bed, and sufficient lighting for each resident. The bedrooms had appropriate and adequate bedding and linens such as sheets, pillowcases, and blankets. Bathrooms: The LPA observed the resident bathrooms to be clean, and properly supplied. Residents have sufficient supplies for personal hygiene products. Common Areas: These included but are not limited to the living area, activity area, and dining area. The common areas were checked for cleanliness and furniture was checked for functionality during time of visit. In the areas toured no immediate health, safety, or personal rights violations were observed. Surrounding Grounds (Outdoors): The LPA observed appropriate outdoor furniture, with a covered shaded area for residents. There are no firearms or bodies of water on the premises. Record Review: A review of facility files was initiated. The LPA observed documentation of the Infection Control, Disaster prevention and last fire drill. Facility records are stored inaccessible to residents. The LPA reviewed four (4) staff, and four (4) resident files. All documents reviewed appeared complete and current. Medications: During the facility visit a medications review was initiated. Medications are centrally stored and locked in a cabinet inaccessible to residents in care; medications are labeled and checked for expiration dates. Medications are properly documented on the centrally stored medications and destruction record log. No errors observed during the medication review. No deficiencies cited during today's visit. Exit interview conducted and a copy of the report was provided.the state’s words, verbatim · CDSS document, May 6, 2026

Allegation investigated: Staff does not treat residents with dignity/respect

On October 13, 2025, Licensing Program Analyst (LPA) Ivan Avila conducted an unannounced complaint investigation visit regarding the above allegation directed by the Department. LPA Avila met with Grace Puckett and explained the purpose of the visit. During the investigation process, interviews and a review of records were initiated. LPA investigated the allegation, “Staff does not treat residents with dignity/respect.” Based on documentation provided and interviews conducted, interviews stated S1 was recently hired and needed more training on how to address residents and their care needs. Staff made management aware of S1 making inappropriate comments about residents to other staff. S1 did not directly make comments to residents. Facility addressed the staff concerns and scheduled S1 for additional training and removed S1 from the schedule. Based on interviews conducted and observations, the preponderance of evidence standards have not been met. Therefore, the above allegations are found to be UNSUBSTANTIATED. Findings that the complaint is Unsubstantiated means that, although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. An exit interview was conducted, and a copy of the report was provided. Unsubstantiatedthe state’s words, verbatim · CDSS document, Oct 13, 2025 · control 59-AS-20250715082743

Type of visit: Case Management - Incident

On July 16, 2025, Licensing Program Analyst (LPA), Ivan Avila arrived at the facility unannounced to conduct a case management visit. LPA met with Laurie Schlottman and explained the purpose of the visit. The purpose of today's visit is to follow up on an Unusual Incident/Injury Report that was sent to the Department on June 24, 2025. During the incident, medication was administered to the wrong resident in care. Staff stated they got distracted and believed the medication was for R1. Staff immediately called the Administrator. The Administrator instructed staff to contact Poison Control. Instructions were given by Poison Control to take R1 to the emergency room due to a high medication dose R1 does not normally take. R1 was taken to Shasta Regional Medical Center and was later sent home with instructions for staff to monitor R1 throughout the night. LPA explained to the Administrator on the importance of ensuring that all medications are dispensed as outlined in the resident’s physician orders and as outlined in Title 22 Regulations. Administrator reported that staff that dispensed the wrong medication will be going through additional training. LPA also advised that if this medication error happens again, a citation will be issued. No deficiencies were cited during today's Case Management - Incident Inspection. Exit interview was conducted and a copy of this report was signed and given to the Administrator.the state’s words, verbatim · CDSS document, Jul 16, 2025

Allegation investigated: Staff are not adhering to food service requirement Staff do not treat residents with dignity and respect Staff are not providing residents with adequate hand washing supplies

