The Highlands Care Home III

Type of visit: Required - 1 Year

At approximately 2:00 PM, Licensing Program Analyst (LPA) Magdaleno arrived unannounced to conduct a required 1-year annual inspection and was greeted by Caregiver Leonida Arinzana. Administrator Maria Salvador was contacted via telephone and gave permission for Caregiver Leonida Arinzana to sign and receive report. Facility is a Residential Care Facility for the Elderly (RCFE) with six (6) residents in care. Facility has a Dementia Care Plan, a Hospice waiver for two (2), with zero (0) Hospice residents currently in care, and is approved for five (5) non-ambulatory residents. At approximately 2:10 PM, LPA initiated a tour of the facility with Caregiver and observed the following: Facility is a one (1) story home, was a comfortable temperature, and passageways were free from obstructions. Fire extinguishers were last inspected 3/25. Smoke and Carbon Monoxide detectors were tested and operational during inspection. Water temperature measured 108.3- and 108.8 degrees F, which is within the allowable range of 105 to 120 degrees F per Title 22 regulations. LPA observed a supply of clean linens, hygiene, incontinent care, and paper products available for residents. Residents' bedrooms were inspected and observed to have all the appropriate furnishings as outlined in Title 22 regulations. Cabinets containing cleaning supplies and other items that could pose a risk were locked. LPA observed at least a two (2) day supply of perishable and seven (7) day supply of non-perishable food, as well as an emergency water supply. Food was found to be stored in a safe manner with open items covered. There is a shaded seating area in the backyard with outdoor space for activities. LPA observed one (1) locked sheds in the backyard which contains extra storage. Facility has an internet access device and internet available to residents in care, and the phone was tested and operational during today's inspection. Continued LIC809C... Continued from LIC809... Facility conducts monthly disaster drills (no deficiency cited). LPA observed facility's infection control plan and emergency disaster plan which was last updated 2/25. LPA observed a supply of PPE, emergency supplies, a first aid kit, and flashlights. At approximately 3:00 PM LPA conducted a review of three (3) resident records. Three (3) of three (3) residents did not have current Appraisal Needs and Service Plans (deficiency cited). At approximately 3:15 PM LPA conducted review of three (3) staff records (no deficiency cited). At approximately 3:45 PM LPA and Caregiver conducted a spot check of medication and medication records. Medication is centrally stored and locked. Maria Salvador Administrator Certificate 7004161740 expires 3/21/2026. All fees are current as of this time. Updated copies of the following documents shall be submitted to CCL by 2/5/2026: Liability Insurance LIC308 - Designation of Responsibility LIC400 - Affidavit Regarding Client Cash Resources LIC610E - Emergency Disaster Plan Deficiencies are cited from the California Code of Regulations, Title 22, Division 6 of California Regulation and the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, or repeat violations within a 12-month period, may result in a civil penalty assessment. Appeal rights were provided. See LIC809D. Exit interview conducted with Caregiver, whose signature on form confirms receipt.the state’s words, verbatim · CDSS document, Jan 5, 2026

The state marks this report as 6 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Type of visit: Case Management - Other

At Approximately 9:00 AM Licensing Program Analyst (LPA) Robert Frank arrived unannounced to Amend the Annual Inspection report. LPA was greeted by Caregiver Leonida Arinzana. No deficiencies cited. Annual Inspection report was amended and exit interview conducted with Caregiver Leonida Arinzana. Copy of report, discussed and provided to caregiver Arinzana. Signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, Mar 6, 2025