On June 09, 2025, Licensing Program Analyst (LPA) Ivan Avila conducted an unannounced complaint investigation visit regarding the above allegations directed by the Department. LPA Avila met with Dwight McGuire and explained the purpose of the visit. LPA investigated the allegation, “Staff are not adhering to food service requirements.” During visit conducted on April 8, 2025, LPA observed multiple food items in the kitchen refrigerator to be uncovered and not labeled. LPA observed raw chicken uncovered on the middle rack. Directly underneath the raw chicken was an uncovered salad bowl on the bottom shelf. Staff removed the salad bowl during LPA's inspection. As a result of LPA's initial visit to the facility, LPA determined that the facility was not adhering to food service requirements prior to visit conducted on April 8, 2025. Additionally, interviews conducted stated multiple staff have served residents spoiled food during meals. ----- Continued on LIC9099C ----- Substantiated LPA investigated the allegation, “Staff do not treat residents with dignity and respect.” Based on interviews conducted it was indicated that multiple staff would tell R1 they would use the hoyer lift to get R1 out of bed, knowingly R1 is afraid of the lift. Interviews revealed staff suggest the use of the hoyer lift as a motivational tool to get R1 out of bed. Interviews indicated that staff would yell at R1 when he did not want to get out of bed in the mornings, which negatively impacts resident's sense of well-being. LPA investigated the allegation, “Staff are not providing residents with adequate hand washing supplies.” During visit conducted on April 8, 2025, LPA observed two of two facility bathrooms did not have paper towels and soap. Staff stated they would provide paper towels for both bathrooms during LPA’s inspection. Additionally, during visit conducted on April 17, 2025, LPA observed both bathrooms still did not have paper towels. As a result of LPA’s visits on April 8, 2025, and April 17, 2025, LPA determined that the facility was not providing adequate hand washing supplies. Interviews also indicated the facility had been running out of hand soap on multiple occasions. Based on LPAs observations and interviews which were conducted and record review, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulations, Title 22, and the California Health and Safety Code are cited on the attached LIC9099-D. An exit interview was conducted, and a copy of the report and appeal rights were provided. LPA investigated the allegation, “Staff do not maintain resident areas clean and orderly.” Based on interviews and observations, LPA observed that the facility was relatively clean and organized. LPA toured resident rooms which also appeared to be clean and orderly. No interviews revealed that the facility is kept unsanitary or that cleaning duties are neglected. Staff stated that, at times, they become busy or are behind schedule, but that they work together to accomplish cleaning tasks. LPA investigated the allegation, “Staff do not seek timely medical attention for residents.” Based on interviews conducted that medical assistance had been sought out when facility staff found out about R1’s sores. Interviews indicated that facility policy is that when it is determined a resident needs emergency medical attention, the facility initiates emergency services. Staff made appointments to address R1’s sores. The Department was unable to determine through interviews and documentation if the facility failed to seek timely medical attention for R1. LPA investigated the allegation, “Licensee does not ensure enough staff to meet residents needs.” Based on interviews and observations, evidence was not found to support that there were insufficient staff to meet the needs of resident identified care needs. Interviews indicated there are usually two staff working on each shift. LPA observed during multiple visits two staff members working at the facility during the time of the investigation. LPA investigated the allegation, “Staff are not meeting resident bathing needs.” Based on interviews conducted, staff indicated that residents receive sufficient care with bathing, grooming, and hygiene. Staff interviews revealed that residents receive showers unless they refuse. If a resident refuses the staff will make several attempts to see if they want to shower. Based on interviews conducted and observations, the preponderance of evidence standards have not been met. Therefore, the above allegations are found to be UNSUBSTANTIATED. Findings that the complaint is Unsubstantiated means that, although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.the state’s words, verbatim · CDSS document, Jun 9, 2025 · control 59-AS-20250402080642

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87555(b)(15) · Plan of correction due date: Jun 23, 2025

87555(b)(15) The following food service requirements shall apply: All persons engaged in food preparation and service shall observe personal hygiene and food services sanitation practices which protect the food from contamination. This requirement is not met as evidenced by: Based on LPA's observations, the facility did not ensure food to be protected from contamination when multiple food items were left uncovered, which poses a potential health, safety, and personal rights violation to the residents in care.the state’s words, verbatim · CDSS document, Jun 9, 2025

Plan of correction: Facility will ensure that all food items on the premises are covered and labeled to prevent contamination. Licensee will conduct training for safe food practices and for staff to properly identify spoiled food and discard before use. Licensee will email LPA the training by POC due date: 06/23/2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(1) · Plan of correction due date: Jun 23, 2025

87468.1(a)(1) Residents in all residential care facilities for the elderly shall have all of the following personal rights: To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement is not met as evidenced by: Based on interviews, the facility did not protect the personal rights of R1 when staff yell at R1 by telling R1 they will use the hoyer lift as intimidation to get R1 out of bed, which poses a potential health, safety, and personal rights violation to the residents in care.the state’s words, verbatim · CDSS document, Jun 9, 2025

Plan of correction: The Licensee agrees to provide training to all staff regarding the personal rights of residents residing in a facility. Licensee will email LPA the taining by POC due date: 06/23/2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87307(a)(3)(D) · Plan of correction due date: Jun 23, 2025

87307(a)(3)(D) The following provisions shall apply:...supplies necessary for personal care and maintenance of adequate hygiene practice shall be readily available to each resident....such as soap and toilet paper. This requirement is not met as evidenced by: Based on LPA's observations, the facility did not provide paper towels, soap to residents and staff to maintain an adequate hygiene practice, which poses a potential health, safety, and personal rights violation to the residents in care.the state’s words, verbatim · CDSS document, Jun 9, 2025

Plan of correction: Licensee will ensure to have adequeate hand washing soap and paper towels at the facility. Licensee will come up with a plan to ensure a checklist will be developed to restock the hand soap and paper towels. Licensee will email LPA the training by POC due date: 06/23/2025

Type of visit: Required - 1 Year

On May 1, 2025, Licensing Program Analyst (LPA) Ivan Avila arrived at the facility unannounced to conduct a 1-year annual inspection and met with Laurie Schlottman and explained the purpose of the visit. LPA Avila and Administrator toured facility together to ensure the health and safety of residents in care. Kitchen: The kitchen appeared clean and the appliances and fixtures functional during the time of visit. The LPA observed a sufficient supply of perishable and non-perishable food at the facility; Sharp objects are stored in a locked area. Water temperature measured within the required range. Bedrooms: The LPA observed resident bedrooms furnished with at least one night stand, bed, and sufficient lighting for each resident. The bedrooms had appropriate and adequate bedding and linens such as sheets, pillowcases, and blankets. Bathrooms: The LPA observed the resident bathrooms to be clean, and properly supplied. Residents have sufficient supplies for personal hygiene products. Common Areas: These included but are not limited to the living area, activity area, and dining area. The common areas were checked for cleanliness and furniture was checked for functionality during time of visit. In the areas toured no immediate health, safety, or personal rights violations were observed. Surrounding Grounds (Outdoors): The LPA observed appropriate outdoor furniture, with a covered shaded area for residents. There are no firearms or bodies of water on the premises. Record Review: A review of facility files was initiated. The LPA observed documentation of the Infection Control, Disaster prevention and last fire drill. Facility records are stored inaccessible to residents. The LPA reviewed four (4) staff, and four (4) resident files. All documents reviewed appeared complete and current. Medications: During the facility visit a medications review was initiated. Medications are centrally stored and locked in a cabinet inaccessible to residents in care; medications are labeled and checked for expiration dates. Medications are properly documented on the centrally stored medications and destruction record log. No errors observed during the medication review. No deficiencies cited during today's visit. Exit interview conducted and a copy of the report was provided.the state’s words, verbatim · CDSS document, May 1, 2025