Type of visit: Required - 1 Year

*Amended to Correct Facility Name. At approximately 1:30 PM, Licensing Program Analyst (LPA) Robert Frank arrived unannounced to conduct a Required 1 Year visit and was greeted by Caregiver Leonida Arinzana. Facility Administrator Maria Salvador was not available for the Inspection. Designated Responsible Party (DRP), Christiane Salvador arrived at 1:45 PM. Highlands Care Home III, is Licensed as a Residential Care Facility for the Elderly (RCFE). The facility is a single story ranch house. The facility has an approved fire clearance for five (5) non-ambulatory residents and one (1) ambulatory resident. The facility has a Hospice Waiver for two (2) residents. Upon arrival, LPA was informed that there were five (5) residents in care and one (1) staff members on-site. At approximately 1:50 PM, LPA reviewed the Facility's Staff Roster and found that all staff on-site were background cleared and associated to the facility per regulation. At approximately 2:00 PM, LPA toured the facility with Administrator Salvador. All exits were clear and unobstructed. Fire extinguisher were last serviced and tagged in 3/2024. Fire Department inspected and cleared the fire alarm system in 1/2024. Food supply was sufficient. The facility was sufficiently lighted. LPA inspected four (4) resident bedrooms and found all to have sufficient lighting and furnishings as required per Title 22 Regulations. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. There was an appropriate supply of cleaning products, linens, hygiene products and paper products available for residents. Toxins were observed to be stored inaccessible to residents. Facility has an infection control plan as required. The facility has a required emergency disaster plan. The facility is conducting fire and emergency drills quarterly. The last disaster drill was conducted on 11/2/2024. The facility does have emergency food and supplies to meet the "72 hour shelter in place" requirements. Hot water temperatures for all sinks in facility were found to be within Title 22 regulations of 105 to 120 degrees Fahrenheit. Facility smoke detectors and carbon monoxide detectors were tested and operational. Continued on 809-C ...Continued from 809 At approximately 2:50 PM, LPA reviewed four (4) resident files. Four (4) of four (4) resident files were found to have all required documentation. LPA reviewed four (4) staff files. One (1) staff file (S2) was observed to have a medical assessment and Tuberculosis test that was dated prior to six (6) months before employment. This deficiency will be cited. Four (4) of four (4) staff files were observed to have First Aid and CPR certification. Four (4) of four (4) staff files were observed to lack proper training documentation. This deficiency will be cited. LPA spot checked Medication for three (3) residents. LPA observed all medications to be centrally stored, secure and with proper documentation. The facility does not handle resident’s monies for personal and incidental items. The Facility does not have an internet access device. This deficiency will be cited. Maria Salvador’s Administrator Certification 7004161740 is current with an expiration date of 3/21/2026. LPA requested the following documents be submitted to Community Care Licensing by 3/12/2025: LIC 500 Personnel Report LIC 308 Designation of Responsibility LIC 610D Emergency Disaster Plan Updated Lease Proof of Liability Insurance Exit interview conducted with Caregiver Leonida Arinzana. Copy of report, LIC809Ds (Deficiency Pages) with plans of corrections, Confidential Names (LIC811), and Appeal Rights discussed and provided to caregiver Arinzana. Signature on form confirms receipt of documentsthe state’s words, verbatim · CDSS document, Feb 12, 2025

Allegation investigated: Staff do not distribute residents' medications as prescribed

Licensing Program Analyst (LPA), Araceli Canela arrived unannounced, for the purpose of gathering additional information and delivering findings, regarding the above listed allegation. LPA met with care staff, Francesca Cristobal, reviewed records and made observations. Staff, Lolita Pimentel arrived towards the end of the visit. It was alleged staff do not distribute residents' medications as prescribed. Investigation revealed, several discrepancies in documentation and dispensing of residents medication. LPA Canela conducted a medication count and it revealed R1 was not being provided the medication as prescribed. Records show one medication that was received on 2/5/2024 and facility documented on their Centrally Stored Log (CST) that the resident started to take that particular medication on 2/10/2024. The total quantity received was 600 pills and as of today 3/15/2024 resident had 4 bottles still closed and the only bottle that was observed open still had all medication. Continue report see LIC9099-C Substantiated Continue report from LIC9099 There was additional medication that had too many pills in the container and facility has no documentation to explain why R1 has too much based on the medication count of when medication was started or is missing medication in their box. Based on LPAs medication count and review of records the allegation for Staff do not distribute residents' medications as prescribed is found to be SUBSTANTIATED. A finding that the allegation is SUBSTANTIATED means that the allegation is valid because the preponderance of the evidence standard has been met. The following deficiencies were cited on 9099-D, per Title 22 Regulations, Division 6. Appeal Rights Giventhe state’s words, verbatim · CDSS document, Mar 15, 2024 · control 21-AS-20240215083304