Allegation investigated: Staff did not serve residents an adequate amount of food portions Staff left residents unsupervised Staff did not ensure that facility appliances were repaired Staff did not maintain a comfortable temperature for residents in care

On April 17, 2025, Licensing Program Analyst, (LPA) Ivan Avila conducted an unannounced complaint investigation visit regarding the above allegations directed by the Department. LPA Avila met with Grace Puckett and explained the purpose of the visit. During the investigation process, interviews and a records review were initiated. LPA investigated the allegation, “Staff did not serve residents an adequate amount of food portions.” Based on interviews and observations, the facility has an adequate amount of food for the residents. Food supplies in facility were adequate per requirement. LPA could not corroborate the allegation. ----- Continued on LIC9099C ----- Unsubstantiated LPA investigated the allegation, “Staff left residents unsupervised.” Based on interviews conducted it was stated that residents are not left alone at the facility or unsupervised for extended periods of time. Staff interviewed acknowledged that when the weather is nice, the residents are free to go in the backyard while staff observe. LPA could not corroborate the allegation. LPA investigated the allegation, “Staff did not ensure that facility appliances were repaired.” Based on interviews and record review, two appliances were under repair. LPA observed work orders for the washer and dishwasher and parts were ordered to get them both repaired by a service company. Even though the washer was down for maintenance, the laundry was taken to another facility to get washed and staff were hand washing the dishes after meals until the dishwasher was repaired. LPA investigated the allegation, “Staff did not maintain a comfortable temperature for residents in care.” Based on interviews and observations, the facility was at a comfortable temperature during each visit. Staff acknowledged the facility to be cold in the winter and hot in the summer and staff will adjust the temperature to a comfortable setting for the residents. LPA could not corroborate the allegation. Based on interviews conducted and observations, the preponderance of evidence standards have not been met. Therefore, the above allegations are found to be UNSUBSTANTIATED. Findings that the complaint is Unsubstantiated means that, although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. An exit interview was conducted, and a copy of the report was provided.the state’s words, verbatim · CDSS document, Apr 17, 2025 · control 59-AS-20250114165215

Type of visit: Required - 1 Year

On 05/01/2024 Licensing Program Analyst (LPA) Ivan Avila arrived at the facility unannounced to conduct a 1-year annual inspection and met with Grace Puckett and explained the purpose of the visit. LPA Avila and Administrator toured facility together to ensure the health and safety of residents in care. Kitchen: The kitchen appeared clean and the appliances and fixtures functional during the time of visit. The LPA observed a sufficient supply of perishable and non-perishable food at the facility; Sharp objects are stored in a locked area. Water temperature measured at 115.3 degrees. Bedrooms: The LPA observed resident bedrooms furnished with at least one night stand, bed, and sufficient lighting for each resident. The bedrooms had appropriate and adequate bedding and linens such as sheets, pillowcases, and blankets. Bathrooms: The LPA observed the resident bathrooms to be clean, and properly supplied. Residents have sufficient supplies for personal hygiene products. Common Areas: These included but are not limited to the living area, activity area, and dining area. The common areas were checked for cleanliness and furniture was checked for functionality during time of visit. In the areas toured no immediate health, safety, or personal rights violations were observed. Surrounding Grounds (Outdoors): The LPA observed appropriate outdoor furniture, with a covered shaded area for residents. There are no firearms or bodies of water on the premises. Record Review: A review of facility files was initiated. The LPA observed documentation of the Infection Control, Disaster prevention and last fire drill. Facility records are stored inaccessible to residents. The LPA reviewed four (4) staff, and four (4) resident files. All documents reviewed appeared complete and current. Medications: During the facility visit a medications review was initiated. Medications are centrally stored and locked in a cabinet inaccessible to residents in care; medications are labeled and checked for expiration dates. Medications are properly documented on the centrally stored medications and destruction record log. No errors observed during the medication review. No deficiencies cited during today's visit. Exit interview conducted and a copy of the report was provided.the state’s words, verbatim · CDSS document, May 1, 2024