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(4) · Plan of correction due date: Mar 19, 2024

87465(a)(4) Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following: (4) The licensee shall assist residents with self-administered medications as needed. This requirement was not met, As evidenced by: Based on medication count for R1, some medication bottles had too much medication left or were missing medication. This is an immediate risk to the Health & Safety of residents in care.the state’s words, verbatim · CDSS document, Mar 15, 2024

Plan of correction: Facility to send in written statement on how they will stay in compliance and assist residents correctly with their medications. Facility to provide proof ALL staff have received medication training and confirm they have reviewed and all medication is properly documented in the centrally stored log. POC for written statement due 3/19/24, Proof of staff training due 3/25/24 and medication audit/log due 3/29/24 to LPA A Canela

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Araceli Canela arrived unannounced and met with care staff, Francesca Cristobal and Lolita Pimentel arrived towards the end of the visit. Administrator is out of the country and not available. During a complaint investigation and in review of staff training records, staff S2 has been providing medication assistance and has no proof of medication training. Staff S1 was missing 2 additional hours of medication training and S2 did not have all of the required training in the areas required. LPA requested facility to provide an updated medical assessment for R2 who shows as being ambulatory but R2 is using a walker. In addition, facility does not have the required size PUB475 and facility was advised to get and post the correct poster size, failure will result in the facility being cited. LPA also found some incident reports for R1 but the facility was unsure if the reports were sent to Community Care Licensing (CCL). It was also disclosed that R1 moved and were not sure if R1 left on their own or if the facility evicted R1. LPA will review facility file to ensure CCL was notified, failure to show that the facility notified CCL will result in the facility being cited for failure to report within the required time. LPA will also review if a 30 day eviction was properly issued to R1 and a copy sent to CCL. Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties.the state’s words, verbatim · CDSS document, Mar 15, 2024

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87412(c) · Plan of correction due date: Mar 29, 2024

87412(c) Personnel Records (c) Licensees shall maintain in the personnel records verification of required staff training and orientation. This requirement was not met. As evidenced by: during review of medication, LPA discovered staff did not have proof of required training. This is a potential risk to the health and Safety of residents in care.the state’s words, verbatim · CDSS document, Mar 15, 2024

Plan of correction: Facility to send in proof of required training and training certificates for staff. Facility to send in written statement they understand requirement and how they will ensure they stay in compliance. POC due date for staff training due 3/29/2024 Attention LPA A canela

Type of visit: Required - 1 Year

LPA Hiratsuka conducted this unannounced annual visit. LPA toured the facility. This facility currently has five residents. LPA toured the facility and the backyard. Three staff and three resident records were reviewed. LPA observed a lot of trash on the side of the house with the gate. The trash does not impede the walkway and LPA is not issuing a citation because right now it does not impede the walkway, but it does need to be removed. The following was observed and citations issued: -The perishable food supply is not enough for three meals a day for two days for five residents. The refrigerator and freezer were almost empty. LPA was informed today is shopping day. Regulations require a two day perishable food supply to be maintained. -The nonperishable food supply is not enough to maintain three meals a day for seven days for five residents. The regulations require the nonperishable food supply to be maintained for three meals a day for seven days for the amount of residents in the facility. -LPA observed R1 leave the facility property. LPA reviewed R1's physician's report (LIC 602) and it states the resident is not able to leave the facility unassisted. -LPA observed locks on the freezer and refrigerator that were not being used during visit. LPA asked the caregivers and they stated they use the locks at night. The facility does not have a waiver from Community Care Licensing Division allowing the locks. Deficiencies cited from Title 22 Regulations and or the California Health and Safety Code. Failure to correct shall result in civil penalties. appeal rights leftthe state’s words, verbatim · CDSS document, Jan 14, 2024